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On demand services – Results from a low-threshold- Buprenorphine/Naloxone program (LASSO)
Jon-Aksel Jacobsen and Peter Krajci
Oslo Municipality and Oslo University
Aims and PurposeBackground:Approx 3-4.000 patients outside OMT in spite of liberal inclusion criteriaHigh prevalence of injecting usePoly-drug abuseIn extensive need for medical and social follow up
Facilities to reach the ”Hard to reach” abusers• Motivational Clinic in Oslo (2006-09)• LASSO (Low Threshold Substitutional Treatment in Oslo)
– Collaboration: Oslo University Hospital/The Welfare Services in Oslo
Aims to• Reduce the risk of negative health effects from opioid abuse• Reduce opioid use and overdose related mortality• Facilitate treatment of somatic and psychic diseases• Facilitate social stabilization• Reduce criminal activities, prostitution, etc
Dalsbergstien House
Intention to Treat
”Hard to Reach” Opioid Addicts
Low-threshold housing and limited contacts with specialized health care
Varying degree of motivation
Low Threshold Buprenophine Stabilization Treatment
Consultations with nurseMedical examinationPreparation for treatment startMedication startFollow up of somatic and psychic healthEstimated time within one week
Start on substitution medicationPreparationOpioid abstinence for 16-24 hours Stabilization on sleep medication• Trimipramin (25-50 mg 4 hours before sleep)
StartClinical evaulation of opioid abstinence (OOWS and SOWS)Prophylactic treatment with antiemetics Metoclopramid 10 mg 30 min before buprenorphine-naloxone (Suboxone®)
Policlinical start • Day 1 4 mg (+ 4 mg) • Day 2 8 mg (+ 4 mg) • Day 3 12 mg (+ 4 mg) • From day 4 16 mgSupervised intake, with medical/psychosocial follow-up
Results – Patient background Status on December 31st, 2012
Initial contacts 215• Previous treatment experience from OMT 80 (37,2%)• Previous treatment experience without OMT 88 (40,9%)• No previous treatment experience 47 (21,9%)
• Average age 38 years• Male 72.7%• Female 27.3%
Progression• Start on medication 139 (64,9%)
– Transfer to OMT 53• In-patient OMT 16
• More than 90% of these patients were started policlinically by LASSO• A total of 258 policlinical medication starts in 2012, with no episodes of
prominent adverse buprenorphine-provoced abstinence symptoms
Summary and ConclusionOriginal aims of the LASSO Project was to reduce harm of continuous injection
of opioids
ExperienceAmbivalence• Patients need time to start their treatmentBreaks• Fall-outs and restarts are common - many patients experience the need of
tailored treatment to succeedContinuation• Stabilization is often followed by rehabilitation requests
LASSO is beeing adopted by other major cities in Norway
