3rd December 2017

US: For opiate addiction, study finds drug-assisted treatment is more effective than detox

Say you’re a publicly-insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit.

New research suggests you can do it the way most treatment-seeking addicts in the state do — by undergoing a medically-supervised “detoxification” that’s difficult, expensive and highly prone to failure.

Or you can try to quit the way that addiction researchers now widely agree it should be done (but rarely is): by combining abstinence programs with long-acting opioid medications such as methadone and buprenorphine, which allow patients to slowly wean themselves off their dangerous habit.

Deep into a crisis of opioid addiction that claims 91 lives a day and holds close to 2.6 million Americans in its grip, the United States continues to suffer a yawning gap between what it knows about treatment and how the opiate-addicted are actually treated.

Close to 80% of those with an opioid-use disorder weren’t getting any treatment at all in 2015. Of the small sliver of those who did get some treatment, fewer than half in California got the kind of open-ended opioid agonist treatment that addiction researchers widely agree is most likely to lead to abstinence.

Published Monday in the Annals of Internal Medicine, the new study, headed by Bohdan Nosyk, a health economist with British Columbia’s Center of Excellence in HIV/AIDs, underscores that public policies that limit access to treatments such as methadone or buprenorphine don’t just shortchange patients who need help quitting; they’re costly to taxpayers footing the bill for their treatment as well.

If just one year’s worth of treatment-seeking opiate addicts were to get opioid agonist therapy instead of detox, the societal savings over the patients’ lifetimes would amount to $3.869 billion, the new study estimates.

Those patients would be in treatment longer, and the immediate cost of their treatment would increase, the new research finds. But over time, their increased likelihood of getting and staying clean would translate into lower downstream healthcare costs, a decreased likelihood of HIV infection (along with the costs of treating it), and less costly involvement with the criminal justice system.

Nosyk’s co-authors included addiction and epidemiological experts from UCLA’s Integrated Substance Abuse Programs and the Veterans Affairs Greater Los Angeles Healthcare System of Los Angeles.

In an editorial published alongside the study Monday, Drs. Jeanette M. Tetrault and David A. Fiellin said the new research strongly suggests that lawmakers should be using their policy clout to promote outpatient clinics that treat opiate addicts in their communities rather than costly inpatient units where patients go to detox.

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