title: The newer Opioid Agonist Treatment with lower substitutive opiate doses is associated with better toxicology outcome than the older Harm Reduction Treatment.
abstract: BACKGROUND
  Charge-free heroin use disorder treatment in Italy follows two main approaches, i.e., harm reduction treatment (HRT) strategy in community low-threshold facilities for drug addiction and opioid agonist treatment (OAT) in high-threshold facilities for opioid addiction, focusing on pharmacological maintenance according to the Dole and Nyswander strategy. We aimed to compare the impact of HRT and OAT on patient outcome, as assessed through negativity for drugs on about 1-year urinalyses.
  
  
  METHODS
  We examined retrospectively the urinalyses of HRT and OAT patients for which at least four randomly sampled urinalyses per month were available for about 1 year, during which patients were undergoing methadone or buprenorphine maintenance; urinalyses focused on heroin, cocaine, cannabinoids, and their metabolites.
  
  
  RESULTS
  Included were 189 HRT and 58 OAT patients. The latter were observed for a significantly longer period. There was a higher proportion of heroin- and cocaine-clean urinalyses in OAT patients, with cocaine-clean urinalyses discriminating best between the two groups. OAT patients were older, with longer dependence duration, more severe addiction history, and received lower methadone doses. Buprenorphine maintenance was more often associated with heroin-clean urinalyses. The higher the methadone doses, the lower were the percentage of heroin-clean urinalyses in HRT patients (negative correlation).
  
  
  CONCLUSIONS
  The OAT approach was related to higher recovery and polyabuse abstinence rates compared to the HRT approach, despite greater severity of substance use, psychiatric and physical comorbidities. Our results are consistent with the possibility to use lower maintenance opiate doses (after induction and stabilization in methadone treatment according to Dole and Nyswander methodology) in treating heroin addiction. This seemed to be impossible adopting the currently accepted HRT model.
authors.affiliation: Department of Psychiatry of Bolzano, Bolzano, Italy.
authors.forename: Jacopo V
authors.initials: JV
authors.lastname: Bizzarri
authors.affiliation: Department of Psychiatry of Bolzano, Bolzano, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Casetti
authors.affiliation: Department of Psychiatry of Bolzano, Bolzano, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Sanna
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56100 Pisa, Italy ; AU-CNS-Association for the Application of Neuroscientific Knowledge to Social Aims, Pietrasanta, Italy.
authors.forename: Angelo Giovanni Icro
authors.initials: AG
authors.lastname: Maremmani
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56100 Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Rovai
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56100 Pisa, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bacciardi
authors.affiliation: Department of Psychiatry of Bolzano, Bolzano, Italy.
authors.forename: Daria
authors.initials: D
authors.lastname: Piacentino
authors.affiliation: Department of Psychiatry of Bolzano, Bolzano, Italy.
authors.forename: Andreas
authors.initials: A
authors.lastname: Conca
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56100 Pisa, Italy ; AU-CNS-Association for the Application of Neuroscientific Knowledge to Social Aims, Pietrasanta, Italy ; G De Lisio Institute of Behavioural Sciences, Pisa, Italy.
authors.forename: Icro
authors.initials: I
authors.lastname: Maremmani
keywords: Agonist opioid treatment; Cannabinoids; Cocaine; Harm reduction treatment; Heroin; Polysubstance use; Urinalyses