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Home > Review of research on substitute prescribing for opiate dependence and implications for Northern Ireland.

McElrath, Karen (2003) Review of research on substitute prescribing for opiate dependence and implications for Northern Ireland. Belfast: Department of Health, Social Services and Public Safety.

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This report draws from extensive literature on subscribing prescribing for opiate dependence, and focuses largely on heroin use. The report includes an international review of both clinical and observational studies. Most research has focused on methadone, largely because of its longer history for treating heroin dependence. The review includes findings from studies that have compared methadone, buprenorphine (Subutex), and to a lesser extent, Levo-Alpha-Acetyl Methadol and heroin maintenance. The effects of these drugs on persons dependent on heroin and other opiates are examined in relation to outcomes, e.g., treatment retention and subsequent opiate use.

The review identified dozens of controlled and observational studies from various countries that have reported favourable outcomes with respect to the effects of methadone treatment for heroin dependence. This literature strongly suggested that methadone maintenance be implemented as a treatment option for persons dependent on heroin in N. Ireland. Several factors (e.g., maintenance rather than reduction or abstinence programmes, dosage levels and flexible dosing policies, treatment in conjunction with counselling), however, were shown to increase or decrease the degree of successful treatment outcomes and programmes should be organised accordingly. Additionally, it was recommended that reduction programmes be an option for heroin users as well, however, this decision should be an informed one, following balanced advice from drug treatment specialists or physicians.

Diverted methadone that results in improper use of the drug is a primary concern, however, the review found that programme regulations such as supervised consumption of methadone appears to reduce methadone-related deaths. This literature led to the recommendation that methadone clients undergo supervised consumption of methadone for the first six months of treatment and that drug treatment specialists and physicians consider the possibility of take-home doses after that time. Alternatively, the research suggested that supervised consumption of methadone might reduce the number of clients who otherwise might be interested in methadone treatment, and might also affect treatment retention. The research also identified limitations associated with programmatic urinalysis during treatment and called into question its effectiveness.


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