Role of maintenance treatment in opioid dependence

Ward, Jeffrey T.; Hall, Wayne; Mattick, Richard P.

doi:10.1016/s0140-6736(98)05356-2

Cited by 380 publications

(254 citation statements)

References 45 publications

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“…This class of medications is highly regulated in the US, with clinics and prescribing physicians facing specific regulatory requirements (Jaffe and O'Keefe, 2003). A large literature has established methadone maintenance (MMT) as an evidence-based treatment for opiate dependence (Hubbard et al, 1997;Mattick et al, 2003;Ward et al, 1999;NIH, 1997). MMT has tended to be concentrated within a treatment sector consisting of opioid treatment programs (OTPs) that exclusively dispense this medication.…”

Section: Introductionmentioning

confidence: 99%

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

Knudsen

Ducharme

Roman

2007

Drug and Alcohol Dependence

124

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Despite growing interest in closing the "research to practice gap," there are few data on the availability of medications in American substance abuse treatment settings. Recent research suggests that organizational characteristics may be associated with medication availability. It is unclear if the availability of medications can be conceptualized in terms of "technology clusters," where the availability of a medication is positively associated with the likelihood that other medications are also offered. Using data from 403 privately funded and 363 publicly funded specialty substance abuse treatment centers in the US, this research models the availability of agonist medications, naltrexone, disulfiram, and SSRIs. Bivariate logistic regression models indicated considerable variation in adoption across publicly funded non-profit, government-owned, privately funded non-profit, and forprofit treatment centers. Some of these differences were attenuated by organizational characteristics, such as accreditation, the presence of staff physicians, and the availability of detoxification services. There was some evidence that naltrexone, disulfiram, and SSRIs represent a group of less intensely regulated medications that is distinct from more intensely regulated medications. These types of medications were associated with somewhat different correlates. Future research should continue to investigate the similarities and differences in the predictors of medication availability across national contexts.

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Section: Introductionmentioning

confidence: 99%

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

Knudsen

Ducharme

Roman

2007

Drug and Alcohol Dependence

124

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“…1,2 The evolution of this disease depends on a genetic contribution, influenced by personal choices and environmental factors, and it can be fatal if not treated. 3 Heroin dependence remains a critical public health problem in Canada and most other parts of the world.…”

Section: Introductionmentioning

confidence: 99%

“…Evidence shows that MMT is effective 19 if delivered under best practices guidelines. 1,20,21 Although MMT has been proven to be effective for some, it is well documented that a significant proportion of patients are not attracted into or do not respond to this therapy. 22,23 Many nonresponders relapse into the use of illicit street drugs and/or continue injecting illicit opiates even during methadone treatment.…”

Section: Introductionmentioning

confidence: 99%

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

et al. 2008

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Standardized assessment instruments such as the European Addiction Severity Index and the Maudsley Addiction Profile were employed. A total of 251 individuals were randomized from Vancouver, BC (192, 76.5%), and Montreal, Quebec (59, 23.5%); 38.5% were female, the mean age was 39.7 years (SD:8.6), and participants had injected drugs for 16.5 years (SD:9.9), on average. In the prior month, heroin was used a mean of 26.5 days (SD:7.4) and cocaine 16 days (SD;12.6). Vancouver had significantly more patients residing in unstable housing (88.5 vs. 22%; pG0.001) and higher use of smoked crack cocaine (16.9 days vs. 2.3 days in the prior month; pG0.001), while a significantly higher proportion of Montreal participants reported needle sharing in the prior 6 months (25% vs. 3.7%; pG0.001). In many respects, the patient cohort was similar to the European trials; however, NAOMI had a higher proportion of female participants and participants residing in unstable housing. This study suggests that the NAOMI study successfully recruited participants with a profile indicated for HAT. It also raises concern about the high levels of crack cocaine use and social marginalization.

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“…Methadone, which blocks the euphoric effects of heroin, should be prescribed as a treatment for long-term heroindependent individuals as long as necessary to avoid relapse to illegal drug use [1,16] . Methadone maintenance involves prescribed doses of liquid or pill-form methadone for treating opiate addiction, mostly in outpatient settings [15] .…”

Section: Substitution Maintenance Treatmentmentioning

confidence: 99%

Harm reduction for injecting opiate users: an update and implications in China

et al. 2009

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The harm associated with high-risk injected opiate use and the threat of the HIV epidemic among injecting drug users has become a worldwide problem. Twenty years ago, in the face of a rapid increase in mortality rates among injecting drug users and the upcoming threat of HIV, the first harm-reduction programs were implemented in the Western world. This paper is a literature review describing four forms of harm reduction currently in use in Europe, North America, and Australia. Each represents a reasonable counterapproach to the threat of increased prevalence of HIV among injecting drug users in transitional and developing countries. The paper attempts to explain the concepts behind the most commonly used types of harm reduction and provides a brief overview of the advantages and disadvantages of each and the reasons for their implementation. The main focus of the review is on the definition and the practical aspects of harm reduction; it includes a brief introduction of Chinese harm-reduction efforts and their implications.

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Role of maintenance treatment in opioid dependence

Cited by 380 publications

References 45 publications

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

Harm reduction for injecting opiate users: an update and implications in China

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