Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women

Oviedo-Joekes, Eugenia; Guh, Daphne; Brissette, Suzanne; Marchand, Kirsten; Marsh, David; Chettiar, Jill; Nosyk, Bohdan; Krausz, Michael; Anis, Aslam; Schechter, Martin T.

doi:10.1016/j.drugalcdep.2010.03.016

« Previous Next »Drug and Alcohol Dependence
Volume 111, Issue 1 , Pages 50-57, 1 September 2010

Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women

Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 5804 Fairview Ave, Vancouver, BC, Canada V6T 1Z3
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
- Corresponding author at: St. Paul's Hospital, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. Tel.: +1 604 682 2344x62973; fax: +1 604 806 8210.
Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
Suzanne Brissette
- Centre Hospitalier de l’Université de Montréal, Hôpital Saint-Luc, CHUM Montréal, QC, Canada H2X 3J4
Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
David Marsh
- School of Population and Public Health, University of British Columbia, 5804 Fairview Ave, Vancouver, BC, Canada V6T 1Z3
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall Vancouver, BC, Canada V6T 2A1
- Vancouver Coastal Health & Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
- Centre for Addiction Treatment BC, University of Victoria, 2300 McKenzie Ave, Victoria, BC, Canada V8P 5C2
Jill Chettiar
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
Bohdan Nosyk
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
Michael Krausz
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall Vancouver, BC, Canada V6T 2A1
Aslam Anis
- School of Population and Public Health, University of British Columbia, 5804 Fairview Ave, Vancouver, BC, Canada V6T 1Z3
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
Martin T. Schechter
- School of Population and Public Health, University of British Columbia, 5804 Fairview Ave, Vancouver, BC, Canada V6T 1Z3
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 620-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6

Received 22 October 2009; received in revised form 16 March 2010; accepted 16 March 2010.

Abstract

Background

There is consistent evidence showing women access treatment with more severe substance-related profiles relative to men; however, treatment outcome evaluation shows inconclusive results regarding gender differences. Furthermore, few studies evaluate response by gender.

Methods

The present analyses were performed using data from the NAOMI study, an open-label, phase III randomized controlled trial, carried out between 2005 and 2008 in Vancouver and Montreal, Canada. A total of 226 long-term treatment-refractory opioid dependent individuals were randomized to receive injectable diacetylmorphine or oral methadone for 12 months. Patients in both treatment groups were offered psychosocial and primary care services. Main outcomes were retention in addiction treatment at 12 months. Drug use, health, psychosocial adjustment and health-related quality of life were examined at baseline and during treatment, using the European Addiction Severity Index, Maudsley Addiction Profile, SF-6D and EuroQol EQ-5D.

Results

A total of 88 (38.9%) females and 138 (61.1%) males were included in the present analysis. Retention rates among female participants in the diacetylmorphine group were significantly higher than oral methadone (83.3% vs. 47.8%). Males receiving diacetylmorphine improved significantly more than females in physical health, health-related quality of life, and family relations but female participants in the diacetylmorphine group had significantly greater improvements in illicit drug use scores and psychological health compared to females allocated to oral methadone.

Conclusions

Among long-term opioid dependent women who have not benefited sufficiently from available treatments, medically prescribed diacetylmorphine is more effective than oral methadone. Men receiving diacetylmorphine showed more improvements than women.

Keywords: Gender, Opioid dependence, Substitution treatment, Diacetylmorphine, Injectable, Methadone, Oral, Treatment outcome