title: A call for evidence-based medical treatment of opioid dependence in the United States and Canada.
abstract: Despite decades of experience treating heroin or prescription opioid dependence with methadone or buprenorphine--two forms of opioid substitution therapy--gaps remain between current practices and evidence-based standards in both Canada and the United States. This is largely because of regulatory constraints and pervasive suboptimal clinical practices. Fewer than 10 percent of all people dependent on opioids in the United States are receiving substitution treatment, although the proportion may increase with expanded health insurance coverage as a result of the Affordable Care Act. In light of the accumulated evidence, we recommend eliminating restrictions on office-based methadone prescribing in the United States; reducing financial barriers to treatment, such as varying levels of copayment in Canada and the United States; reducing reliance on less effective and potentially unsafe opioid detoxification; and evaluating and creating mechanisms to integrate emerging treatments. Taking these steps can greatly reduce the harms of opioid dependence by maximizing the individual and public health benefits of treatment.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia. bnosyk@cfenet.ubc.ca
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.forename: M Douglas
authors.initials: MD
authors.lastname: Anglin
authors.forename: Suzanne
authors.initials: S
authors.lastname: Brissette
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: David C
authors.initials: DC
authors.lastname: Marsh
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
mesh_terms: D000701:Analgesics, Opioid / Q000191:economics; D002170:Canada; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000191:economics / Q000458:organization & administration* / Q000592:standards*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration / Q000592:standards; D006556:Heroin Dependence / Q000191:economics / Q000534:rehabilitation*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000458:organization & administration / Q000592:standards; D008691:Methadone / Q000191:economics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000191:economics / Q000592:standards*; D009293:Opioid-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D010824:Physicians' Offices / Q000191:economics; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Cost Of Health Care; Financing Health Care; Health Economics; Health Reform; Mental Health/Substance Abuse
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