A randomized trial of effectiveness and cost‐effectiveness of observed versus unobserved administration of buprenorphine–naloxone for heroin dependence

Abstract

Retention and heroin use was not significantly different between observed and unobserved dosing groups. Attendance for observed dosing was not associated with worse retention. Treatment with close clinical monitoring, but no observation of dosing, was significantly cheaper and therefore significantly more cost-effective.

Opioid Drug Utilization and Cost Outcomes Associated With the Use of Buprenorphine-Naloxone in Patients With a History of Prescription Opioid Use

“…15 The mean retention in treatment did not differ between treatments (P = 0.84), and mean reduction in days of self-reported heroin use in the preceding month did not differ between the unobserved group (18.5 days) versus the observed group (22.0 days, P = 0.13). At 3 months, 52% of 92 interviewed patients reported no use of heroin in the last month.…”

The effect of an electronic medicine dispenser on diversion of buprenorphine-naloxone—experience from a medium-sized Finnish city

“…These are increased accessibility to OST (Bell, Byron, Gibson, & Morris, 2004;Gunderson, Wang, Fiellin, Bryan, & Levin, 2010) and positive effect on social and occupational rehabilitation (Bell et al, 2004;Anstice, Strike, & Brands, 2009). Retention in treatment is similar (Fiellin et al, 2006;Bell et al, 2007;Moore et al, 2012) or even improved (Holland et al, 2012) in comparison with observed dosing. OST patients value unobserved dosing and consider it as an essential part of OST (Stone & Fletcher, 2003;Treloar, Fraser, & Valentine, 2007;Madden, Lea, Bath, & Winstock, 2008).…”

Opioid pharmacotherapy: Treatment, regimes, constructions and control

“…Studies have found that the adoption of more flexible dosing regimens including the provision of 'takeaways' have better outcomes than inflexible dosing and/or supervised consumption; resulting in improved treatment retention rates and no demonstrated increases in criminal activity, illicit drug use, or OST black market sales (Gerra et al, 2011;Robles et al, 2001). The removal of supervised consumption has been associated with reductions in heroin use and improved reported quality of life (Bell et al, 2007), including the commencement of employment (Gerra et al, 2011). Non-observed treatment, comprising weekly take home doses, is found to be significantly more cost effective than observed treatment (Bell et al, 2007).…”

“…The removal of supervised consumption has been associated with reductions in heroin use and improved reported quality of life (Bell et al, 2007), including the commencement of employment (Gerra et al, 2011). Non-observed treatment, comprising weekly take home doses, is found to be significantly more cost effective than observed treatment (Bell et al, 2007). We add to this literature by illustrating how the generous constraints of unsupervised consumption can act with individuals to have harm reducing as well as harm producing potentials, and conversely, how the rigid constraints of supervised consumption can produce as well as reduce harm.…”