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Scientific Evidence
ModuleModule 2 2
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The evidence of effectivenessThe evidence of effectiveness
• Most research is on methadone, much less on other medications
• Has proven effective for the individual• Has proven effective for society at large
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Large body of evidenceLarge body of evidence
• JC Ball and A Ross (1991). The effectiveness of Methadone Maintenance Treatment. New York: Springer Verlag
• M Farrell, J Ward, R Mattick, W Hall, G Stimson, D des Jarlais, M Gossop, J Strang (1994). Methadone Maintenance Treatment in Opiate Dependence: a Review. BMJ 309: 997-1001.
• A Preston (1996). The Methadone Briefing • J Ward, R Mattick, W Hall (1998). Methadone Maintenance
Treatment and other Opioid Replacement Therapies. Harwood Academic Publishers, Amsterdam, The Netherlands
• H Joseph, S Stancliff, J Langrod (2000). Methadone Maintenance Treatment (MMT): A review of Historical and Clinical Issues. In: the Mount Sinai Journal of Medicine Vol.67 Nos 5&6
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Effectiveness for the individualEffectiveness for the individual
• Stay alive• Achieve abstinence or a stabilised pattern of
use• Stabilise social live• Improve physical health• Reduce criminal activity
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Effectiveness for societyEffectiveness for society
• Improve public health• Reduce emergencies, hospitalisations• Reduce spread of HIV and other infectious
diseases• Reduce social welfare costs
• Reduce costs in criminal justice system
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What are the cost–benefits of ST?What are the cost–benefits of ST?
• DASA, NYC, 1991 estimated the annual costs of opiate addicts:– Untreated on the street €40.000– In prison €40.000– In residential TC €10.000– In methadone maintenance € 2.500
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Costs-benefits 2Costs-benefits 2
• DASA calculated the effects of ST in 2001 in reductions of:
• 64% in property crimes• 54% overall arrests• 63% drug offence arrests• 65% emergency room visits• 59% medical hospitalisations• 55% psychiatric hospitalisations
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Cost – benefits 3Cost – benefits 3
• Collaboration between departments is important because spending in one can yield savings in another:
– NTORS (UK,1998): Every €1,5 spent on treatment (health) return €4,5 savings in costs of crime (criminal justice)
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Chronic versus acute careChronic versus acute care
• Opiate dependence often chronic condition• Treatment for many patients needs to be
chronic too• Effectiveness higher with long term treatment
at adequate dosage and provided properly
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Pre During During During Post
Source: McLellan, 2002. Treatment Research Institute, USA
Outcome in hypertension
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Pre During During During Post
Source: McLellan, 2002. Treatment Research Institute, USA
Outcome in addiction
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Comprehensive treatmentComprehensive treatment
• Assessment of co-morbidity• Assessment of psycho-social problems
• Treatment of these issues
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LimitationsLimitations
• Being stable on agonist medication can cause dependency to treatment and to the doctor
• Substitution treatment is often not considered as valid as recovery to abstinence
• It is corrective rather than curative
• However, these limitations do not outweigh the benefits
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Limitations of prescribingLimitations of prescribing
• There are some side effects (e.g. increased transpiration, constipation, and disturbances of sleep, sex drive and concentration) which affect 20% of patients
• They are however without medical consequences• Methadone helps around 70% of patients • Despite the scientific basis, there is no consensus in
practice, leading to contradictory or excessively rigid practice
• Existing oral formulations are not well designed and unpopular
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ConclusionsConclusions
• As drug addiction is a condition not easy to overcome, it is important to reduce the harm both to society at large and to the individual patient
• Scientific evidence has shown that good quality substitution treatment available for anybody who needs it can save many other costs in health care, social welfare and the criminal justice system.