Medically supervised opioid withdrawal treatment: is it possible to predict the successful outcome?

Despite the relatively high number of high-risk opioid users in Lithuania, the proportion of these people receiving opioid agonist treatment (OAT) is low – 0.16. Although the number of people in OAT is increasing, the waiting lists for treatment persist. Considering this or refusing OAT, some opioid-dependent individuals seek inpatient treatment to stop using illicit opioids. This study reviews the short-term outcomes of the patients seeking medical help to stop using illicit drugs and maintain in OAT or participate in abstinence-based psychosocial treatment in Vilnius, Lithuania.

Methods: All 65 patients with opioid dependence and current drug use hospitalized in the Republican Centre for Addictive Disorders Vilnius Branch during the year 2021 were included. A case-control study was conducted to determine the sociodemographic and clinical characteristics related to the successful treatment outcomes during the medically supervised opioid withdrawal.

Results: Most of the patients (70.8%) were currently not in the OAT. The main sociodemographic characteristics were: mean age 35.7 (22-59) years, 26.2% women, and 80% officially unemployed. Along with opioids, 86.2% reported polydrug use – benzodiazepines (43.1%) and alcohol (36.9%) being the most common. 4.6% were comorbid with other psychiatric disorders, 6.2% with HIV infection. 15.4% were first-time treatment entrants. 72.3% had no or mild withdrawal symptoms. Only 36.9% of the patients successfully completed the treatment and were referred to OAT or abstinence-based psychosocial treatment. While calculating the odds ratios for potential determinants of successful treatment, none of them were statistically significant.

Conclusion: Our results suggest that there is no reliable predictor for the medically supervised withdrawal treatment outcome. This treatment option with referral to long-term addiction treatment might be suitable for some patients if there is a clear patient consent. An emphasis should be placed on informing patients about possible treatment options, including their risks and outcomes, and increasing the accessibility of OAT.