Global opioid agonist treatment: a review of clinical practices by country

Harry Jin, Brandon D. L Marshall, Louisa Degenhardt, John Strang, Matt Hickman, David A Fiellin, Robert Ali, Julie Bruneau, Sarah Larney

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Aims
We assessed how opioid agonist treatment (OAT) for opioid use disorder (OUD), specifically methadone andbuprenorphine, including buprenorphine-naloxone, is delivered in routine clinical practice, with a focus on factors thataffect access to and delivery of these services. The aims of this review were to summarize eligibility criteria for entry toOAT, doses in routine clinical practice, access to and eligibility for unsupervised dosing and urine drug screening practicesin OAT programs globally.

Methods
We completed searches of PubMed, Embase, and grey literature databases forcross-sectional or observational cohort studies of OAT using either methadone or buprenorphine. Dose data extracted fromeligible studies were compared with guidelines provided by WHO.

Results
We found 140 reports from 41 countries thatcontained data for at least one of the relevant indicators. A diagnosis of opioid dependence or opioid use disorder was themost common eligibility requirement for OAT (13 or 17 countries). Reported mean or median doses for methadoneranged from 16–131 mg whereas range for buprenorphine was 2.5–19 mg. Access to unsupervised dosing under someconditions was reported in 18 of 27 countries. Frequency of regular urine drug screenings (UDS) ranged from several timesa week to eight times per year (methadone) or as clinically indicated.

Conclusions
Opioid agonist treatment practices,including doses prescribed, vary greatly both within and across countries. Of particular concern is the persistence of lowerdose prescribing practices, in which patients may be prescribed doses below those proven to yield significant clinicalbenefits
Original languageEnglish
Number of pages12
JournalAddiction
Early online date19 May 2020
DOIs
Publication statusE-pub ahead of print - 19 May 2020

Keywords

  • Buprenorphine
  • clinical practice
  • dosing, methadone
  • opioid agonist treatment
  • opioid use disorder

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