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Heroin Addiction and Related Clinical Problems: 2009, 11, 2 (pages: 9 - 20)

Methadone-treated Patients After Switching to Buprenorphine in Residential Therapeutic Communities: An Addiction-specific Assessment of Quality of Life

González-Saiz F., Gómez R. B., Bilbao Acedos I., Lozano Rojas O., Gutiérrez Ortega J.

Summary: Background: evaluating the addiction-related quality of life of a sample of opiate-dependent patients in treatment with buprenorphine in therapeutic communities after a switch from methadone. Design and participants: observational (descriptive), open longitudinal prospective study (‘before-after' design); a non-probabilistic consecutive sampling procedure was used. After their admission to five therapeutic communities, a sample of patients in treatment with methadone switched to buprenorphine induction (SubutexR). When considered appropriate, a gradual reduction in buprenorphine dose was begun, so as to bring it down to 0 mg within 16 weeks. The patients met DSM-IV-TR criteria for Opiate Dependence, were adults and had signed an informed consent release. All the patients were evaluated at three times; baseline assessment (Mo), after one month of treatment (M1) and after three months (M2). The study protocol was approved by the Andalusian Regional Committee for Clinical Trials, and was conducted in accordance with the Declaration of Helsinki. Measurements: The Objective Opiate Withdrawal Scale (OOWS), the Subjective Opiate Withdrawal Scale (SOWS), the Health Related Quality of Life for Drug Abusers Test (HRQoLDA Test), the General Health Questionnaire (GHQ-28), the Opiate Treatment Index (OTI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Results: A total of 119 patients met the selection criteria. Of these, 46 subjects transferred from methadone to buprenorphine, while the remaining 73 decided to stay on their methadone maintenance treatment. A statistically significant increase was observed in scores on the quality of life scale after one month of treatment with buprenorphine (from 0.62 to 0.99; p<0.05) and at three months (from 0.43 to 0.77; p<0.05). One month after the start of treatment, statistically significant improvements were observed in “general state of health” (from 10.7 to 4.3; p<0.05), in “severity of dependence” (11.7 to 4.1; p<0.05) and in “psychological adjustment” (from 7.5 to 3.7; p<0.05). At the three-month assessment, statistically significant differences were again observed in the same variables, except for “psychological adjustment”. Conclusions: the patients who were in treatment with methadone after their admission to a therapeutic community and switched to buprenorphine were able to experience ongoing improvement in their quality of life.