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Abstract
PURPOSE OF REVIEW The current article reviews the impact of the biggest health crisis for many decades, coronavirus disease 2019 (COVID-19), on opioid treatment programs and the strategies adopted for maintaining opioid treatment programs during the pandemic. RECENT FINDINGS The difficulty of access to opioid treatment services and the mental health problems accompanying opioid use disorders are the two main challenges to maintaining accessible and effective opioid treatment. Many countries and institutions issued guidance and recommendations to address these challenges. General coping strategies, loosening of policies, telemedicine, and depot buprenorphine are four main strategies to cope with the challenges posed by the pandemic. SUMMARY There were considerable obstacles to maintaining opioid intervention programs during the COVID-19 pandemic. Strategies addressing the obstacles are identified. Research in this area needs to be strengthened.
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Affiliation(s)
- Ruihua Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
- Shanghai Key Laboratory of Psychotic Disorders
- CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China
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152
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Panlilio LV, Stull SW, Bertz JW, Burgess-Hull AJ, Lanza ST, Curtis BL, Phillips KA, Epstein DH, Preston KL. Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use. Psychopharmacology (Berl) 2021; 238:1513-1529. [PMID: 33558983 PMCID: PMC8141007 DOI: 10.1007/s00213-021-05782-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
RATIONALE Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized. OBJECTIVES AND METHODS We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine-naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study. RESULTS Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use. CONCLUSIONS People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.
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Affiliation(s)
- Leigh V Panlilio
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA.
| | - Samuel W Stull
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA
| | - Jeremiah W Bertz
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Albert J Burgess-Hull
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Stephanie T Lanza
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA
| | - Brenda L Curtis
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Karran A Phillips
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - David H Epstein
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Kenzie L Preston
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
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153
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Abstract
Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality-notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.
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Affiliation(s)
- Megan Buresh
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Stern
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Darius Rastegar
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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154
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Lintzeris N, Dunlop AJ, Haber PS, Lubman DI, Graham R, Hutchinson S, Arunogiri S, Hayes V, Hjelmström P, Svedberg A, Peterson S, Tiberg F. Patient-Reported Outcomes of Treatment of Opioid Dependence With Weekly and Monthly Subcutaneous Depot vs Daily Sublingual Buprenorphine: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e219041. [PMID: 33970256 PMCID: PMC8111483 DOI: 10.1001/jamanetworkopen.2021.9041] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Patient-reported outcomes in the treatment of opioid dependence may differ between subcutaneously administered depot buprenorphine and daily sublingual buprenorphine. OBJECTIVE To compare patient satisfaction between depot buprenorphine and sublingual buprenorphine in adult outpatients with opioid dependence. DESIGN, SETTING, AND PARTICIPANTS This open-label, randomized clinical trial was conducted among adult patients with opioid dependence at 6 outpatient clinical sites in Australia from October 2018 to September 2019. Data analysis was conducted from October 2019 to May 2020. INTERVENTIONS Participants were randomized to receive treatment with weekly or monthly depot buprenorphine or daily sublingual buprenorphine over 24 weeks. MAIN OUTCOMES AND MEASURES The primary end point was the difference in global treatment satisfaction, assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 (range, 0-100; higher score indicates greater satisfaction) at week 24. Secondary end points included other patient-reported outcomes, including quality of life, treatment burden, and health-related outcomes, as well as measures of opioid use, retention in treatment, and safety. RESULTS A total of 119 participants (70 [58.8%] men; mean [SD] age, 44.4 [10.5] years) were enrolled, randomized to, and received either depot buprenorphine (60 participants [50.4%]) or sublingual buprenorphine (59 participants [49.6%]). From the initial sample of 120, a participant (0.8%) in the sublingual buprenorphine group withdrew consent and did not receive study treatment. All participants were receiving sublingual buprenorphine when enrolled. The mean TSQM global satisfaction score was significantly higher for the depot group compared with the sublingual group at week 24 (mean [SE] score, 82.5 [2.3] vs 74.3 [2.3]; difference, 8.2; 95% CI, 1.7 to 14.6; P = .01). Improved outcomes were also observed for several secondary end points after treatment with depot buprenorphine (eg, mean [SE] treatment burden assessed by the Treatment Burden Questionnaire global score, on which lower scores indicate lower burden: 13.2 [2.6] vs 28.6 [2.5]; difference, -15.4; 95% CI, -22.6 to -8.2; P < .001). Thirty-nine participants (65.0%) in the depot buprenorphine group experienced 117 adverse drug reactions, mainly injection site reactions of mild intensity following subcutaneous administration, and 12 participants (20.3%) in the sublingual buprenorphine group experienced 21 adverse drug reactions. No participants withdrew from the trial medication or the trial due to adverse events. CONCLUSIONS AND RELEVANCE In this study, participants receiving depot buprenorphine reported improved treatment satisfaction compared with those receiving sublingual buprenorphine. The results highlight the application of patient-reported outcomes as alternative end points to traditional markers of substance use in addiction treatment outcome studies. TRIAL REGISTRATION anzctr.org.au Identifier: ANZCTR12618001759280.
