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

2. 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

3. Dalsbergstien House

4. Intention to Treat ”Hard to Reach” Opioid Addicts Low-threshold housing and limited contacts with specialized health care Varying degree of motivation Low Threshold Buprenophine Stabilization Treatment Consultations with nurse Medical examination Preparation for treatment start Medication start Follow up of somatic and psychic health Estimated time within one week

5. 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 14 mg (+ 4 mg) Day 28 mg (+ 4 mg) Day 312 mg (+ 4 mg) From day 416 mg Supervised intake, with medical/psychosocial follow-up

6. Results – Patient background Status on December 31st, 2012 Initial contacts 215 Previous treatment experience from OMT 80 (37,2%) Previous treatment experience without OMT 88 (40,9%) No previous treatment experience 47 (21,9%) Average age 38 years Male 72.7% Female 27.3% Progression Start on medication 139 (64,9%) –Transfer to OMT 53 In-patient OMT16 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

7. 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

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