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

Angelo Giovanni Icro Maremmani,Jacopo V. Bizzarri,Livia Sanna,Daria Piacentino,Luca Rovai,Icro Maremmani,Silvia Bacciardi,Valentina Casetti,Andreas Conca

doi:10.1186/s12991-016-0109-z

Angelo Giovanni Icro Maremmani, Jacopo V. Bizzarri + Show 7 more

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https://doi.org/10.1186/s12991-016-0109-z

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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.

Highlights

Charge-free heroin use disorder treatment in Italy follows two main approaches, i.e., harm reduction treatment (HRT) strategy [13, 14] in community lowthreshold 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 [9, 15,16,17]
Design of the study We conducted a retrospective and naturalistic study to compare urinalyses results 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
Patients were selected if urinalyses for heroin, cocaine, and cannabinoids had been monitored for almost a year and collected randomly at least four times per month

Summary

Introduction

Charge-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. The main pharmacological approach in treating opioid dependence involves opioid agonist maintenance [4, 9] It consists in the replacement of the illegal drug, which has a 2- to 3-h half-life, with a prescribed opioid, which has a longer half-life and a good μ-receptor activity [10]. The medications most frequently used are methadone and buprenorphine [9], which have proven to be effective in reducing heroin use, maintaining prolonged periods of abstinence, increasing retention in drug treatment, and reducing the risk of overdose-related death [4, 11, 12] Given their proven efficacy, these two drugs have been included by the World Health Organization in the Model List of Essential Medicines [4]

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