Low-threshold Opioid Agonist Therapy Is a Safe Option

Low-threshold access to opioid agonist therapy (OAT) may increase the number of people benefiting from treatment. This study assessed the impact of low-threshold OAT (outpatient initiation of methadone or buprenorphine without prerequisite referral or abstinence from non-medical substance use, no urine testing) on treatment retention, non-medical opioid use, and safety (non-fatal and fatal intoxications, all-cause mortality) compared with the Norway standard intervention (treatment initiation with methadone or buprenorphine with referral and abstinence from non-medical substance use confirmed by urine testing).

• 128 patients receiving low-threshold OAT were included and compared with the 7900 patients in the Norway national reference cohort.
• Treatment retention rates were 95% and 92% in the low-threshold and reference cohort, respectively. Illicit opioid use rates were 7% and 10%.
• The rates of non-fatal intoxication were 7% and 6% in the low-threshold and reference cohort, respectively, and all-cause mortality was 1% and 1.3%.
• Healthcare utilization increased (incident rate ratios >3) for in- and outpatient care among both groups.

Comments: This study gives indications that in Norway—a country with a high coverage of OAT—a low-threshold access model of OAT appears at least as safe as the standard provision of OAT, with similar retention rates and non-medical opioid use rates. OAT was associated with an increase in healthcare utilization indicating that patients had better access to care than before OAT initiation.

Nicolas Bertholet, MD, MSc

Reference: Chalabianloo F, Ohldieck C, Haaland ØA, et al. Effectiveness and safety of low-threshold opioid-agonist treatment in hard-to-reach populations with opioid dependence. Eur Addict Res. 2022;28(3):199–209.