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Rethinking retention in treatment of opioid dependence : the eye of the beholder


Vogel, Marc; Dürsteler, Kenneth M; Walter, Marc; Herdener, Marcus; Nordt, Carlos (2017). Rethinking retention in treatment of opioid dependence : the eye of the beholder. International Journal of Drug Policy, 39:109-113.

Abstract

Opioid dependence often is a chronic relapsing disorder. The evidence for medication-assisted treatment (MAT) being the treatment of first choice is unequivocal. Yet, health systems, professionals and patients often fail to offer or, respectively, to enter long-term and low-threshold MAT and instead treat opioid dependence as a semi-acute disorder. We claim that the typical perspective on treatment retention, one of the pivotal outcomes used for evaluation of MAT, contributes to this phenomenon by obscuring the chronic nature of opioid dependence. To support this hypothesis, we use data of 11,819 patients obtained from the MAT register of the canton of Zurich 1991-2015 and illustrate three different perspectives on treatment retention: the prospective "trial" perspective looking at the duration of single treatment episodes; the retrospective "provider" perspective looking at the duration of treatment episodes of patients still in treatment; and the "public health" perspective looking at the proportion of days spent in treatment regardless of single treatment episodes. Integrating these perspectives will lead to a more realistic perception of the chronic nature of opioid dependence. This will allow determining more appropriate aims and time frames for MAT in practice and research.

Abstract

Opioid dependence often is a chronic relapsing disorder. The evidence for medication-assisted treatment (MAT) being the treatment of first choice is unequivocal. Yet, health systems, professionals and patients often fail to offer or, respectively, to enter long-term and low-threshold MAT and instead treat opioid dependence as a semi-acute disorder. We claim that the typical perspective on treatment retention, one of the pivotal outcomes used for evaluation of MAT, contributes to this phenomenon by obscuring the chronic nature of opioid dependence. To support this hypothesis, we use data of 11,819 patients obtained from the MAT register of the canton of Zurich 1991-2015 and illustrate three different perspectives on treatment retention: the prospective "trial" perspective looking at the duration of single treatment episodes; the retrospective "provider" perspective looking at the duration of treatment episodes of patients still in treatment; and the "public health" perspective looking at the proportion of days spent in treatment regardless of single treatment episodes. Integrating these perspectives will lead to a more realistic perception of the chronic nature of opioid dependence. This will allow determining more appropriate aims and time frames for MAT in practice and research.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2017
Deposited On:13 Feb 2017 10:06
Last Modified:19 Feb 2018 07:40
Publisher:Elsevier
ISSN:0955-3959
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.drugpo.2016.09.003
PubMed ID:27788405

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