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How do different pathways for the treatment of problem opioid use compare under real-world conditions? For US patients with health insurance, opioid substitution therapy was associated with the greatest risk reduction. However, its protective effect may not be fully realised while federal and insurance plan restrictions continue to limit access to this treatment option.
STUDY 2019 HTM file
Efficacy and cost-effectiveness of an adjunctive personalised psychosocial intervention in treatment-resistant maintenance opioid agonist therapy: a pragmatic, open-label, randomised controlled trial
Instead of a set programme, a clinic in London tried offering methadone or buprenorphine patients still using heroin or cocaine a selection from a suite of well-supported psychological interventions tailored to the patient and then systematically re-tailored in the light of how they responded. It worked – but did it work well enough, and would the findings be replicated in more typical circumstances?
The unexpected resignations of two counsellors at a US methadone clinic in early 1985 triggered a unique study of the influence of counsellors on their patients’ recovery. Its insight remains relevant today, and the study has been added to the Effectiveness Bank as a piece of ‘old gold’.
STUDY 2008 HTM file
Does following research-derived practice guidelines improve opiate-dependent patients’ outcomes under everyday practice conditions? Results of the Multisite Opiate Substitution Treatment study
In everyday practice at methadone maintenance clinics and with the full range of patients, does implementing clinical guidelines lead to better outcomes for patients? Two sets of US clinics selected for high versus low adherence to guidelines provided evidence that the recommended high doses and intensive psychosocial services really do make the intended difference.
DOCUMENT 2017 HTM file
Drug misuse and dependence: UK guidelines on clinical management
Last published in 2007, there is no more important document for UK clinicians involved in treating problem drug use than the so-called ‘Orange guidelines’. This major update offers detailed guidance on the range of problems, settings and patients clinicians encounter, substantially informing judgements of what constitutes good medical practice.
Strongest support for ‘therapeutic community’ approach to incarceration-based drug treatment according to robust review of evidence – with consistent reductions found in both drug relapse and recidivism.
Implication of this English study is that to save the lives of people dependent on heroin or similar drugs, they should be engaged and retained in substitute prescribing programmes like methadone maintenance until there is little risk of their relapsing after leaving. Shortly after leaving residential/inpatient settings was the highest risk period.
Up to a year after starting methadone treatment US patients offered virtually no counselling for the first four months were still doing as well as those offered regular counselling. But there is a hint that intensive and high quality counselling enabled more to safely leave treatment.
HOT TOPIC 2016 HTM file
Are the drugs enough? Counselling and therapy in substitute prescribing programmes
One of our hot topics offering background and analysis on important issues which sometimes generate heated debate. Explore the somewhat heretical proposition that the counsellor can virtually be dispensed with in opiate substitute prescribing programmes with little loss of impact. The gain would be that methadone could be spread ‘thin and wide’, reaching more potential patients.
HOT TOPIC 2016 HTM file
Prizes for not using drugs?
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Contingency management programmes reward patients for complying with treatment or not engaging in undesired substance use. It works, but often only temporarily – and perhaps at the cost of eroding the patient’s confidence and motivation.
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