Canada is among the world’s top consumers of opioids, whether they’re medically prescribed or obtained illegally from illicit producers of very powerful substances such as fentanyl.
Scientists from Université de Montréal found that a more flexible model of care than methadone can be as effective in treating opioid use disorder.
The research is published in the American Journal of Psychiatry and was conducted by Professor Didier Jutras-Aswad et al.
In the study, the team focused on buprenorphine-naloxone, known commercially as Suboxone. They tested more than 270 adult volunteers in seven hospitals and clinics.
With an average age of 39, and with one in three a woman, all people presented problematic opioid use from either prescribed or illegally produced opioids. Among the opioids inventoried were hydromorphone, morphine, oxycodone, and fentanyl.
Participants were assigned to two groups: half received methadone under close supervision in a pharmacy, and the other half received Suboxone, which could most often be taken at home.
They were followed for 24 weeks to compare the efficacy of each of the treatments in reducing their opioid use.
The team found the home treatment approaches proved just as effective as that using methadone, without the need for close supervision.
Up until now, studies comparing the efficacy of these two opioid-agonist therapies (OATs) were conducted under strict medical surveillance, deemed essential to ensure the safety and efficacy of the therapies.
Those receiving such treatment often find this approach restrictive—and many others simply don’t get it, as the requirement to be under supervision limits easy access to it.
The team found the approach proposed with buprenorphine-naloxone, more flexible in many regards than the usual model of care with methadone, allows them to simplify and facilitate access to OATs nationally.
It’s an additional option, to better take the treatment preferences of people with opioid use disorder into account, and to be more respectful of their autonomy.
The team says while the solution supported by the data from the study is an important component of the response to the opioid and overdose crisis, it must absolutely be part of a broader range of harm reduction strategies to deal with these problems.
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