Opioid use disorder (OUD) is a chronic condition that affects millions of people worldwide. Methadone, a medication-assisted treatment, is a commonly used treatment for OUD, but it has limitations, including issues with treatment retention and sleep quality. However, recent studies suggest that the use of placebo as an adjunct to methadone may significantly improve these outcomes. In this article, we will explore the benefits of using placebo in the treatment of OUD and how it can improve treatment retention and sleep quality.
A recent randomized clinical trial found that the use of open-label placebo alongside methadone for opioid use disorder (OUD) was associated with greater 90-day treatment retention rates and better sleep quality compared with the use of methadone alone. The study’s findings were published in JAMA Network Open. According to the lead researcher, Annabelle M. Belcher, PhD, an assistant professor of psychiatry at the University of Maryland School of Medicine, retention in treatment is a serious challenge for the field of addiction medicine.
Methadone is a first-line treatment for OUD, but strategies are needed to reduce the adverse effects of high dosages, such as constipation or cardiac arrhythmia. One such strategy the study explores is harnessing placebo effects through pharmacologic conditioning, “wherein a medication’s therapeutic effects are conferred to placebos following repeated pairings with the drug.”
To evaluate the effectiveness of this approach, Belcher and colleagues conducted a single-site randomized clinical trial between Dec. 5, 2017, and Aug. 2, 2019, where participants were exposed to either pharmacologic conditioned open-label placebo (C-OLP) and methadone or solely methadone as part of treatment as usual (TAU). The study included 131 participants (mean age, 45 years), 64.1% of whom were men. Following randomization, 77 were assigned to C-OLP while 54 were assigned to TAU.
The researchers did not find any significant differences in the mean methadone dose at 90 days, which was 83.1 mg for the TAU group and 79.4 mg for the C-OLP group, despite hypothesizing mean dosage would be lower for C-LOP. However, methadone retention rates at 3 months for participants on C-OLP (77.9%) were significantly greater than those receiving TAU (61.1%). C-OLP participants also reported better sleep quality, with an estimated mean Pittsburgh Sleep Quality Index score difference of 1.79 points between the two groups.
Belcher and colleagues underlined the strategy’s potential for low burden and financial impacts, but future studies should rigorously evaluate implementation outcomes, such as patient and staff acceptability and measures of feasibility, to better inform the practicality of implementing a placebo adjunct to methadone treatment. Further studies are also needed to evaluate this intervention’s efficacy on methadone treatment retention.
Overall, the findings of this study highlight the potential benefits of using a placebo adjunct in combination with methadone treatment for opioid use disorder. Not only did it lead to improved treatment retention, but it also had a positive impact on sleep quality. This is an important development in the field of addiction medicine, as retention in treatment is a vital factor in achieving long-term recovery. Moving forward, further research may be needed to determine the optimal dosage and duration of placebo adjunct therapy, as well as its potential for reducing opioid cravings and other withdrawal symptoms. However, this study offers a promising avenue for improving outcomes for those struggling with opioid addiction.
