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• W1548488371 abstract "In a randomized controlled trial, Holland et al. 1 compared 3 months of daily supervised consumption of opioid maintenance treatment (OMT) with 1 month or less of daily supervised OMT, then daily unsupervised consumption. This study was carefully executed and may be helpful for clinical work. For the first outcome, retention in treatment at 12 weeks, there was no significant difference between the two groups. Secondly, it was found that illicit opioid use and criminal activity was higher in the supervised group. Opioid maintenance treatment is a well-known and established drug addiction treatment 2. Retention in treatment is necessary for the success of the therapy, and the reduction of illicit opioid use and criminal activity is preferable. Supervised consumption of OMT is practised in many drug centres as a standard, but it is costly, and authors ask the very important question: are there any benefits of supervised consumption, especially for retention in treatment or illicit opioid use and criminal activity? As a first result, they tell us that treatment retention in the supervised group is as good as in the unsupervised group. In the literature, retention rates are lower in more supervised methadone treatment groups 3, but only few data are available in this field. What do these data tell us? Should we prefer supervised consumption, because these data tell us that patients remain in treatment even though they are not confident, and are receiving supervision; or does the message from the data show that patients do not need supervised consumption because they remain in treatment without supervision, and are even less criminal? Some determining factors should be discussed. For this kind of research, there is no possibility of a double-blind comparative trial. The results shown may also describe what patients and physicians wish as best treatment; there are clear arguments preferring opioid maintenance treatment without supervision. Supervised opioid consumption is known to contribute to stigma for clients, and the reduction of stigma may improve the treatment outcome and increase treatment motivation 4. Results from the unsupervised patient group may be an effect of trusting patient–physician relationships, which is known to improve treatment outcome 5. However, there are also some arguments to differentiate between treatment options. Several other side effects may influence the result of this investigation, or may act as predictors of which supervision dose is needed. In Holland et al.'s Table 1, elements such as current psychiatric diagnosis, having a drug user partner, number ever injected, accommodation, current physical diagnosis and number ever injected are identified as a priori confounders. These data may, perhaps, influence the results or act as predictors for the necessity of supervision. Certainly, patients with comorbid anxiety disorders, active benzodiazepine use (contrary to clinic policy) or active alcohol abuse were significantly more likely to relapse 6. It is probable that comorbid psychiatric and physical disorders and use of alcohol and other drugs may act as predictors of whether or not supervision is necessary or what type of supervision is required. One important question in this context regards why we use supervised consumption in opioid treatment. What concerns do we have with an unsupervised patient? What are unsupervised patients doing with their substitute? Do they endanger uninvolved people? Do they endanger themselves by intravenous consumption? Perhaps how we handle substitutes is a political discussion. We all know that any kind of threshold drug misuse intervention is known to save many lives. It is not easy to come to a decision as to how much trust or how much control is necessary in opioid substitution. In the literature, findings suggest that flexibly timed discontinuation of supervision may have positive benefits 7. Ultimately, every opioid-substituted person probably needs a different dose of supervision, and different methods of supervised consumption are possible in everyday clinical work. Science should help in defining the criteria for the manner of supervision. None." @default.
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• W1548488371 date "2014-03-10" @default.
• W1548488371 modified "2023-10-18" @default.
• W1548488371 title "Commentary on Hollandet al. (2014): Opioid maintenance treatment-how much supervision is helpful?" @default.
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• W1548488371 doi "https://doi.org/10.1111/add.12488" @default.
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