Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat 28: 321-329

Department of Epidemiology, 00198 Rome, Italy.
Journal of Substance Abuse Treatment (Impact Factor: 3.14). 07/2005; 28(4):321-9. DOI: 10.1016/j.jsat.2005.02.007
Source: PubMed


To summarize the major findings of the five Cochrane reviews on substitution maintenance treatments for opioid dependence.
We conducted a narrative and quantitative summary of systematic review findings. There were 52 studies included in the original reviews (12,075 participants, range 577-5894): methadone maintenance treatment (MMT) was compared with methadone detoxification treatment (MDT), no treatment, different dosages of MMT, buprenorphine maintenance treatment (BMT), heroin maintenance treatment (HMT), and l-alpha-acetylmethadol (LAAM) maintenance treatment (LMT).
Outcomes considered were retention in treatment, use of heroin and other drugs during treatment, mortality, criminal activity, and quality of life.
Retention in treatment: MMT is more effective than MDT, no treatment, BMT, LMT, and heroin plus methadone. MMT proved to be less effective than injected heroin alone. High doses of methadone are more effective than medium and low doses. Use of heroin: MMT is more effective than waiting list, less effective than LAAM, and not different from injected heroin. No significant results were available for mortality and criminal activity.
These findings confirm that MMT at appropriate doses is the most effective in retaining patients in treatment and suppressing heroin use but show weak evidence of effectiveness toward other relevant outcomes. Future clinical trials should collect data on a broad range of health outcomes and recruit participants from heterogeneous practice settings and social contexts to increase generalizability of results.

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    • "For HIVinfected patients, OMT also contributes to improved HIV treatment outcomes , from diagnosis to linkage and retention in antiretroviral therapy (Altice, Kamarulzaman et al., 2010; Altice et al., 2011; Binford, Kahana, & Altice, 2012; Kamarulzaman & Altice, 2015; Thompson et al., 2012). BMT has similar efficacy as MMT, although retention is improved by using higher doses of methadone (Amato et al., 2005; Mattick et al., 2008). Methadone, however, has also been documented to have more adverse side effects and pharmacokinetic drug interactions (Chou et al., 2014; Saber-Tehrani, Bruce, & Altice, 2011; Weimer & Chou, 2014), especially with antiretroviral therapy (Altice et al., 2010; Bruce, Moody, Altice, Gourevitch, & Friedland, 2013; Saber-Tehrani et al., 2011). "
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    ABSTRACT: Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experience with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. There are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Substance Abuse Treatment 02/2015; 54. DOI:10.1016/j.jsat.2015.01.014 · 3.14 Impact Factor
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    • "To better understand the reluctance of the Ukrainian CJS to introduce OST despite new laws allowing it, alongside the overwhelming evidence supporting its health benefits and improved criminal justice outcomes (Amato et al., 2005; Kermode et al., 2011), it is crucial to assess the prison personnel's attitudes towards OST. As there are virtually no data on prison staff attitudes and knowledge about OST in Ukraine, we conducted the first survey of Ukrainian prison administrative, medical and custodial staff attitudes towards addiction in general, OST, and PLWHA in four distinct regions of Ukraine. "
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    ABSTRACT: Ukraine is experiencing one of the most volatile HIV epidemics globally, fueled primarily by people who inject drugs (PWIDs), and a parallel incarceration epidemic. Opioid substitution therapy (OST) is internationally recognized as one of the most effective forms of treatment for opioid dependence and is among the most effective HIV prevention strategies available, yet efforts to adopt it in Ukraine's Criminal Justice System (CJS) have been thwarted. To understand the reluctance of the Ukrainian CJS to adopt OST despite the overwhelming evidence pointing to its health benefits and improved criminal justice outcomes, we conducted the first survey of Ukrainian prison administrative, medical and custodial staff (N=243) attitudes towards addiction in general, OST, and people living with HIV/AIDS (PLWHA) in representative regions of Ukraine. Results revealed that Ukrainian CJS workers' attitudes toward OST, PLWHA, and drug addiction were universally negative, but differed substantially along geographic and occupational lines. Whereas geographic and cultural proximity to the European Union drove positive attitudes in the west, in the southern region we observed an identifiability effect, as workers who worked directly with prisoners held the most positive attitudes. We also found that knowledge mediated the effect of drug intolerance on OST attitudes. In Ukraine, adoption of OST is more influenced by myths, biases and ideological prejudices than by existing scientific evidence. By elucidating existing attitudes among CJS personnel, this study will help to direct subsequent interventions to address the barriers to implementing evidence-based HIV prevention treatments. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 12/2014; 148. DOI:10.1016/j.drugalcdep.2014.12.008 · 3.42 Impact Factor
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    • "While globally the transition from CDDCs to voluntary C&C centres has been heralded as a positive change in Malaysian policy by the international community (Amon et al., 2014), no assessment of what these services provide nor how patients react to them has yet been conducted. In addition, while the effectiveness of OST has been validated in many studies (Amato et al., 2005; Mattick, Breen, Kimber, & Davoli, 2009), the supplemental value of religious programs, counseling, and vocational training combined with drug addiction treatment in Southeast Asia has not been assessed. Though traditional assessments of drug treatment effectiveness have relied on an array of specific substance abuse treatment outcomes (e.g., urine toxicology testing, employment, lack of involvement with the law, social and family integration), qualitative research provides useful context into health services acceptability and can guide health policy with its ability to detail individual perspectives and provide meaningful explanations about treatment (Curry, Nembhard, & Bradley, 2009; Sofaer, 1999). "
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    ABSTRACT: In Malaysia, compulsory drug detention centres (CDDCs) hold suspected drug users for two years without adjudication. Acute detoxification without healthcare access has been documented. CDDCs are criticized globally due to ineffectiveness in treating addiction and human rights violations. In response, the Malaysian government began transitioning these facilities into voluntary drug treatment centres known as “Cure and Care” (C&C) centres that embrace a holistic treatment-based approach to drug addiction rehabilitation.Methods An explorative qualitative study was undertaken to explore patient perspectives and satisfaction regarding treatment and services at the new Cure and Care centre in Kota Bharu, Malaysia. A convenience sample of 20 patients was recruited to participate in semi-structured in-depth interviews. Content analysis approach was used to identify the salient themes.ResultsPatients identified methadone treatment, psychosocial programs, religious instruction, and recreational activities as important factors contributing to treatment success for addressing both health and addiction needs. Though many had previously been in a CDDC, adherence to treatment in the C&C centre was perceived to be facilitated by the degree of social support, the voluntary nature and the array of new programs available for selection.ConclusionC&Cs represents a dramatic shift in the Malaysian government's approach to drug addiction. Our findings demonstrate positive patient experiences associated with the holistic treatment-based approach of these centres. This exploratory study provides additional evidence to document this ongoing policy transition and may guide continued expansion of new holistic drug treatment programs across the country.
    International Journal of Drug Policy 10/2014; 26(2). DOI:10.1016/j.drugpo.2014.10.002 · 2.40 Impact Factor
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