Mind the gap - between research and clinical outcomes
Presenter: James Bell
Author names: 1 Bell, JR
Author affiliations: 1 University of New South Wales
Introduction: Opioid agonist treatment (OAT) is the most effective treatment of Opioid Use Disorder (OUD). The four modalities are supervised methadone, unsupervised buprenorphine, buprenorphine depot, and supervised injectable treatment (with heroin or hydromorphone). Evidence exists for the effectiveness of all modalities, but variations in treatment practice and variable effectiveness of medications makes it difficult to say with confidence which programs should be supported, and how to allocate individuals to the optimal treatment.
Aims: To review the basis of OAT, differences between medications, and to identify questions which are difficult to answer through clinical trials (and which therefore will never come to have the status of high level evidence), but which are important in clinical practice and policy.
Methods: Literature review
Results: The four modalities of OAT are supervised methadone, unsupervised buprenorphine, buprenorphine depot, and supervised injectable opioid treatment (SIOT). These are distinct modalities. SIOT is most reinforcing, and holds people in structured treatment more than supervised methadone, which holds people better than unsupervised buprenorphine. The role of depot buprenorphine remains to be determined, because the importance of structure in treatment is uncertain.
Implications: Clinical trials are unlikely to answer the unresolved questions about optimal public health approach to OAT; ongoing observational studies will be required.