Editing Harm reduction (section)

====== Medication assisted treatment (MAT): Opioid agonist therapy (OAT) and Opioid substitution therapy (OST) ======
[[Medication assisted treatment]] (MAT) is the prescription of legal, prescribed opioids or other drugs, often long-acting, to diminish the use of illegal opioids. Many types of MAT exist, including opioid agonist therapy (OAT) where a safer opioid agonist is employed or opioid substitution therapy (OST) which employs partial opioid agonists. However, MAT, OAT, OST are often used synonymously.<ref>{{Cite journal |last1=Noble |first1=Florence |last2=Marie |first2=Nicolas |date=18 January 2019 |title=Management of Opioid Addiction With Opioid Substitution Treatments: Beyond Methadone and Buprenorphine |journal=Frontiers in Psychiatry |volume=9 |page=742 |doi=10.3389/fpsyt.2018.00742 |pmc=6345716 |pmid=30713510 |doi-access=free}}</ref>

[[Opioid agonist therapy]] (OAT) involves the use of a full opioid agonist treatment like methadone and is generally taken daily at a [[Methadone clinic|clinic]].<ref name="NEPOD Report">{{Cite web |last=Mattick |first=Richard P. |display-authors=etal |title=National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD): Report of Results and Recommendation |url=http://www.health.gov.au/internet/drugstrategy/publishing.nsf/Content/8BA50209EE22B9C6CA2575B40013539D/$File/mono52.pdf |archive-url=https://web.archive.org/web/20110309195541/http://www.health.gov.au/internet/drugstrategy/publishing.nsf/Content/8BA50209EE22B9C6CA2575B40013539D/$File/mono52.pdf |archive-date=9 March 2011 |website=Department of Health and Aged Care |publisher=Australian Government}}</ref><ref>{{Cite journal |last1=Soyka |first1=Michael |last2=Franke |first2=Andreas G |date=19 September 2021 |title=Recent advances in the treatment of opioid use disorders – focus on long-acting buprenorphine formulations |journal=World Journal of Psychiatry |volume=11 |issue=9 |pages=543–552 |doi=10.5498/wjp.v11.i9.543 |pmc=8474991 |pmid=34631459 |doi-access=free}}</ref> [[Opioid substitution therapy]] (OST) involves the use of the partial agonist [[buprenorphine]] or a combination of buprenorphine/naloxone (brand name [[Suboxone]]). Oral/sublingual formulations of buprenorphine incorporate the opioid antagonist naloxone to prevent people from crushing the tablets and injecting them.<ref name="NEPOD Report" /> Unlike methadone treatment, buprenorphine therapy can be prescribed month-to-month and obtained at a traditional [[pharmacy]] rather than a clinic.<ref>{{Cite web |title=Opioid Agonist Treatment (OAT): The Gold Standard for Opioid Use Disorder Treatment |url=https://drugpolicy.org/resource/opioid-agonist-treatment-oat-gold-standard-opioid-use-disorder-treatment |url-status=dead |archive-url=https://web.archive.org/web/20220608194055/https://drugpolicy.org/resource/opioid-agonist-treatment-oat-gold-standard-opioid-use-disorder-treatment |archive-date=8 June 2022 |access-date=28 June 2022 |website=Drug Policy Alliance |language=en}}</ref>

The driving principle behind OAT/OST is the program's capacity to facilitate a resumption of stability in the person's life, while they experience reduced symptoms of [[Drug withdrawal|withdrawal]] symptoms and less intense [[Craving (withdrawal)|drug cravings]]; however, a strong euphoric effect is not experienced as a result of the treatment drug.<ref name="NEPOD Report" />

In some countries, such as Switzerland, Austria, and Slovenia, patients are treated with slow-release morphine when methadone is deemed inappropriate due to the individual's circumstances. In Germany, [[dihydrocodeine]] has been used [[Off-label use|off-label]] in OAT for many years, however it is no longer frequently prescribed for this purpose. Extended-release dihydrocodeine is again in current use in Austria for this reason.{{citation needed|date=April 2014}} Research into the usefulness of [[piritramide]], extended-release [[hydromorphone]] (including polymer implants lasting up to 90 days), [[dihydroetorphine]] and other substances for OAT is at various stages in a number of countries.<ref name="NEPOD Report" />  In 2020 in Vancouver, Canada, health authorities began vending machine dispensing of hydromorphone tablets as a response to elevated rates of fatal overdose from street drugs contaminated with fentanyl and fentanyl analogues.<ref>{{Cite web |date=17 February 2020 |title=Opioid vending machine opens in Vancouver |url=http://www.theguardian.com/science/2020/feb/17/opioid-vending-machine-opens-vancouver-mysafe-canada |url-status=live |archive-url=https://web.archive.org/web/20220110180705/https://www.theguardian.com/science/2020/feb/17/opioid-vending-machine-opens-vancouver-mysafe-canada |archive-date=10 January 2022 |access-date=10 January 2022 |website=The Guardian |language=en}}</ref>

