Methadone Induction in Primary Care for Opioid Dependence: A Pragmatic Randomized Trial (ANRS Methaville)
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{"title"=>"Methadone induction in primary care for opioid dependence: A pragmatic randomized trial (ANRS Methaville)", "type"=>"journal", "authors"=>[{"first_name"=>"Patrizia Maria", "last_name"=>"Carrieri", "scopus_author_id"=>"35855619400"}, {"first_name"=>"Laurent", "last_name"=>"Michel", "scopus_author_id"=>"13006651200"}, {"first_name"=>"Caroline", "last_name"=>"Lions", "scopus_author_id"=>"35293105900"}, {"first_name"=>"Julien", "last_name"=>"Cohen", "scopus_author_id"=>"35338954900"}, {"first_name"=>"Muriel", "last_name"=>"Vray", "scopus_author_id"=>"6701756539"}, {"first_name"=>"Marion", "last_name"=>"Mora", "scopus_author_id"=>"36562264800"}, {"first_name"=>"Fabienne", "last_name"=>"Marcellin", "scopus_author_id"=>"16064300400"}, {"first_name"=>"Bruno", "last_name"=>"Spire", "scopus_author_id"=>"7003921028"}, {"first_name"=>"Alain", "last_name"=>"Morel", "scopus_author_id"=>"7103412617"}, {"first_name"=>"Perrine", "last_name"=>"Roux", "scopus_author_id"=>"20335718300"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"scopus"=>"2-s2.0-84911915785", "doi"=>"10.1371/journal.pone.0112328", "sgr"=>"84911915785", "pmid"=>"25393311", "issn"=>"19326203", "pui"=>"600507561"}, "id"=>"2d7164fd-7c88-35a5-824c-b1c612a01cbb", "abstract"=>"OBJECTIVE: Methadone coverage is poor in many countries due in part to methadone induction being possible only in specialized care (SC). This multicenter pragmatic trial compared the effectiveness of methadone treatment between two induction models: primary care (PC) and SC.\\n\\nMETHODS: In this study, registered at ClinicalTrials.Gov (NCT00657397), opioid-dependent individuals not on methadone treatment for at least one month or receiving buprenorphine but needing to switch were randomly assigned to start methadone in PC (N = 155) or in SC (N = 66) in 10 sites in France. Visits were scheduled at months M0, M3, M6 and M12. The primary outcome was self-reported abstinence from street-opioids at 12 months (M12) (with an underlying 15% non-inferiority hypothesis for PC). Secondary outcomes were abstinence during follow-up, engagement in treatment (i.e. completing the induction period), retention and satisfaction with the explanations provided by the physician. Primary analysis used intention to treat (ITT). Mixed models and the log-rank test were used to assess the arm effect (PC vs. SC) on the course of abstinence and retention, respectively.\\n\\nRESULTS: In the ITT analysis (n = 155 in PC, 66 in SC), which compared the proportions of street-opioid abstinent participants, 85/155 (55%) and 22/66 (33%) of the participants were classified as street-opioid abstinent at M12 in PC and SC, respectively. This ITT analysis showed the non-inferiority of PC (21.5 [7.7; 35.3]). Engagement in treatment and satisfaction with the explanations provided by the physician were significantly higher in PC than SC. Retention in methadone and abstinence during follow-up were comparable in both arms (p = 0.47, p = 0.39, respectively).\\n\\nCONCLUSIONS: Under appropriate conditions, methadone induction in primary care is feasible and acceptable to both physicians and patients. It is as effective as induction in specialized care in reducing street-opioid use and ensuring engagement and retention in treatment for opioid dependence.\\n\\nTRIAL REGISTRATION: Number Eudract 2008-001338-28; ClinicalTrials.gov: NCT00657397; International Standard Randomized Controlled Trial Number Register ISRCTN31125511.", "link"=>"http://www.mendeley.com/research/methadone-induction-primary-care-opioid-dependence-pragmatic-randomized-trial-anrs-methaville", "reader_count"=>24, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Researcher"=>4, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>1, "Student > Master"=>6, "Other"=>5, "Student > Bachelor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Researcher"=>4, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>1, "Student > Master"=>6, "Other"=>5, "Student > Bachelor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>2, "Biochemistry, Genetics and Molecular Biology"=>1, "Nursing and Health Professions"=>1, "Medicine and Dentistry"=>10, "Psychology"=>6, "Social Sciences"=>3, "Economics, Econometrics and Finance"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>10}, "Social Sciences"=>{"Social Sciences"=>3}, "Psychology"=>{"Psychology"=>6}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>2}}, "reader_count_by_country"=>{"United States"=>1}, "group_count"=>2}

