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Heroin Addiction and Related Clinical Problems: 2020, 22, N1 (pages: 41 - 48)

Nearly thirty years of experience of real-world long-term treatment with Opioid Agonists

Lamanna F., Maremmani A.G.I., and Maremmani I.

Summary: Background: The most significant contradiction in the treatment of Heroin Use Disorder (HUD) is that the disease is considered by the WHO to be a chronic brain disease necessarily involving proneness to relapse over many years, whereas, in most countries, Agonist Opioid Treatment (AOT) has a limited time-span. Methods: The authors describe the demographic, anamnestic, behavioural, psychopathological features, and the loss and traumatic event reactions of 7 patients treated with AO medications continuously for nearly thirty years. Results: At treatment entry, we treated all patients with methadone, but five patients are currently being treated with a low daily dose of buprenorphine. The achieved stabilization dosage was over-standard, between 100 and 250 mg/die, and the stabilization time varied between 2 and 45 months. Drastic changes, all pointing in a positive direction, were observed in the demographic, anamnestic, behavioural and psychopathological features of these patients. The patients' addictive behaviours practically disappeared. The Worthlessness-Being Trapped (W/BT) psychopathological dimension was reduced to a frequency of zero, while all the other dimensions showed much lower scores (less than 50 standardized scores). Regrettably, a Heroin Post-Traumatic Stress Disorder Spectrum (H/PTSD-S) persisted in 5 out of 7 patients even after nearly 30 years of continuous Agonist Opioid Treatment. Conclusions: If addictive behaviours have not disappeared, opioid agonist treatment must not be terminated. Unless and until that condition is met, the W/BT psychopathological dimension continues to be predominant; the same is true if the H/PTSD-S is over 32.