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20.03.2023 | Publication

Improving maintenance treatment of opiate addiction: Clinical aspects

Julkaisun nimi:

Improving maintenance treatment of opiate addiction: Clinical aspects


Simojoki, K.


The purpose of this study was to investigate whether pharmacological or clinical management methods could improve patients' adherence to treatment and reduce the resource burden, thus improving treatment effectiveness.







Julkaisun tiedot:

University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Unit of Substance Abuse Medicine Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki.

Lyhyt kuvaus:

Finland was the first country in Europe to use buprenorphine-naloxone combination medication as part of opioid maintenance treatment (OMT), which was expected to have lower potential for diversion into the drug market. The study investigated whether the transition from monobuprenorphine to buprenorphine-naloxone combination would cause adverse events or lower patient compliance. One way to reduce the diversion of buprenorphine medication is to crush the tablet when administering it, this has not been studied earlier, and it was investigated whether crushing mono-buprenorphine tablets would influence the kinetics and serum levels of buprenorphine, or whether patients would have adverse events following the use of crushed tablets. One main problem in OMT has been patient compliance and adherence to treatment. One main component has been visually supervised urine drug screens. Thus it was investigated whether a new unsupervised screening method would affect urine testing reliability, patient compliance, and the time/resources used by personnel in screening. The large buprenorphine abuse problem in Finland provides good possibilities for being able to study the abuse. A seven-year follow-up study evaluated the trends in street buprenorphine prices, intravenous abuse doses, and its abuse potential in Finland.

The studies showed that the use of the new buprenorphine-naloxone combination product is as safe as mono-buprenorphine alone, and that no dose adjustments are needed during medication change. Crushing of the mono-buprenorphine tablet did not affect serum levels or buprenorphine kinetics, and the study subjects did not experience more or less adverse events than the control group. It was concluded that crushing is a safe and effective management for patients with high risk of medication abuse or diversion. The study with the new marker-based urine drug screen indicated that the new method did not jeopardize the safe and reliable assessment of concomitant drug use. Both patients and medical staff thought it was more comfortable than the traditional visually controlled screen. The new method saved considerable time previously spent on controlling the screen. So it was concluded that the new screening method improves patient compliance, reduces the burden of the control time and thus may  increase the effectiveness of the treatment. The long-term follow-up study revealed that the street price of the new combination product is significantly less than of the monobuprenorphine product and that the price difference remained the same during the follow-up period. Thus it was concluded that the abuse potential of the combination product is less than that of mono-buprenorphine.

The studies demonstrate that there are several effective methods for reducing the abuse of OMT medications, and that patient compliance and thus the outcomes of treatment can both be improved. These methods should be used broadly in the clinical management of OMT.

Keywords: Medicine, addiction medicine, maintenance treatment, opioids, buprenorfine

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