MONTREAL – Researchers say a new treatment that is less intrusive and more accessible than that offered to patients struggling with opioid addiction has been shown to be just as effective.
At present, patients with opioid disorder may be asked to come to a pharmacy every day for two to three months to begin treatment with methadone or morphine, which should be taken under close supervision.
“It takes a high level of motivation to follow these treatments,” said Didier Jutras-Aswad, a 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 might be really motivated to be treated, but who don’t want to embark on that kind of treatment knowing how demanding it is.”
He noted that people struggling with addiction often find themselves in precarious and vulnerable situations.
The new study shows that it is possible to offer a 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, accounting for about 20 deaths a day. In 2018, before the COVID-19 pandemic, there were 12 deaths per day.
The new treatment, developed in a clinical trial through the Canadian Substance Abuse Research Initiative, is based on the prescription buprenorphine-naloxone, also known as Suboxone.
Between October 2017 and March 2020, the clinical research team recruited more than 270 volunteers from seven hospitals in Quebec, Ontario, Alberta, and British Columbia. The average age of the participants was 39 years and 35% of them were women. Everyone was struggling with opioid addiction for prescription or illegally produced drugs such as morphine, oxycodone or fentanyl.
Patients were randomly divided into two groups, 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.
“(Suboxone) … is a little less potent than methadone and is often associated with less risk of overdose,” Jutras-Aswad said. This fits in with the model of care proposed by researchers in which the level of supervision was reduced.
Jutras-Aswad said the researchers recommended that after the first two weeks, patients be able to continue treatment with Suboxone without supervision at home for a week, which only requires a visit to the pharmacy. Eventually, visits to the pharmacy broke down to two a month.
He said the study aimed to determine whether more flexible treatment, with much less supervision, would be as effective at reducing drug use as current methadone treatment.
“‘Our study showed that buprenorphine … was not inferior to methadone treatment for people taking it without supervision, even a trend that shows that buprenorphine is a little more effective than methadone,” dir Jutras-Aswad. He added that buprenorphine also offers greater flexibility than methadone in case a change in treatment is needed.
“It’s not a small thing to have to go to the pharmacy every day,” Jutras-Aswad said. “I think this is a winning model … that really allows us to respond to a catastrophic situation.”
This report from The Canadian Press was first published on June 15, 2022.
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