An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research.
ABSTRACT 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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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; DOI:10.1016/j.jsat.2015.01.014 · 3.14 Impact Factor
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ABSTRACT: Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been conducted nationwide; the purpose of this study was, therefore, to determine whether such a pattern could be identified. Methods. A total number of 577 analyses were performed during a three-year period on people suspected of non-lethal substance abuse, in more than two-thirds of the counties in Romania. Preliminary tests were conducted using immunoassay tests (blood or urine) and confirmatory tests were carried out using either GC-MS or HPLC. Results. 240 cases (41.6%) were negative while 327 cases (58.4%) tested positive for illegal drugs, central nervous system medication or both. Men represented 89.5% of all cases, while women accounted for only 10.5%. The pattern of substance abuse varied significantly, depending on the geographical area. In most cases, the identified drugs of abuse were cannabinoids and opiates, with a significantly different distribution of cases, depending on the geographical area. The highest number of positive cases was identified in the month of October, whereas the smallest numbers were identified in July and December. The annual trend of consumption revealed a significant decrease in the analysed substances in 2011. Conclusions. Our study has determined the presence of a specific pattern of consumption in different geographical areas - a result that suggests the need for more targeted prevention programmes, addressing local particularities in consumption behaviours. A significant decrease in the identification of drugs of abuse in the third year of our study, combined with data attesting the significant increase in the consumption of legal highs suggests that the forensic toxicology laboratories need to be equipped with apparatus able to detect these newer substances of abuse more efficiently.Heroin Addiction and Related Clinical Problems 01/2014; 16(3):7-13. · 0.35 Impact Factor
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ABSTRACT: AIMS – To examine what happens to patients who have been involuntarily discharged from medicationassisted treatment (MAT) with methadone or buprenorphine in Malmö, Sweden. MATERIAL AND METHOD – A total of 35 people, with a long history of heroin addiction, were interviewed, including ten women. Most interviewees were recruited among visitors with discharge experiences at the local needle exchange programme. The article focuses on these informants’ experiences and interpretations of being discharged. RESULTS – Discharge had little legitimacy and was perceived as unfair. Several of the interviewees went back to heroin abuse while others tried to create their own maintenance programmes by buying methadone or buprenorphine on the black market. Many resorted to crime or prostitution to make ends meet. CONCLUSIONS – According to National Board of Health and Welfare regulations, discharge and a three-month exclusion from all MAT is an appropriate response to violation of rules. Exclusion nevertheless led to harsh consequences. The interviewees’ living conditions were consistently impaired, as were their physical and mental health and contacts with family members, since they soon returned to a lifestyle and drug abuse similar to that before treatment. KEY WORDS – heroin addiction, methadone treatment, buprenorphine treatment, involuntary discharge, disciplining.Nordic Studies on Alcohol and Drugs 03/2012; · 0.61 Impact Factor