Effectiveness of buprenorphine maintenance treatment as compared to a syringe exchange program among buprenorphine misusing opioid-dependent patients

Aalto, Mauri; Visapää, Jukka-Pekka; Halme, Jukka T.; Fabritius, Carola; Salaspuro, Mikko

doi:10.3109/08039488.2010.531762

Cited by 14 publications

(16 citation statements)

References 17 publications

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“…Lifetime prevalence of illicit methadone use among intravenous drug users outside treatment has varied between 17% and 95% in different studies, but high prevalence is the rule rather than the exception (Davis & Johnson, 2007;Hall, Leukefeld, & Havens, 2013;Roche, McCabe, & Smyth, 2008;Vlahov et al, 2007). Illicit buprenorphine use is prevalent, as well (Håkansson, Medvedeo, Andersson, & Berglund, 2007;Yokell, Zaller, Green, & Rich, 2011) and in some countries this substance has become the most common opioid on the illicit market (Aalto, Visapää, Halme, Fabritius, & Salaspuro, 2011;Moatti, Vlahov, Feroini, Perri, & Odabia, 2001;Yokell et al, 2011). Methadone and buprenorphine typically enter a user's drug career at a late stage, and they are rare among younger people, unless they have already developed severe drug problems (Richert & Johnson, 2013).…”

Section: Introductionmentioning

confidence: 99%

Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors

Johnson

Richert

2015

International Journal of Drug Policy

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Section: Introductionmentioning

confidence: 99%

Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors

Johnson

Richert

2015

International Journal of Drug Policy

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“…[12][13][14][15] Illicit buprenorphine use is prevalent, as well, [16][17] and in some countries this substance has become the most common opioid on the illicit market. [17][18][19] Methadone and buprenorphine typically enter a user's drug career at a late stage, and they are rare among younger people, unless they have already developed severe drug problems. 20 The substances are mainly used by people with a long-standing opioid addiction.…”

Section: Introductionmentioning

confidence: 99%

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

Johnson

Richert

2014

Journal of Psychoactive Drugs

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BackgroundDiversion-patients who sell or share their medication-is a hotly debated but relatively unresearched phenomenon. We have investigated the prevalence of self-reported diversion of methadone and buprenorphine at OST programs in Sweden. We have also examined if demographic, treatment, and social factors can be associated with an increased risk of diversion. MethodsStructured interviews were conducted with 411 patients from eleven OST programs. A standardized questionnaire with 106 close-and five open-ended questions were used. 280 interviews were done on site, by the researchers, while 131 interviews were conducted by specially trained patients through privileged access interviewing. The data were analyzed through frequency-and averages-calculations, cross-tabulations, and logistic regression analysis. ResultsIn total, 24.1% (n=99) of the patients reported diversion in the past month. 67.6% (n=277) stated that they had diverted at some point. The peer interviews showed significantly higher levels of diversion (37.4% past month) compared with the researcher interviews (17.2%).Neither demographic factors, dosages, nor collection routines were associated with diversion.The likelihood of diversion was higher for patients on mono-buprenorphine (OR=5.64) and buprenorphine-naloxone (OR=2.10), than among methadone patients. Other factors which increased the likelihood of diversion were current illicit drug use (OR=5.60), having had 3 patients as a primary source of illicit methadone or buprenorphine prior to treatment (OR=3.39), and mainly socializing with active drug users (OR=2.12). ConclusionSelf-reported diversion was considerably higher than in previous studies. This is most likely due to the new methodological strategy we used, but may also partly be explained by low availability of OST in Sweden, leading to a high demand for the substances by heroin users outside treatment. Efforts to decrease diversion should primarily focus on psychosocial and lifestyle-changing interventions, and expanded access to treatment, rather than on control measures.

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“…However both medications were well accepted by buprenorphine injectors and outcomes on both were significantly better than if treated only with clonidine. In Finland, a naturalistic follow-up study found an 83% retention rate in opioid dependent patients that were injecting buprenorphine and treated with sublingual buprenorphine (Aalto et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

Methadone and buprenorphine-naloxone are effective in reducing illicit buprenorphine and other opioid use, and reducing HIV risk behavior—Outcomes of a randomized trial

Otiashvili

Piralishvili²,

Sikharulidze³

et al. 2013

Drug and Alcohol Dependence

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Aims Determine the extent to which buprenorphine injectors continue treatment with buprenorphine-naloxone or methadone, and the impact of these treatments on substance use and HIV risk in the Republic of Georgia. Methods Randomized controlled 12-week trial of daily-observed methadone or buprenorphine-naloxone followed by a dose taper, referral to ongoing treatment, and follow-up at week 20 at the Uranti Clinic in Tbilisi, Republic of Georgia. Eighty consenting treatment-seeking individuals (40/group) aged 25 and above who met ICD-10 criteria for opioid dependence with physiologic features and reported injecting buprenorphine 10 or more times in the past 30 days. Opioid use according to urine tests and self-reports, treatment retention, and HIV risk behavior as determined by the Risk Assessment Battery. Results Mean age of participants was 33.7 (SD5.7), 4 were female, mean history of opioid injection use was 5.8 years (SD4.6), none were HIV+ at intake or at the 12-week assessment and 73.4% were HCV+. Sixty-eight participants (85%) completed the 12-week medication phase (33 from methadone and 35 from buprenorphine/naloxone group); 37 (46%) were in treatment at the 20-week follow-up (21 from methadone and 16 from the buprenorphine/naloxone group). In both study arms, treatment resulted in a marked reduction in unprescribed buprenorphine, other opioid use, and HIV injecting risk behavior with no clinically significant differences between the two treatment arms. Conclusions Daily observed methadone or buprenorphine-naloxone are effective treatments for non-medical buprenorphine and other opioid use in the Republic of Georgia and likely to be useful for preventing HIV infection.

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Effectiveness of buprenorphine maintenance treatment as compared to a syringe exchange program among buprenorphine misusing opioid-dependent patients

Abstract: BMT appears to be an effective treatment for opioid dependents using mainly buprenorphine intravenously. On the other hand, bare SEP appears to result in high drop-out, not significant improvements and deaths.

Cited by 14 publications

References 17 publications

Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors

Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

Methadone and buprenorphine-naloxone are effective in reducing illicit buprenorphine and other opioid use, and reducing HIV risk behavior—Outcomes of a randomized trial

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