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Study: Heroin Addiction Treatment Should Include Inpatient and Outpatient Therapy

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Treatment for heroin addiction is most effective if it includes both inpatient and outpatient therapy, according to a new study.

Researchers at Boston Medical Center compared two groups of patients addicted to heroin: those who started buprenorphine treatment while in the hospital and then were referred directly to an outpatient buprenorphine treatment program, and patients who took a tapered dose of buprenorphine in the hospital to help with withdrawal, but only received referral information about local community treatment programs. Buprenorphine is an opioid substitute used to treat opioid addiction. It helps curb opioid withdrawal symptoms.

The study found 37 percent of patients in the group directed to the buprenorphine treatment program reported no illicit drug use in the month after leaving the hospital, compared with just 9 percent of those who only received general referral information, according to HealthDay. Patients in the outpatient treatment group reported fewer days of illicit drug use, and less drug use overall during the six months after they left the hospital.

The study of 139 patients appears in JAMA Internal Medicine.

“Unfortunately, referral to substance abuse treatment after discharge is often a secondary concern of physicians caring for hospitalized patients,” lead researcher Dr. Jane Liebschutz said in a news release. “However, our results show that we can have a marked impact on patient’s addiction by addressing it during their hospitalization.”

17 Responses to this article

  1. John Mark Blowen APRN / August 2, 2014 at 8:06 pm

    Inpt stabilization would be particularly beneficial for pregnant women with opiate addiction who present for medication assisted treatment. It is difficult or impossible to suppress withdrawal for more than a few hours given the conservative dosing required in an out patient facility. We really know little about intrauterine abstinence syndrome but more and more is known about the effect of prenatal stress on the developing human being.Getting people feeling better as soon as possible is fundamental to helping them get into and learn how to maintain recovery.

  2. Karen Scott / August 1, 2014 at 6:52 am

    Opioid addiction is a chronic condition and should be treated accordingly.

  3. Susan Weinstock , M.D. / July 29, 2014 at 1:06 pm

    As a physician trained in addiction medicine, I wanted to reiterate an important point made by Rocky Hill. Given the current literature on the effectiveness of medication-assisted treatment, the design of this study put lives at risk and should be viewed as medical malpractice.

  4. Rocky Hill MA, NCAC II, CADC II / July 21, 2014 at 5:12 pm

    I think that this article could have been vastly improved by adding “Some” to the beginning of the title. Many opioid dependent patients have a need for short term STABILIZATION in hospital based programs, followed by a seamless transition to full service outpatient addiction programs with continuation of their OTP. Thus, patients who have medical, psychiatric or withdrawal related issues can be readied to join their families in the outpatient program while being stabilized in an acute care setting. Including the family, from the outset, is a unique opportunity of outpatient care, enhancing outcomes and giving the entire system an understanding of addictive disorders.
    Continuing to use a medical procedure that offered a 9% recovery rate vs. a 37% recovery rate, for any other medical condition, would be considered malpractice and welcome a flood of lawsuits. The question begs, why are so many inpatient programs so adamant about their disdain for using buprenorphine? It would be oversimplification if we held that it was simply bias born of avarice. It is bias, but it has many parents.

  5. Ross Fishman, Ph.D. / July 16, 2014 at 11:55 am

    I have read only the abstract of the article in the original journal. It is an interesting study and adds a bit of knowledge to the literature but it appears to me to be totally irrelevant to the challenges facing the opioid addicted population. It is certainly of limited value to me as a long-time addiction specialist who happens to run a buprenorphine clinic as part of comprehensive outpatient substance use disorder treatment. I believe that inpatient rehabs can be helpful to some people but for the majority of opioid dependent people seeking treatment, an inpatient stay is unnecessary and a wasteful financial burden. The educational component of treatment and the induction to buprenorphine can be well accomplished in an outpatient setting. Outpatient clinics can also provide the individual counseling that inpatient rehabs often avoid. With regard to the study, tapering buprenorphine in a short-term medical setting and then merely receiving referral information without a specific referral to an outpatient facility for continuing care is poor medical care. Perhaps this work should be restricted to addiction specialists.

  6. Susan Weinstock MD / July 15, 2014 at 11:45 pm

    Agree with Anne Fletcher that the title of this article is misleading. The study does not compare efficacy of inpatient BUP detox vs. outpatient BUP detox. Would conclude that BUP maintenance reduces relapse risk, but would not draw conclusions regarding benefits of inpt. therapy.

    The fact that most residential programs do not allow medication-assisted treatment is currently a major problem with out treatment system.

  7. Anne Fletcher / July 11, 2014 at 9:32 am

    It’s important to take a look at the study – there is a link to it right in this article. This JT article (and it’s title) is misleading. These patients did not receive inpatient drug and alcohol treatment, nor were they then placed in an outpatient addiction treatment program. They were general medical patients who were then referred for buprenorphine MEDICAL treatment, not to a structured outpatient program. Although it It did require counseling, it didn’t offer counseling within the program. I got this information from one of the study authors. In short, this study findings are not as suggested.

    Anne Fletcher, Author of Inside Rehab and Sober for Good

  8. Carlos / July 10, 2014 at 5:52 pm

    Makes no sense to me that residential treatment facilities do not offer bupernorphine, methadone and naltrexone as an option to the patients that would wanted. For too long they have bad mouth this approach ignoring the effectiveness and safety. As a result they are ill prepare to offer it. They will really need to be educated or they will make the same mistakes that MMt facilities made in the 80 and 90. Ignoring excellent federal guidelines.

