Studying opioid addicted patients is difficult for numerous reasons, namely high rate of drop out and low participation. It’s the nature of addictive disease.
Yet previous studies using patients who came to a local emergency department for overdose of opioid related morbidity, who were initiated into Suboxone (buprenorphine plus naloxone) and continued to receive Suboxone in primary care were more likely to sustain engagement in addiction treatment and reduce their use illicit opioids at 30 days post assessment compared to ED patients who received either brief intervention without Medically-Assisted Treatment (MAT), or were referred to an addiction treatment provider.
However, 30 days is not a goal or outcome that most researchers would use to determine the efficacy of any treatment for a life threatening, chronic disease. In oncology, for example, the 5 year mortality rate is the “gold standard” for treatment efficacy. With this in mind, the authors recruited and evaluated randomized participants (n=290) at 2, 6 and 12 months post ED initiated intervention. The bench marks included: Self-reported engagement in formal addiction treatment, the number of days of illicit opioid use, and HIV risk behavior (2, 6, 12 months); and urine toxicology testing at 2 and 6 months, which is the best indicator of outcome.
At two months, the MAT group reported fewer days of illicit opioid use versus brief intervention. But, no significant differences in illicit opioid use were observed at 6 or 12 months. There were also no significant differences in HIV risk or rates of opioid-negative urine results between the groups at any time.
Why Does This Matter?
Considering the increasing mortality rate associated with the illicit use of opioids and the resources being expended to curtail this epidemic, better prevention and treatment resources are needed. Emergency intervention with MAT appear to be short-lived. Smaller studies have shown that MAT combined with addiction centered, multiphasic, multimodal and multidisciplinary treatment of appropriate intensity and duration is associated with superior outcomes. The key to successful treatment is continuous supportive care and accountability, including continuous monitoring.