Abstract
BackgroundOpioid use disorder is a public health problem and treatment variability, coverage and accessibility poses some challenges. The study’s objective is to review the impact of interim opioid agonist treatment (OAT), a short-term approach for patients awaiting standard OAT, in terms of treatment retention, access to standard OAT, quality of life and satisfaction with treatment.MethodWe conducted a systematic review searching MEDLINE, EMBASE, PsycINFO, and CENTRAL up to May 2020. Due to variability between studies and outcome measurements, we did not pool effect estimates and reported a narrative synthesis of findings rating their certainty according to GRADE.ResultsWe identified 266 unique records and included five randomized trials with some limitations in risk of bias and one observational study limited by selection bias. The studies assessed similar approaches to interim OAT but were compared to three different control conditions. Four studies reported on treatment retention at 4 months or less with no significant differences between interim OAT and waiting list or standard OAT. Two studies reported treatment retention at 12 months with no differences between interim OAT and standard OAT. Two trials assessed access to standard OAT and showed significant differences between interim OAT and waiting list for standard OAT. We rated the quality of evidence for these outcomes as moderate due to the impact of risk of bias. Data on quality of life or satisfaction with treatment was suboptimal.ConclusionsInterim OAT is likely more effective than a waiting list for standard OAT in access to treatment, and it is probably as effective as standard OAT regarding treatment retention.PROSPERO registration CRD42018116269.
Highlights
Opioid use disorder is a public health problem and treatment variability, coverage and accessibility poses some challenges
Four studies reported on treatment retention at 4 months or less with no significant differences between interim opioid agonist treatment (OAT) and waiting list or standard OAT
Eligible studies included patients with an opioid use disorder diagnosed according to standardized criteria (e.g., Diagnostic and Statistical Manual of Mental Disorders (DSM), International Classification of Diseases (ICD)) who were candidates to be admitted into a standard OAT
Summary
Opioid use disorder is a public health problem and treatment variability, coverage and accessibility poses some challenges. The safety, efficacy and effectiveness of the two most commonly Despite this evidence, there is great worldwide variability in OAT practices and coverage. In USA, demand for OAT far exceeds available capability, with an alarming number of OAT clinics having extensive waitlists (even of years) [16] and, despite the current opioid crisis, treatment coverage does not improve proportionally [17]. These waitlists have a direct detrimental effect on people awaiting treatment, placing them at high risk for criminal activity, infectious disease, overdose, and mortality [16, 18]. The costs of untreated opioid use disorder of patients placed on a methadone treatment waiting list entail a significant financial burden to society [19]
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