Differential long-term outcomes for voluntary and involuntary transition from injection to oral opioid maintenance treatment

Simple item page
dc.contributor.authorOviedo-Joekes, Eugenia
dc.contributor.authorGuh, Daphne
dc.contributor.authorMarchand, Kirsten
dc.contributor.authorMarsh, David C.
dc.contributor.authorLock, Kurt
dc.contributor.authorBrissette, Suzanne
dc.contributor.authorAnis, Aslam H
dc.contributor.authorSchechter, Martin T
dc.date.accessioned2015-06-03T23:06:58Z
dc.date.available2015-06-03T23:06:58Z
dc.date.copyright2014en_US
dc.date.issued2014-06-08
dc.descriptionBioMed Centralen_US
dc.description.abstractBackground: The most widely used maintenance treatment for opioid dependency is substitution with long-acting oral opioids. Treatment with injectable diacetylmorphine provides an opportunity for patients to stabilize and possibly transition to oral treatment, if clinically indicated. The aim of this study was to explore outcomes of individuals that received injectable diacetylmorphine and voluntarily transitioned to oral methadone. Design and methods: The North American Opiate Medication Initiative was a randomized controlled trial that compared the effectiveness of injectable diacetylmorphine (or hydromorphone) to oral methadone for long-term opioid-dependency. Treatment was provided for 12-months with an additional 3 months for transition and weaning. Participants were followed until 24-months from randomization. Among the participants randomized to injectable treatments, a sub-group voluntarily chose to transition to oral methadone (n = 16) during the treatment period. Illicit heroin use and treatment retention were assessed at 24-months for those voluntarily and involuntarily transitioning (n = 95) to oral methadone. Results: At 24-months, the group that voluntarily transitioned to oral methadone had higher odds of treatment retention (adjusted odds ratio = 5.55; 95% confidence interval [CI] = 1.11, 27.81; Chi-square = 4.33, df = 1, p-value = 0.037) than the involuntary transition group. At 24-months, the adjusted mean difference in prior 30 days of illicit heroin use for the voluntary, compared to the involuntary group was −5.58 (95% CI = −11.62, 0.47; t-value = −1.83, df = 97.4, p-value = 0.070). Conclusions: Although the results of this study were based on small groups of self-selected (i.e., non-randomized) participants, our data underlines the critical importance of voluntary and patient-centered decision making. If we had continued offering treatment with diacetylmorphine, those retained to injectable medication may have sustained the achieved improvements in the first 12 months. Diversified opioid treatment should be available so patients and physicians can flexibly choose the best treatment at the time. Trial registration: Clinical Trial Registration: NCT00175357en_US
dc.description.reviewstatusRevieweden_US
dc.description.scholarlevelFacultyen_US
dc.description.sponsorshipThe NAOMI trial was funded through an operating grant from the Canadian Institutes of Health Research with additional support from the Canada Foundation for Innovation, the Canada Research Chairs Program, the University of British Columbia, Providence Health Care, the University of Montreal, Centre de Recherche et Aide aux Narcomanes, the Government of Quebec, Vancouver Coastal Health Authority and the BC Centre for Disease Control. Dr. Oviedo-Joekes is also funded by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.en_US
dc.identifier.citationOviedo-Joekes et al.: Differential long-term outcomes for voluntary and involuntary transition from injection to oral opioid maintenance treatment. Substance Abuse Treatment, Prevention, and Policy 2014 9:23.en_US
dc.identifier.urihttp://www.substanceabusepolicy.com/content/9/1/23
dc.identifier.urihttp://dx.doi.org/10.1186/1747-597X-9-23
dc.identifier.urihttp://hdl.handle.net/1828/6223
dc.language.isoenen_US
dc.publisherSubstance Abuse Treatment, Prevention, and Policyen_US
dc.rightsAttribution-NonCommercial-NoDerivs 2.5 Canada*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/ca/*
dc.subjectCanadian Institute for Substance Use Research (CISUR)
dc.subjectCentre for Addiction Research BC (CARBC)
dc.subjectOpioid dependency
dc.subjectDiacetylmorphine
dc.subjectInjectable
dc.subjectOral methadone
dc.subjectOpioid maintenance treatment
dc.titleDifferential long-term outcomes for voluntary and involuntary transition from injection to oral opioid maintenance treatmenten_US
dc.typeArticleen_US

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
OviedoJoekes_Eugenia_SubstanceAbuseTreatPrevPolicy_2014.pdf
Size:
230.48 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.74 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

CISUR publications
 
University of Victoria Libraries

We acknowledge and respect the Lək̓ʷəŋən (Songhees and Esquimalt) Peoples on whose territory the university stands, and the Lək̓ʷəŋən and W̱SÁNEĆ Peoples whose historical relationships with the land continue to this day.