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MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell B3: Practitioners; Medical treatment

Seminal and key research and reviews on the influence of the practitioner in the medical treatment of drug dependence. Investigates the how clinician-patient relationships might be affected by enforcing clinic rules and the potential importance of doctors forming a “whole person’ relationship with patients.

REVIEW 2017 HTM file
Supervised dosing with a long-acting opioid medication in the management of opioid dependence

Trials challenge the need for the widely accepted policy of making opioid-dependent patients take their methadone or other opioid substitutes at the clinic or pharmacy, but ‘no difference’ findings may be due to the limitations of the research.

STUDY 2014 HTM file
Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the Super C randomized controlled trial

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.

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.

STUDY 2015 HTM file
Clonidine maintenance prolongs opioid abstinence and decouples stress from craving in daily life: a randomized controlled trial

From the USA the first study to show that the drug clonidine can not only ease withdrawal from heroin but also help prevent relapse, seemingly by moderating stress-related craving for the drug.

STUDY 2015 HTM file
Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study

Primary care methadone patients in Ireland were nearly four times more likely to die during periods out of treatment; the first few weeks after leaving were the peak risk period. The study’s support for unbroken, long-term treatment runs counter to recent UK government policy.

REVIEW 2014 HTM file
A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world

Practice-oriented review of what we know about the diversion (to other people) and misuse (mainly by injecting it) of buprenorphine used in the treatment of opiate dependence, featuring extended, practical guidance on how to identify and respond to these life-threatening behaviours as a therapeutic challenge rather than a disciplinary issue.

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.

STUDY 2010 HTM file
Unobserved versus observed office buprenorphine/naloxone induction: a pilot randomized clinical trial

Having for several hours to medically monitor opiate-addicted patients starting buprenorphine maintenance is a major impediment to spreading the benefits of the treatment, but this first randomised trial suggests that many patients can manage the process safely at home.

STUDY 2010 HTM file
Impact of supervision of methadone consumption on deaths related to methadone overdose (1993-2008): analyses using OD4 index in England and Scotland

Introduced in Scotland and England in the mid-late 1990s to prevent overdose, did supervised consumption of methadone really make methadone maintenance safer? After accounting for increased prescribing, this analysis concludes that it did curb methadone-related deaths.


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