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Affiliation(s)
- Nicholas Lintzeris
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- University Sydney, Discipline of Addiction Medicine, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
| | - Adrian J. Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
- University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Paul S. Haber
- University Sydney, Discipline of Addiction Medicine, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Dan I. Lubman
- Turning Point, Eastern Health and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Robert Graham
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah Hutchinson
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- University Sydney, Discipline of Addiction Medicine, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Victoria Hayes
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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155
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Landeck J, Zgierska AE. Six Tips to Effectively Treat Opioid Use Disorder in Rural Areas. Fam Pract Manag 2021; 28:23-27. [PMID: 33973752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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156
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Benville JR, Compton P, Giordano NA, Cheatle MD. Perceived social support in patients with chronic pain with and without opioid use disorder and role of medication for opioid use disorder. Drug Alcohol Depend 2021; 221:108619. [PMID: 33667781 PMCID: PMC8796693 DOI: 10.1016/j.drugalcdep.2021.108619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/31/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND A significant predictor of treatment outcomes for patients with chronic non-cancer pain (CNCP) and opioid use disorder (OUD) is the degree and quality of social support they receive. Specifically, in patients with CNCP and on long-term opioid therapy, the development of OUD tends to be associated with losses in social support, while engagement in treatment for OUD improves support networks. Delivery of the evidence-based OUD treatment medications, methadone and buprenorphine, occurs in clinical environments which patently differ with respect to social support resources. The aims of this study were to describe perceived social support in patients with CNCP without OUD (no-OUD), with OUD and on buprenorphine (OUD-BP), and with OUD and on methadone (OUD-methadone). METHODS Using the Duke Social Support Index (DSSI), perceived social support in a sample of Caucasian patients with CNCP and on opioid therapy was compared between no-OUDs (n = 834), OUD-methadone (n = 83) and OUD-BP (n = 99) therapy. Average DSSI scores were compared across groups and a linear regression model computed to describe association between group and perceived social support. RESULTS No difference was observed in DSSI scores between no-OUDs and OUD-methadone, however scores were lower among OUD-BP participants than those receiving methadone (x = -5.2; 95% CI: -7.5, -2.9) and (x = -6.5, 95% CI: -8.2, -4.9). CONCLUSIONS Patients with CNCP and OUD on methadone therapy endorse levels of social support comparable to those without OUD, however those on buprenorphine therapy report significantly less support, bringing implications for OUD treatment outcomes.
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Affiliation(s)
- Julia R Benville
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 500, Philadelphia, PA, 19104, United States; Department of Psychiatry, NYU School of Medicine, Bellevue Hospital, 462 First Avenue, Room A842, New York, NY 10016, United States.
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Claire Fagin Hall, Room 402, Philadelphia, PA, 19104, United States.
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, United States.
| | - Martin D Cheatle
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 500, Philadelphia, PA, 19104, United States.
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157
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Wong JSH, Nikoo M, Westenberg JN, Suen JG, Wong JYC, Krausz RM, Schütz CG, Vogel M, Sidhu JA, Moe J, Arishenkoff S, Griesdale D, Mathew N, Azar P. Comparing rapid micro-induction and standard induction of buprenorphine/naloxone for treatment of opioid use disorder: protocol for an open-label, parallel-group, superiority, randomized controlled trial. Addict Sci Clin Pract 2021; 16:11. [PMID: 33579359 PMCID: PMC7881636 DOI: 10.1186/s13722-021-00220-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Buprenorphine/naloxone (Suboxone) is a current first-line treatment for opioid use disorder (OUD). The standard induction method of buprenorphine/naloxone requires patients to be abstinent from opioids and therefore experience withdrawal symptoms prior to induction, which can be a barrier in starting treatment. Rapid micro-induction (micro-dosing) involves the administration of small, frequent does of buprenorphine/naloxone and removes the need for a period of withdrawal prior to the start of treatment. This study aims to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone in patients with OUD. METHODS This is a randomized, open-label, two-arm, superiority, controlled trial comparing the safety and effectiveness of rapid micro-induction versus standard induction of buprenorphine/naloxone for the treatment of OUD. A total of 50 participants with OUD will be randomized at one Canadian hospital. The primary outcome is the completion of buprenorphine/naloxone induction with low levels of withdrawal. Secondary outcomes are treatment retention, illicit drug use, self-reported drug use behaviour, craving, pain, physical health, safety, and client satisfaction. DISCUSSION This is the first randomized controlled trial to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone. This study will thereby generate evidence for a novel induction method which eliminates substantial barriers to the use of buprenorphine/naloxone in the midst of the ongoing opioid crisis. Trial registration ClinicalTrials.gov, NCT04234191; date of registration: January 21, 2020; https://clinicaltrials.gov/ct2/show/NCT04234191.
