As political debate over how to curb the opioid crisis rages in this country, a major new U.S. study has found replacement drugs such as methadone are much more effective at preventing overdoses and medical emergencies than more traditional abstinence-based programs.

The study’s lead researcher says she hopes policymakers take note of the results and work to make medical drug-replacement treatments more widely available throughout North America.

“(This study) has real implications for what we promote as treatment and then where we direct patients and their families, and also what we pay for,” said Dr. Sarah Wakeman, an assistant professor at Harvard’s medical school and director of the Mass General Hospital substance-use disorder initiative in Boston.

The study, which was published in JAMA Network Open, looked at more than 40,000 adult opioid users. It was led by Wakeman, along with co-authors Marc Larochelle and Omid Ameli.

Wakeman said that while good data already existed on the effectiveness of methadone and buprenorphine, which she called the “gold standard treatments,” there had been little data comparing them to other, more common opioid addiction treatments.

“We were really interested in looking at a real-world sample of people,” she said.

The study checked in on subjects after three months of treatment and again after a year, tracking their opioid-related overdoses and the times they received opioid-related acute care.

Methadone or buprenorphine, also known as Suboxone, was the only treatment that showed a reduced risk of overdose and acute medical care.

Over a year, those treatments were associated with a 59 per cent reduction in overdoses, and a 26 per cent reduction in acute medical care, Wakeman said.

Here’s a look at the study’s patients:

* Just under 60 per cent received nonintensive behavioural health treatment, which generally means regular talk therapy;

* Almost 16 per cent received inpatient services, which are residential programs generally based on abstinence from drugs alongside behaviour therapies;

* Just under five per cent received intensive behavioural health treatment, which Wakeman explained uses many of the same methods as inpatient services but without the residential component;

* Another 12.5 per cent received treatment with methadone or buprenorphine, also known as opioid agonist therapy;

* 2.4 per cent were treated with naltrexone; and

* The last 5.2 per cent received no treatment.

Buprenorphine and methadone work by reducing the symptoms of opioid withdrawal and cravings. Meanwhile, naltrexone works by blocking the receptors activated by opioids, rendering them ineffective.

Wakeman said the ratio of different treatments within the study more or less reflect the use of these treatments by insured patients in the real world — behavioural approaches are most common, while medical approaches, often associated with harm-reduction efforts, are more difficult for patients to access in the United States, she said.

In Alberta, the provincial government has recently been announcing funding for abstinence-based addiction treatment centres while musing about cuts to supervised consumption sites across the province.

There are hundreds of such abstinence-based addiction treatment centres, often privately run, across Canada. Private centres are largely unregulated, and in the past several years some have come under scrutiny after stories of questionable practices at some sites.

Wakeman and the other researchers recommended strategies be put in place to address the underuse of medical opioid addiction treatments, and to make these medications more readily available to patients struggling with addiction.

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Wakeman said addiction is still often framed as an issue of morality or bad behaviour, instead of as a medical disorder.

She said medical treatments for opioid addiction such as methadone should be seen the same as insulin is for diabetes: a medical treatment for a medical condition.

“That’s why it’s so crazy to me that there are these residential so-called treatment programs that either don’t allow or are opposed to medication,” she said. “It’d be like having a cancer centre that’s opposed to chemotherapy. … It just doesn’t make sense.”

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