Good to see some research from Aberdeen focusing on mental health in patients on methadone and other opiate replacement therapy. Academics in Primary Care conducted a systematic review looking at twenty-two studies where mental health had been assessed at baseline and again at follow up. What did they find?
“Mental health significantly improved for all groups receiving ORT in 14 studies in either some or all of the domains assessed. There was tentative evidence to suggest methadone is less effective at improving mental health than other types of ORT.”
What’s doing the improving?
I’m not sure it’s the methadone itself that improves the mental health, it’s not an antidepressant, but more the decreased consequences of active addiction and engagement in moving forward. In any case, it’s good to see evidence that things get better in terms of mental health for many once ORT (opioid substitution therapy) starts. Suboxone might be even more helpful. And things can get better quite quickly. What’s not so clear is what happens in the longer term. There was less evidence that gains were sustained.
Methadone is an evidence based intervention, but it’s a tool. Ideally it should form a part of the recovery journey rather than be the final destination. What happens next, what happens alongside the prescription is vitally important in this regard. With recovery oriented systems of care, many ought to be able to move on. The recent ORT Expert Review recommended:
In all settings, ORT should be delivered as part of a coherent, person centred recovery plan with SMART (specific, measurable, achievable, realistic, timeous) goals and based upon an assessment of individual recovery capital.
Recovery and mental health
There is some nice research showing that people in long term recovery report higher scores on wellbeing than the general population norms. It looks like recovery is good for mental health though we need more information on how populations of recovering people do over time. Research suggests that in the first five years, mental health may be lower than the general population. After five years that flips. (The ‘better than well’ research.) The service users in Leeds, interviewed on what they felt was a ‘good outcome’ from treatment identified that things just got better ‘naturally’ with abstinence.
Wouldn’t it also be fascinating to see some British research published looking at mental health in populations in abstinent recovery over time? That would add to the evidence base in a very helpful way.
[A version of this blog was first published in May 2014]