Opioid Maintenance Treatment - A Call for a Joint European Quality Care Approach

Abstract

Aims: The aim of this exploratory analysis of European Quality Audit of Opioid Treatment data was to identify areas of improvement for current opioid maintenance treatment (OMT) approaches. Methods: Factors facilitating treatment entry, retention and refusal were compared between 8 European countries and between OMT patient (OMT-P) and active opioid user (AOU) sample groups. Both groups were divided into those who had never had OMT before (un-experienced OMT-P (n = 573) and AOU (n = 360)) and those who had been maintained at least once prior to this investigation (experienced OMT-P (n = 746) and AOU (n = 377)). Results: The European comparison showed that motives for starting OMT vary distinctly between countries (p ≤ 0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p ≤ 0.05). Conclusion: Increasing awareness of potential shortcomings of OMT delivery systems is crucial to optimally match treatment approaches to patient needs and also to reduce the considerable economic burden of addiction to society.

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

“…Upon collection, intake of that day's methadone dose is not necessarily supervised in the current setting, according to guidelines, and hence a regular verification of continued OMT medication intake and tolerance is not performed. Adoption of more rigorous supervision and control procedures in accordance with evidence-based OMT guidelines should be considered but without impeding treatment engagement or reducing accessibility and attractiveness of OMT [43,44] . So far, national strategies to improve provision of MMT and reduce the number of methadone-related overdose deaths have been successfully introduced in other countries [39,41] .…”

Implementation of opioid maintenance treatment in prisons in North Rhine-Westphalia, Germany – a top down approach

“…There may be different reasons for patients staying out of OMT. Firstly, OMT is a difficult choice for patients, who might fear treatment rules [9,33]: Drug urine screens regarding not only heroin, but also possibly concomitantly used drugs are a treatment requirement in OMT in Germany. Concomitant use of other drugs can endanger the continuation of OMT in the community as well as in prison.…”

“…For some patients this might seem impossible to achieve. Negative experiences with treatment, like side-effects such as sedation under methadone, episodes of OMT without success, as well as a lack of information may be additional reasons for staying out of OMT [17,33]. In addition, patients might fear to become unable to withdraw from the maintenance medication [34].…”

Interest in Extended Release Naltrexone among Opioid Users

“…This suggests that long-acting naltrexone as a treatment option may be welcomed by opioid users in a clinical setting. Although OMT conditions pertaining in many European countries vary [21] , given its effectiveness [22] , this remains the treatment that should be recommended if an FDA/EMA approved long-acting naltrexone formulation is not available. Once XR-NTX is available, patients should be informed about the high level of commitment inherent to the XR-NTX treatment.…”