Malmö Treatment Referral and Intervention Study—High 12-Month Retention Rates in Patients Referred from Syringe Exchange to Methadone or Buprenorphine/Naloxone Treatment

Abstract

BackgroundHeroin dependence is associated with high mortality. Opioid agonist treatment (OAT) with methadone or buprenorphine has strong evidence for treatment of this relapsing condition. In our setting, OAT has been associated with strict and demanding intake procedures, often with requirements of social stability, but also high, approximately 80 percent 12-month retention rates. In a recent randomized controlled trial, we demonstrated high rates of successful rapid referral from a syringe exchange programme (SEP) to treatment with methadone or buprenorphine, including actual treatment initiation. The objectives of this study were to assess 12-month retention rates, in order to assess whether a novel referral program of current drug users at a SEP would achieve retention rates comparable to more traditional intake procedures.MethodsThe present report is a 12-month follow-up of 71 patients who successfully started treatment with methadone or buprenorphine/naloxone. Patient data from baseline and at 12 months were collected.ResultsOut of the 71 patients who started treatment, 58 (82%) were still in treatment after 12 months.ConclusionThis was a population, referred from a SEP, with a high drug use severity on admission and no pretreatment requirement for social stability, but there were still high retention rates at 12 months comparable to regular opioid agonist clinics in our setting.

A missed opportunity: underutilization of inpatient behavioral health services to reduce injection drug use sequelae in Florida

“…One proposed explanation for the paucity of interventions offered to PWID may be presumed lack of social stability or resources for treatment adherence. However, a Swedish study found parity in 12-month retention rates among MOUD program participants with and without strict social stability requirements [ 25 ]. Another study found homelessness positively predicted MOUD initiation among hospitalized adults seen by an addiction consult service, indicating that hospitalization may be an important opportunity to engage typically harder to reach populations [ 26 ].…”

A Missed Opportunity: Underutilization of Inpatient Behavioral Health Services to Reduce Injection Drug Use Sequelae in Florida

“…However, a Swedish study found parity in 12-month retention rates among MOUD program participants with and without strict social stability requirements. 24 Another study found homelessness positively predicted MOUD initiation among hospitalized adults seen by an addiction consult service, indicating that hospitalization may be an important opportunity to engage typically harder to reach populations. 25 Insurance status was also likely not the primary barrier in receiving behavioral health services as only 36% of the admitted patients receiving services in that study had private insurance.…”

Health Related Quality of Life in Individuals Transferred from a Needle Exchange Program and Starting Opioid Agonist Treatment

“…We have previously presented a low-threshold procedure for rapidly referring opioid-dependent individuals from a NEP to evidence-based treatment with methadone and buprenorphine [48]. Despite having a high degree of problems due to use of illicit substances, signs of severe psychiatric symptomatology, and social problems, patients were retained in treatment to a high degree at 12-month follow-up [53]. In conclusion, authors have however suggested that patients and staff are not always in agreement with what characterizes efficient OAT [7], that retention and reduction in substance use and other “hard” data only describe part of the truth when it comes to treatment success, and that quality of life measures should be used as part of outcome evaluation [10–12].…”

“…Out of the 71 individuals who started OAT, 67 patients (94%) were still in treatment after three months [53]. In-treatment patients had to leave observed toxicology screens twice a week.…”