Methods

1. COBRA*: 1-Year Retention and Outcome of Methadone and Buprenorphine Maintenance in Different Care Settings in Germany Apelt SM, Bühringer G, Siegert J, Soyka M & Wittchen H-U Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden 2,694 patients (223 doctors) baseline 8 doctors withdrew participation (N = 66 patients) Prestudy 405 patients discontinued therapy, reasons were: 1 – death n = 13 2 – disciplinary reasons n = 58 3 – treatment success (clean) n = 55 4 – change to drug-free therapy n = 86 5 – side effects n = 0 6 – change of residence n = 135 7 – other/unknown n = 58 OR 0.41** 1st short assessment (6-month-fu) 2,223 patients still in treatment (215 doctors) Representative sample of substitution physicians in Germany(N=3006) Random sample Participation at prestudy (Jun-Sep/2003): N=379 physicians OR 0.51*** OR 0.58*** Prestudy Questionnaire Maintenance Staff Questionnaire 9 doctors withdrew participation (N = 47 patients) 169 patients discontinued therapy, reasons were: 1 – death n = 5 2 – disciplinary reasons n = 29 3 – treatment success (clean) n = 15 4 – change to drug-free therapy n = 37 5 – side effects n = 0 6 – change of residence n = 52 7 – other/unknown n = 31 OR 0.73** 2nd short assessment (9-month-fu) 2,007 patients still in treatment (206 doctors) Main Study Target week assessment (Feb-Mar/2004) Small setting (<10 p/d) Medium setting (10-40 p/d) Large setting (>40 p/d) 12 doctors withdrew participation (N = 120 patients) 256 patients discontinued therapy, reasons were: 1 – death n = 10 2 – disciplinary reasons n = 32 3 – treatment success (clean) n = 30 4 – change to drug-free therapy n = 51 5 – side effects n = 0 6 – change of residence n = 67 7 – other/unknown n = 66 Patients Questionnaire Urine Drug Screening Doctors Questionnaire 12-month follow-up 1,631 patients still in treatment (194* doctors) Follow-Up 6- and 9-month Follow-up Monitoring with Drop-out Documentation 830 patients with complete drop-out documentation! Reasons for drop-out were: 1 – death n = 28 2 – disciplinary reasons n = 119 3 – treatment success (clean) n = 100 4 – change to drug-free therapy n = 174 5 – side effects n = 0 6 – change of residence n = 254 7 – other/unknown n = 155 documentation available of 2,461 patients Response Rate = 91,35% Target week assessment of 12-month Follow-up summary Patients Questionnaire Urine Drug Screening Doctors Questionnaire * Cost-Benefit and Risk Appraisal of Substitution Treatment Background Extract of Objectives Results • Buprenorphine and methadone are two established substitution drugs licensed in many countries for the maintenance treatment of opioid dependence. • Little ist known about how these two treatments work under routine care conditions... • ...and particular in different provider formats, such as small, primary care based and large, specialized substitution centres. 12-MONTH RETENTION To describe over a period of 12 months: • Differences in retention rates... • Differences in concomitant drug use... • Differences in therapy outcome... ...in a nationally representative sample of N=223 substitution • physicians and a total of N=2,694 consecutive patients in • substitution treatment. Settings were divided into small, primary • care based settings (<10 patients per day) and large, specialized substitution centres (>40 patients per day). Retention rate (%) Methods weeks after baseline ATTAINMENT OF TREATMENT TARGETS % Conclusion References & Publications • The study confirms an overall effectiveness of agonist maintenance treatments in routine care. • Small-scale, primary care based settings perform as well or better as large-scale substitution centres... • ...suggesting that these primary care based settings might be a promising alternative to improve access to maintenance therapy in underserved areas. • Further analyses of possible patient‘ diffences between settings are necessary. CONCOMITANT DRUG USE Wittchen, H.-U., Apelt, S. M., Soyka, M., Bühringer, G. et al. (2005). Buprenorphine and methadone in the treatment of opioid dependence: methods and design of the COBRA study. International Journal of Methods in Psychiatric Research, 14(1), 14-28 Wittchen, H.-U. (2005). Buprenorphine and Methadone Treatments in Routine Care: Findings from the 12-month COBRA Cohort Study in Germany. Conference Abstract Book, "Safer Options in the Treatment of Opioid Dependence", Day 3, S. 16 Apelt, Sabine M. (2005). Correlates of High-Risk Behavior Among Methadone and Buprenorphine Patients with HIV (COBRA). NIDA 2005 International Forum Abstracts, Page 5 of 52 Apelt, S.M., Siegert, J. & Wittchen, H.-U. (2005). Substitution in Routine Care: Retention Rates after 9 Months of Follow-up (COBRA). WPA-World Congress 2005 Abstract Book, Page 607 Wittchen, H.-U., Apelt, S.M., Mühlig, S. (2005). Die Versorgungslage der Substitutionstherapie. Buchbeitrag in Gerlach, R. & Stöver, H. (Hrsg.) Vom Tabu zur Normalität: 20 Jahre Substitution in Deutschland - Zwischenbilanz und Aufgaben für die Zukunft. Wittchen, H.-U., Apelt, S. M., Christl, B., Hagenau, K. A., Groß, A., Klotsche, J. & Soyka, M. (2004). Die Versorgungspraxis der Substitutionstherapie Opiatabhängiger (COBRA). Suchtmed 6 (1) 80-87 *without methadone-patients ASAT BMBF -SuchtforschungsverbundSachsen – Bayern Allocating Substance Abuse Treatments to Patient Heterogeneity This work has been prepared in the context of the project F8 “Allocation in substitution treatments – COBRA (PI) within the Addiction Research Network ASAT (Allocating Substance Abuse Treatments to Patient Heterogeneity).Contact information: e-mail: asatkoordination@mpipsykl.mpg.de (www.asat-verbund.de). ASAT is sponsored by a federal grant of the Federal Ministry of Education and Research (01 EB 0440 - 0441, 01 EB 0142). First phases of this project have been funded in addition by an unrestricted educational grant of essex pharma GmbH, Munich, Germany . COBRA contact information: COBRA@psychologie.tu-dresden.de