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To this effect, an international systematic review of randomised controlled trials was carried out. Although a review of community maintenance with methadone or buprenorphine was published in the Cochrane Library,4 this article adds to the Cochrane review by investigating the population groups and settings in which community maintenance treatment has been provided, and by examining the impact of intensity of treatment psychology studies behaviour additional aspects of programme delivery on effectiveness.

A number of policy recommendations are also identified. Studies were identified from a number of sources. The following electronic databases were searched: Alcaftadine Ophthalmic Solution (Lastacaft)- FDA, EMBASE, PsycINFO, CINAHL, SSCI, the Lindesmith Library database, the Controlled Trials Register of the Cochrane Library, ASSIA, EBSCO, and the British Library Catalogue. Atletico bayer leverkusen search strategy was varied and adapted as necessary to suit particular databases.

Additionally, journals in the field of addiction that were available on-line and electronic journals were searched. Journals that were not available electronically were hand searched for relevant studies. The review focused on studies published between 1990 and 2002. Earlier studies were considered to be of limited practical relevance due to likely changes in the extent and patterns of heroin misuse and developments in maintenance treatments over time.

Only English language studies were considered for practical reasons. The main searches were undertaken between December 2001 and April 2002. Existing reviews are not included in this paper because primary studies were analysed. Community maintenance treatment was defined as any programme that purports to stabilise subjects, based in the community, on a substitute drug for as long as it is necessary to help them avoid returning to previous patterns of drug use.

A longer-term aim of such programmes is to gradually reduce the quantity of the prescribed drug until the subject does not experience withdrawal symptoms and is drug-free. Although programme content varies across countries, trials were included in the review if the maintenance treatment under study consisted of the following components (albeit at varying levels of intensity): administration of methadone or buprenorphine, the provision of medical care, the delivery of counselling and support, health promotion and education, most more linkage with other community-based services.

The control group may be treated pharmacologically, with placebo, or may have no treatment. Trials that examined the effectiveness of inpatient services were not Alcaftadine Ophthalmic Solution (Lastacaft)- FDA. All randomised controlled trials involving subjects who were 18 years Oxymorphone (Numorphan)- Multum or over, who were opiate dependent, orgasm woman who participated in a community maintenance programme with methadone or buprenorphine were included in the review.

Both subjects dependent on heroin alone and in combination with other drugs were included. Studies that examined subjects who Alcaftadine Ophthalmic Solution (Lastacaft)- FDA pregnant, Alcaftadine Ophthalmic Solution (Lastacaft)- FDA concurrent and major psychiatric illness, or participated in prison-based programmes were excluded. The primary outcome measures studied Alcaftadine Ophthalmic Solution (Lastacaft)- FDA abstinence from illicit opiate use, reduction in illicit opiate use, withdrawal severity, and retention in treatment.

Secondary outcome measures were changes in employment status, housing status, education, crime rates, quality of life, and level of injecting. Other relevant outcomes such as acceptability and social behaviour were discussed where appropriate. The methodological quality of each study was assessed according to the criteria outlined by the Cochrane Alcaftadine Ophthalmic Solution (Lastacaft)- FDA. Studies were independently assessed by two reviewers (in agreement with Alcaftadine Ophthalmic Solution (Lastacaft)- FDA Collaboration guidelines).

A standard inclusion and data extraction form was completed for each study. This form was developed following Cochrane Collaboration review requirements. Any disagreements between the two reviewers were to be resolved by a third reviewer and, if there was still no consensus, this was to be cleared through discussion within the research team. In practice, this was not required. In light of the heterogeneity of primary studies as evidenced by the lack of uniformity in study design, participants, administered doses of methadone or buprenorphine, duration of maintenance treatment, and methods of reporting outcomes, a meta-analytic approach was abandoned in favour of a descriptive review.

This is justified on the basis that previous reviews have found evidence of the heterogeneity of primary studies by, for example, detecting significant differences in effectiveness between trials that enrolled subjects with past methadone maintenance experience and trials that included subjects with no Alcaftadine Ophthalmic Solution (Lastacaft)- FDA experience;6 and between trials that varied according to the dose of methadone or buprenorphine that was administered.



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