Abstinence-orientated replacement therapy for opioid dependence

Abstract

BACKGROUND Opioid dependence is associated with substantial medical, psychological and social problems. Long-term opioid replacement therapy is the most common treatment option internationally. Ac-cording to Norwegian health authority regulations, medicationassisted rehabilitation (MAR) is generally only available for persons aged 25 years or more who have treatment experience from non-medical programmes. The aim of this research project was to assess the feasibility of shortterm buprenorphine replacement therapy programmes for dependent opioid users who were not eligible for the ordinary long-term programmes. I also aimed to explore individual differences in the patient group. METHODS The research project comprised three studies. First, a literature review was undertaken to assess post-treatment abstinence rates in former patients in methadone or buprenorphine replacement programmes. Second, 75 dependent opioid users in outpatient counselling were recruited to a 9-month buprenorphine replacement programme and followed up for two years. Third, 65 study participants’ personality profiles were compared to those of an agematched norm sample. RESULTS We identified 14 studies in the literature review. The pooled abstinence rate across the studies was 33%. For individuals who had left treatment voluntarily or on staff recommendations, the pooled abstinence rate was 48%, versus 22% for persons who had been discharged involuntarily or against staff recommendations. Forty study participants (53%) completed the 9-month buprenorphine replacement programme. Three non-completers died during detoxification. At two-year follow-up, the number of deaths had increased to five. Nine participants were abstinent from all opioids (illicit and prescribed), and thirtyseven participants were still in or had returned to opioid replacement therapy. The opioiddependent sample was less emotionally stable, less outgoing and less conscientious than the non-clinical sample. CONCLUSION Abstinence-orientated buprenorphine replacement therapy did not seem to be a feasible alternative to current treatments.