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

Università degli Studi di Torino, Torino, Piedmont, 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.

Download full-text


Available from: Marina Davoli
  • Source
    • "MAT is an EBP that refers to any treatment for a substance use disorder that includes a pharmacologic intervention as part of a comprehensive substance abuse treatment plan with the ultimate goal of patient recovery with full social function (SAMHSA, 2013). MAT has been demonstrated to be effective in the treatment of alcohol dependence with Food and Drug Administration (FDA) approved drugs such as disulfiram, naltrexone, and acamprosate (Johnson, 2008), and in opioid dependence with methadone, naltrexone, and buprenorphine (Amato et al., 2005). Although MAT has long been recommended for use in criminal justice (CJ) and non-CJ involved populations (National Institutes of Health [NIH] Consensus Development Panel on Effective Medical Treatment of Opiate Addiction, 1998), current MAT availability in CJ settings is extremely limited (Pecoraro, Ma, & Woody, 2012). "

    Full-text · Article · Aug 2015 · Criminal Justice and Behavior
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Feb 2015 · Journal of Substance Abuse Treatment
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Dec 2014 · Drug and Alcohol Dependence
Show more