Authors: Wright, Nat MJ¹; Sheard, Laura²; Adams, Clive E³; Rushforth, Bruno J⁴; Harrison, Wendy⁵; Bound, Nicole⁶; Hart, Roger⁶; Tompkins, Charlotte NE¹

Source: British Journal of General Practice, Volume 61, Number 593, December 2011 , pp. e772-e780(9)

Publisher: Royal College of General Practitioners

Abstract:

Background:

Many opiate users require prescribed medication to help them achieve abstinence, commonly taking the form of a detoxification regime. In UK prisons, drug users are nearly universally treated for their opiate use by primary care clinicians, and once released access GP services where 40% of practices now treat drug users. There is a paucity of evidence evaluating methadone and buprenorphine (the two most commonly prescribed agents in the UK) for opiate detoxification.

Aim:

To evaluate whether buprenorphine or methadone help to achieve drug abstinence at completion of a reducing regimen for heroin users presenting to UK prison health care for detoxification.

Design:

Open-label, pragmatic, randomised controlled trial in three prison primary healthcare departments in the north of England.

Method:

Prisoners (n = 306) using illicit opiates were recruited and given daily sublingual buprenorphine or oral methadone, in the context of routine care, over a standard reduced regimen of not more than 20 days. The primary outcome measure was abstinence from illicit opiates at 8 days post detoxification, as indicated by urine test (self-report/clinical notes where urine sample was not feasible). Secondary outcomes were also recorded.

Results:

Abstinence was ascertained for 73.7% at 8 days post detoxification (urine sample = 52.6%, self report = 15.2%, clinical notes = 5.9%). There was no statistically significant difference in the odds of achieving abstinence between methadone and buprenorphine (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 0.81 to 3.51; P = 0.163). Abstinence was associated solely with whether or not the participant was still in prison at that time (15.22 times the odds; 95% CI = 4.19 to 55.28). The strongest association for lasting abstinence was abstinence at an earlier time point.

Conclusion:

There is equal clinical effectiveness between methadone and buprenorphine in achieving abstinence from opiates at 8 days post detoxification within prison.

Keywords: opiate substitution treatment; prison; randomised controlled trial

Document Type: Research article

DOI: http://dx.doi.org/10.3399/bjgp11X613106

Affiliations: 1: NHS Leeds, based at HMP Leeds, Armley, Leeds, UK 2: Health Sciences, University of York, York (formerly NHS Leeds), UK 3: Faculty of Medicine and Health Sciences, University of Nottingham, UK 4: Academic Unit of Primary Care, Leeds Institute for Health Sciences, University of Leeds, UK 5: Division of Biostatistics, Centre for Epidemiology and Biostatistics; School of Medicine and Leeds Institute of Health Sciences and School of Healthcare, University of Leeds, UK 6: Armley, Leeds, UK

Publication date: 2011-12-01

More about this publication?

• The British Journal of General Practice is an international journal publishing articles of interest to family practitioners and primary care researchers worldwide. The journal's 2010 Impact Factor is 2.07, making it the world's second most highly cited journal of general practice and primary health care.
  
  Recent issues: members of the Royal College of General Practitioners receive complementary access to the British Journal of General Practice. Access is via the members' login area using your RCGP membership details. All users can freely access articles published up to 1 year ago, and the BJGP archive is available via PubMed Central.
  
  Email alerts can be enabled by registering with ingentaconnect. For information, see Help for web users.
• Information for Authors
• Subscribe to this Title
• Membership Information
• BJGP Archive
• ingentaconnect is not responsible for the content or availability of external websites

Related content

• In this: publication
• By this: publisher
• In this Subject: Public Health
• By this author: Wright, Nat MJ ;  Sheard, Laura ;  Adams, Clive E ;  Rushforth, Bruno J ;  Harrison, Wendy ;  Bound, Nicole ;  Hart, Roger ;  Tompkins, Charlotte NE

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers