Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Abstract

Introduction: Opiate dependence is a serious, chronic and recurrent psychiatric disorder, whose prevalence reach epidemic proportions. This also contributes to a significant increase in mortality, associated with overdose with opiates, as well as the rise in other health and social problems of the society. The methods and availability of treatment do not correspond to increased treatment needs, and treatment success is limited by the characteristics of the disorder, or numerous risk factors, which contribute to a high percentage of recidivism. Good clinical practice guidelines have defined treatment recommendations that include high and low-demanding programs. The personalized and integrative approaches are emphasized. Case report: The patient aged 41 years, intravenous-use opiate addict from his adolescences, with numerous psychological, health and social complications of addiction, is a participant in institutional treatment, following a court order as a measure of obligatory treatment, due to criminal offenses related to addiction. The history of the disease refers to numerous unsuccessful attempts to heal and short-term abstinence in the past, mainly in penal institutions. The patient meets all the criteria defined by the guidelines for inclusion in the buprenorphine maintenance program started in the year 2013. During the four-year treatment, the doses of the drug were adapted as needed; two heroin relapses and many in-risk situations for relapse were registered. The treatment continued with close monitoring of the patient's condition and, with appropriate psychosocial interventions, contribute to keeping the patient in treatment and preventing the development of new complications of addiction, as well an improving the quality of his life. Discussion: Pharmacological treatment of opioid dependence relies on agents belonging to groups of antagonists, agonists and partial agonists of opiate receptors. The earlier programs with abstinence as a treatment goal have significantly allocated the place to 'harm reduction' programs, where the therapeutic goals are less demanding and defined as the harm-reduction of opiate dependence on the individual and the society. Treatment guidelines define the principles and types of treatment regimens with agonists and partial agonists of opiate receptors and most commonly used are methadone and buprenorphine. The high risk of relapses despite treatment is defined and a comprehensive approaches and inclusion of Cognitive Behavior Therapy /CBT/, family and social therapy are needed. Conclusion: Defining opioid addiction as severe, chronic and recurrent disease, with high prevalence and mortality rate, forces a therapeutic approach similar to the other chronic and widespread diseases in the population. First of all this implies changing treatment goals, in terms of controlling and reducing harm to individuals and society, and then increasing the availability of treatment at the level of primary care outside the hospital and psychiatric institutions. In addition to pharmacological approach maintenance programs, psychosocial programs are also needed to contribute to the better treatment outcome.

Keywords

• dependence
• opiates
• maintenance
• buprenorphine