BACKGROUND: Many opiate users require prescribed medication to help them achieve abstinence, commonly taking the form of a detoxification regime. In UK prisons, drug users are nearly universally treated for their opiate use by primary care clinicians, and once released access GP services where 40% of practices now treat drug users. There is a paucity of evidence evaluating methadone and buprenorphine (the two most commonly prescribed agents in the UK) for opiate detoxification. AIM: To evaluate whether buprenorphine or methadone help to achieve drug abstinence at completion of a reducing regimen for heroin users presenting to UK prison health care for detoxification. DESIGN: Open-label, pragmatic, randomised controlled trial in three prison primary healthcare departments in the north of England. METHOD: Prisoners (n = 306) using illicit opiates were recruited and given daily sublingual buprenorphine or oral methadone, in the context of routine care, over a standard reduced regimen of not more than 20 days. The primary outcome measure was abstinence from illicit opiates at 8 days post detoxification, as indicated by urine test (self-report/clinical notes where urine sample was not feasible). Secondary outcomes were also recorded. RESULTS:Abstinence was ascertained for 73.7% at 8 days post detoxification (urine sample = 52.6%, self report = 15.2%, clinical notes = 5.9%). There was no statistically significant difference in the odds of achieving abstinence between methadone and buprenorphine (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 0.81 to 3.51; P = 0.163). Abstinence was associated solely with whether or not the participant was still in prison at that time (15.22 times the odds; 95% CI = 4.19 to 55.28). The strongest association for lasting abstinence was abstinence at an earlier time point. CONCLUSION: There is equal clinical effectiveness between methadone and buprenorphine in achieving abstinence from opiates at 8 days post detoxification within prison.
RCT Entities:
BACKGROUND: Many opiate users require prescribed medication to help them achieve abstinence, commonly taking the form of a detoxification regime. In UK prisons, drug users are nearly universally treated for their opiate use by primary care clinicians, and once released access GP services where 40% of practices now treat drug users. There is a paucity of evidence evaluating methadone and buprenorphine (the two most commonly prescribed agents in the UK) for opiate detoxification. AIM: To evaluate whether buprenorphine or methadone help to achieve drug abstinence at completion of a reducing regimen for heroin users presenting to UK prison health care for detoxification. DESIGN: Open-label, pragmatic, randomised controlled trial in three prison primary healthcare departments in the north of England. METHOD: Prisoners (n = 306) using illicit opiates were recruited and given daily sublingual buprenorphine or oral methadone, in the context of routine care, over a standard reduced regimen of not more than 20 days. The primary outcome measure was abstinence from illicit opiates at 8 days post detoxification, as indicated by urine test (self-report/clinical notes where urine sample was not feasible). Secondary outcomes were also recorded. RESULTS:Abstinence was ascertained for 73.7% at 8 days post detoxification (urine sample = 52.6%, self report = 15.2%, clinical notes = 5.9%). There was no statistically significant difference in the odds of achieving abstinence between methadone and buprenorphine (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 0.81 to 3.51; P = 0.163). Abstinence was associated solely with whether or not the participant was still in prison at that time (15.22 times the odds; 95% CI = 4.19 to 55.28). The strongest association for lasting abstinence was abstinence at an earlier time point. CONCLUSION: There is equal clinical effectiveness between methadone and buprenorphine in achieving abstinence from opiates at 8 days post detoxification within prison.
Authors: Cliff Howells; Steve Allen; John Gupta; Garry Stillwell; John Marsden; Michael Farrell Journal: Drug Alcohol Depend Date: 2002-07-01 Impact factor: 4.492
Authors: J Seifert; C Metzner; W Paetzold; M Borsutzky; T Passie; J Rollnik; B Wiese; H M Emrich; U Schneider Journal: Pharmacopsychiatry Date: 2002-09 Impact factor: 5.788
Authors: Annie Umbricht; Donald R Hoover; Marvin J Tucker; Jo M Leslie; Richard E Chaisson; Kenzie L Preston Journal: Drug Alcohol Depend Date: 2003-04-01 Impact factor: 4.492
Authors: Sasha Uhlmann; Michael John Milloy; Keith Ahamad; Paul Nguyen; Thomas Kerr; Evan Wood; Lindsey Richardson Journal: Am J Addict Date: 2015-03-24
Authors: Fiona G Kouyoumdjian; Kathryn E McIsaac; Jessica Liauw; Samantha Green; Fareen Karachiwalla; Winnie Siu; Kaite Burkholder; Ingrid Binswanger; Lori Kiefer; Stuart A Kinner; Mo Korchinski; Flora I Matheson; Pam Young; Stephen W Hwang Journal: Am J Public Health Date: 2015-02-25 Impact factor: 9.308
Authors: Nitika Sanger; Meha Bhatt; Laura Zielinski; Stephanie Sanger; Hamnah Shahid; Bianca Bantoto; M Constantine Samaan; Russell de Souza; Zainab Samaan Journal: Syst Rev Date: 2018-01-25