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Affiliation(s)
- James S H Wong
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada.
| | - Mohammadali Nikoo
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Jean N Westenberg
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Janet G Suen
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Y C Wong
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Reinhard M Krausz
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Christian G Schütz
- Behavioral Reward Affect + Impulsivity Neuroscience Lab, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Marc Vogel
- Division of Addictive Disorders, University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jesse A Sidhu
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Nickie Mathew
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Pouya Azar
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
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158
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Barenie RE, Sinha MS, Kesselheim AS. Factors Affecting Buprenorphine Utilization and Spending in Medicaid, 2002-2018. Value Health 2021; 24:182-187. [PMID: 33518024 DOI: 10.1016/j.jval.2020.04.1840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Buprenorphine is an essential medication for the treatment of opioid use disorder (OUD), but studies show it has been underused over the last 2 decades. We sought to evaluate utilization of and spending on buprenorphine formulations in Medicaid and to evaluate the impact of key market and regulatory factors affecting availability of different formulations and generic versions. METHODS We first identified all buprenorphine formulations approved by the Food and Drug Administration for OUD using Drugs@FDA. We then used National Drug Codes to identify each drug in the Medicaid State Drug Utilization Data and extracted annual utilization rates and spending between 2002 and 2018 by drug and according to whether a brand-name or generic version was dispensed. We compared these trends to market and regulatory factors that affected competition, which we identified through searching the Federal Register, Westlaw, PubMed, and Google News. RESULTS Brand-name buprenorphine-naloxone sublingual tablet and film formulations (Suboxone) were dispensed 2.7 times more (n = 634 213 140) and reimbursed 4.4 times more (n = $4 440 556 473) than all other formulations combined (n = 237 769 689; $1 018 988 133). We identified numerous market and regulatory factors that contributed to an estimated 9-year delay in generic versions of the tablet formulation and 6-year delay for generic versions of the film formulation. CONCLUSIONS Brand-name buprenorphine formulations have been widely used in Medicaid, leading to substantial costs, in part because generic versions were delayed by multiple years owing to market and regulatory factors. Timely availability of low-cost generics could have helped encourage OUD treatment with buprenorphine during the height of the opioid crisis.
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Affiliation(s)
- Rachel E Barenie
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Michael S Sinha
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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159
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Beaulieu E, DiGennaro C, Stringfellow E, Connolly A, Hamilton A, Hyder A, Cerdá M, Keyes KM, Jalali MS. Economic Evaluation in Opioid Modeling: Systematic Review. Value Health 2021; 24:158-173. [PMID: 33518022 PMCID: PMC7864393 DOI: 10.1016/j.jval.2020.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/29/2020] [Accepted: 07/25/2020] [Indexed: 05/08/2023]
Abstract
OBJECTIVES The rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature. METHODS A systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. RESULTS The screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studies' accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. CONCLUSION The review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research.
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Affiliation(s)
- Elizabeth Beaulieu
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Catherine DiGennaro
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Erin Stringfellow
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Ava Connolly
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Ava Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ayaz Hyder
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA; Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.
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160
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Joudrey PJ, Bart G, Brooner RK, Brown L, Dickson-Gomez J, Gordon A, Kawasaki SS, Liebschutz JM, Nunes E, McCarty D, Schwartz RP, Szapocnik J, Trivedi M, Tsui JI, Williams A, Wu LT, Fiellin DA. Research priorities for expanding access to methadone treatment for opioid use disorder in the United States: A National Institute on Drug Abuse Center for Clinical Trials Network Task Force report. Subst Abus 2021; 42:245-254. [PMID: 34606426 PMCID: PMC8790761 DOI: 10.1080/08897077.2021.1975344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the US, methadone treatment can only be provided to patients with opioid use disorder (OUD) through federal and state-regulated opioid treatment programs (OTPs). There is a shortage of OTPs, and racial and geographic inequities exist in access to methadone treatment. The National Institute on Drug Abuse Center for Clinical Trials Network convened the Methadone Access Research Task Force to develop a research agenda to expand and create more equitable access to methadone treatment for OUD. This research agenda included mechanisms that are available within and outside the current regulations. The task force identified 6 areas where research is needed: (1) access to methadone in general medical and other outpatient settings; (2) the impact of methadone treatment setting on patient outcomes; (3) impact of treatment structure on outcomes in patients receiving methadone; (4) comparative effectiveness of different medications to treat OUD; (5) optimal educational and support structure for provision of methadone by medical providers; and (6) benefits and harms of expanded methadone access. In addition to outlining these research priorities, the task force identified important cross-cutting issues, including the impact of patient characteristics, treatment, and treatment system characteristics such as methadone formulation and dose, concurrent behavioral treatment, frequency of dispensing, urine or oral fluid testing, and methods of measuring clinical outcomes. Together, the research priorities and cross-cutting issues represent a compelling research agenda to expand access to methadone in the US.
