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 Post subject: Injectable opioid tx more effective than oral methadone...
PostPosted: Wed Oct 02, 2013 5:56 am 
Injectable opioid treatment for chronic heroin addiction more cost-effective than oral methadone

Supervised injectable opiate treatments are more cost-effective than optimised oral methadone treatment for chronic heroin addiction, according to new research from King’s College London.

Although injectable treatments are more expensive to provide, they are associated with reduced levels of criminal activity and the researchers estimate that the overall savings of providing supervised injectable treatments for chronic heroin addiction in England may be between £29 and £59 million per year.

The study, published in the British Journal of Psychiatry, reports the results of an economic evaluation of the RIOTT Randomised Injectable Opiate Treatment Trial led by the National Addictions Centre at King’s.

Approximately 5-10% of people addicted to heroin fail to respond to conventional treatments (usually oral methadone) and continue to use heroin regularly. The researchers examined the relative costs and outcomes of three different treatments for 127 people who fell within this group. They were either given optimised oral methadone, supervised injectable methadone or supervised injectable heroin.

Professor Sarah Byford, lead author of the study from the Centre for the Economics of Mental and Physical Health (CEMPH) at the Institute of Psychiatry at King’s says: “Given the increasing pressures on health services, injectable opiate treatments may seem like an unaffordable luxury, but when we look at the cost-effectiveness, injectable treatments result in substantial cost savings to the wider community. Clinics will need to be supported to provide the more expensive injectable treatments, since the cost savings generated by injectable treatments are not located in the NHS but in the criminal justice sector, through reductions in criminal activity.

“The RIOTT trial established that injectable heroin was more effective in treating chronic heroin addiction, but this study reveals that there is also an economic argument to make – that both injectable treatments are more cost-effective than oral methadone treatment.”

The RIOTT trial reported that 72% of participants in the injectable heroin group responded well to treatment compared to those treated with injectable methadone (39%) or oral methadone (27%). Quality of life was also higher in the injectable heroin group, although the differences between the three groups were small.

Whilst treatment costs for injectable opiates were estimated to be between £4,000 (injectable methadone) and £10,000 (injectable heroin) more per person per year than oral methadone, individuals receiving an injectable treatment committed far fewer crimes than those receiving oral methadone. Once the cost to the criminal justice service and to victims was taken into account, the overall costs were highest in the oral methadone group and lowest in the injectable heroin group.

The authors estimate that injectable opiate treatments could generate additional savings to the criminal justice sector of £14,000 per person per year - a net saving of around £6,000 per person on average, compared to oral methadone treatment. With an estimated 93,400 people in England addicted to injectable heroin in 2010-11, of whom 5-10% will be unresponsive to conventional treatment, the total cost savings of providing injectable opiate treatment for this chronic group in England could be between £29 and £59 million per year.

Nick Barton, Chief Executive of Action on Addiction the Charity that commissioned the RIOTT Trial says: “This is another interesting finding from the RIOTT study in that it makes an economic case for providing more expensive injectable opiates as a form of treatment as these are more cost-effective in the long-run than oral methadone in reducing crime.

While recognising their potential economic benefits to society, as a charity committed to finding ever more effective ways to disarm addiction in individuals, families and communities, our overriding interest is in how such treatments benefit our beneficiaries. A reduction in criminal activity is a positive step and one that we hope will enable clients to make further progress to free themselves from addiction and achieve long-term well-being.”

This study was funded by the Community Fund (Big Lottery Research section), through Action on Addiction.

Paper reference: Byford, S. et al. ‘Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction’ British Journal of Psychiatry doi: 10.1192/bjp.bp.112.111583

For further information, please contact: Seil Collins, Press Officer, King’s College London, Institute of Psychiatry. Tel: (+44) 207 848 5377

SOURCE: http://www.healthcanal.com/substance-abuse/43501-injectable-opioid-treatment-for-chronic-heroin-addiction-more-cost-effective-than-oral-methadone.html


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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Wed Oct 02, 2013 1:23 pm 
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Location: Santa Cruz
If they would give their patients an adequate dose I bet that study would be defunct! The UK trips on numbers and not Facts!

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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Wed Oct 02, 2013 3:15 pm 
I was emailing with Walter and Bob Newman about this study earlier and Walter made a good point: We have to look at the way the heroin program was administered. In the British study patient received NO takehome heroin and had to be at the dispensing site every 6 hours except when the site was closed at night when the patient got (surprise surprise) methadone to carry them through the night. Also MANY transferred to a traditional methadone program... Does that really surprise us?

And Bob said we need to remember that we are talking about folks who on average did poorly in MMT at least 3 times in the past and who volunteered to participate for the obvious reasons that they wanted injectable heroin. I really liked this quote from Dr. Bob: "And I do suspect that in Canada as well as in the U.S. it ain't no piece of cake being subjected to the high-handed, patronizing, distrustful (but conceivably well-intentioned, to be very generous) therapeutic tyranny of the "counselors," nurses, physicians, etc."

