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Improving opioid agonist care continuation, meta-analysis

Improving opioid agonist care continuation remains to be a challenge for many community based addiction treatment organizations. Research into effective strategies has used both randomized and non-randomized designs. Is there any difference in treatment dropout between these different study types?

What is the study about?

Retention in treatment has been traditionally regarded as a key outcome measure of addiction treatment. Other, perhaps more fitting term for retention is care continuation. Methadone and buprenorphine are two of the most commonly studied opioid agonists. Slow release oral morphine is one of the recent medications repurposed for the treatment of opioid use disorders.

The terminology around opioid agonist care is evolving. We have also learned much and are still learning from the response to HIV/AIDS epidemic. Cochrane collaboration plays a big role in this learning by storing a large database of systematic reviews and clinical trials.

 

How was the study done?

We looked at all scientific literature published until April 2018. We wanted to know if randomization has any impact on care continuation. We first compared two opioid agonists head to head, then we compared the findings reported in controlled studies which used randomization to those studies that did not use it.

What did the study find?

We found very little treatment in how long people stayed in care between randomized studies and non-randomized studies. There was also no difference in care continuation between different medications. 

Why is care continuation important?

Many people who overdose on synthetic opioids have untreated opioid addiction. Current treatment medications have unique side effects and not everyone is able or willing to take them for a long time. Finding ways to speed up the evaluation of novel medications, and non-medical interventions, can have a dramatic effect on the course of opioid overdose epidemic.

Study: Klimas, J., et al. (2021). “Retention in opioid agonist treatment: a rapid review and meta-analysis comparing observational studies and randomized controlled trials.” Systematic Reviews 10(1): 216. Link: 
https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01764-9

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