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REVIEW 2013 HTM file
Maintenance agonist treatments for opiate dependent pregnant women
Is it better to prescribe pregnant opioid-dependent women methadone, buprenorphine or oral morphine? Just four randomised trials have addressed this issue and their findings are inconclusive, suggesting greater holding power for methadone but less severe neonatal withdrawal with buprenorphine.
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.
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.
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.
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?
Opioid substitution therapy is a safe and effective approach for suppressing illicit opioid use. Helping to guide optimal provision, this review investigates the relative effects of methadone and buprenorphine on the rate of mortality over time.
REVIEW 2016 HTM file
Buprenorphine versus methadone for opioid dependence in pregnancy
Among pregnant women, substitute prescribing is preferable to continued illicit opioid use and supervised withdrawal. Buprenorphine has different properties to the dominant treatment option methadone, but both stand to improve pregnancy and infant outcomes.
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.
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?
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.
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