Scientific Evidence
Module 2Module 2
The evidence of effectivenessThe evidence of effectiveness
•Most research is on methadone, much lesson other medications
•Has proven effective for the individual
•Has proven effective for society at large
Large body of evidenceLarge body of evidence
•JC Ball and A Ross (1991). The effectiveness ofMethadone Maintenance Treatment. New York:Springer Verlag
•M Farrell, J Ward, R Mattick, W Hall, G Stimson, Ddes Jarlais, M Gossop, J Strang (1994). MethadoneMaintenance Treatment in Opiate Dependence: aReview. BMJ 309: 997-1001.
•A Preston (1996). The Methadone Briefing
•J Ward, R Mattick, W Hall (1998). MethadoneMaintenance Treatment and other OpioidReplacement Therapies. Harwood AcademicPublishers, Amsterdam, The Netherlands
•H Joseph, S Stancliff, J Langrod (2000). MethadoneMaintenance Treatment (MMT): A review of Historicaland Clinical Issues. In: the Mount Sinai Journal ofMedicine Vol.67 Nos 5&6
Effectiveness for the individualEffectiveness for the individual
•Stay alive
•Achieve abstinence or a stabilised pattern ofuse
•Stabilise social live
•Improve physical health
•Reduce criminal activity
Effectiveness for societyEffectiveness for society
•Improve public health
•Reduce emergencies, hospitalisations
•Reduce spread of HIV and other infectiousdiseases
•Reduce social welfare costs
•Reduce costs in criminal justice system
What are the cost–benefits of ST?What are the cost–benefits of ST?
•DASA, NYC, 1991 estimated the annual costsof opiate addicts:
–Untreated on the street€40.000
–In prison€40.000
–In residential TC€10.000
–In methadone maintenance€ 2.500
Costs-benefits 2Costs-benefits 2
•DASA calculated the effects of ST in 2001 inreductions of:
•64% in property crimes
•54% overall arrests
•63% drug offence arrests
•65% emergency room visits
•59% medical hospitalisations
•55% psychiatric hospitalisations
Cost – benefits 3Cost – benefits 3
•Collaboration between departments isimportant because spending in one can yieldsavings in another:
–NTORS (UK,1998): Every €1,5 spent ontreatment (health) return €4,5savings in costs of crime (criminal justice)
Chronic versus acute careChronic versus acute care
•Opiate dependence often chronic condition
•Treatment for many patients needs to bechronic too
•Effectiveness higher with long term treatmentat adequate dosage and provided properly
Source: McLellan, 2002. Treatment Research Institute, USA
Outcome in hypertension
Source: McLellan, 2002. Treatment Research Institute, USA
Outcome in addiction
Comprehensive treatmentComprehensive treatment
•Assessment of co-morbidity
•Assessment of psycho-social problems
•Treatment of these issues
LimitationsLimitations
•Being stable on agonist medication cancause dependency to treatment and to thedoctor
•Substitution treatment is often not consideredas valid as recovery to abstinence
•It is corrective rather than curative
•However, these limitations do not outweighthe benefits
Limitations of prescribingLimitations of prescribing
•There are some side effects (e.g. increasedtranspiration, constipation, and disturbances ofsleep, sex drive and concentration) which affect20% of patients
•They are however without medical consequences
•Methadone helps around 70% of patients
•Despite the scientific basis, there is noconsensus in practice, leading to contradictory orexcessively rigid practice
•Existing oral formulations are not well designedand unpopular
ConclusionsConclusions
•As drug addiction is a condition not easy toovercome, it is important to reduce the harmboth to society at large and to the individualpatient
•Scientific evidence has shown that goodquality substitution treatment available foranybody who needs it can save many othercosts in health care, social welfare and thecriminal justice system.