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training manual training manual Scientific Evidence Module Module 2 2

Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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Page 1: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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Scientific Evidence

ModuleModule 2 2

Page 2: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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

Page 3: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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

Page 4: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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

Page 5: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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

Page 6: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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

Page 7: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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

Page 8: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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)

Page 9: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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

Page 10: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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Pre During During During Post

Source: McLellan, 2002. Treatment Research Institute, USA

Outcome in hypertension

Page 11: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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Pre During During During Post

Source: McLellan, 2002. Treatment Research Institute, USA

Outcome in addiction

Page 12: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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Comprehensive treatmentComprehensive treatment

• Assessment of co-morbidity• Assessment of psycho-social problems

• Treatment of these issues

Page 13: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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

Page 14: Scientific Evidence Module 2. The evidence of effectiveness Most research is on methadone, much less on other medications Has proven effective for the

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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.