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DOCUMENT 2020 HTM file
Guidance on contingency planning for people who use drugs and COVID-19 (v1.0)
How can needle exchange services and opioid substitution therapy be safeguarded in the midst of a novel viral outbreak? Scottish Guidance considers potential disruptions to delivery, and suggests ways of ensuring continuity of services when best practice or ‘service as usual’ might be out of the question.
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.
Can a limited period of being prescribed opiate-type medications generate longer term reductions in the criminal behaviour of patients dependent on illegal opiates like heroin? And of the two main medications – buprenorphine and methadone – which performs best? It seems a key factor is how well they retain patients in treatment.
In the Canadian province of British Columbia there was a rapid rise in overdose deaths from 2015, leading to the declaration of a public health emergency in 2016. The response rested on three key interventions: take-home naloxone, opioid substitution therapy, and drug consumption rooms. The province’s highly detailed surveillance data offered an opportunity to estimate their collective and individual impacts on opioid overdose deaths.
In the new form of extended-release injections with effects lasting a month, the opioid medication buprenorphine was found to suppress illegal opioid use more effectively than a placebo, reinforcing its promise as a possible “game-changer” in opiate addiction treatment.
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?
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell A3: Interventions; Medical treatment
Key studies on the effectiveness of medical interventions and treatment in medical settings.
From the USA, a rare randomised trial found in favour of continuing methadone maintenance when patients entered prison rather than compulsory withdrawal. The potential benefits were most apparent in the near-100% continuation of protective treatment during the highly overdose-prone weeks after leaving prison.
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?
Expanding access to medication is an important public health strategy for tackling opioid use disorder, concludes US government agency guidelines. While some people stop using opioids without medication, many benefit from access to methadone, naltrexone, and buprenorphine for varying lengths of time, including lifelong treatment.
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