training manual Module 2 Scientific Evidence training manual

training manual Module 2 Scientific Evidence

training manual The evidence of effectiveness • Most research is on methadone, much less on other medications • Has proven effective for the individual • Has proven effective for society at large

training manual Large body of evidence • JC Ball and A Ross (1991). The effectiveness of Methadone Maintenance Treatment. New York: Springer Verlag • M Farrell, J Ward, R Mattick, W Hall, G Stimson, D des Jarlais, M Gossop, J Strang (1994). Methadone Maintenance Treatment in Opiate Dependence: a Review. BMJ 309: 997 -1001. • A Preston (1996). The Methadone Briefing • J Ward, R Mattick, W Hall (1998). Methadone Maintenance Treatment and other Opioid Replacement Therapies. Harwood Academic Publishers, Amsterdam, The Netherlands • H Joseph, S Stancliff, J Langrod (2000). Methadone Maintenance Treatment (MMT): A review of Historical and Clinical Issues. In: the Mount Sinai Journal of Medicine Vol. 67 Nos 5&6

training manual Effectiveness for the individual • Stay alive • Achieve abstinence or a stabilised pattern of use • Stabilise social live • Improve physical health • Reduce criminal activity

training manual Effectiveness for society • Improve public health • Reduce emergencies, hospitalisations • Reduce spread of HIV and other infectious diseases • Reduce social welfare costs • Reduce costs in criminal justice system

training manual What are the cost–benefits of ST? • DASA, NYC, 1991 estimated the annual costs of opiate addicts: – Untreated on the street € 40. 000 – In prison € 40. 000 – In residential TC € 10. 000 – In methadone maintenance € 2. 500

training manual Costs-benefits 2 • DASA calculated the effects of ST in 2001 in reductions of: • • • 64% in property crimes 54% overall arrests 63% drug offence arrests 65% emergency room visits 59% medical hospitalisations 55% psychiatric hospitalisations

training manual Cost – benefits 3 • Collaboration between departments is important because spending in one can yield savings in another: – NTORS (UK, 1998): Every € 1, 5 spent on treatment (health) return € 4, 5 savings in costs of crime (criminal justice)

training manual Chronic versus acute care • Opiate dependence often chronic condition • Treatment for many patients needs to be chronic too • Effectiveness higher with long term treatment at adequate dosage and provided properly

training manual Outcome in hypertension Source: Mc. Lellan, 2002. Treatment Research Institute, USA

training manual Outcome in addiction Source: Mc. Lellan, 2002. Treatment Research Institute, USA

training manual Comprehensive treatment • Assessment of co-morbidity • Assessment of psycho-social problems • Treatment of these issues

training manual Limitations • Being stable on agonist medication cause dependency to treatment and to the doctor • Substitution treatment is often not considered as valid as recovery to abstinence • It is corrective rather than curative • However, these limitations do not outweigh the benefits

training manual Limitations of prescribing • There are some side effects (e. g. increased transpiration, constipation, and disturbances of sleep, sex drive and concentration) which affect 20% of patients • They are however without medical consequences • Methadone helps around 70% of patients • Despite the scientific basis, there is no consensus in practice, leading to contradictory or excessively rigid practice • Existing oral formulations are not well designed and unpopular

training manual Conclusions • As drug addiction is a condition not easy to overcome, it is important to reduce the harm both to society at large and to the individual patient • Scientific evidence has shown that good quality substitution treatment available for anybody who needs it can save many other costs in health care, social welfare and the criminal justice system.