    I can see them using 12 Step ideology and ignoring the research available.

    We still have a lot to learn as a profession and field.

  9. Dave Finch / July 10, 2014 at 12:54 pm

    Dean Hale is right and so is the conclusion of the lead researcher. However your title to this piece, might suggest that it is necessary to have formal treatment to treat addiction. There is ample evidence that addicts can recover on their own without treatment and that in fact most do so. Counseling alone is enough for many. See the works of Ann Fletcher and of Dr. Sally Satel.

    • Carlos / July 10, 2014 at 6:18 pm

      Dave Finch
      Yes the evidence exist, but what the patients need is options, all the options that would work
      for them not what treatment staff would want them to be. Fletcher “Inside Rehab.” Although the dogma and ideology of 12 step treatment was too prominent for the lack of effective data. I could understand she is a journalist. She was quite insightful and clear thinker otherwise talking about options that are not offered enough. While Sally Satel is an MD. Although I do not agree with all their conclusions. I specially enjoy her reason book Brainwashed: The Seductive Appeal of Mindless Neuroscience, with Dr. Scott Lillienfeld..

      Which work did Fletcher and Satel have done together? am not familiar with it. I Google their names together and could not find anything significant. Or were you using their name separately but meaning that their conclusions were similar.

      One of the problems I have been having is with some studies just suggest and others are quite compelling. Too frequently conclusive claims are made with few studies and/or studies that conflict in results. While all humans are created equal not all scientific studies are created equal and one need to be familiar with the design of the studies.

      • Anne Fletcher / July 16, 2014 at 2:15 pm

        The study did not look at inpatient addiction treatment. See my comment above. The inpatient subjects were general medicine patients, not addiction treatment patients. I did not do any work with Sally Satel. Our books are separate and have nothing to do with each other. And neither of us are “just” authors. Feel free to research our backgrounds if you would like to understand them.
        Anne M. Fletcher, M.S., R.D., Author of Sober for Good and Inside Rehab

  10. Dr.P / July 10, 2014 at 12:32 pm

    The problem here is that, they didn’t study those addicts that started buprenorphine as outpatients. IMO-the inpatient part of the treatment is generally not any more beneficial than outpatient. Inpatient treatment is of course, much mors costly. The other problem is, the 100 patient cap, which makes if more difficult for outpatients to find a doctor who is not “full” with 100 patients. The 100 patient cap needs to be lifted.

  11. Zac Talbott / July 10, 2014 at 10:38 am

    What about methadone maintenance treatment (MMT)? The Centers for Disease Control & Prevention (CDC) has made it clear it is the “most effective treatment” available for opioid addiction — and the National Institutes of Health (NIH) has been very clear that MMT is the “gold standard treatment” for the same. The same, rooted in the evidence base of the past nearly 50 years, has been re-iterated by SAMHSA’s Center for Substance Abuse Treatment (CSAT), the Institute of Medicine, World Health Organization (WHO), American Association for the Treatment of Opioid Dependence (AATOD), and countless other governmental, research, academic and medical authorities throughout the world. To say (generally) that “treatment for heroin addiction is most effective if it includes both inpatient and outpatient therapy” without a single mention of the GOLD STANDARD, *truly* most effective treatment (MMT) causes anyone with a working knowledge of the evidence base to seriously question the legitimacy and credibility of the authors’ claims.

    • Carlos / July 10, 2014 at 6:17 pm

      The problem for including methadone (although I strongly agree with you) is the amount of restrictions and regulations that is placed on MMt may not transfer to Inpatient residential. They surely need to think about it.

  12. dean hale / July 10, 2014 at 10:03 am

    These medications help addicts and save lives!

    • Laurie Fear / July 10, 2014 at 1:01 pm

      Amen! Opioid medication-assisted treatment works! Suboxone, buprenorphine and methadone! However, there has not been enough emphasis on developing a comprehensive transition program to detox patients off of the medications once their life and health have stabilized, and in fact, they begin to thrive! I worked as a counselor in a medication-assisted treatment clinic for 5 years and saw many lives resurrected. But given that the clinic was a private business, there was very little management emphasis on helping patients transition off the medications.

      I left the clinic last November to become a Personal Recovery Life Coach and I am working with a psychiatrist’s office to develop a 3-step Client Transition Program — from medical addiction treatment, to intense outpatient counseling, to recovery life coaching. Lots of promise for this ongoing system of support for the patient’s long-term recovery!

  13. Zac Talbott / July 9, 2014 at 1:26 pm

    What about methadone maintenance treatment (MMT)? The Centers for Disease Control & Prevention (CDC) has made it clear it is the “most effective treatment” available for opioid addiction — and the National Institutes of Health (NIH) has been very clear that MMT is the “gold standard treatment” for the same. The same, rooted in the evidence base of the past nearly 50 years, has been re-iterated by SAMHSA’s Center for Substance Abuse Treatment (CSAT), the Institute of Medicine, World Health Organization (WHO), American Association for the Treatment of Opioid Dependence (AATOD), and countless other governmental, research, academic and medical authorities throughout the world. To say (generally) that “treatment for heroin addiction is most effective if it includes both inpatient and outpatient therapy” without a single mention of the GOLD STANDARD, *truly* most effective treatment (MMT) causes anyone with a working knowledge of the evidence base to seriously question the legitimacy and credibility of the authors’ claims.

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