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Heroin Addiction and Related Clinical Problems: 2021, 23, N4 (pages: 69 - 79)

Early-readmission after Agonist Opioid Treatment in five European countries. A drug addiction health policy challenge?

Maremmani I., Hill D., Scherbaum N., Auriacombe M., Bacciardi S., Benyamina A., Casella P., D'Agnone O., Daulouede J.-P., Deruvo G., Fonseca F., Guareschi M., Maremmani A.G.I., Villeger P., Ratcliffe K., Somaini L., Touzeau D., Vernole E., Walcher S., and

Summary: Background: During the natural history of heroin addiction, the ‘revolving door syndrome' marks the final stage for patients with a severe form of addiction. At this stage, patients who leave treatment unsuccessfully, or who, after detoxification, relapse into addictive behaviour, may reflect an unfolding dramatic sequence of being treated, quitting the treatment, falling out, being arrested, being hospitalized, going back to treatment, and so on. Long-term treatment with opioid agonist medications (AOT) can be considered a valid copy of this condition. By contrast, treatment followed by early readmission can be considered a proxy for the tendency to avoid implementing long-term treatment for HUD patients. Methods: The RADARS®-System-EUROPAD cohort survey was conducted in 6 European Countries in the 2015-2018 period as a multi-centre study. Survey questions included inquiries about demographics, treatment history, drugs taken to ‘get high' in the past 30 days, frequency, route of use and time elapsing since the latest unsuccessful treatment. Considering the 3,035 patients who had requested treatment, and after applying the exclusion criteria chosen for this study, we compared, both at univariate and multivariate level, 109 patients who, before coming to a treatment centre, had left their previous treatment within the previous 30 days, with 1,033 patients who had left their previous treatment over a month earlier. Results: Compared with those not classifiable as early-stage readmitted peers, early stage re-admitted patients were mostly males, with a higher number of past unsuccessful treatments, with a history of medical treatment for overdoses of prescribed opioids, more frequently in France and less frequently in Spain and the UK. Before going into treatment, they had obtained their primary substance 'to get high' in Internet, or in emergency departments, or by getting prescriptions, or even by stealing. Less frequently, they were in contact with a dealer. At a higher frequency they were receiving take-home buprenorphine or finding their medication at a community pharmacy or, if methadone-treated, using take-home or community pharmacy modalities. Conclusions: Keeping the patient in treatment as long as possible, removing obstacles to chronic treatment, and the unification of treatment modalities across Europe remain the main drug addiction health policy challenges for the near future.