A clinical trial conducted by the University of Maryland School of Medicine has found that administering placebos to patients with opioid use disorder can enhance their adherence to methadone treatment, as well as improve their sleep patterns.
Substance use disorder affects 20 million Americans, and drug overdoses caused over 100,000 fatalities in 2021, as per the Centers for Disease Control and Prevention.
Despite methadone’s proven effectiveness in preventing relapse, approximately half of the patients discontinue their treatment within a year of commencing it.
The study’s findings suggest that including a simple “sugar pill” or placebo could be a viable solution.
Today, JAMA Network Open published a randomized clinical trial led by Annabelle Belcher, PhD, Assistant Professor of Psychiatry at the University of Maryland School of Medicine, which discovered that patients with opioid use disorder who knowingly took a placebo alongside methadone had a higher probability of adhering to their treatment and receiving additional benefits, such as better sleep.
In this research, the investigators recruited 131 patients who were seeking treatment for moderate-to-severe opioid use disorder. These individuals were randomly assigned to receive methadone in combination with a placebo pill or just the standard methadone treatment that is typically administered daily at a clinic. Patients who were selected for the placebo group were informed that they would receive a placebo alongside methadone and were initially briefed about prior studies that had reported the potential benefits of taking placebos to relieve symptoms like pain and low mood. Clinicians were unaware of which patients were receiving placebos and which were receiving only methadone.
Following three months of observation, the researchers observed that 78 percent of the individuals who received placebos remained on methadone, while only 61 percent of the group who did not receive placebos continued the treatment. The placebo group also reported experiencing better sleep quality.
Dr. Belcher added: “We’ve demonstrated it’s feasible to administer a placebo in addition to standard-of-care methadone in a community-based opioid treatment setting without adding a significant burden to clinic procedures; the low-cost, low-risk nature of this intervention could provide an appealing strategy to target early methadone treatment adherence.”
Methadone, among the federally-approved medications used to address opioid use disorder, boasts the most extensive evidence base for generating long-term positive treatment outcomes, including decreased drug use, reduced crime rates, and improved health outcomes. Despite its benefits, methadone can elicit adverse reactions, such as constipation and nausea.
But, according to co-author Eric Weintraub, “there are many factors that get in the way of people’s ability to stay in treatment, including the fact that due to its bioavailability, clearance and half-life, methadone dosing requires a necessarily slow induction process. This means that it could take weeks before a person arrives at a therapeutic dose—a vulnerable time for our patients.”
Traditionally, it has been assumed that deception or concealment is a prerequisite for the placebo effect to take effect, such as convincing a patient that an inactive pill is an active medication. However, an increasing body of research has revealed that placebos can yield benefits even when patients are aware they are taking them. For instance, a clinical trial conducted by Beth Israel Deaconess Medical Center (BIDMC) in 2021 demonstrated that patients with irritable bowel syndrome who knowingly received a placebo experienced a noteworthy decrease in their gastrointestinal symptoms.
Moreover, mounting evidence suggests that open-label placebos engage the same neurotransmitters as double-blind and deceptive placebos. It should be emphasized that the patient-clinician relationship is a crucial aspect of open-label placebo treatments.
Source: 10.1001/jamanetworkopen.2023.7099
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