Innovations in agonist maintenance treatment of opioid-dependent patients.
OBJECTIVE
To provide an overview of published studies on agonist maintenance treatment options for opioid-dependent patients.


RESULTS
The recent publication of controlled trials confirms earlier clinical evidence of the efficacy of diamorphine (heroin) in the treatment of opioid dependence. Findings show not only efficacy with respect to improvement of health, reduction of illicit drug use, reduction of criminality and stabilization of social conditions, but also cost effectiveness in the treatment of chronic treatment-resistant heroin addicts.


CONCLUSIONS
Agonist maintenance treatment has become the first-line treatment for chronic opioid dependence. High-quality studies demonstrate the effectiveness of a growing number of different agonist maintenance treatments for opioid dependence such as methadone and buprenorphine. In addition, there is new evidence for the effectiveness of other agonists, mainly slow-release morphine, intravenous and inhalable diamorphine and possibly oral diamorphine. Maintenance treatment with intravenous or inhalable diamorphine should be implemented into the healthcare system to treat a group of severely dependent treatment-resistant patients. Furthermore, the opioid-dependent patients not under treatment need to be engaged in maintenance treatments through other harm reduction measures. Agonist maintenance treatment is very effective in stabilizing the health condition and social situation, while also reducing harm, thereby increasing life expectancy and quality of life.
Haasen
Christian
C
Department of Psychiatry, University Medical Center Eppendorf, Center for Interdisciplinary Addiction Research, Hamburg, Germany. haasen@uke.uni-hamburg.de
van den Brink
Wim
W
D002047:Buprenorphine / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic / Q000379:methods; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D003932:Heroin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009294:Narcotics / Q000191:economics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D011788:Quality of Life
D003692:Delayed-Action Preparations; D009294:Narcotics; D002047:Buprenorphine; D003932:Heroin; D009020:Morphine; D008691:Methadone