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Affiliation(s)
- Paul J. Joudrey
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gavin Bart
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Robert K. Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lawrence Brown
- START Treatment and Recovery Centers, Brooklyn, New York, USA
| | - Julie Dickson-Gomez
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adam Gordon
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Sarah S. Kawasaki
- Department of Psychiatry and Behavioral Health, Penn State University, State College, Pennsylvania, USA
| | - Jane M. Liebschutz
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Dennis McCarty
- Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - José Szapocnik
- Department of Public Health Sciences, University of Miami, Coral Gables, Florida, USA
| | - Madhukar Trivedi
- Division of Mood Disorders, Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Judith I. Tsui
- Division of General Internal Medicine, Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Arthur Williams
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University, New York, New York, USA
| | - Li-Tzy Wu
- Department of Medicine and Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - David A. Fiellin
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, Yale School of Public Health, New Haven, Connecticut, USA
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Eydt E, Glegg S, Sutherland C, Meador K, Trew M, Perreault M, Goyer MÈ, Le Foll B, Turnbull J, Fairbairn N. Service delivery models for injectable opioid agonist treatment in Canada: 2 sequential environmental scans. CMAJ Open 2021; 9:E115-E124. [PMID: 33622764 PMCID: PMC8034381 DOI: 10.9778/cmajo.20200021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) is an emerging evidence-based option in the continuum of care for opioid use disorder in parts of Canada. Our study objective was to identify and describe iOAT programs operating during the ongoing opioid overdose crisis. METHODS We conducted 2 sequential environmental scans. Programs were eligible to participate if they were in operation as of Sept. 1, 2018, and Mar. 1, 2019. Information was collected over 2-3 months for each scan (September-October 2018, March-May 2019). Programs that participated in the first scan and newly established programs were invited to participate in the second scan. The scans included questions about location, service delivery model, clinical and operational characteristics, numbers and demographic characteristics of clients, and program barriers and facilitators. Descriptive analysis was performed. RESULTS We identified 14 unique programs across the 2 scans. Eleven programs located in urban centres in British Columbia and Ontario participated in the first scan. At the time of the second scan, 2 of these programs were on hold and 2 of 3 newly established programs were in Alberta. The total capacity of all participating programs was 420 clients at most. Four service delivery models were identified; iOAT was most commonly integrated within existing health and social services. All programs offered hydromorphone, and 1 program also offered diacetylmorphine. In the first scan, 73% of clients (133/183) were male; the mean age of clients was 47 years. Limited capacity, pharmacy operations and lack of diacetylmorphine access were among the most frequently reported barriers. The most commonly reported facilitators included client-centred care, client relationships and access to other health and social support. INTERPRETATION Evidence indicates that iOAT can be successfully implemented using diverse service delivery models. Future work should facilitate scale-up of this evidence-based treatment where gaps persist in high-risk communities.
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Affiliation(s)
- Erin Eydt
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Stephanie Glegg
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Christy Sutherland
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Karine Meador
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Michael Trew
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Michel Perreault
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Marie-Ève Goyer
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Bernard Le Foll
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Jeffrey Turnbull
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
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Steel D, Tekin Ş. Can Treatment for Substance Use Disorder Prescribe the same Substance as that Used? The Case of Injectable Opioid Agonist Treatment. Kennedy Inst Ethics J 2021; 31:271-301. [PMID: 34565745 DOI: 10.1353/ken.2021.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article examines injectable Opioid Agonist Treatment (iOAT), in which patients suffering from long-term, treatment refractory opioid use disorder (OUD) are prescribed injectable diacetylmorphine, the active ingredient of heroin. While iOAT is part of the continuum of care for OUD in some European countries and in some parts of Canada, it is not an available treatment in the United States. We suggest that one reason for this situation is the belief that a genuine treatment for substance use disorder cannot prescribe the same substance as that used. We examine possible rationales for this belief by considering four combinations of views on the constitutive causal basis of substance use disorders and the definition of effective treatment. We show that all but one combination counts iOAT as a genuine treatment and that there are good reasons to reject the one that does not. Specifically, we claim that medical interventions, such as iOAT, that significantly reduce the severity of a disorder deserve to be categorized as effective treatments and regarded as such in practice.
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163
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Patel A, Dietz P, Casto A, DePond J, Taylor L, Seybold D, Blake A, Calhoun B. Autonomous Care Pathway to Patient Opioid Abstinence: Should All Programs Offer this Approach? Issues Law Med 2021; 36:193-210. [PMID: 36629776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The opioid epidemic resulted in vast increase in neonatal opioid withdrawal syndrome (NOWS). To mitigate NOWS and opioid dependency among women, staff established a gender specific, patient driven, autonomy based, outpatient therapeutic substitution program. METHODS Prospective observational study of obstetric patients receiving prenatal care 7/1/2016-12/31/2019. Patients underwent universal urine drug screens to identify illicit drug use with dependency and offered addiction counseling with voluntary outpatient therapeutic substitution in an obstetrical-addictions combined clinic to achieve abstinence with oral Buprenorphine tapering protocol. Urine substance screening and cord blood testing were obtained at delivery. Birth outcomes compared among groups who achieved abstinence at birth, were successful at tapering, or continued opioid use. RESULTS Of 783 births, 165 (20.9%) demonstrated opioid use with 91 (55.2%) participating at some point in pregnancy in therapeutic substitution program. At birth, 14/94 (14.9%) patients completed the program and achieved opioid abstinence, 22/94 (23.4%) still enrolled and actively tapering. 57/94 (34.5%) patients were lost to follow-up, relapsed, or terminated due to non-compliance. Seventy-four of 67 (44.3%) opioid positive mothers chose not to enroll. Of 14 women who completed the program, 0 babies born with NOWS, compared to 11/22 (50%) still enrolled in program and actively tapering, 29/57 (50.9%) lost to follow-up, relapsed, or terminated due to non-compliance, and 28/74 (37.8%) never enrolled in program. CONCLUSION/IMPLICATIONS Outpatient therapeutic substitution with oral Buprenorphine with abstinence is possible in pregnant patients and results zero NOWS. More data are needed to confirm findings and explore methods for enhanced success in obtaining abstinence. SUPPORT Appalachian Regional Commission and Prevention (ARC) 1st through Charleston Area Medical Center in cooperation with Charleston Health Education and Research Institute (CHERI).
