Comparative Long-term Outcomes of Detoxification and Opioid Maintenance Therapy for the Management of Opioid Dependence

For the pharmacological management of dependence to illicit opioids detoxification and opioid maintenance therapy (OMT) are the primary treatment options. Over the past decade the United Kingdom has seen a mostly political push towards a more abstinence-oriented treatment agenda and away from the prevailing approach of ‘harm reduction’, however concerns exist that those completing detoxifications suffer from higher relapse rates and may be at increased risk of death. A systematic review was conducted, assessing the evidence on the comparative effect of detoxification and OMT on mortality and illicit opioid use. Following this, a retrospective cohort study using routine patient data compared a cohort of dependent opioid users that had been detoxified with those on continuous OMT over a two-year follow-up period, with regard to a number of outcomes related to mortality, illicit opioid use and health service utilisation. <br/><br/>The systematic review demonstrated that a majority of studies show a clear superiority of OMT over detoxification in reducing illicit opioid use, but few studies investigated mortality. Our own investigation found a higher, but statistically non-significant, risk of mortality over the two-year follow-up period for detoxification, but no difference over a longer follow-up period. Those who had completed a detoxification had a significantly higher chance of relapse than those on OMT, whereas the chance of a lapse was higher too, but not to a statistically significant level. No differences were found in the proportion of positive opiate tests, or any of the outcomes related to health service utilisation.<br/><br/>Both past research as well as our study have failed to conclusively demonstrate an advantage of OMT over detoxification in reducing all-cause or drug-related mortality. Future research utilising significantly larger samples is needed to further investigate this issue. When it comes to reducing illicit use, OMT has proven its clear superiority to detoxification in reducing the risk of lapses and relapses. However, as we found a considerable number of patients who had not relapsed in the two years after detoxification, the treatment should remain available for highly motivated individuals, as complete abstinence can remain a realistic goal, even if it requires multiple attempts. While we did not find differences in health-service utilisation, this outcome, and health-related quality of life, should be utilised more frequently in future research in order to gain a more complete picture of the impact of treatment for substance misuse on the patients’ lives.

Name dc:type.qualificationname

Master of Science

Level dc:type.qualificationlevel

Master's Thesis

Grantor dc:publisher.institution

University of Dundee

Year dc:date.issued

2017

Author dc:creator

• Vos, Carsten

Advisor dc:contributor.advisor

• Matthews, Keith

• Addiction
• Opioids

Language dc:language

eng

Identifier

oai:discovery.dundee.ac.uk:studenttheses/2a831dde-964d-435d-99bf-a21c727ae0db

OAI identifier oai:identifier

oai:discovery.dundee.ac.uk:studenttheses/2a831dde-964d-435d-99bf-a21c727ae0db