An article from our lab, led by Dr. Didier Jutras-Aswad, was published in the American Journal of Psychiatry this month. This publication presents and discusses the most recent data generated through the Optima study, which focuses on the comparison of care models for the management of opioid use.
Specifically, the text discusses about a flexible model of care that is based on using buprenorphine/naloxone. This treatment targets opioid use reduction in individuals with prescription opioid use disorder (POUD).
The study demonstrates that this model of care, which allows the intended clientele to take home doses of buprenorphine/naloxone, is non-inferior to the use of supervised methadone in reducing opioid use among individuals with POUD. The study ran for 24 weeks and included 272 participants aged 18 to 64 years.
Monitored treatment with methadone
Intensive exposure to prescription opioids combined with several factors, such as the pandemic context of COVID-19, has contributed to an increase in estimated opioid mortality, now at 89%.
In order to address this significant increase and reduce the use of these substances, the authors determined that it is important to study and plan an implementation of opioid agonist treatment.
The typical treatment uses methadone, which has a low therapeutic index, in which the difference between therapeutic and toxic doses is small. Therefore, methadone use must be strictly monitored, especially during treatment initiation. This requirement for in-person treatment in specialized clinics, especially in a pandemic context, may demotivate participants to proceed with treatment.
The flexible buprenorphine/naloxone model: is it effective?
Dr. Jutras-Aswad’s team’s paper indicates that buprenorphine/naloxone treatment poses less of a risk at the beginning of treatment, which would allow for earlier implementation of home dosing.
According to the study, participants in the buprenorphine/naloxone usage group were 0.47 times more likely to be maintained in assigned treatment than those in the methadone group.
This model of home care is more flexible, and therefore more acceptable, less costly and better suited to the current context.
There is still room for improvement
The results also show that the overall effectiveness of treatment in a real-life setting is lower than expected. The success rate is particularly low in the context of consumption of very potent opioids (e.g., fentanyl), that are frequently used by people living with a TUO.
The text highlights the importance of developing and testing new and innovative strategies to improve treatment outcomes. A few possible solutions are proposed, such as improving integrated psychosocial interventions, pharmacological treatments and developing new models of care.
To view the article, click here.