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Affiliation(s)
- Akhil Patel
- West Virginia University/Charleston Area Medical Center, Charleston, WV, United States
| | - Paul Dietz
- West Virginia University/Charleston Area Medical Center, Charleston, WV, United States
| | - Angela Casto
- Charleston Area Medical Center (CAMC), Women's Medicine Center, Charleston, WV United States
| | - Jennifer DePond
- Charleston Area Medical Center (CAMC), Women's Medicine Center, Charleston, WV United States
| | - Lesli Taylor
- CAMC Health, Education, and Research Institute, Charleston WV, United States
| | - Dara Seybold
- CAMC Health, Education, and Research Institute, Charleston WV, United States
| | - Ashley Blake
- West Virginia University of Osteopathic Medicine, Lewisburg, WV, United States
| | - Byron Calhoun
- West Virginia University/Charleston Area Medical Center, Charleston, WV, United States
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Leo P, Gastala N, Fleurimont J, Messmer S, Maes P, Richardson J, Neeb C, Stackhouse N, Koruba S, Watson DP. A Community Partnership to Improve Access to Buprenorphine in a Homeless Population. Ann Fam Med 2021; 19:85. [PMID: 33431401 PMCID: PMC7800747 DOI: 10.1370/afm.2636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Paul Leo
- Corresponding author Paul A. Leo, MD, 1919 W. Taylor Street M/C 663, Chicago, IL 60612,
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165
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Ramli FF, Syed Hashim SA, Mohd Effendy N. Factors Associated with Low Bone Density in Opioid Substitution Therapy Patients: A Systematic Review. Int J Med Sci 2021; 18:575-581. [PMID: 33390827 PMCID: PMC7757153 DOI: 10.7150/ijms.52201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/19/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Long-term opioid therapy is a risk factor for low bone mineral density (BMD). However, other factors may also contribute to low BMD. Several studies have examined the variables that might contribute to low BMD in patients receiving opioid replacement therapy (OST). However, to our knowledge, there was no systemic review conducted to address this particular issue. Thus, we reviewed the articles on the factors associated with low BMD in the population of opioid use disorder receiving substitution therapy. Methods: The articles that examined correlates or risk factors of low BMD in OST population were retrieved from OVID, SCOPUS, and PUBMED from inception until July 2020 by two independent investigators. Results: A total of 429 articles from three databases were retrieved initially. After screening based on eligibility criteria, five articles were included in the final analysis. The risk factors or correlates found to be significantly associated with low BMD in the OST population include male gender, low body mass index, low testosterone level, methadone or heroin use, and longer duration of heavy alcohol use. The review limitations include small sample sizes and inconsistent definition of variables. Conclusion: OST patients should be screened for BMD and its associated factors. Guidelines and training of practitioners involving in the OST service should be provided to increase the detection of low BMD in the OST population.
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Affiliation(s)
- Fitri Fareez Ramli
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Syed Alhafiz Syed Hashim
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Nadia Mohd Effendy
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Bandar Baru Nilai, 71800 Nilai, Negeri Sembilan, Malaysia
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Hughto JMW, Peterson L, Perry NS, Donoyan A, Mimiaga MJ, Nelson KM, Pantalone DW. The provision of counseling to patients receiving medications for opioid use disorder: Telehealth innovations and challenges in the age of COVID-19. J Subst Abuse Treat 2021; 120:108163. [PMID: 33298301 PMCID: PMC7545305 DOI: 10.1016/j.jsat.2020.108163] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/02/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
| | | | - Nicholas S Perry
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | | | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - David W Pantalone
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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Oberleitner LMS, Madden LM, Muthulingam D, Marcus R, Oberleitner DE, Beitel M, Gaeta M, Tamberelli JF, Barry DT. A qualitative investigation of addiction counselors' perceptions and experiences implementing an open-access model for treating opioid use disorder. J Subst Abuse Treat 2020; 121:108191. [PMID: 33357602 DOI: 10.1016/j.jsat.2020.108191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine addiction counselors' perceptions and experiences of implementing an open-access model for methadone maintenance treatment (MMT), in which the program rapidly enrolled prospective patients, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. Between 2006, when the treatment program initially implemented this model, and 2020, the census of clients receiving methadone maintenance at the study site grew from 1431 to 4500. METHODS Participants were 31 addiction counselors employed at a treatment organization that implemented an open-access model to scale up MMT. We examined counselors' perceptions and experiences of working in programs that employed this model, using individual semi-structured interviews, which an interdisciplinary team audiotaped, transcribed, and systematically coded using grounded theory. The team reviewed themes and reconciled disagreements (rater agreement was 98%). We describe themes that more than 10% of participants reported. RESULTS Counselors described perceived advantages of the open-access model for clients (e.g., "individualized to client needs"), clinicians (e.g., "fewer demands"), and the community (e.g., "crime reduced"). Counselors also described perceived disadvantages of the open-access model for clinicians (e.g., "uneven workload") and clients (e.g., "need for more intensive services for some clients"), as well as program-level concerns (e.g., "perceived lack of structure"). CONCLUSIONS Counselors who work in opioid treatment programs that use an open-access framework described multiple benefits to themselves, their clients, and the public; they also outlined disadvantages for themselves and clients, which research should further explore and address to facilitate MMT scale up.