In some countries (not the US, UK, Canada, or Australia),<ref name="NEPOD Report" /> regulations enforce a limited time period for people on OAT/OST programs that conclude when a stable economic and psychosocial situation is achieved. (Patients with [[HIV|HIV/AIDS]] or [[hepatitis C]] are usually excluded from this requirement.) In practice, 40–65% of patients maintain complete abstinence from opioids while receiving opioid agonist therapy, and 70–95% are able to reduce their use significantly, while experiencing a concurrent elimination or reduction in medical (improper [[diluent]]s, non-[[Sterilization (microbiology)|sterile]] injecting equipment), psychosocial ([[mental health]], relationships), and legal (arrest and [[imprisonment]]) issues that can arise from the use of illicit opioids.<ref name="NEPOD Report" />

OAT/OST outlets in some settings also offer basic primary health care. These are known as 'targeted primary health care outlet'—as these outlets primarily target people who inject drugs and/or 'low-threshold health care outlet'—as these reduce common barriers clients often face when they try to access health care from the conventional health care outlets.<ref>{{Cite journal |last1=Islam |first1=M. Mofizal |last2=Topp |first2=Libby |last3=Day |first3=Carolyn A. |last4=Dawson |first4=Angela |last5=Conigrave |first5=Katherine M. |year=2012 |title=The accessibility, acceptability, health impact and cost implications of primary healthcare outlets that target injecting drug users: A narrative synthesis of literature |journal=International Journal of Drug Policy |volume=23 |issue=2 |pages=94–102 |doi=10.1016/j.drugpo.2011.08.005 |pmid=21996165}}</ref><ref>{{Cite journal |last1=Islam |first1=M. Mofizal |last2=Topp |first2=Libby |last3=Day |first3=Carolyn A. |last4=Dawson |first4=Angela |last5=Conigrave |first5=Katherine M. |year=2012 |title=Primary healthcare outlets that target injecting drug users: Opportunity to make services accessible and acceptable to the target group |journal=International Journal of Drug Policy |volume=23 |issue=2 |pages=109–10 |doi=10.1016/j.drugpo.2011.11.001 |pmid=22280917}}</ref> For accessing sterile injecting equipment clients frequently visit NSP outlets, and for receiving pharmacotherapy (e.g. methadone, buprenorphine) they visit OST clinics; these frequent visits are used opportunistically to offer much needed health care.<ref>{{Cite journal |last1=Islam |first1=M. Mofizal |last2=Reid |first2=Sharon E. |last3=White |first3=Ann |last4=Grummett |first4=Sara |last5=Conigrave |first5=Katherine M. |last6=Haber |first6=Paul S. |year=2012 |title=Opportunistic and continuing health care for injecting drug users from a nurse-run needle syringe program-based primary health-care clinic |journal=Drug Alcohol Rev |volume=31 |issue=1 |pages=114–115 |doi=10.1111/j.1465-3362.2011.00390.x |pmid=22145983}}</ref><ref>{{Cite journal |last=Islam, M. Mofizal |year=2010 |title=Needle Syringe Program-Based Primary Health Care Centers: Advantages and Disadvantages |journal=Journal of Primary Care & Community Health |volume=1 |issue=2 |pages=100–03 |doi=10.1177/2150131910369684 |pmid=23804370 |s2cid=8663924 |doi-access=free}}</ref> These targeted outlets have the potential to mitigate clients' perceived barriers to access to healthcare delivered in traditional settings. The provision of accessible, acceptable and opportunistic services which are responsive to the needs of this population is valuable, facilitating a reduced reliance on inappropriate and cost-ineffective emergency department care.<ref>{{Cite journal |last1=Harris |first1=Hobart W. |last2=Young |first2=D. M. |year=2002 |title=Care of injection drug users with soft tissue infections in San Francisco, California |journal=Arch Surg |volume=137 |issue=11 |pages=1217–1222 |doi=10.1001/archsurg.137.11.1217 |pmid=12413304}}</ref><ref>{{Cite journal |last1=Pollack |first1=Harold A. |last2=Khoshnood |first2=Kaveh |last3=Blankenship |first3=Kim M. |last4=Altice |first4=Frederick L. |year=2002 |title=The impact of needle exchange-based health services on emergency department use |journal=Journal of General Internal Medicine |volume=17 |issue=5 |pages=341–348 |doi=10.1007/s11606-002-0037-2 |pmc=1495047 |pmid=12047730}}</ref>