On demand services Results from a lowthreshold-

On demand services – Results from a lowthreshold- Buprenorphine/Naloxone program (LASSO) Jon-Aksel Jacobsen and Peter Krajci Oslo Municipality and Oslo University

Aims and Purpose Background: Approx 3 -4. 000 patients outside OMT in spite of liberal inclusion criteria High prevalence of injecting use Poly-drug abuse In 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 Low Threshold Buprenophine Stabilization Treatment Consultations with nurse Varying degree of motivation Medical examination Preparation for treatment start Medication start Follow up of somatic and psychic health Estimated time within one week

Start on substitution medication Preparation Opioid abstinence for 16 -24 hours Stabilization on sleep medication • Trimipramin (25 -50 mg 4 hours before sleep) Start Clinical 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 mg Supervised intake, with medical/psychosocial follow-up

Results – Patient background Status on December 31 st, 2012 Initial contacts 215 • Previous treatment experience from OMT • Previous treatment experience without OMT • No previous treatment experience • • • Average 38 years Male Female Progression • Start on medication – Transfer to OMT • In-patient OMT • • 80 (37, 2%) 88 (40, 9%) 47 (21, 9%) 72. 7% 27. 3% 139 (64, 9%) 53 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 Conclusion Original aims of the LASSO Project was to reduce harm of continuous injection of opioids Experience Ambivalence • Patients need time to start their treatment Breaks • Fall-outs and restarts are common - many patients experience the need of tailored treatment to succeed Continuation • Stabilization is often followed by rehabilitation requests LASSO is beeing adopted by other major cities in Norway

Thank you for your attension jon. aksel. jacobsen@vel. oslo. kommune. no petkra@ous-hf. no