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Affiliation(s)
- Lindsay M S Oberleitner
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Lynn M Madden
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA
| | - Dharushana Muthulingam
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA; Washington University, Division of Infectious Disease, St. Louis, MO 63112, USA
| | - Ruthanne Marcus
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA
| | - David E Oberleitner
- The APT Foundation, Inc., New Haven, CT 06519, USA; University of Bridgeport, Department of Psychology, Bridgeport, CT 06604, USA
| | - Mark Beitel
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Child Study Center, New Haven, CT 06510, USA
| | - Marina Gaeta
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Joseph F Tamberelli
- Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Declan T Barry
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Child Study Center, New Haven, CT 06510, USA.
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Abstract
BACKGROUND The prevalence of substance use, both prescribed and non-prescribed, is increasing in many areas of the world. Substance use by women of childbearing age contributes to increasing rates of neonatal abstinence syndrome (NAS). Neonatal opioid withdrawal syndrome (NOWS) is a newer term describing the subset of NAS related to opioid exposure. Non-pharmacological care is the first-line treatment for substance withdrawal in newborns. Despite the widespread use of non-pharmacological care to mitigate symptoms of NAS, there is not an established definition of, and standard for, non-pharmacological care practices in this population. Evaluation of safety and efficacy of non-pharmacological practices could provide clear guidance for clinical practice. OBJECTIVES To evaluate the safety and efficacy of non-pharmacological treatment of infants at risk for, or having symptoms consistent with, opioid withdrawal on the length of hospitalization and use of pharmacological treatment for symptom management. Comparison 1: in infants at risk for, or having early symptoms consistent with, opioid withdrawal, does non-pharmacological treatment reduce the length of hospitalization and use of pharmacological treatment? Comparison 2: in infants receiving pharmacological treatment for symptoms consistent with opioid withdrawal, does concurrent non-pharmacological treatment reduce duration of pharmacological treatment, maximum and cumulative doses of opioid medication, and length of hospitalization? SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 10); Ovid MEDLINE; and CINAHL on 11 October 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster trials. SELECTION CRITERIA We included trials comparing single or bundled non-pharmacological interventions to no non-pharmacological treatment or different single or bundled non-pharmacological interventions. We assessed non-pharmacological interventions independently and in combination based on sufficient similarity in population, intervention, and comparison groups studied. We categorized non-pharmacological interventions as: modifying environmental stimulation, feeding practices, and support of the mother-infant dyad. We presented non-randomized studies identified in the search process narratively. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Primary outcomes in infants at risk for, or having early symptoms consistent with, opioid withdrawal included length of hospitalization and pharmacological treatment with one or more doses of opioid or sedative medication. Primary outcomes in infants receiving opioid treatment for symptoms consistent with opioid withdrawal included length of hospitalization, length of pharmacological treatment with opioid or sedative medication, and maximum and cumulative doses of opioid medication. MAIN RESULTS We identified six RCTs (353 infants) in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated between 1975 and 2018. We identified no RCTs in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. The certainty of evidence for all outcomes was very low to low. We also identified and excluded 34 non-randomized studies published between 2005 and 2018, including 29 in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated and five in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. We identified seven preregistered interventional clinical trials that may qualify for inclusion at review update when complete. Of the six RCTs, four studies assessed modifying environmental stimulation in the form of a mechanical rocking bed, prone positioning, non-oscillating waterbed, or a low-stimulation nursery; one study assessed feeding practices (comparing 24 kcal/oz to 20 kcal/oz formula); and one study assessed support of the maternal-infant dyad (tailored breastfeeding support). There was no evidence of a difference in length of hospitalization in the one study that assessed modifying environmental stimulation (mean difference [MD) -1 day, 95% confidence interval [CI) -2.82 to 0.82; 30 infants; very low-certainty evidence) and the one study of support of the maternal-infant dyad (MD -8.9 days, 95% CI -19.84 to 2.04; 14 infants; very low-certainty evidence). No studies of feeding practices evaluated the length of hospitalization. There was no evidence of a difference in use of pharmacological treatment in three studies of modifying environmental stimulation (typical risk ratio [RR) 1.00, 95% CI 0.86 to 1.16; 92 infants; low-certainty evidence), one study of feeding practices (RR 0.92, 95% CI 0.63 to 1.33; 49 infants; very low-certainty evidence), and one study of support of the maternal-infant dyad (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). Reported secondary outcomes included neonatal intensive care unit (NICU) admission, days to regain birth weight, and weight nadir. One study of support of the maternal-infant dyad reported NICU admission (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). One study of feeding practices reported days to regain birth weight (MD 1.10 days, 95% CI 2.76 to 0.56; 46 infants; very low-certainty evidence). One study that assessed modifying environmental stimulation reported weight nadir (MD -0.28, 95% CI -1.15 to 0.59; 194 infants; very low-certainty evidence) and one study of feeding practices reported weight nadir (MD -0.8, 95% CI -2.24 to 0.64; 46 infants; very low-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain whether non-pharmacological care for opioid withdrawal in newborns affects important clinical outcomes including length of hospitalization and use of pharmacological treatment based on the six included studies. The outcomes identified for this review were of very low- to low-certainty evidence. Combined analysis was limited by heterogeneity in study design and intervention definitions as well as the number of studies. Many prespecified outcomes were not reported. Although caregivers are encouraged by experts to optimize non-pharmacological care for opioid withdrawal in newborns prior to initiating pharmacological care, we do not have sufficient evidence to inform specific clinical practices. Larger well-designed studies are needed to determine the effect of non-pharmacological care for opioid withdrawal in newborns.
