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DOCUMENT 2014 HTM file
Time limiting opioid substitution therapy
Rather than being ‘parked’ on methadone, generally Britain’s heroin-addicted patients leave too soon to fully benefit, argue official government advisers on drug policy. Their report unambiguously countered concerns within the current UK government over methadone maintenance.
STUDY 2010 HTM file
Were the changes to Sweden’s maintenance treatment policy 2000–06 related to changes in opiate-related mortality and morbidity?
Ironically, the fact that opiate substitute prescribing has been opposed and limited in Sweden has meant that country has been able provide solid evidence of its lifesaving potential. This study concluded that easing the restrictions was associated with and may have led to fewer opiate-related deaths.
REVIEW 2012 HTM file
Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis
The first study to synthesise the relevant evidence adds weight to the conclusion that methadone programmes protect dependent opiate injectors against HIV infection, and that the evidence in their favour is more convincing than for alternative types of treatments.
A randomised trial conducted in England found that the (at the time) recommended three months of supervised consumption of prescribed opioid substitutes like methadone conferred no significant advantages over supervising only for up to the first four weeks of treatment, but the findings applied only to the minority of patients for whom random allocation was thought feasible and safe.
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.
HOT TOPIC 2015 HTM file
Prescribing opiate-type drugs to opiate addicts: good sense or nonsense?
One of our hot topics offering background and analysis on important issues which sometimes generate heated debate. For decades deeply felt and at times intemperate debate has surrounded a treatment which achieves unparalleled success by going with the grain of addiction, prescribing the same type of drug which opiate-dependent patients used illegally – a substitution castigated as surrender or hailed as an enlightened lifesaver.
STUDY 2018 HTM file
The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom
Buprenorphine may be associated with a lower risk of mortality than methadone among people engaged in opioid substitution treatment – but is the pattern of short treatment duration in the UK preventing maximal impact at a population level?
STUDY 2012 HTM file
Defining dosing pattern characteristics of successful tapers following methadone maintenance treatment: results from a population-based retrospective cohort study
Based on detailed treatment records kept by the Canadian province of British Columbia, a slow taper liberally interspersed with stabilisation periods offers the best chance of sustainably withdrawing from methadone without severe relapse, but still very few manage to avoid this risk – an argument for careful consideration and informed consent before making the attempt.
STUDY 2020 HTM file
Comparative effectiveness of different treatment pathways for opioid use disorder
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 2008 HTM file
Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial
This unique randomised trial tested what would happen if detoxified opiate addicts were then maintained on a substitute drug, on an opiate-blocking medication, or simply counselled. The results led to the introduction of methadone prescribing programmes in Malaysia.
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