Historique
Article de Périodique
Opioid substitution therapy: Lowering the treatment thresholds (2016)
Auteur(s) :
KOUROUNIS, G. ;
RICHARDS, B. D. W. ;
KYPRIANOU, E. ;
SYMEONIDOU, E. ;
MALLIORI, M. M. ;
SAMARTZIS, L.
Année
2016
Page(s) :
1-8
Sous-type de document :
Revue de la littérature / Literature review
Langue(s) :
Anglais
Domaine :
Drogues illicites / Illicit drugs
Thésaurus mots-clés
TRAITEMENT DE MAINTENANCE
;
SUBSTITUTION
;
ACCES AUX SOINS
;
METHADONE
;
BUPRENORPHINE
;
EFFICACITE
;
COMPARAISON
Résumé :
Background: Opioid substitution therapy (OST) has been established as the gold standard in treating opioid use disorders. Nevertheless, there is still a debate regarding the qualitative characteristics that define the optimal OST intervention, namely the treatment threshold. The aim of this review is twofold: first, to provide a summary and definition of "treatment thresholds", and second, to outline these thresholds and describe how they related to low and high threshold treatment characteristics and outcomes.
Method: We searched the main databases of Medline, PubMed, PsycInfo, EMBASE, CINAHL and the Cochrane Library. Original published research papers, reviews, and meta-analyses, containing the eligible keywords: "opioid substitution", "OST", "low threshold", "high threshold" were searched alone and in combination, up to June, 2015.
Results: Treatment thresholds were defined as barriers a patient may face prior to and during treatment. The variables of these barriers were classified into treatment accessibility barriers and treatment design barriers. There are increasing numbers of studies implementing low threshold designs with an increasing body of evidence suggesting better treatment outcomes compared to high threshold designs.
Conclusion: Clinical characteristics of low threshold treatments that were identified to increase the effectiveness of OST intervention include increasing accessibility so as to avoid waiting lists, using personalized treatment options regarding medication choice and dose titration, flexible treatment duration, a treatment design that focuses on maintenance and harm reduction with emphasis on the retention of low adherence patients.
Highlights:
We defined opioid substitution therapy (OST) thresholds and we compared the effectiveness of low and high threshold OST found in the literature.
An increasing number of studies are evaluating the implementation of low threshold designs.
Low threshold OST compared to usual care is associated with better treatment outcomes.
Method: We searched the main databases of Medline, PubMed, PsycInfo, EMBASE, CINAHL and the Cochrane Library. Original published research papers, reviews, and meta-analyses, containing the eligible keywords: "opioid substitution", "OST", "low threshold", "high threshold" were searched alone and in combination, up to June, 2015.
Results: Treatment thresholds were defined as barriers a patient may face prior to and during treatment. The variables of these barriers were classified into treatment accessibility barriers and treatment design barriers. There are increasing numbers of studies implementing low threshold designs with an increasing body of evidence suggesting better treatment outcomes compared to high threshold designs.
Conclusion: Clinical characteristics of low threshold treatments that were identified to increase the effectiveness of OST intervention include increasing accessibility so as to avoid waiting lists, using personalized treatment options regarding medication choice and dose titration, flexible treatment duration, a treatment design that focuses on maintenance and harm reduction with emphasis on the retention of low adherence patients.
Highlights:
We defined opioid substitution therapy (OST) thresholds and we compared the effectiveness of low and high threshold OST found in the literature.
An increasing number of studies are evaluating the implementation of low threshold designs.
Low threshold OST compared to usual care is associated with better treatment outcomes.
Affiliation :
St George’s University of London, Medical School at the University of Nicosia, Nicosia, Cyprus