Injectable Opioid Agonist Treatment for Patients with Opioid Dependence: A Review of Clinical and Cost-Effectiveness [Internet]

Excerpt

Opioids have analgesic and central nervous system depressant effects and have been used as medication for pain relief. However, opioids also have the potential to cause euphoria and have been misused, resulting in opioid dependency and consequently increased morbidity and mortality. Opioid dependency is a serious problem and impacts public health with considerable clinical, social and economic implications.^, The Centers of Disease Control and Prevention estimated that in the US, the economic burden resulting from the misuse of prescription opioids is $78.5 billion per year (which includes costs for health care, productivity loss, treatment for dependency, and criminal justice involvement). In Canada, overdose deaths resulting from opioid dependency are on the rise and are a serious concern. It was estimated that in Canada in 2018, there were at least 4,460 deaths due to opioid overdose and 94% of these were determined to be unintentional overdose; this is a 9.4% increase in overdose deaths from 2017, and 48% increase from 2016.

Opioid agonists have the ability to suppress opioid cravings and withdrawal symptoms from acute effects of other opioids, and have been used as a treatment option for opioid dependency. Opioid agonists include drugs such as methadone, buprenorphine, diacetylmorphine (DAM) and hydromorphone (HDM). In some individuals with opioid dependency, even with repeated treatment with oral opioid agonists no benefit was achieved. Injectable opioid agonists have shown some promise in treating opioid dependency in these individuals. Injectable opioid agonists have a rapid onset of action and shorter duration to reach peak values in comparison to oral opioid agonists, and hence there is potential for overdose issues. Administration of injectable opioid agonist under supervision would allow for immediate action to be taken in case of overdose to help ensure safety, although take-home dosing has also been studied.^,

The purpose of this review is to summarize the evidence on the clinical effectiveness and cost-effectiveness of injectable opioid agonist treatment (with DAM or HDM, alone or in combination with methadone or buprenorphine/naloxone), compared with alternative pharmacological treatments or no treatment, for individuals with opioid dependency.