The newer Opioid Agonist Treatment with lower substitutive opiate doses is associated with better toxicology outcome than the older Harm Reduction Treatment

Abstract

BackgroundCharge-free heroin use disorder treatment in Italy follows two main approaches, i.e., harm reduction treatment (HRT) strategy in community low-threshold facilities for drug addiction and opioid agonist treatment (OAT) in high-threshold facilities for opioid addiction, focusing on pharmacological maintenance according to the Dole and Nyswander strategy. We aimed to compare the impact of HRT and OAT on patient outcome, as assessed through negativity for drugs on about 1-year urinalyses.MethodsWe examined retrospectively the urinalyses of HRT and OAT patients for which at least four randomly sampled urinalyses per month were available for about 1 year, during which patients were undergoing methadone or buprenorphine maintenance; urinalyses focused on heroin, cocaine, cannabinoids, and their metabolites.ResultsIncluded were 189 HRT and 58 OAT patients. The latter were observed for a significantly longer period. There was a higher proportion of heroin- and cocaine-clean urinalyses in OAT patients, with cocaine-clean urinalyses discriminating best between the two groups. OAT patients were older, with longer dependence duration, more severe addiction history, and received lower methadone doses. Buprenorphine maintenance was more often associated with heroin-clean urinalyses. The higher the methadone doses, the lower were the percentage of heroin-clean urinalyses in HRT patients (negative correlation).ConclusionsThe OAT approach was related to higher recovery and polyabuse abstinence rates compared to the HRT approach, despite greater severity of substance use, psychiatric and physical comorbidities. Our results are consistent with the possibility to use lower maintenance opiate doses (after induction and stabilization in methadone treatment according to Dole and Nyswander methodology) in treating heroin addiction. This seemed to be impossible adopting the currently accepted HRT model.

Substance Addiction Consequences: Outpatients Severity Indicators in a Medication-Based Program

“…Mostly are men and single, unemployed (with a higher percentage in women), with low professional qualifications (27% have no profession), living on family or social support benefits (only 35.2% live from their job). These data are in line with what has been reported in studies with drug and alcohol consuming populations, with a progressive increase in the average age of its participants (Diniz et al 2015;Wakeman et al 2020) and with many social exclusion factors such as unemployment and living on social support benefits (Bizzarri et al 2016). In some studies, data from patients with slightly lower average ages still appears (Bizzarri et al 2016;Klimas et al 2017;Rosa et al 2015).…”

“…These data are in line with what has been reported in studies with drug and alcohol consuming populations, with a progressive increase in the average age of its participants (Diniz et al 2015;Wakeman et al 2020) and with many social exclusion factors such as unemployment and living on social support benefits (Bizzarri et al 2016). In some studies, data from patients with slightly lower average ages still appears (Bizzarri et al 2016;Klimas et al 2017;Rosa et al 2015). Other exclusion factors that can be pointed out are isolation, as the data shows that the older the age, the smaller the aggregate, as seen in other studies (Bizzarri et al 2016) and the fact that the unemployed are older than those in employment.…”

“…In some studies, data from patients with slightly lower average ages still appears (Bizzarri et al 2016;Klimas et al 2017;Rosa et al 2015). Other exclusion factors that can be pointed out are isolation, as the data shows that the older the age, the smaller the aggregate, as seen in other studies (Bizzarri et al 2016) and the fact that the unemployed are older than those in employment.…”

Management of Opioid Addiction With Opioid Substitution Treatments: Beyond Methadone and Buprenorphine

“…They help addicts to follow their recovery program and contribute to their social reintegration. OST were also shown to preserve immune (50) and memory (51) functions, have positive effects on psychopathology (52, 53) and reduce polyabuse (54).…”

Erratum to: Agonist Opioid Treatment as historical comprehensive treatment (‘Dole & Nyswander’ methodology) is associated with better toxicology outcome than Harm Reduction Treatment

“…After publication of our article [ 1 ], we realised that the title used was incorrect. The correct title “Agonist Opioid Treatment as historical comprehensive treatment (‘Dole and Nyswander’ methodology) is associated with better toxicology outcome than Harm Reduction Treatment” appears above.…”