Alternative to methadone shows promise for people addicted to opioids: researchers

The researchers say a new treatment that is less intrusive and more accessible than that offered to patients struggling with opioid addiction has proven to be just as effective.

Currently, patients with opioid use disorder 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 surveillance.

« You need a high level of motivation to follow these treatments, » said Didier Jutras-Aswad, 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 were really motivated, or people who could be really motivated to get treatment, but who don’t want to go into this type of treatment knowing how demanding it is. »

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He noted that people struggling with drug addiction often find themselves in precarious and vulnerable situations.

The new study shows that it is possible to offer more flexible treatment at home without reducing the chances of success.

The Public Health Agency of Canada reported that more than 5,386 Canadians died from an opioid overdose between January and September 2021, which is approximately 20 deaths per day. In 2018, before the COVID-19 pandemic, there were 12 deaths per day.

The new treatment, developed in a clinical trial under the Canadian Research Initiative in Substance Abuse, is based on prescription buprenorphine-naloxone, also known by the trade name Suboxone.

Between October 2017 and March 2020, the clinical research team recruited over 270 volunteers from seven hospitals in Quebec, Ontario, Alberta and British Columbia. The average age of the participants was 39 years old and 35% of them were women. All were struggling with opioid addiction from prescription or illegally produced drugs like morphine, oxycodone or fentanyl.

The patients were randomly divided into two groups, with half receiving methadone under close supervision at a pharmacy and the other half receiving Suboxone, which could be taken primarily at home. Both groups were asked to undergo treatment for 24 weeks.

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« (Suboxone) is somewhat less strong than methadone and is often associated with less risk of overdose, » Jutras-Aswad said. This corresponded to the model of care proposed by the researchers in which the level of supervision was reduced.

Jutras-Aswad said the researchers recommended that after the first two weeks, patients could continue treatment with Suboxone unattended at home for a week, which only requires one visit to the pharmacy. Finally, visits to the pharmacy were spaced out to two per month.

He said the study aimed to find out if more flexible treatment, with far less supervision, would be as effective in reducing drug use as current methadone treatment.

“Our study showed that buprenorphine was not inferior to methadone treatment for people taking it unsupervised, with even a trend showing that buprenorphine was somewhat more effective than methadone,” said Jutras- Aswad. He added that buprenorphine also offers greater flexibility than methadone in the event that a change in treatment is needed.

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« It’s no small thing to have to go to the pharmacy every day, » Jutras-Aswad said. « I think it’s a winning model that really allows you to respond to a catastrophic situation. »

© 2022 The Canadian Press


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