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Review
. 2021;8(2):298-305.
doi: 10.1007/s40429-021-00373-9. Epub 2021 May 26.

New Approaches in Drug Dependence: Opioids

Juliane Mielau  1 , Marc Vogel  2   3 , Stefan Gutwinski  1 , Inge Mick  1
Affiliations
Review

New Approaches in Drug Dependence: Opioids

Juliane Mielau et al. Curr Addict Rep. 2021.

Abstract

Purpose of review: This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches.

Recent findings: Currently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce.

Summary: Maintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.

Keywords: Harm reduction; Heroin-assisted treatment; Opiod substitution.

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