MONTREAL – Researchers say a new treatment that is less intrusive and more affordable than that offered to patients struggling with opioid addiction has proved just as effective.
At present, patients with opioid disorders may be asked to come to the pharmacy every day for two to three months to start treatment with methadone or morphine, which must be taken under close supervision.
“A high level of motivation is needed to follow these treatments,” said Didier Utras-Aswad, a professor of psychiatry at the University of Montreal and lead author of a study published Wednesday in the American Journal of Psychiatry.
“But we also have people who have been really motivated or people who may be really motivated to be treated, but who don’t want to embark on this kind of treatment, knowing how demanding it is.
He noted that those struggling with addiction are often in precarious and vulnerable situations.
A new study shows that it is possible to offer more flexible treatment at home without reducing the chance of success.
The Public Health Agency of Canada reported that more than 5,386 Canadians died from opioid overdoses between January and September 2021, amounting to about 20 deaths a day. In 2018, before the COVID-19 pandemic, there were 12 deaths a day.
The new treatment, developed in a clinical trial through the Canadian Substance Abuse Research Initiative, is based on the prescribing of buprenorphine-naloxone, also known by the trade name Suboxone.
Between October 2017 and March 2020, the clinical research team recruited more than 270 volunteers at seven hospitals in Quebec, Ontario, Alberta and British Columbia. The average age of the participants is 39, and 35 percent of them are women. All are struggling with opioid dependence on prescription or illicit drugs such as morphine, oxycodone or fentanyl.
Patients were randomly divided into two groups, with half receiving methadone under strict pharmacy supervision and the other half receiving Suboxone, which could be taken mainly at home. Both groups were asked to undergo treatment for 24 weeks.
“(Suboxone) … is slightly weaker than methadone and is often associated with a lower risk of overdose,” Jutras-Aswad said. This corresponds to the model of care proposed by researchers, in which the level of supervision is reduced.
Jutras-Aswad said that researchers recommend that after the first two weeks, patients be able to continue treatment with Suboxone unsupervised at home for one week – requiring only one visit to the pharmacy. In the end, the visits to the pharmacy were divided into two per month.
He said the study aims to determine whether a more flexible treatment, with much less oversight, would be as effective at reducing drug use as current methadone treatment.
“Our study has shown that buprenorphine is no lower than methadone treatment for people taking it unattended, and there is even a trend showing that buprenorphine is slightly more effective than methadone,” said Jutras-Aswad. He added that buprenorphine also offers more flexibility than methadone in case a change in treatment is needed.
“It’s not a small thing to have to go to the pharmacy every day,” said Jutras-Aswad. “I think this is a winning model … that really allows us to react to a catastrophic situation.
This report from The Canadian Press was first published on June 15, 2022.
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