Background: The most significant contradiction in the treatment of Heroin Use Disorder (HUD) is that the disease is considered by the WHO to be a chronic brain disease necessarily involving proneness to relapse over many years, whereas, in most countries, Agonist Opioid Treatment (AOT) has a limited time-span. Methods: The authors describe the demographic, anamnestic, behavioural, psychopathological features, and the loss and traumatic event reactions of 7 patients treated with AO medications continuously for nearly thirty years. Results: At treatment entry, we treated all patients with methadone, but five patients are currently being treated with a low daily dose of buprenorphine. The achieved stabilization dosage was over-standard, between 100 and 250 mg/die, and the stabilization time varied between 2 and 45 months. Drastic changes, all pointing in a positive direction, were observed in the demographic, anamnestic, behavioural and psychopathological features of these patients. The patients’ addictive behaviours practically disappeared. The Worth-lessness-Being Trapped (W/BT) psychopathological dimension was reduced to a frequency of zero, while all the other dimensions showed much lower scores (less than 50 standardized scores). Regrettably, a Heroin Post-Traumatic Stress Disorder Spectrum (H/PTSD-S) persisted in 5 out of 7 patients even after nearly 30 years of continuous Agonist Opioid Treatment. Conclusions: If addictive behaviours have not disappeared, opioid agonist treatment must not be terminated. Unless and until that condition is met, the W/BT psychopathological dimension continues to be predominant; the same is true if the H/PTSD-S is over 32. © 2020, Pacini Editore S.p.A. All rights reserved.
Nearly thirty years of experience of real-world long-term treatment with Opioid Agonists
Maremmani, Angelo G. I.;
2020-01-01
Abstract
Background: The most significant contradiction in the treatment of Heroin Use Disorder (HUD) is that the disease is considered by the WHO to be a chronic brain disease necessarily involving proneness to relapse over many years, whereas, in most countries, Agonist Opioid Treatment (AOT) has a limited time-span. Methods: The authors describe the demographic, anamnestic, behavioural, psychopathological features, and the loss and traumatic event reactions of 7 patients treated with AO medications continuously for nearly thirty years. Results: At treatment entry, we treated all patients with methadone, but five patients are currently being treated with a low daily dose of buprenorphine. The achieved stabilization dosage was over-standard, between 100 and 250 mg/die, and the stabilization time varied between 2 and 45 months. Drastic changes, all pointing in a positive direction, were observed in the demographic, anamnestic, behavioural and psychopathological features of these patients. The patients’ addictive behaviours practically disappeared. The Worth-lessness-Being Trapped (W/BT) psychopathological dimension was reduced to a frequency of zero, while all the other dimensions showed much lower scores (less than 50 standardized scores). Regrettably, a Heroin Post-Traumatic Stress Disorder Spectrum (H/PTSD-S) persisted in 5 out of 7 patients even after nearly 30 years of continuous Agonist Opioid Treatment. Conclusions: If addictive behaviours have not disappeared, opioid agonist treatment must not be terminated. Unless and until that condition is met, the W/BT psychopathological dimension continues to be predominant; the same is true if the H/PTSD-S is over 32. © 2020, Pacini Editore S.p.A. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
