Adrian J Dunlop1, Amanda L Brown2, Christopher Oldmeadow3, Anthony Harris4, Anthony Gill5, Craig Sadler6, Karen Ribbons7, John Attia8, Daniel Barker9, Peter Ghijben10, Jennifer Hinman11, Melissa Jackson12, James Bell13, Nicholas Lintzeris14. 1. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Brain and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia. Electronic address: Adrian.Dunlop@hnehealth.nsw.gov.au. 2. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Brain and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia. Electronic address: Amanda.Brown@hnehealth.nsw.gov.au. 3. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Clinical Research Design, IT and Statistical Support (CRεDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia. Electronic address: Christopher.Oldmeadow@hmri.org.au. 4. Centre for Health Economics, Monash University, Clayton, Victoria, Australia. Electronic address: Anthony.Harris@monash.edu. 5. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia. Electronic address: anthony.gill@svha.org.au. 6. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Alcohol and Drug Unit, Calvary Mater Newcastle, Waratah, NSW, Australia. Electronic address: Craig.Sadler@calvarymater.org.au. 7. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia. Electronic address: Karen.Ribbons@hnehealth.nsw.gov.au. 8. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Clinical Research Design, IT and Statistical Support (CRεDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Medicine, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia. Electronic address: john.attia@newcastle.edu.au. 9. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia. Electronic address: daniel.barker@newcastle.edu.au. 10. Centre for Health Economics, Monash University, Clayton, Victoria, Australia. Electronic address: Peter.Ghijben@monash.edu. 11. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia. Electronic address: Jennifer.Hinman@hnehealth.nsw.gov.au. 12. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia. Electronic address: Mel.Jackson@hnehealth.nsw.gov.au. 13. Addictions Department, Institute of Psychiatry, Kings College London, London, United Kingdom; Drug Health Services, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. Electronic address: james.bell@kcl.ac.uk. 14. Drug and Alcohol Services, South East Sydney Local Health District, Surry Hills, NSW, Australia; Central Clinical School,Discipline of Addiction Medicine, University of Sydney, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. Electronic address: Nicholas.Lintzeris@health.nsw.gov.au.
Abstract
BACKGROUND: Access to opioid agonist treatment can be associated with extensive waiting periods with significant health and financial burdens. This study aimed to determine whether patients with heroin dependence dispensedbuprenorphine-naloxone weekly have greater reductions in heroin use and related adverse health effects 12-weeks after commencing treatment, compared to waitlist controls and to examine the cost-effectiveness of this strategy. METHODS: An open-label waitlist RCT was conducted in an opioid treatment clinic in Newcastle, Australia. Fifty patients with DSM-IV-TR heroin dependence (and no other substance dependence) were recruited. The intervention group (n=25) received take-home self-administered sublingual buprenorphine-naloxone weekly (mean dose, 22.7±5.7mg) and weekly clinical review. Waitlist controls (n=25) receivedno clinical intervention. The primary outcome was heroin use (self-report, urine toxicology verified) at weeks four, eight and 12. The primary cost-effectiveness outcome was incremental cost per additional heroin-free-day. RESULTS: Outcome data were available for 80% of all randomized participants. Across the 12-weeks, treatment group heroin use was on average 19.02days less/month (95% CI -22.98, -15.06, p<0.0001). A total 12-week reduction in adjusted costs including crime of $A5,722 (95% CI 3299, 8154) in favor of treatment was observed. Excluding crime, incremental cost per heroin-free-day gained from treatment was $A18.24 (95% CI 4.50, 28.49). CONCLUSION: When compared to remaining on a waitlist, take-home self-administered buprenorphine-naloxone treatment is associated with significant reductions in heroin use for people with DSM-IV-TR heroin dependence. This cost-effective approach may be an efficient strategy to enhance treatment capacity. Crown
RCT Entities:
BACKGROUND: Access to opioid agonist treatment can be associated with extensive waiting periods with significant health and financial burdens. This study aimed to determine whether patients with heroin dependence dispensed buprenorphine-naloxone weekly have greater reductions in heroin use and related adverse health effects 12-weeks after commencing treatment, compared to waitlist controls and to examine the cost-effectiveness of this strategy. METHODS: An open-label waitlist RCT was conducted in an opioid treatment clinic in Newcastle, Australia. Fifty patients with DSM-IV-TR heroin dependence (and no other substance dependence) were recruited. The intervention group (n=25) received take-home self-administered sublingual buprenorphine-naloxone weekly (mean dose, 22.7±5.7mg) and weekly clinical review. Waitlist controls (n=25) received no clinical intervention. The primary outcome was heroin use (self-report, urine toxicology verified) at weeks four, eight and 12. The primary cost-effectiveness outcome was incremental cost per additional heroin-free-day. RESULTS: Outcome data were available for 80% of all randomized participants. Across the 12-weeks, treatment group heroin use was on average 19.02days less/month (95% CI -22.98, -15.06, p<0.0001). A total 12-week reduction in adjusted costs including crime of $A5,722 (95% CI 3299, 8154) in favor of treatment was observed. Excluding crime, incremental cost per heroin-free-day gained from treatment was $A18.24 (95% CI 4.50, 28.49). CONCLUSION: When compared to remaining on a waitlist, take-home self-administered buprenorphine-naloxone treatment is associated with significant reductions in heroin use for people with DSM-IV-TR heroin dependence. This cost-effective approach may be an efficient strategy to enhance treatment capacity. Crown
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