For opiate addiction, study finds drug-assisted treatment is more effective than detox

November 23, 2017 by Melissa Healy, Los Angeles Times
Credit: CC0 Public Domain

Say you're a publicly insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit.

New research suggests you can do it the way most -seeking addicts in the state do - by undergoing a medically supervised "detoxification" that's difficult, expensive and highly prone to failure.

Or you can try to quit the way that researchers now widely agree it should be done (but rarely is): by combining abstinence programs with long-acting opioid medications such as methadone and buprenorphine, which allow to slowly wean themselves off their dangerous habit.

Neither method is easy, nor by any means failure-proof. But for each patient funneled into the second form of treatment, known as opioid agonist treatment, instead of the first, a study published Monday shows that taxpayers could reap substantial savings - $78,257 a person. And the patients themselves stand to gain longer and better lives.

Deep into a crisis of opioid addiction that claims 91 lives a day and holds close to 2.6 million Americans in its grip, the United States continues to suffer a yawning gap between what it knows about treatment and how the opiate-addicted are actually treated.

Close to 80 percent of those with an opioid-use disorder weren't getting any treatment at all in 2015. Of the small sliver of those who did get some treatment, fewer than half in California got the kind of open-ended opioid agonist treatment that addiction researchers widely agree is most likely to lead to abstinence.

In fact, California, the state with the nation's largest population of people with opiate addiction, still has regulations on the books that favor detox over opioid agonist treatment. For patients who are publicly insured, the state requires proof that a patient has tried detoxing two times or more and subsequently relapsed before it will pay for treatment with methadone or buprenorphine.

California's Society of Addiction Medicine has said that medically managed withdrawal by itself should not be considered treatment of opioid use disorder. And exemptions to the state's requirement are thought to be widely granted. Still, the language remains.

Published Monday in the Annals of Internal Medicine, the new study underscores that public policies that limit access to treatments such as methadone or buprenorphine don't just shortchange patients who need help quitting; they're costly to taxpayers footing the bill for their treatment as well.

If just one year's worth of treatment-seeking opiate addicts were to get opioid agonist therapy instead of detox, the societal savings over the patients' lifetimes would amount to $3.869 billion, the new study estimates.

Those patients would be in treatment longer, and the immediate cost of their treatment would increase, the new research finds. But over time, their increased likelihood of getting and staying clean would translate into lower downstream health care costs, a decreased likelihood of HIV infection (along with the costs of treating it), and less costly involvement with the criminal justice system.

"We believe our findings really do represent the reality in California," said the study's senior author, Bohdan Nosyk, a health economist with British Columbia's Center of Excellence in HIV/AIDs. "The findings were really robust and, as new people come in, the savings will accumulate. So the numbers are conservative."

Nosyk's co-authors included addiction and epidemiological experts from the University of California, Los Angeles' Integrated Substance Abuse Programs and the Veterans Affairs Greater Los Angeles Healthcare System of Los Angeles.

In an editorial published alongside the study Monday, Drs. Jeanette M. Tetrault and David A. Fiellin said the new research strongly suggests that lawmakers should be using their policy clout to promote outpatient clinics that treat opiate addicts in their communities rather than costly inpatient units where patients go to detox.

"Threats to health care funding may have lasting consequences, especially if lawmakers do not heed the most science-based and policy-applicable data as decisions are being made," wrote Tetrault and Fiellin, both Yale University internists with interests in .

Explore further: Immediate access to opioid agonists found cost-effective

Related Stories

Immediate access to opioid agonists found cost-effective

November 22, 2017
(HealthDay)—Immediate access to opioid agonist treatment (OAT) for patients presenting with opioid use disorder may provide greater health benefits at less cost than observed standard of care, according to a study published ...

Medicaid coverage for methadone improves treatment for opioid use disorder in pregnancy

November 14, 2017
Pregnant women with opioid use disorder (OUD) are more likely to receive evidence-based treatment with an "opioid agonist"—usually methadone—in states where those medications are covered by Medicaid, reports a study in ...

Starting opioid addiction treatment in the ED is cost-effective

August 16, 2017
The most cost-effective treatment for people with untreated opioid addiction who visit the emergency department (ED) is buprenorphine, a medication to reduce drug cravings and withdrawal, say Yale researchers. Their study ...

ACOG: Opioid agonist Rx first choice in affected pregnancies

July 28, 2017
(HealthDay)—While opioid agonist pharmacotherapy continues to be the recommended therapy for pregnant women with an opioid use disorder, medically supervised withdrawal can be considered under the care of a physician experienced ...

Study examines opioid agonist therapy use in Medicare patients

July 20, 2016
Few Medicare enrollees appear to be receiving buprenorphine-naloxone, the only opioid agonist therapy for opioid addiction available through Medicare Part D prescription drug coverage, according to a study published online ...

New care model closes significant gap in addiction treatment

November 8, 2017
A new program at Boston Medical Center's Grayken Center for Addiction is showing that connecting patients to addiction treatment when they are hospitalized for other conditions can be a powerful tool in closing a gap in addiction ...

Recommended for you

Smoking cessation: A genetic mutation involved in relapse

October 4, 2018
Why is it so difficult to stop smoking? Why do some people relapse months after giving up? Scientists from the Institut Pasteur and the CNRS, in collaboration with Sorbonne University and Inserm, have demonstrated that a ...

Study shows cigarillo flavors enhanced by high-intensity sweeteners

October 3, 2018
In a new study, Yale researchers found that popular brands of cigarillos are flavored with high-intensity sweeteners, potentially reducing the aversive sensation of smoking and making cigarillos more palatable. The concern ...

Leading addiction experts call for more neuroscience research on long-term recovery

September 24, 2018
September is addiction recovery month, and, in the midst of the current opioid epidemic, it's an apt moment for addiction research experts to map the future path forward for a long-term recovery strategy for substance abuse. ...

The connection between alcoholism and depression

September 21, 2018
Alcoholism and depression often go hand-in-hand.

Quitting junk food produces similar withdrawal-type symptoms as drug addiction

September 20, 2018
If you plan to try and quit junk food, expect to suffer similar withdrawal-type symptoms—at least during the initial week—like addicts experience when they attempt to quit using drugs.

Low academic achievement can lead to drug abuse decades later, research finds

September 13, 2018
A Virginia Commonwealth University researcher has found that poor academic achievement can lead to substance abuse. Data collected from Swedish participants over a period of 15 to 20 years indicate a strong correlation.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

tjcoop3
not rated yet Nov 27, 2017
Cannabiodals seem a possible option if attitudes of addict clinics could be changed. Also much safer than drugs mentioned in the article.

https://www.proje...can-help

https://www.ncbi....4444130/

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.