28 As a result, there is insufficient evidence that oral naltrexone is an effective treatment for opioid use disorder. Poor treatment adherence has primarily limited the real-world effectiveness of this formulation. It does not produce tolerance or withdrawal. Naltrexone was initially approved for the treatment of opioid use disorder in a daily pill form. Notably, flexible dose regimens of buprenorphine and doses of buprenorphine of 6 mg or below are less effective than methadone at keeping patients in treatment, highlighting the need for delivery of evidence-based dosing regimens of these medications. A comprehensive Cochrane review comparing buprenorphine, methadone, and placebo found no differences in opioid-positive drug tests or self-reported heroin use when treating with methadone or buprenorphine at medium-to-high doses. Methadone and buprenorphine are equally effective at reducing opioid use. Some treatment providers wary of using opioids have prescribed lower doses for short treatment durations, leading to failure of buprenorphine treatment and the mistaken conclusion that the medication is ineffective. To be effective, buprenorphine must be given at a sufficiently high dose (generally, 16 mg per day or more). Meta-analysis determined that patients on doses of buprenorphine of 16 mg per day or more were 1.82 times more likely to stay in treatment than placebo-treated patients, and buprenorphine decreased the number of opioid-positive drug tests by 14.2 percent (the standardized mean difference was -1.17). Of patients not retained in treatment, there was a 20 percent mortality rate. More than two opioid-positive urine tests within 3 months resulted in cessation of treatment, so treatment retention was closely related to relapse. In this study, the treatment failure rate for placebo was 100 percent vs. 25 All patients received psychosocial supports. 22,23Ī Swedish study compared patients maintained on 16 mg of buprenorphine daily to a control group that received buprenorphine for detoxification (6 days) followed by placebo. 12 Methadone treatment significantly improves outcomes, even when provided in the absence of regular counseling services 18,19,21 long-term (beyond 6 months) outcomes are better in groups receiving methadone, regardless of the frequency of counseling received. 12,16–20 Patients on methadone had 33 percent fewer opioid-positive drug tests and were 4.44 times more likely to stay in treatment compared to controls. A comprehensive Cochrane review in 2009 compared methadone-based treatment (methadone plus psychosocial treatment) to placebo with psychosocial treatment and found that methadone treatment was effective in reducing opioid use, opioid use-associated transmission of infectious disease, and crime. A large number of studies (some of which are summarized in the graph below) support methadone's effectiveness at reducing opioid use. Methadone is the medication with the longest history of use for opioid use disorder treatment, having been used since 1947. 15 These medications also increase the likelihood that a person will remain in treatment, which itself is associated with lower risk of overdose mortality, reduced risk of HIV and HCV transmission, reduced criminal justice involvement, and greater likelihood of employment. Abundant evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms, and they reduce the risk of infectious disease transmission as well as criminal behavior associated with drug use.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |