Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain

Brugal, M. Teresa; Domingo‐Salvany, Antònia; Puig, Ricardo Rubini; Barrio, Gregorio; Olalla, Patricia García de; Fuente, Luís de la

doi:10.1111/j.1360-0443.2005.01089.x

Cited by 206 publications

(145 citation statements)

References 42 publications

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“…A reduction in drug-related AIDS cases was also seen in Spain (from 5,085 cases in 1994 to 639 in 2007) following the scaling up of opiate substitution treatment (Brugal et al 2005).…”

Section: What Can We Learn From the Portuguese Decriminalization Of Imentioning

confidence: 90%

What Can We Learn From The Portuguese Decriminalization of Illicit Drugs?

Hughes

Stevens

2010

British Journal of Criminology

273

161

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“…A reduction in drug-related AIDS cases was also seen in Spain (from 5,085 cases in 1994 to 639 in 2007) following the scaling up of opiate substitution treatment (Brugal et al 2005).…”

Section: What Can We Learn From the Portuguese Decriminalization Of Imentioning

confidence: 90%

What Can We Learn From The Portuguese Decriminalization of Illicit Drugs?

Hughes

Stevens

2010

British Journal of Criminology

273

161

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“…5,[9][10][11] Injectors are exposed to life-threatening health risks such as drug overdoses, bloodborne viral infections, endocarditis, and others. [12][13][14] Those who remain untreated or who are outside the social and health care system are known to experience higher rates of morbidity and mortality. [15][16][17] Given that abstinence-oriented therapies for opioid addiction have relatively low efficacy, 18 opioid agonist substitution is currently the most effective treatment option.…”

Section: Introductionmentioning

confidence: 99%

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

et al. 2008

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Standardized assessment instruments such as the European Addiction Severity Index and the Maudsley Addiction Profile were employed. A total of 251 individuals were randomized from Vancouver, BC (192, 76.5%), and Montreal, Quebec (59, 23.5%); 38.5% were female, the mean age was 39.7 years (SD:8.6), and participants had injected drugs for 16.5 years (SD:9.9), on average. In the prior month, heroin was used a mean of 26.5 days (SD:7.4) and cocaine 16 days (SD;12.6). Vancouver had significantly more patients residing in unstable housing (88.5 vs. 22%; pG0.001) and higher use of smoked crack cocaine (16.9 days vs. 2.3 days in the prior month; pG0.001), while a significantly higher proportion of Montreal participants reported needle sharing in the prior 6 months (25% vs. 3.7%; pG0.001). In many respects, the patient cohort was similar to the European trials; however, NAOMI had a higher proportion of female participants and participants residing in unstable housing. This study suggests that the NAOMI study successfully recruited participants with a profile indicated for HAT. It also raises concern about the high levels of crack cocaine use and social marginalization.

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“…MAT is associated with a reduction in substance use, mortality, treatment dropouts, HIV infections, psychosocial symptom load and delinquency, and an overall increase in quality of life (Brugal et al, 2005;Cacciola, 2001;Deck et al, 2009;Feelemyer et al, 2014;MacArthur et al, 2012;Mattick et al, 2009). Most treatment studies focused on putative objective parameters, while the subjective outcomes of MAT have received less attention.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of medication-assisted treatment of opioid dependence—The physicians’ perspective

Vogel

Nordt

Dürsteler

et al. 2016

Drug and Alcohol Dependence

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BACKGROUND: There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore how physicians evaluate MAT, and which predictors are most relevant. METHODS: We conducted a retrospective cohort study of all MAT episodes with oral opioid agonists in the canton of Zurich between 1998 and 2013 using a case register. Termination forms of the register include a physician-completed assessment on the course of the treatment episode. Mixed model analysis was applied to determine relevant predictors. RESULTS: The analysis was based on 17,234 episodes from 7432 patients. Mean global assessment of the course of MAT was 'moderate'. The most important predictors for treatment evaluation by physicians were treatment break off as reason for termination (p<0.0001), psychological improvement throughout treatment (p<0.0001), wish for abstinence from the substitute (p<0.0001), social integration index at termination (p<0.0001), and social (p<0.0001) as well as medical (p<0.0001) improvement. The negative association of treatment break off with MAT assessment was more pronounced in semi-rural than urban areas (p<0.0001). CONCLUSION: Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use. Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use.

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Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain

Abstract: The observed mortality decline could be linked to the effectiveness of low-threshold MT. The life expectancy of heroin users increased by 21 years during the study period.

Cited by 206 publications

References 42 publications

What Can We Learn From The Portuguese Decriminalization of Illicit Drugs?

What Can We Learn From The Portuguese Decriminalization of Illicit Drugs?

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

Evaluation of medication-assisted treatment of opioid dependence—The physicians’ perspective

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