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In this piece of original research set in the United Arab Emirates (UAE), Dr Hesham Elarabi and colleagues studied the impact of offering take-home buprenorphine as an incentive for attendance at treatment and for abstinence from opioid drugs. The SSA caught up with Dr Elarabi to find out more.

SSA: What are the benefits of take-home buprenorphine for people who use drugs?

Dr Elarabi: “Take home prescriptions within the incentivised frame work delivered in this study significantly reduced drug use, increased the chances for enhanced retention in treatment, reduced outpatient clinic visits over the long term maintenance, and possibly contributed to higher accessibility by reducing waiting time to address clinics. Take home doses may provide a potential for higher treatment cost effectiveness. This approach carries particular merit at the moment given the limited access to in-person treatment during the the COVID-19 pandemic and the recent drop of the X-waiver requirement for prescribing buprenorphine in the USA”

Why do you think there was an affect on negative drug tests but not on treatment adherence, and is this important?

“Retention is an important outcome as it simulates the benefits of residential programmes in reducing mortality and violations of criminal justice system. Retention may be influenced by interacting factors that need to be studied further. However, in this study a possible reason why enhanced retention was not significant is reduced statistical power due to recruiting a lower than anticipated sample.”

What kind of social problems were diminished in the I-AAM arm?

“Social problems such as poor functioning at work, home management, social and private leisure and personal or family relationships were diminished.”

What are the implications of your study for people who prescribe buprenorphine?

“Clinically, individuals can receive extended take-home or unsupervised doses with minimal concern over poor adherence and diversion – hence reduced outpatient visits. Treatment with buprenorphine can be extend to a wider population of people with opioid use disorder.”

What did you do?

“I developed and delivered a medication management protocol that used both abstinence and adherence monitoring as two separate contingencies to provide take-home doses of buprenorphine as a reward. Monitoring of adherence was performed by a novel technique applying therapeutic drug monitoring.”

Can you briefly describe how addiction treatment is delivered in the United Arab Emirates? How does this differ from the UK?

“Treatment in the UAE is delivered at specialised services with an extended inpatient stay for early recovery and rehabilitation (up to 4 weeks). Similarly, office-based or outpatient management is only provided at specialised addiction facilities and buprenorphine is dispensed at such facilities. In contrast, treatment of addiction in the UK is not limited to a tertiary programme and adopts a shorter inpatient duration. Outpatient management in the UK is available at community mental health service that are widely spread geographically. Buprenorphine dispensing is, performed at these services and licensed community pharmacies.”

The original research was published in Addiction and is available here.


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