Opioids: new, less restrictive treatment but just as effective

Jean Benoit Legault, The Canadian Press

MONTREAL – A simpler, less invasive, and less demanding treatment than that currently offered to patients with opioid use disorders appears to be just as effective, a Montreal researcher found.

For example, we can currently ask these patients to come to the pharmacy every day for two or three months as part of the initiation of their therapy with methadone or morphine.

“It takes a high level of motivation to follow these treatments,” said the study’s author, Doctor Didier Jutras-Aswad, psychiatrist at CHUM. But we also have people who were very motivated or would be very motivated to get treatment but didn’t want to get involved in this type of treatment because they knew it was so tiring.

The situation becomes even more complex when we remember that this is a population that is often in a precarious and vulnerable situation, he added.

dr In the latest issue of the American Journal of Psychiatry, Jutras-Aswad and his colleagues from the Canadian Research Initiative in Substance Abuse show that it is possible to treat these patients more flexibly without compromising the chances of success.

This treatment is based on the use of buprenorphine naloxone, also known by the trade name Suboxone, which is also an opioid agonist.

The research team recruited more than 270 volunteers at seven hospitals and clinics in Quebec, Ontario, Alberta and British Columbia between October 2017 and March 2020.

The mean age of the participants, 35% of whom were women, was 39 years. They all had problems taking prescription or illicitly manufactured opioids, such as hydromorphone, morphine, oxycodone, or fentanyl.

The subjects were randomly divided into two groups: the first received methadone, the intake of which was monitored in pharmacies, and the second received Suboxone, which could most often be taken at home.

Participants were followed for 24 weeks, specifically to compare the effectiveness of each treatment in reducing their opioid use.

“(Suboxone) is slightly less potent than methadone and is associated with a lower risk of overdose,” said Dr. Jutras Aswad. We are banking on the safety profile of buprenorphine as being beneficial for testing a treatment model where we would reduce the monitoring burden, the intensity of direct monitoring at the start of treatment.”

It was recommended that after the first two weeks of treatment, the patient could take up to a week of unattended doses at home, requiring a one-off visit to the pharmacy. After two weeks, it was recommended that these visits be spread even further, two per month.

The purpose of the study, according to Dr. Jutras-Aswad, was to determine whether a much more flexible treatment model with much less surveillance would be as effective in reducing substance use as the standard methadone model.

“Our study showed us that buprenorphine (…) was non-inferior to methadone treatment in people receiving unsupervised buprenorphine treatment, with a tendency for buprenorphine to be even slightly more effective than methadone,” he underlined.

The researchers conclude that it is possible to use a more flexible model of care that requires less close monitoring, while achieving outcomes similar to those obtained using methadone under very close monitoring.

Buprenorphine also offers the patient greater flexibility than methadone should a change in treatment ever be required.

“It’s not for nothing that you have to go to the pharmacy every day,” says Dr. Jutras-Aswad concluding. I think it’s really a win-win model (…) that really makes it possible to respond to a catastrophic situation.

About 27,000 Canadians died from opioid-related poisoning between January 2016 and September 2021. It is estimated that more than 350,000 people who took opioid pain relievers had problem use.

In Quebec alone, 339 people died as a result of opioid-related poisoning between January and September 2021, according to the latest data from the Public Health Agency of Canada.

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