Scopus | Further Information

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  • {"files"=>["https://ndownloader.figshare.com/files/1793340"], "description"=>"<p>ITT and <i>per protocol</i> analysis for the difference in the percentage of street-opioid abstinent patients by induction arm and its 95% confidence interval.</p>", "links"=>[], "tags"=>["isrctn", "retention", "anrs", "pc", "abstinence", "Pragmatic Randomized Trial", "methadone induction", "methadone treatment", "sc", "nct", "ITT analysis"], "article_id"=>1240650, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Patrizia Maria Carrieri", "Laurent Michel", "Caroline Lions", "Julien Cohen", "Muriel Vray", "Marion Mora", "Fabienne Marcellin", "Bruno Spire", "Alain Morel", "Perrine Roux"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0112328.t003", "stats"=>{"downloads"=>1, "page_views"=>19, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_ITT_and_per_protocol_analysis_for_the_difference_in_the_percentage_of_street_opioid_abstinent_patients_by_induction_arm_and_its_95_confidence_interval_/1240650", "title"=>"ITT and <i>per protocol</i> analysis for the difference in the percentage of street-opioid abstinent patients by induction arm and its 95% confidence interval.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-11-13 04:00:12"}
  • {"files"=>["https://ndownloader.figshare.com/files/1793342"], "description"=>"<p>Odds ratio from the adjusted mixed model for abstinence from opioids use during the treatment (n = 615 visits and 188 patients).</p>", "links"=>[], "tags"=>["isrctn", "retention", "anrs", "pc", "abstinence", "Pragmatic Randomized Trial", "methadone induction", "methadone treatment", "sc", "nct", "ITT analysis"], "article_id"=>1240652, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Patrizia Maria Carrieri", "Laurent Michel", "Caroline Lions", "Julien Cohen", "Muriel Vray", "Marion Mora", "Fabienne Marcellin", "Bruno Spire", "Alain Morel", "Perrine Roux"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0112328.t004", "stats"=>{"downloads"=>2, "page_views"=>18, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Odds_ratio_from_the_adjusted_mixed_model_for_abstinence_from_opioids_use_during_the_treatment_n_8202_8202_615_visits_and_188_patients_/1240652", "title"=>"Odds ratio from the adjusted mixed model for abstinence from opioids use during the treatment (n = 615 visits and 188 patients).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-11-13 04:00:12"}
  • {"files"=>["https://ndownloader.figshare.com/files/1793344", "https://ndownloader.figshare.com/files/1793345"], "description"=>"<div><p>Objective</p><p>Methadone coverage is poor in many countries due in part to methadone induction being possible only in specialized care (SC). This multicenter pragmatic trial compared the effectiveness of methadone treatment between two induction models: primary care (PC) and SC.</p><p>Methods</p><p>In this study, registered at ClinicalTrials.Gov (NCT00657397), opioid-dependent individuals not on methadone treatment for at least one month or receiving buprenorphine but needing to switch were randomly assigned to start methadone in PC (N = 155) or in SC (N = 66) in 10 sites in France. Visits were scheduled at months M0, M3, M6 and M12. The primary outcome was self-reported abstinence from street-opioids at 12 months (M12) (with an underlying 15% non-inferiority hypothesis for PC). Secondary outcomes were abstinence during follow-up, engagement in treatment (i.e. completing the induction period), retention and satisfaction with the explanations provided by the physician. Primary analysis used intention to treat (ITT). Mixed models and the log-rank test were used to assess the arm effect (PC vs. SC) on the course of abstinence and retention, respectively.</p><p>Results</p><p>In the ITT analysis (n = 155 in PC, 66 in SC), which compared the proportions of street-opioid abstinent participants, 85/155 (55%) and 22/66 (33%) of the participants were classified as street-opioid abstinent at M12 in PC and SC, respectively. This ITT analysis showed the non-inferiority of PC (21.5 [7.7; 35.3]). Engagement in treatment and satisfaction with the explanations provided by the physician were significantly higher in PC than SC. Retention in methadone and abstinence during follow-up were comparable in both arms (p = 0.47, p = 0.39, respectively).</p><p>Conclusions</p><p>Under appropriate conditions, methadone induction in primary care is feasible and acceptable to both physicians and patients. It is as effective as induction in specialized care in reducing street-opioid use and ensuring engagement and retention in treatment for opioid dependence.</p><p>Trial registration</p><p>Number Eudract <a href=\"https://eudract.ema.europa.eu/\" target=\"_blank\">2008-001338-28</a>; ClinicalTrials.gov: <a href=\"http://clinicaltrials.gov/\" target=\"_blank\">NCT00657397</a>; International Standard Randomized Controlled Trial Number Register <a href=\"http://www.controlled-trials.com/isrctn/\" target=\"_blank\">ISRCTN31125511</a></p></div>", "links"=>[], "tags"=>["isrctn", "retention", "anrs", "pc", "abstinence", "Pragmatic Randomized Trial", "methadone induction", "methadone treatment", "sc", "nct", "ITT analysis"], "article_id"=>1240654, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Patrizia Maria Carrieri", "Laurent Michel", "Caroline Lions", "Julien Cohen", "Muriel Vray", "Marion Mora", "Fabienne Marcellin", "Bruno Spire", "Alain Morel", "Perrine Roux"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0112328.s001", "https://dx.doi.org/10.1371/journal.pone.0112328.s002"], "stats"=>{"downloads"=>21, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Methadone_Induction_in_Primary_Care_for_Opioid_Dependence_A_Pragmatic_Randomized_Trial_ANRS_Methaville_/1240654", "title"=>"Methadone Induction in Primary Care for Opioid Dependence: A Pragmatic Randomized Trial (ANRS Methaville)", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-11-13 04:00:12"}

PMC Usage Stats | Further Information

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Relative Metric

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