Effects of medication assisted treatment (MAT) for opioid use disorder on functional outcomes: A systematic review

Abstract

This systematic review synthesizes evidence on the effects of Medication-Assisted Treatment (MAT) for opioid use disorder (OUD) on functional outcomes, including cognitive (e.g., memory), physical (e.g., fatigue), occupational (e.g., return to work), social/behavioral (e.g., criminal activity), and neurological (e.g., balance) function. Five databases were searched from inception to July 2017 to identify English-language controlled trials, case control studies, and cohort comparisons of one or more groups; cross-sectional studies were excluded. Two independent reviewers screened identified literature, abstracted study-level information, and assessed the quality of included studies. Meta-analyses used the Hartung-Knapp method for random-effects models. The quality of evidence was assessed using the GRADE approach. A comprehensive search followed by 1411 full text publication screenings yielded 30 randomized controlled trials (RCTs) and 10 observational studies meeting inclusion criteria. The studies reported highly diverse functional outcome measures. Only one RCT was rated as high quality, but several methodologically sound observational studies were identified. The statistical power to detect differences in functional outcomes was unclear in most studies. When compared with matched "healthy" controls with no history of substance use disorder (SUD), in two studies MAT patients had significantly poorer working memory and cognitive speed. One study found MAT patients scored worse in aggressive responding than did "healthy" controls. A large observational study found that MAT users had twice the odds of involvement in an injurious traffic accident as non-users. When compared with persons with OUD not on MAT, one cohort study found lower fatigue rates among buprenorphine-treated OUD patients. No differences were reported for occupational outcomes and results for criminal activity and other social/behavioral areas were mixed. There were few differences among MAT drug types. A pooled analysis of three RCTs found a significantly lower prevalence of fatigue with buprenorphine compared to methadone, while a meta-analysis of the same RCTs found no statistical difference in insomnia prevalence. Three RCTs that focused on cognitive function compared the effects of buprenorphine to methadone; no statistically significant differences in memory, cognitive speed and flexibility, attention, or vision were reported. The quality of evidence for most functional outcomes was rated low or very low. In sum, weaknesses in the body of evidence prevent strong conclusions about the effects of MAT for opioid use disorder on functional outcomes. Rigorous studies of functional effects would strengthen the body of literature.

The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder

“…Fifty-eight percent (14/24) of systematic reviews on pharmacological interventions included studies which reported housing instability or homelessness [41,42,44,46,50,51,53,[55][56][57][58][59][60]64]. All systematic reviews on SCFs included observational studies reporting the rate of The effectiveness of substance use interventions for homeless and vulnerably housed persons homelessness ranging from 10% to as high as 75% among SCF clients, the majority of studies were from Sydney, Australia and Vancouver, Canada [65][66][67].…”

“…Methadone was associated with more adverse events compared to buprenorphine, including sedation [50,60], but not compared to slow release oral morphine (81% SROM vs 79% methadone, p = 0.62 [no further data reported]) [63]. Buprenorphine patients had a significantly lower prevalence of fatigue (15.5% vs 25.1%; risk ratio 0.62; 95% CI 0.41-0.95; GRADE certainty of evidence [as reported in [64]: moderate) but no difference in insomnia (risk ratio1.12 95%CI 0.78-1.62) compared to methadone patients [64].…”

Neuropsychological impairment associated with substance use by physicians

“…Some report neurocognitive performance that does not differ from abstinent former heroin users or controls; however, others have found impairment in episodic memory, psychomotor speed, working and long-term memory, decision-making, and response inhibition [55]. A systematic review examined the effects of opioid substitution therapy (i.e., methadone and buprenorphine treatment) on cognitive function [56]. Compared to healthy controls, individuals taking either medication displayed worse performance in working memory (i.e., number sequencing tasks), with no significant difference found between methadone and buprenorphine users [57].…”

Auricular neural stimulation as a new non-invasive treatment for opioid detoxification

“…Currently, there are three approved medications for the treatment of opioid addiction, including methadone, buprenorphine, and naltrexone (McElrath 2018;Maglione et al 2018;Herring et al 2019;Blanco and Volkow 2019) (Table 1). Buprenorphine, for example, has been quite effective in randomized clinical trials (Herring et al 2019;Gowing et al 2017) for managing acute symptoms during the detoxification and maintenance phases of opioid addiction treatment.…”