Download Running head: PICOT PAPER 1 PICOT Paper Natalie Teles

Running head: PICOT PAPER
1 PICOT Paper Natalie Teles University of San Francisco PICOT PAPER
2 PICOT Paper This semester, our clinical group has been placed at HealthRight 360 in the Mission District of San Francisco. Health Right 360 works with clients who deal with substance abuse issues​
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and helps them change their lives by offering medical services, detox, and residential treatment. A large population of the clients at our site are struggling with heroin addiction and show serious signs of withdrawal. These symptoms include the following: anxiety, depression, and sleeplessness. The goal of HealthRight 360 is to help clients get clean and stay clean, while giving them the necessary tools to succeed after treatment. After meeting with our supervisor for post conference, we discussed our client population and what the main issues were. Our group was interested in this topic because we wanted to know the best way to treat heroin addicts and how to prevent relapse and regression. We see the constant struggle with these clients and it is important for us to find the best way to help get these clients back on their feet. Our clinical question is, “ Do young adult male heroin addicts taking Methadone have a higher retention rate in recovery programs compared to those taking Suboxone?” This clinical question is well into our nursing scope of practice. Finding the answer to this clinical question helps us as future nurses to know the best way to treat heroin addicts who are in recovery. We are constantly giving patients their medications and it is important to tell our clients what side effects they may have depending on whether they are on Methadone or Suboxone. A big part of our job as health care professionals is providing education and if clients ask us about treatment options, it is important for us to be able to answer their questions. In addition, it is also important PICOT PAPER
3 for us to know the side effects of each of these treatment options so that our clients and patients know what to expect during recovery. Heroin addiction has been a huge health concern in our country, causing an increase in morbidity and mortality rates. The increase in heroin addiction can cause Hepatitis C, HIV, and overdose, as well as destroy relationships and affect the person’s future. When clients are looking into treatment options, Methadone and Suboxone are commonly prescribed for maintenance therapy and detoxification. Before deciding which treatment is best, it is important to know a little about each of the drugs and the side effects that come along with their usage (Whelan, 2012). From research done on drug users, heroin dependence is more common among a younger age group and also more common among males than females. This is why we wanted to target the young adult male population using heroin for our clinical question. Methadone is a synthetic opioid and can be used with all levels of dependence (Lofwall). Suboxone, also known as, buprenorphine, is a semisynthetic opioid with a “ceiling effect.” After taking a certain amount, the effects of the drug no longer will be increased ( Whelan, 2012). Because of Suboxone’s “ceiling effect”, it causes less respiratory depression than Methadone, which has lower overdose potential; compared to Methadone which has no protective overdose factors. Methadone also has more abuse potential compared to Buprenorphine. Another difference between Methadone and Suboxone is the price of treatment: Suboxone is more expensive than Methadone. There are many factors that go into deciding between Methadone and Suboxone, for example, the patient/doctor’s preference as well as specific guidelines and potential side effects. PICOT PAPER
4 In a recent study done on young adults with heroin addiction going through Methadone treatment, the study showed that there was a high retention rate (​
Kellogg). In another study with both Suboxone and Methadone, the side effects were nearly the same with “nausea ( Suboxone: 17%; Methadone: 16%), bodily pain (Suboxone: 14%; Methadone: 15%), and sweating (Suboxone: 15%; Methadone: 14%)” ​
(Lofwall ). These are all factors that must be considered when deciding between which medication is best to give to the young adult males to have a higher retention rate. In another study with twenty four randomized control trials, Suboxone and Methadone were compared in maintenance therapy for heroin addiction. The study was done with 4,497 young adults in a systematic review as well as a meta­ analysis. In the study, the retention rates were measured and analyzed. The results included that low dose Methadone retained more patients than a low or even medium dose of Suboxone (Whelan, 2012). This then answers the question as to which maintenance therapy was the most successful and had the highest retention rate among the subjects. In conclusion, from the evidence provided above, Methadone is more successful in having a higher retention rate than Suboxone. Although Suboxone tends to be safer because of its “ceiling effect”, the goal is to find the best treatment with the highest retention rate with young males recovering from heroin addiction. In this case, the best treatment option for young adult male heroin addicts would be Methadone. PICOT PAPER
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References Kellogg, S., Melia, D., Khuri, E., Lin, A., Ho, A., & Kreek, M. (n.d.). Adolescent And Young
Adult Heroin Patients. ​
Journal of Addictive Diseases,​
15­25. Lofwall, M., Stitzer, M., Bigelow, G., & Strain, E. (n.d.). Comparative Safety and Side Effect
Profiles of Buprenorphine and Methadone in the Outpatient Treatment of Opioid
Dependence. ​
Addictive Disorders & Their Treatment,​
49­64. Whelan, P., & Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. ​
Journal of Neurosciences in Rural Practice,
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(1), 45­45. doi:10.4103/0976­3147.91934