STAGE 5. Defining the action plan

What steps should be completed?

Step 1: Specify intervention actions

EVIDENCE ON PHARMACOLOGICAL TREATMENT PROGRAMMES

HEROIN / OPIATES

Methadone (opioid agonist). Methadone-based treatments are effective in addressing dependence on heroin and other opiates.1 They also increase the individual’s chances of getting a job, and reduce criminal behaviour and the risks of transmitting infectious diseases2 or of death (particularly through overdose),1,3 which is progressively reduced with time in the programme.4,5 Buprenorphine (partial opioid receptor agonist, with agonist and antagonist properties). Administered alone, or often combined with naloxone (opioid antagonist), it is effective in addressing opioid/heroin dependence, although less so than methadone in suitable doses.1, 6, 7, 8 The efficacy of methadone/buprenorphine treatment improves when combined with individual or group therapies, and even more so if patients are also given other medical, psychological and social services. In turn, patients who have been stabilised with these medicines are admitted more readily into psychological therapies and other interventions that are essential for rehabilitation.9 Naltrexone (opioid antagonist). Useful in highly motivated, recently detoxified patients who want total abstinence for external circumstances. It requires a positive therapeutic relationship, effective counselling or therapy, and careful control to ensure that medicines are taken correctly.9

 

 

References:

1 Amato L et al. (2005). An overview of systematic reviews of the effectiveness of opiate maintenance therapies: Available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment. 28: 321-330.

2 Pani et al. (2010). Disulfiram for the treatment of cocaine dependence. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD007024. DOI: 10.1002/14651858.CD007024.pub2.

3  Barnett P. (1999). The cost-effectiveness of methadone maintenance as a health care intervention. Addiction. 94: 479-488.

4  Segest E et al. (1990). The influence of prolonged stable methadone maintenance treatment on mortality and employment: an 8-year follow-up.  International Journal of Mental Health and Addiction. 25: 53-63.

5  Langendam MW et al.  (2001). The impact of harm-reduction-based Methadone treatment on Mortality among Heroin users. American Journal of Public Health. 91: 774–780.

6 Kakko J et al. (2003). 1 year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomized, placebo controlled trial. The Lancet. 36: 662-668.

7 Bobes J et al. (2010). Guía para el tratamiento de la adicción a opiáceos con buprenorfina/naloxona. Guías clínicas basadas en la evidencia científica [Guide to treatment of opioid addiction with buprenorphine/naloxone. Evidence-based clinical guides]. Valencia: Socidrogalcohol.    

8 Connock M et al. (2007). Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technology Assessment. 11: 1-190

9  National Institute on Drug Abuse (NIDA).  (2010). Principles of drug addiction treatment: a research-based guide. Washington: National Institute on Drug Abuse (NIDA).