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Better to start treatment for opioid addiction while in A&E

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Starting drug treatment for patients addicted to opioids while they are in accident and emergency appears to be a more successful strategy than waiting for until referral to a specialist clinic.  

US researchers have conducted what they think is the first known randomised trial comparing three treatment strategies for opioid-dependent patients receiving emergency care.

They found that patients given buprenorphine were most likely to engage in addiction treatment and reduce their illicit opioid use.

“This is a huge public health problem”

Gail D’Onofrio

Dependence on prescription and illicit opioids is a “huge public health problem”, said lead author Dr Gail D’Onofrio, from Yale School of Medicine.

The researchers noted that patients addicted to opioids often sought treatment in hospital emergency departments but were typically referred to addiction treatment centres.

To test the efficacy of an intervention including buprenorphine – a medication that reduces opioid cravings and helps to prevent relapse to opioid use – the researchers randomised more than 300 opioid-dependent individuals into three treatment groups.

A referral group received a list of treatment services, a brief intervention group received a motivational consultation and referral, and a third group were given a brief intervention and treatment with buprenorphine that was continued in primary care.

Compared to the referral and brief intervention groups, the buprenorphine-treated patients fared best, said the researchers.

“The patients who received emergency department-initiated medication and referral for ongoing treatment in primary care were twice as likely than the others to be engaged in treatment 30 days later,” said Dr D’Onofrio. “They were less likely to use illicit opioids of any kind.”

The researchers said their findings pointed to an innovative strategy for a persistent public health problem.

They said that effectively linking emergency department-initiated buprenorphine treatment to ongoing treatment in primary care represented an “exciting new model for engaging patients who are dependent on opioids into state-of-the-art care”.

The study findings are published in the Journal of the American Medical Association.

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