Walter said that some of the studies make him "want to scream," and I concur. It's quite SIMPLE how you improve treatment (perhaps we could get NIDA to send some money to Walter to do a REAL study): If you PAY ATTENTION TO and RESPECT patients they do better! Period. 8-)


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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Fri Oct 04, 2013 7:33 am 
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@Rokki is completely right that if clinics would optimally dose patients, there would not be half as many problems with poly addiction as there are now.

The root of the problem is that as the government pays for our clinic system, they want to have a say in how it's run, and as this govt. is quite right wing, they, and the majority of people that would vote for them, are completely against long term MMT, even though it has been proven that for every £1 spent on treatment, £4 is saved in other ways.

Under the last govt. which was more left of centre, things had started to get much better, with people getting the doses they needed, but now we have this govt. they are obsessed with getting people off methadone by hook or by crook.

It is really good to see some positive evidence regarding the injectable opioid trials, especially in financial terms, as with the austerity measures the govt. have invoked, the general public seem more concerned about saving money than helping save peoples' lives.

There are some older people (50-60+) that were part of the old "British System" and so were allowed to remain on injectable heroin, or methadone as they had been on it for so long, but the only way that people can get a brand new script is to either apply to be part of the RIOTT trials (which are only in a few areas and are difficult to get on), or try to find a consultant that will prescribe for you (next to impossible).

I know some people on injectable scripts, and they are stable, have jobs etc, so for some people it really does seem the answer.

Personally I don't think I would swap to it though given the chance, as the injecting has to be supervised which would be a PITA for people that had jobs, and I like the long half life of methadone, it's much easier to plan things around, iykwim?

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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Sat Oct 05, 2013 7:06 am 
Howdy ho, @sapphire! Good to run into you here, and I'm so thankful you shed some light & perspective on this thread since you are a long-term MMT patient in the UK.

The thing that truly caught my attention - that I was more 'curious' about than anything else - was the injectable methadone. I didn't even really raise an eyebrow about the heroin because unless and until a time released or otherwise long-acting formulation is developed and manufactured I just can't imagine that having to medicate multiple times a day would be anywhere NEAR as effective OR as desirable as methadone & her long half life. And I recall you, @sapphire, and perhaps a peer or two from the National Users' Network discussion/email list had mentioned injectable methadone in the past (why or how it came up I can't remember) and that the few folks you've known that were on that particular 'formulation' or modality are doing - or did - very well. But I'm curious: How exactly does the injectable methadone work? Obviously the half life isn't suddenly shorter or less just because it is injected vs. taken orally, so is the injectable methadone only administered once a day? Is it just the injectable heroin patients that have to administer the medicine multiple times a day? And how does the injectable methadone work (if you know)? Seems like I remember you - or one of my NUN peers - mention that the methadone injections are 'ampoules' (sp?) or something... Is that where the injection goes under the skin and a little "collection" of methadone then slowly releases throughout the day? Or is it an intravenous injection like (I assume) the heroin is?

I know this doesn't really have anything to do with the study; It's just more curiosity. I just can't really get it in my mind how it works and how it is similar vs. different from the heroin program.

It's truly a shame, really, that your current gov't is ignoring science & proven effective evidence-based treatments and research. ::sigh:: You would THINK that a more "conservative" government - seeing that they (in theory) are more about "fiscal responsibility" and "cost effectiveness" and "cutting down on wasteful and/or unnecessary government spending," etc. - would be the ones that INSISTED on adequate/optimal doses of medicine because that is one of the most effective means of reducing the incidence of HIV/HCV infection (thereby reducing healthcare costs), reducing drug-related crime (thereby saving money through the prevention of vandalism and theft & through reduced incarceration costs), increased productivity and societal contribution, reducing the incidence of overdose and/or death... We could go on and on... So it would seem to me that the "conservative" thing to do would be to implement policies and practices that will lead to all those things! That is how you "save money" and can be "more fiscally responsible," etc. (I am no conservative, I am just saying... You would think from a statistical and fiscal point of view conservatives would be for optimal doses & most effective treatment practices.... Us progressives/liberals tend to be more true believers in harm reduction & doing what's best for the afflicted INDIVIDUAL - and that is clearly optimal dosing... But I would think that both conservatives and progressives/liberals would have the same conclusion even though we arrive at that conclusion through different thought processes based on different values: Optimal/adequate dose levels are PARAMOUNT!) ..... Not to mention we have STUDY after STUDY after STUDY that shows that higher doses typically work better & lead to increased treatment effectiveness and more desirable treatment outcomes!! :? :roll: :? :roll: :? Oh well.... Keep up the good fight @sapphire. What is the advocacy situation over there now? I know you are involved with The Alliance, right? And I know National Users' Network has been less active since Alan Joyce's passing, though they seem to be getting reorganized and active again just from my observations of discussions and events that are being discussed on the email list. Is there any organized campaign/effort to let the government - and the general public - know that what they are doing goes AGAINST what is PROVEN to be BEST for not only the opioid dependent individual in treatment but also SOCIETY AS A WHOLE? Or is such a campaign/organized effort even possible? Just curious.... I would think the methadone patients would be out the the streets raising all sorts of a stink if they are being denied proper, adequate medical treatment and are feeling like CRAP a good portion of the day!

