In this randomized trial, researchers in Australia examined the differences between observed and unobserved dosing of another opioid replacement therapy — buprenorphine-naloxone — on treatment outcomes and costs. Treatment was dispensed to 61 subjects in the observed group daily, on alternating days, or 3 times per week depending on the stability of the subject. The 58 subjects in the unobserved group were provided take-home medication weekly. All subjects met weekly with a nurse case-manager and participated in intensive treatment services.

At the 3-month follow-up, the observed dosing and unobserved dosing groups did not significantly differ on:

• Retention in treatment services
• Self-reported heroin use
• Use of other drugs
• Improvement in psychological symptoms or quality of life

Comments by Michael G. Boyle, MA
While replication of these study results is needed, we may have to reconsider observed dosing practices. The burden and costs of daily visits to clinics did not add value in this study. Perhaps the time and travel costs would be better spent in activities such as pursuit of employment or education. Further, the savings in treatment costs per person could be used to expand treatment capacity for substitution therapy.