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Affiliation(s)
- Adrienne Pahl
- Pediatrics, University of Vermont Medical Center, Burlington, VT, USA
| | - Leslie Young
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Madge E Buus-Frank
- The Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | | | - Roger Soll
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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169
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Abstract
Kratom (Mitragyna speciosa) is a plant extract that exhibits opioid agonistic activity at the µ-opioid receptor. The use of this substance has increased recently due to widespread local availability across the United States, primarily at gas stations. Repeated kratom use has been shown to have major adverse effects leading to physiological dependence and addiction similar to other opioids. We used a novel contingency management (CM) program utilizing nonmonetary reinforcers along with medication-assisted treatment (MAT) using buprenorphine in an office-based setting to treat kratom use disorder in two cases. MAT with buprenorphine in a CM-based setting was found to be an effective strategy for treating kratom use disorder.
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Affiliation(s)
- Seth Kalin
- House Officer, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Salaahuddin Dakhlalla
- House Officer, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Saurabh Bhardwaj
- Medical Director, Addiction Program, Assistant Professor of Psychiatry, Department of Psychiatry and Hu-man Behavior, University of Mississippi Medical Center, Jackson, Mississippi
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170
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Zarkin GA, Orme S, Dunlap LJ, Kelly SM, Mitchell SG, O'Grady KE, Schwartz RP. Cost and cost-effectiveness of interim methadone treatment and patient navigation initiated in jail. Drug Alcohol Depend 2020; 217:108292. [PMID: 32992151 PMCID: PMC7736121 DOI: 10.1016/j.drugalcdep.2020.108292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with opioid use disorder (OUD) who are released from pre-trial detention in jail have a high risk of opioid relapse. While several interventions for OUD initiated during incarceration have been studied, few have had an economic evaluation. As part of a three-group randomized trial, we estimated the cost and cost-effectiveness of a negative urine opioid test. Detainees were assigned to interim methadone (IM) in jail with continued methadone treatment post-release with and without 3 months of post-release patient navigation (PN) compared to an enhanced treatment-as-usual group. METHODS We implemented a micro-costing approach from the provider's perspective to estimate the cost per participant in jail and over the 12 months post-release from jail. Economic data included jail-based and community-based service utilization, self-reported healthcare utilization and justice system involvement, and administrative arrest records. Our outcome measure is the number of participants with a negative opioid urine test at their 12-month follow-up. We calculated incremental cost-effectiveness ratios (ICERs) for intervention costs only and costs from a societal perspective. RESULTS The average cost of providing patient navigation services per individual beginning in jail and continuing in the community was $283. We find that IM is dominated by ETAU and IM + PN. Per additional participant with a negative opioid urine test, the ICER for IM + PN including intervention costs only is $91 and $305 including societal costs. CONCLUSIONS IM + PN is almost certainly the cost-effective choice from both an intervention provider and societal perspective.
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Affiliation(s)
- Gary A Zarkin
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States
| | - Stephen Orme
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States.
| | - Laura J Dunlap
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, 4094 Campus Drive, College Park, MD 20742, United States
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
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171
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Castillo M, Conte B, Hinkes S, Mathew M, Na CJ, Norindr A, Serota DP, Forrest DW, Deshpande AR, Bartholomew TS, Tookes HE. Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic. Harm Reduct J 2020; 17:88. [PMID: 33203460 PMCID: PMC7671179 DOI: 10.1186/s12954-020-00438-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. METHODS Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. RESULTS Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. CONCLUSIONS TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.
