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      Opioid agonist treatment for pharmaceutical opioid dependent people

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          Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

          Cochrane Database of Systematic Reviews
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            Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.

            Opioid-dependent patients often use the emergency department (ED) for medical care.
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              Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.

               Richard P. Mattick (corresponding) ,  Courtney Breen,  Jo Kimber (2009)
              Methadone maintenance was the first widely used opioid replacement therapy to treat heroin dependence, and it remains the best-researched treatment for this problem. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed. To evaluate the effects of methadone maintenance treatment (MMT) compared with treatments that did not involve opioid replacement therapy (i.e., detoxification, offer of drug-free rehabilitation, placebo medication, wait-list controls) for opioid dependence. We searched the following databases up to Dec 2008: the Cochrane Controlled Trials Register, EMBASE, PubMED, CINAHL, Current Contents, Psychlit, CORK [www. state.vt.su/adap/cork], Alcohol and Drug Council of Australia (ADCA) [www.adca.org.au], Australian Drug Foundation (ADF-VIC) [www.adf.org.au], Centre for Education and Information on Drugs and Alcohol (CEIDA) [www.ceida.net.au], Australian Bibliographic Network (ABN), and Library of Congress databases, available NIDA monographs and the College on Problems of Drug Dependence Inc. proceedings, the reference lists of all identified studies and published reviews; authors of identified RCTs were asked about other published or unpublished relevant RCTs. All randomised controlled clinical trials of methadone maintenance therapy compared with either placebo maintenance or other non-pharmacological therapy for the treatment of opioid dependence. Reviewers evaluated the papers separately and independently, rating methodological quality of sequence generation, concealment of allocation and bias. Data were extracted independently for meta-analysis and double-entered. Eleven studies met the criteria for inclusion in this review, all were randomised clinical trials, two were double-blind. There were a total number of 1969 participants. The sequence generation was inadequate in one study, adequate in five studies and unclear in the remaining studies. The allocation of concealment was adequate in three studies and unclear in the remaining studies. Methadone appeared statistically significantly more effective than non-pharmacological approaches in retaining patients in treatment and in the suppression of heroin use as measured by self report and urine/hair analysis (6 RCTs, RR = 0.66 95% CI 0.56-0.78), but not statistically different in criminal activity (3 RCTs, RR=0.39; 95%CI: 0.12-1.25) or mortality (4 RCTs, RR=0.48; 95%CI: 0.10-2.39). Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy. It does not show a statistically significant superior effect on criminal activity or mortality.
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                Author and article information

                Journal
                Cochrane Database of Systematic Reviews
                Wiley
                14651858
                May 09 2016
                Affiliations
                [1 ]UNSW; National Drug and Alcohol Research Centre; Building R3 22 - 32 King Street Randwick NSW Australia 2031
                [2 ]University of Adelaide; Discipline of Pharmacology; Frome Road Adelaide South Australia Australia 5005
                [3 ]South Eastern Sydney Local Health District; Drug and Alcohol Services; The Langton Centre 591 South Dowling St Surry Hills NSW Australia 2010
                Article
                10.1002/14651858.CD011117.pub2
                © 2016
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