Methadone Maintenance vs 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence

Kl, Sees; Kl, Delucchi; Masson, Carmen L.; Rosen, Amy B.; Hw, Clark; Robillard, Helen; Banys, Peter; Sm, Hall

doi:10.1001/jama.283.10.1303

Cited by 371 publications

(250 citation statements)

References 25 publications

(20 reference statements)

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“…Lastly, duration on OAT or "retention" in treatment is highly correlated with better health outcomes in opioid dependent patients (11,(20)(21)(22)(23). The longer patients continued in a treatment program, maintain contact with a health care team and provide evidence of maintaining their will to remain abstinent, the better their treatment outcomes.…”

Section: Literature Review: Item Generation Resultssupporting

confidence: 79%

The Genetics of Opioid Addiction Risk Evaluation Tool (GREAT) for Treatment Response in Methadone Patients

Dennis

Bawor

Paul

et al. 2016

Int J High Risk Behav Addict

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Background: Current tools such as the Maudsley Addiction Profile (MAP) exist to evaluate different facets of addiction severity, however these instruments have neither been designed for nor validated within patients on methadone maintenance treatment (MMT). Objectives: We aimed to provide a reliable tool to evaluate multiple domains of treatment response for patients on MMT. This tool can be applied easily with minimal time to patients, researchers and clinicians. Patients and Methods: We modified the MAP to address health and social outcomes specific to the MMT patient population. Construction of the new tool was accomplished using expert opinion and MAP scores from participants recruited for the Genetics of Opioid Addiction (GENOA) study. This modified scale known as the GENOA Risk Evaluation Tool (GREAT) was then applied to 21 MMT patients in a generalizability study (G-Study) to assess reliability and consistency. We performed a criterion validation of the GREAT to assess the predictive validity of GREAT substance use domain scores against urine toxicology screening for illicit opioids using multi-variable logistic regression analysis (n = 117).

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Section: Literature Review: Item Generation Resultssupporting

confidence: 79%

The Genetics of Opioid Addiction Risk Evaluation Tool (GREAT) for Treatment Response in Methadone Patients

Dennis

Bawor

Paul

et al. 2016

Int J High Risk Behav Addict

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“…Using this approach, anywhere from 8% to 79% of patients achieved an opioid free state, with the proportion of patients remaining opioid free generally decreasing with longer periods of observation 23. Further research indicated that a longer tapering period increased treatment retention, but even with longer tapers, intolerable withdrawal and craving were not eliminated and led some patients to discontinue treatment, resume illicit opioid use, or ask that the dose tapering be stopped or reversed 22, 24. In summary, time‐limited use of methadone puts patients at risk and should generally be avoided, regardless of the schedule of methadone discontinuation.…”

Section: Historical Perspective On Clinical Management Of Opioid Withmentioning

confidence: 99%

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

et al. 2018

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Background and ObjectivesOpioid use disorder (OUD) is a chronic condition with potentially severe health and social consequences. Many who develop moderate to severe OUD will repeatedly seek treatment or interact with medical care via emergency department visits or hospitalizations. Thus, there is an urgent need to develop feasible and effective approaches to help persons with OUD achieve and maintain abstinence from opioids. Treatment that includes one of the three FDA‐approved medications is an evidence‐based strategy to manage OUD. The purpose of this review is to address practices for managing persons with moderate to severe OUD with a focus on opioid withdrawal and naltrexone‐based relapse‐prevention treatment.MethodsLiterature available on PubMed was used to review the evolution of treatment strategies from the 1960s onward to manage opioid withdrawal and initiate treatment with naltrexone.ResultsEmerging practices for extended‐release naltrexone induction include the use of agonist tapers and adjuvant medications. Clinical challenges frequently encountered when initiating this therapy include managing withdrawal and ongoing opioid use during treatment. Clinical factors may inform decisions regarding patient selection and length of naltrexone treatment, such as recent opioid use and patient preferences.Conclusions and Scientific SignificanceTreatment strategies to manage opioid withdrawal have evolved, but many patients with OUD do not receive medication for the prevention of relapse. Clinical strategies for induction onto extended‐release naltrexone are now available and can be safely and effectively implemented in specialty and select primary care settings. (© 2018 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP);27:177–187)

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“…Among heroin users, opiate substitution therapy has been linked to greater linkage with health care services (Spire et al, 2007), and a plethora of positive health and social outcomes, including reductions in drug use (Sees et al, 2000), susceptibility to infection with Human Immunodeficiency Virus (MacArthur et al, 2012), non-fatal overdose (Kerr et al, 2007) and involvement in crime (Keen et al, 2000).…”

Section: Associations Of Stimulant Use Patterns With Suicide Attemptmentioning

confidence: 99%

Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role?

Artenie

Bruneau

Zang

et al. 2015

Drug and Alcohol Dependence

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Background: While the elevated risk of suicide attempt among persons who inject drugs (PWID) is well documented, whether use of different substances is associated with varying degrees of risk remains unclear. We sought to examine the associations between substance use patterns and attempted suicide in a prospective cohort of PWID in Montreal, Canada. Methods: Between 2004 and 2011, participants completed an interviewer-administered questionnaire eliciting information on socio-demographic, substance use patterns, related behaviors, and mental health markers. Generalized estimating equations were used to model the relationship between self-reported use of six common substances (cocaine, amphetamine, opioids, sedative-hypnotics, cannabis and alcohol), associated patterns of use (chronic, occasional and none), and a recent (past six-month) suicide attempt. Results: At baseline, of 1,240 participants (median age: 39.1, 83.7% male), 71 (5.7%) reported a recent suicide attempt. Among 5,621 observations collected during follow-up, 221 attempts were reported by 143 (11.5%) participants. In multivariate analyses adjusting for socio-demographic and psychosocial stressors, among primary drugs of abuse, chronic [Adjusted Odds Ratio (AOR): 1.97] and occasional (AOR: 1.92) cocaine use, and chronic amphetamine use (AOR: 1.96) were independently associated with attempted suicide. Among co-used substances, chronic sedative-hypnotic use was independently associated with an attempt (AOR: 2.29). No statistically significant association was found for the remaining substances. Conclusion: Among PWID at high risk of attempted suicide, stimulant users appear to constitute a particularly vulnerable sub-group. While the mechanisms underlying these associations remain to be elucidated, findings suggest that stimulant-using PWID should constitute a prime focus of suicide prevention efforts

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Methadone Maintenance vs 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence

Abstract: Our results confirm the usefulness of MMT in reducing heroin use and HIV risk behaviors. Illicit opioid use continued in both groups, but frequency was reduced. Results do not provide support for diverting resources from MMT into long-term detoxification.

Cited by 371 publications

References 25 publications

The Genetics of Opioid Addiction Risk Evaluation Tool (GREAT) for Treatment Response in Methadone Patients

The Genetics of Opioid Addiction Risk Evaluation Tool (GREAT) for Treatment Response in Methadone Patients

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role?

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