Adherence to Practice Guidelines Improves Outcomes of Opiate Agonist Treatment
Although treating heroin dependence with high-dose methadone and psychosocial services is well-supported by clinical trial data and practice guidelines, many opioid treatment programs (OTP) do not follow all evidence-based practices. To determine whether adhering to guidelines improves patient outcomes, researchers analyzed data from 232 patients recruited from OTPs in the US Veterans Administration health system that were selected based on whether they were guideline-concordant or guideline-discordant. OTPs in both the guideline-concordant and guideline-discordant groups were geographically similar, as were baseline measures of heroin use, employment, illegal activities, and mental health among patients. The sample also had a high level of psychiatric impairment.
- In the guideline-concordant OTPs, 79% of patients received doses of methadone in the recommended high-dose range compared with 47% of patients in the guideline-discordant OTPs.
- Guideline-concordant OTPs had more full-time equivalent staff than guideline-discordant clinics, despite similar numbers of patients.
- At 6-month follow-up, patients in guideline-concordant OTPs had greater reductions in heroin use, greater improvements in global mental health, and a higher percentage of opioid-free urine tests.
These results demonstrate that adherence to practice guidelines (which emphasize clinical practices found efficacious in controlled trials—e.g., high-dose methadone and psychosocial services) improves opioid treatment outcomes in everyday practice with severely impaired patients. Greater effort should be made to increase adherence to clinical practice guidelines for OST through policy changes.Julia H. Arnsten, MD, MPH
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