Heroin or Conventional Opioid Maintenance? The Patients’ Perspective

Bald, Lena Karoline; Bermpohl, Felix; Heinz, Andreas; Gallinat, Jürgen; Gutwinski, Stefan

doi:10.1097/adm.0b013e3182a11ad0

Cited by 6 publications

(4 citation statements)

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“…In particular, the authors found a greater reduction in the use of illicit heroin in patients receiving prescription diamorphine compared with control groups (Strang, Groshkova & Uchtenhagen, 2015). Also noteworthy, a recent Berlin-wide anonymous survey of patients under opioid services found that approximately 40% of those on conventional maintenance would prefer to transfer into diamorphine substitution (Bald, Bermpohl, Heinz, Gallinat & Gutwinski, 2013). Importantly, despite a higher opioid dose in terms of 'methadone equivalents', these patients reported more frequent use of illicit drugs than patients not desiring to switch to diamorphine maintenance therapy (Bald, Bermpohl, Heinz, Gallinat & Gutwinski, 2013).…”

Section: Discussionmentioning

confidence: 92%

“…Also noteworthy, a recent Berlin-wide anonymous survey of patients under opioid services found that approximately 40% of those on conventional maintenance would prefer to transfer into diamorphine substitution (Bald, Bermpohl, Heinz, Gallinat & Gutwinski, 2013). Importantly, despite a higher opioid dose in terms of 'methadone equivalents', these patients reported more frequent use of illicit drugs than patients not desiring to switch to diamorphine maintenance therapy (Bald, Bermpohl, Heinz, Gallinat & Gutwinski, 2013). Finally, a positive association between patient satisfaction during methadone replacement therapy and treatment retention has been demonstrated, highlighting the great clinical relevance of this variable (Kelly, O'Grady, Mitchell, Brown & Schwartz, 2011).…”

Section: Discussionmentioning

confidence: 99%

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Patients’ Perceptions of Opioid Replacement Therapy: a Comparison of Diamorphine and Methadone/Levomethadone

Guillery

Hellweg

Enge

et al. 2020

Int J Ment Health Addiction

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Diamorphine was first legalized as a novel treatment option for heroin dependence in Germany in 2009. Today, specialized clinics in ten German cities provide diamorphine to heavily addicted patients. As the medical and societal context of diamorphineassisted therapy is evolving, continued research into patients' perceptions of opioid replacement therapy remains important. From February 2018 to June 2018, we conducted a survey study of outpatients on maintenance treatment with either diamorphine (n=85) or methadone/levomethadone (n=126). Patients were asked to complete a self-report questionnaire querying, besides socio-demographic information, the study participant's satisfaction with the substitute drug, relapse with illicit drugs, patterns of craving, and alcohol consumption. Duration of opioid dependence did not differ significantly between groups. Patients on diamorphine were approximately three years younger than patients on methadone / levomethadone. They had a higher frequency of daily drug intake and had had their dosage adjusted more often during the preceding six months. Still, diamorphine patients reported greater satisfaction with their substitute drug in tandem with significant reductions in relapse-related behaviors and cravings. While the most common relapse reported by patients on methadone replacement was heroin relapse (68%), most instances of illicit drug use in the diamorphine group involved cocaine (48%). Although self-reported alcohol consumption did not differ significantly between groups, a higher percentage of diamorphine patients than methadone patients endorsed decreased alcohol consumption since entering therapy. Taken together, these findings point to meaningful differences between diamorphine and methadone / levomethadone in opioid

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Patients’ Perceptions of Opioid Replacement Therapy: a Comparison of Diamorphine and Methadone/Levomethadone

Guillery

Hellweg

Enge

et al. 2020

Int J Ment Health Addiction

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“…Survey data concerning side effects, take-home treatment, and valuation of treatment have been previously published [ 28 – 31 ]. Anonymity of data was part of the ethical agreement.…”

Section: Methodsmentioning

confidence: 99%

Opioid tolerance in methadone maintenance treatment: comparison of methadone and levomethadone in long-term treatment

et al. 2016

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BackgroundThis study aimed to investigate the development of opioid tolerance in patients receiving long-term methadone maintenance treatment (MMT).MethodsA region-wide cross-sectional study was performed focusing on dosage and duration of treatment. Differences between racemic methadone and levomethadone were examined. All 20 psychiatric hospitals and all 110 outpatient clinics in Berlin licensed to offer MMT were approached in order to reach patients under MMT fulfilling the DSM IV criteria of opiate dependence. In the study, 720 patients treated with racemic methadone or levomethadone gave information on the dosage of treatment. Out of these, 679 patients indicated the duration of MMT.ResultsTreatment with racemic methadone was reported for 370 patients (54.5 %), with levomethadone for 309 patients (45.5 %). Mean duration of MMT was 7.5 years. We found a significant correlation between dosage and duration of treatment, both in a conjoint analysis for the two substances racemic methadone and levomethadone and for each substance separately. These effects remained significant when only patients receiving MMT for 1 year or longer were considered, indicating proceeding tolerance development in long-term treatment. When correlations were compared between racemic methadone and levomethadone, no significant difference was found.ConclusionsOur data show a tolerance development under long-term treatment with both racemic methadone and levomethadone. Tolerance development did not differ significantly between the two substances.

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“…Methadone as the most frequently provided opioid pharmacotherapy in MT is nowadays available in diverse modalities but fails to reach a considerable number of illicit opiate users [ 67 ]. Furthermore, Bald et al showed that a large number of patients in conventional OST would prefer HAT, in particular participants on higher dosages of methadone, with more than five detoxifications and continued illicit drug use [ 68 ]. Treatment study reviews of the 1990s pointed out that 30–70% of subjects leave methadone treatment within the first 2 years [ 69 , 70 ].…”

Section: Heroin-assisted Treatmentmentioning

confidence: 99%

New Approaches in Drug Dependence: Opioids

et al. 2021

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Purpose of Review This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches. Recent Findings Currently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce. Summary Maintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.

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Heroin or Conventional Opioid Maintenance? The Patients’ Perspective

Abstract: The data on the patients' perspective complement the existing clinical studies, showing that previously unresponsive opioid-addicted patients especially would switch to HMT, whereas most patients would prefer continuation of COMT.

Cited by 6 publications

References 10 publications

Patients’ Perceptions of Opioid Replacement Therapy: a Comparison of Diamorphine and Methadone/Levomethadone

Patients’ Perceptions of Opioid Replacement Therapy: a Comparison of Diamorphine and Methadone/Levomethadone

Opioid tolerance in methadone maintenance treatment: comparison of methadone and levomethadone in long-term treatment

New Approaches in Drug Dependence: Opioids

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