Lately I’ve been involved in several online discussions of opioid maintenance therapy (OMT), both in terms of traditional methadone maintenance and the newer version that relies on buprenorphine (principally Suboxone). I’ve been asking about the prognosis for someone coming off an extended course of opioid maintenance (say three to five years). What’s the likelihood that a typical client who does so will remain opioid-free?
Here’s why I ask: there are several elements to a model of treatment.
- First, a description of the disorder we propose to treat.
- Second, a theory about its causes (etiology).
- Third, a list of symptoms by which it may be recognized .
- Fourth, a proposed treatment; and
- Fifth, a likely outcome or prognosis, for persons who have the disorder.
In the case of OMT, I think the fifth requirement has to at least include the answer to my question. What are the chances that someone who decides to come off OMT at some point will remain opioid-free? It’s a simple question, I think. But I found it a challenge to get an answer.
That surprised me, given all the research and experience we’ve accumulated. You’d think some researcher would know the answer down to a decimal point. One experienced OMT doc did report that 20% of clients eventually detoxed voluntarily and about half of those returned to OMT within two years. That’s only one program, obviously, and only methadone. But it does suggest that about one in 10 clients achieve that goal.
I’d like to hear from other clinicians about their experience; even more, see some research. That same doc expressed some concern that the information might make addicts more reluctant to enroll. That’s not my intent. I just want to know what’s likely to happen to somebody who we refer to OMT.
Isn’t that what is meant by informed client choice? It’s a value in modern behavioral healthcare. The client to be a full partner in recovery. That means accurate information about the likely outcome of decisions made early in treatment.
Am I off base here? Shouldn’t we be discussing this?
I’m sure folks are tired of hearing that we now have almost half a million people on Suboxone, and another 200,000-plus on methadone, but as I understand it, them’s the facts, ma’am. We should by this time have plenty of data to analyze. I think we should answer this question, and debate its implications, because the population of OMT clients is likely to continue growing – – given the opioid epidemic. It’s a sort of thing we should think about now rather than later.
Do you agree? Or not?