FROM BUPRENORPHINE TO METHADONE - THE PARADOX IN OPIATE AGONIST TREATMENT IN CYPRUS

BACKGROUND

According to the EMCDDA’s 2023 European Drug Report, Cyprus remains among the countries with a low proportion in Opioid Agonist Treatment (OAT) provision. This number has decreased further during COVID-19 pandemic (from 0,31/2019 to 0,17/2021).  Moreover, Cyprus is the only European country that methadone in the addiction field is prescribed exclusively for short-term in-patient detox. In other countries methadone is  widely used as the mainstream opiate agonist treatment option (along with buprenorphine). Based on the estimation of the number of POUs in Cyprus, we argue that methadone provision will attract into treatment a hidden population which seems to have a more problematic pattern of opiate use (polydrug use, chaotic opiate use etc). 

METHODS

Currently, there are five Opiate Agonist Treatment (OAT) units in Cyprus (in all five districts) plus an OAT unit within Central Prison, which provide exclusively buprenorphine/naloxone combination tablets. Considering that only 20% of the total population of POUs in Cyprus receive OAT, it is believed that the introduction of methadone will increase their adherence (and hence, number) in treatment. 

For the purpose of introducing methadone in Cyprus, a set of steps were taken, including the following :

Formulation of methadone guidelines
Training of addiction professionals (doctors, nurses, psychologists, social workers, occupational therapists) in methadone treatment
Study visits in other European countries (Portugal, Greece)
Supervision of addiction professionals
Acquisition of liquid methadone (until now only tablets were available for short term detox)
Modifications in the OAT Units, in order to support methadone clinics

RESULTS

It is expected that the introduction of methadone in OAT will increase the number of POUs receiving agonist treatment. We assume that methadone provision will attract the hidden population, which does not seek any type of treatment at the moment, but might have a more severe pattern of opiate use.

We expect to present our preliminary data on patient number, characteristics and adherence to treatment.

CONCLUSIONS

As pointed out in the evaluation of Cyprus' 2013-2020 National Strategy, there is a need for provision of multiple opioid agonist treatment options.  With the introduction of methadone, as an option in OAT Units, we aim to satisfy this suggestion, in order to provide a person-oriented treatment.