Tuesday, 18 August 2009

Again ... Substitution Treatment More Effective than Abstinence Programs

This is just a friendly reminder for those who want methadone treatment cut back or stopped - methadone and buprenorphine have once again been shown to be more effective for treating opiate addiction than rehab, detox and 12 steps programs.
Thumbs Up For Methadone and BNX
Pharmacy News
August 2009

Buprenorphine-naloxone and methadone have received endorsement as the most effective opioid replacement therapies.

A paper published in the latest issue of the Medical Journal of Australia (MJA) confirmed that buprenorphine-naloxone (BNX) was less likely than buprenorphine alone to be injected by both opioid replacement therapy patients (ORT) and injecting drug users.

Meanwhile a new Cochrane review confirmed that methadone maintenance therapy (MMT) was more effective than "cold turkey" methods in treating heroin dependence.

The MJA study found that in the year after its introduction in Australia, BNX was injected less frequently and by fewer regular injecting drug users and ORT clients than buprenorphine, particularly when differences in the availability of medications were taken into account.

Some individuals did nonetheless regularly inject BNX.

BNX is a combination of a partial opioid agonist and an opioid antagonist for treating opioid dependence, which was specifically developed to limit injection.

"Given that BNX has not only overtaken market sales of buprenorphine, but is also generally available as takeaway medication (unlike buprenorphine), the deterrent effect of the combination product may be even greater than the comparisons in our study suggest," the study's authors wrote.

"This finding has important implications for public health, given the potential for severe consequences of buprenorphine injection."

The Cochrane reviewers looked at 11 studies and found that MMT retained patients in treatment and decreased heroin use better than treatments that did not use ORT such as detoxification, offer of drug-free rehabilitation, placebo medication and wait-list controls.

However, MMT did not have a statistically significant superior effect on mortality or criminal activity, the reviewers found.

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