Office-based maintenance treatment of opioid dependence: how does it compare with traditional approaches?
The increasing global public health burden of heroin dependence and prescription opioid dependence warrants further expansion of treatment models. The most effective intervention for opioid dependence remains maintenance with methadone, a full mu-opioid receptor agonist, or buprenorphine, a partial mu-opioid receptor agonist.A growing body of evidence supports the use of opioid receptor agonist maintenance in office-based settings. Office-based opioid treatment (OBOT) can expand treatment access in a less stigmatized environment, which enables integrated care of co-morbid conditions. The current review primarily examines OBOT in the US, although a comparison with the British and French models is provided, given that the public health impact and implementation of OBOT will likely vary between countries because of policy and logistical differences. The comparative effectiveness of maintenance treatment in office-based and traditional programme-based models of care requires further study. Clinical and practical considerations when providing treatment for opioid dependence in traditional versus office-based settings include patient selection and monitoring, health economics, management of co-morbid conditions, and access to ancillary psychosocial treatment. OBOT is not a replacement for more structured, traditional models of care, but provides an additional opportunity to help address the tremendous public health impact of opioid dependence.
Gunderson
Erik W
EW
Columbia University College of Physicians and Surgeons, New York, New York, USA. eg2009@columbia.edu
Fiellin
David A
DA
D000701:Analgesics, Opioid / Q000008:administration & dosage; D002047:Buprenorphine / Q000008:administration & dosage; D006801:Humans; D008691:Methadone / Q000008:administration & dosage; D009819:Office Visits; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000628:therapy*; D011320:Primary Health Care
D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone