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People who are addicted to opioids have high risks of receiving an overdose of opioid, HIV, hepatitis B and C infections and criminal activity. This has led to a harm reduction treatment approach to drug addiction. Treatment is aimed at a reduction in these risks and relapses to opioid and polysubstance use and promoting psychosocial adjustment. Methadone maintenance treatment is a long‐term opioid replacement therapy that is used to manage opioid dependence, reduce illicit opioid use and promote retention in treatment. Taken by mouth and active over 24 to 36 hours, it is an opioid drug that removes the euphoric effects of heroin and reduces withdrawal symptoms as well as being compatible with normal activities at work or school. The review authors identified 21 controlled trials involving a total of 5994 opioid users. In 11 of these trials, all from the USA, 2279 participants were randomised to methadone treatment at different doses or another treatment (buprenorphine or levomethadyl). Treatment was for between seven and 53 weeks. A further 10 controlled trials did not randomly assign the total of 3715 participants to a treatment. These were from various diverse countries and followed opioid users for one to 10 years. Higher doses of methadone (60 to 100 mg/day) were more effective than lower doses (1 to 39 mg/day) in retaining opioid users in therapy and in reducing illicit use of heroin and cocaine during treatment. Side effects of methadone appeared to be similar at the different doses, in one trial only.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Use of pharmaceutical opioids (medicines that are used to treat pain) has increased dramatically in some parts of the world since the mid‐1990s. With the increased use, there has been increasing numbers of people seeking treatment for dependence (addiction) on pharmaceutical opioids. Currently, most treatment guidelines are based on research that was conducted in people who were dependent on heroin (a highly addictive opioid). This review sought to compare different opioid agonist maintenance treatments (i.e. treatments such as methadone or buprenorphine that are given for at least 30 days to help the person to reduce their unsanctioned drug use) for the treatment of pharmaceutical opioid dependence. We also compared results from maintenance treatment to short term treatments such as detoxification (removal of the drug from the body) or psychological treatments (e.g. talking therapy, counselling).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

We reviewed the evidence about the effectiveness of supervised dosing strategies in opioid substitution treatment for people dependent on opioid drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 27, 2017

Expert-reviewed information summary about pain as a complication of cancer or its treatment. Approaches to the management and treatment of cancer-associated pain are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 31, 2017

Opioid dependence is considered to be a lifelong, chronic relapsing disorder. Substantial therapeutic efforts are needed to keep people drug free. Methadone treatment plays a vital role in detoxification or maintenance programs but some individuals who are on methadone continue to use illicit drugs, commit crime and engage in behaviours that promote the spread of communicable diseases. Naltrexone is a long acting opioid antagonist that does not produce euphoria and is not addicting. It is used in accidental heroin overdose and for the treatment of people who have opioid dependence. Naltrexone is particularly suitable to prevent a relapse to opioid use after heroin detoxification for those for whom failure to comply with treatment has major consequences, for example health professionals, business executives and individuals under legal supervision. Medication compliance and retention rates with naltrexone treatment are however low.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Opium is obtained from the unripe seed capsules of the poppy plant. Opium is usually used by smoking or by swallowing to create a feeling of euphoria, to provide pleasure or as an analgesic or hypnotic. Cultural attitudes affect the patterns of opioid use among different countries. In the Middle East and south east Asia, opium is used in many cases in social settings and the users do not suffer from considerable social dysfunction. It is used occasionally and mainly in male gatherings but regular use can cause dependence. Opium users have a more stable life style than heroin users and, of those who come for treatment, a higher proportion are married and live with their family.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Opioid dependence is associated with public health and social problems. People injecting opioids are particularly at risk, not only because they become dependent faster than with other routes of administration but also because they are exposed to consequences such as an increased risk of overdose mortality, infective diseases and health issues. At least three‐quarters of global opiate users consume heroin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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