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Heroin Addiction and Related Clinical Problems: 2014, 16, 4 (pages: 71 - 78)

Increasing importance of measuring outcomes in opioid dependence care: what matters now and in the future?

Maremmani I., Hill D., Gilman M., and Littlewood R.

Summary: Drug use represents a major public health issue in Scotland: there are more than 50000 people with opioid dependence. Specific actions have been introduced to improve services and promote recovery; these include simple treatment guidelines, protocols to allow for high dose methadone to buprenorphine transfers and non-medical prescribing. Currently used outcome measures provide a limited picture of results; these measures should be developed to improve metrics of success. Investments in opioid dependence treatment have been increasing in the last 30 years. Public health spending in England has reached a record high of almost £1 billion in 2013. The change of decision-makers in commissioning of care is increasing interest in new treatment models and outcomes to measure in opioid dependence care. Lower cost treatment pathways, including those based on mutual aid (e.g. Narcotics Anonymous (NA) and SMART Recovery) rather than medication, can be counter posed and described as important alternatives to medical therapy. The most likely outcome for treatment model success is a combination of all the tools currently employed, but it will be essential to have the outcome measures in place to guide the decisions and ensure access to the right mix of appropriate services and interventions. Review of evidence shows that there is no holistic tool for measuring outcomes in opioid dependence care. Existing tools provide measures of progress at patient level – comparison of outcomes above the patient level is needed. A consensus process was operated to test suggested metrics in a balanced score card approach to measuring such outcomes. Interesting differences in results across Europe were discovered using this tool for measuring outcomes in opioid dependence care. It remains important to progress with the measurement of outcomes in opioid dependence care and to ensure that all stakeholders from different backgrounds are able to engage in this work.