UBC Theses and Dissertations

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UBC Theses and Dissertations

Opium tincture for opioid substitution treatment Nikoo, Mohammadali


Opioids have served as a dual-purpose substance throughout the human history. While they are listed as an essential medicine by the World Health Organization, on account of their effectiveness at treating pain, their harmful use also leaves a significant burden on societies. Among treatments developed to address the latter, opioid substitution treatment (OST) is a very well-documented and evidence-based treatment, which has shown to improve a multitude of treatment outcomes for patients with opioid dependence. Besides well-established medicines for OST, such as methadone and buprenorphine, opium tincture (OT), a hydro alcoholic preparation of opium, is used for this purpose on a large scale in Iran. The first step of this thesis, which was a systematic review, (2014 - 2016) did not find adequate evidence to make a conclusive recommendation about the safety and efficacy of OT for OST. Following this review, a non- inferiority randomized clinical trial (opium trial) with 204 participants and a 12-week follow-up period, compared the safety and efficacy of OT with methadone in treatment of opioid dependence. A comparison of international samples with participants of opium trial at baseline revealed that patterns of substance use and related risk behaviors differed significantly between Iran and other regions of the world, a factor which needs to be considered when generalizing the findings of the opium trial. Next, the comparison of outcomes between the two arms showed that OT was a clinically effective medication and that OT was more effective than methadone at reducing participants’ opioid use outside of treatment; however, the study could not conclude whether or not OT was non-inferior to methadone at retaining participants in treatment. The number of people with AEs (adverse events) were not significantly different between the two groups. There was no serious adverse event in the OT arm and one in the methadone arm. Substitution treatment with OT has expanded in Iran since its introduction and the results of this trial show potential for its further use. OT can serve as a culturally acceptable and widely available medication for OST, diversifying the treatment options for this condition.

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