(sorry to be long winded, just curious about a few things and then got on my soap box and passionate about others...)


Again @sapphire, good to see you back... Don't stay gone so long! You are a great source of information and have years of experience and knowledge that is invaluable to many MAT patients. Also I don't know that we have anyone else that has your level of knowledge, experience & education from the UK on the board... (not that ever posts or comments, anyway).


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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Sat Oct 05, 2013 9:11 am 
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Hi Zac

Yes we do have injectable methadone, and it is only a once a day dosing.

Like you say, it comes in ampoules of certain measurements (usually 50mg) and the patient would draw that into a syringe and inject. They are meant to IM injection, IV injection is discouraged.
I have advocated for people that have been thrown off injectable scripts because they were persistently IV'ing.

The injectable diamorphine (heroin) is the one that people have to inject 2 or 3 times a day, and I think most of them have to be supervised, if they're on the RIOTT trials. The older patients that have been on maintenance since before clinics existed can get an amount for the week and take that home to administer.

The injectable diamorphine, that I think they prefer if you IM it, but if you did IV it there are certain sites (groin, neck) that would be big no-no, and they do check injecting sites regularly to make sure people are OK.



Over the years I have known people do really well on injectable prescriptions, and for some people, they are what keeps them stable.

I can't imagine myself using them, as, only in my personal opinion, I think that needles would be too close to triggering my addiction, iyswim?

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Sapphire Matthews - MAR Patient Advocate
email:sapphirematthews@gmail.com

Please email me if you have any issues with the board, be that logging in, spammers, or anything else at all!!


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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Sun Oct 06, 2013 12:20 am 
Thanks for explaining all that for us @sapphire... When you say "IM" vs "IV" I am assuming that is referring to 'intra-muscular' as in a shot in the muscle...the rear-end, the thigh, arm, etc... versus 'intra-venous' which I'd say most everyone who has any reason to be on this board knows what that means! :lol:

So the recommended means of administering the injectable methadone is IM, which is basically just a good old fashioned 'shot,' right? I just wouldn't think that the injectable methadone would be worth IVing? The pharmacology of methadone is such that is there even a small "rush" when a user IV's methadone? I wouldn't think so, but that is something that - despite ALL the wild and crazy things I did and tried - I have absolutely no personal experience or perspective about. I could certainly better understand the allure of IVing the injectable heroin (and, like you, that would hit a bit too close to my addictive home & I might find it difficult to administer the heroin via IM because to the person with a deranged opiate-ligand system like me it almost seems "wrong" to do anything BUT IV injectable heroin! ::sigh::).

Thanks again for explaining... I wonder if all heroin - even the street dope many of us did before we were in treatment and our disease was in remission - could be IM'd... That's certainly not anything that ever crossed my mind on the streets, but the entire reason I became so overtaken with IV heroin use was precisely BECAUSE of the 'rush' IVing the substance facilitated (in the beginning, anyway, before that stage nearly all of us finally got to where there was no rush, no high, only desperate attempts to maintain the closest thing to normalcy we could achieve, afford or obtain on a day by day basis)... Clearly IMing heroin wouldn't create that ultimate euphoria, the 'rush,' though I could see it lasting longer and the withdrawals not coming on quite as quickly.

Interesting.


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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Mon Oct 07, 2013 6:55 am 
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Yes, IM is intra-muscular. They recommend into a thigh or some place like that and like you say, just like a regular shot you'd get at the doctor's.

I get what you mean about the rush and IV'ing it. People that do IV it claim that they do get a rush and that it takes effect earlier (which I guess is true because it's already in the bloodstream) but I cannot really see you'd get much of a rush from it.

When people are on an injectable script, the prescriber is supposed to check the injecting sites, and if people are persistently IV'ing, especially when they'd been told not to, the prescriber would consider removing the script and replacing it with oral.

Apparently it is quite corrosive when IV'ed, even though it's obviously not adulterated in any way, and that is the main reason they tell you to inject IM.

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Sapphire Matthews - MAR Patient Advocate
email:sapphirematthews@gmail.com

Please email me if you have any issues with the board, be that logging in, spammers, or anything else at all!!


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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Sat Apr 26, 2014 1:41 pm 
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Joined: Sun Jun 20, 2010 5:10 pm
Posts: 20
Im from London, I was also a patient, in patient, and out at King’s College London.. its been 18yrs since I have been to the King’s College hospital, so I find your link very interesting..

Not posted for years!! Wheres all my old buddies??

Rebecca


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 Post subject: Re: Injectable opioid tx more effective than oral methadone.
PostPosted: Sun Apr 27, 2014 3:00 pm 
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Joined: Sun Nov 25, 2012 2:49 pm
Posts: 272
Location: Santa Cruz
Unfortunately some have passed on...:( A lot just switched over at Facebook and ...sniff...sniff...forgot all about Us here collecting dust...;)

Peace Out


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