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Opioid addiction treatable on OPD basis

People who are addicted to drugs like heroin, cocaine or prescription opioids do not need to go to specialised de-addiction centres for treatment.

Opioid addiction treatable on OPD basis

People who are addicted to drugs like heroin, cocaine or prescription opioids can be treated at their regular doctor's office and may not need to go to specialised drug de-addiction centres for treatment. Researchers from the Yale University School of Medicine conducted a 24-week clinical trial that included 166 opioid-dependent patients who were treated in a primary care setting using brief counselling and a medication regimen. Treatment involved taking Suboxone tablets, which contain a combination of buprenorphine and naloxone known to combat craving for drugs, along with weekly counselling by a primary care nurse. In the counselling sessions, discussion included efforts to achieve or maintain opiate abstinence, the use of self-help groups and results of weekly analysis of urine specimens. Standard sessions lasted 20 minutes, while enhanced counselling sessions were 45 minutes with more in-depth drug counselling. Patients were randomly assigned to once-weekly standard counselling and medication distribution, thrice-weekly standard counselling and medication, or enhanced counselling with medication dispensed three times per week. Medication was to be self-administered at home. Patients in all of the treatment groups achieved significant reduction in opioid use as compared to the start of the study, although there were differences according to treatment group. Overall, average self-reported frequency of opioid use fell from 5 days per week before treatment to 0.4 days per week during treatment. Patients preferred standard counselling and once-weekly medication distribution over the other two strategies, but the proportion of patients completing the study did not differ significantly among groups. The researchers saw no significant differences among groups in adherence to treatment, frequency of opioid-negative urine specimens, or in the maximum number of consecutive weeks of abstinence. The findings suggest that primary care, office-based treatment of opioid dependence is feasible and that nurses can deliver it.
New England Journal of Medicine,
July 2006
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