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Affiliation(s)
- Marcus Castillo
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brianna Conte
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sam Hinkes
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Megan Mathew
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - C J Na
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ainhoa Norindr
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Amar R Deshpande
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Meyers SA, Rafful C, Jain S, Sun X, Skaathun B, Guise A, Gonzalez-Zuñiga P, Strathdee SA, Werb D, Mittal ML. The role of drug treatment and recovery services: an opportunity to address injection initiation assistance in Tijuana, Mexico. Subst Abuse Treat Prev Policy 2020; 15:78. [PMID: 33046125 PMCID: PMC7552370 DOI: 10.1186/s13011-020-00322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the U.S. and Canada, people who inject drugs' (PWID) enrollment in medication-assisted treatment (MAT) has been associated with a reduced likelihood that they will assist others in injection initiation events. We aimed to qualitatively explore PWID's experiences with MAT and other drug treatment and related recovery services in Tijuana Mexico, a resource-limited setting disproportionately impacted by injection drug use. METHODS PReventing Injecting by Modifying Existing Responses (PRIMER) seeks to assess socio-structural factors associated with PWID provision of injection initiation assistance. This analysis drew on qualitative data from Proyecto El Cuete (ECIV), a Tijuana-based PRIMER-linked cohort study. In-depth qualitative interviews were conducted with a subset of study participants to further explore experiences with MAT and other drug treatment services. Qualitative thematic analyses examined experiences with these services, including MAT enrollment, and related experiences with injection initiation assistance provision. RESULTS At PRIMER baseline, 607(81.1%) out of 748 participants reported recent daily IDU, 41(5.5%) reported recent injection initiation assistance, 92(12.3%) reported any recent drug treatment or recovery service access, and 21(2.8%) reported recent MAT enrollment (i.e., methadone). Qualitative analysis (n = 21; female = 8) revealed that, overall, abstinence-based recovery services did not meet participants' recovery goals, with substance use-related social connections in these contexts potentially shaping injection initiation assistance. Themes also highlighted individual-level (i.e., ambivalence and MAT-related stigma) and structural-level (i.e., cost and availability) barriers to MAT enrollment. CONCLUSION Tijuana's abstinence-based drug treatment and recovery services were viewed as unable to meet participants' recovery-related goals, which could be limiting the potential benefits of these services. Drug treatment and recovery services, including MAT, need to be modified to improve accessibility and benefits, like preventing transitions into drug injecting, for PWID.
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Affiliation(s)
- Stephanie A Meyers
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Claudia Rafful
- Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico
- Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Andrew Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
- Addison House, Guy's Hospital, King's College London, Strand, London, WC2R 2LS, UK
| | - Patricia Gonzalez-Zuñiga
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
- Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA.
- Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P, 22540, Tijuana, Baja California, Mexico.
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173
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Price S. Opioids: The Forgotten Epidemic? Tex Med 2020; 116:32-35. [PMID: 33126270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
COVID-19 inflamed the crisis; telemedicine helps Texas physicians cope with the fallout.
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174
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Bhatraju EP, Ludwig-Barron N, Takagi-Stewart J, Sandhu HK, Klein JW, Tsui JI. Successful engagement in buprenorphine treatment among hospitalized patients with opioid use disorder and trauma. Drug Alcohol Depend 2020; 215:108253. [PMID: 32890919 PMCID: PMC7531192 DOI: 10.1016/j.drugalcdep.2020.108253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The opioid epidemic continues to cause significant morbidity and mortality. Although there are effective medications for opioid use disorder (OUD), a minority of patients receive these treatments. OUD is common among patients hospitalized for traumatic injury and hospitalization could be an opportunity to initiate medications and link to ongoing buprenorphine care. METHODS This retrospective cohort study based on electronic health record review included patients who were: (1) hospitalized between January 1, 2018 and June 30, 2019, (2) age ≥18 years, (3) seen by an Addiction Medicine Consult Service, and (4) initiated on buprenorphine with plans for continuation post-discharge. Descriptive statistics identified differences between trauma and non-trauma groups and regression analysis identified predictors of 30 day buprenorphine follow up. RESULTS Of 197 eligible patients, 60 (30.5 %) were hospitalized for traumatic injuries. Compared to non-trauma patients, trauma patients were younger, more likely to be employed, more likely to report using cannabis and tobacco, less likely to have recently injected drugs, and hospitalized longer. Among patients with follow-up data available (n = 147), 63.2 % of trauma patients were seen within 30 days, compared to 48.2 % of non-trauma patients (p = 0.16). There were no significant differences between the two groups with regards to urine drug test results or acute care utilization in the follow-up period. CONCLUSIONS Among hospitalized patients with OUD who initiate buprenorphine, those who were hospitalized for trauma were at least as likely to link to out-patient treatment. Trauma admissions represent an important opportunity for diagnosing and linking patients with OUD to buprenorphine treatment.
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Affiliation(s)
- Elenore P Bhatraju
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States.
| | | | | | - Harveen K Sandhu
- University of Washington, School of Medicine, Seattle, WA, United States
| | - Jared W Klein
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States
| | - Judith I Tsui
- Division of General Internal Medicine, University of Washington, Seattle, WA, United States
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175
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Abstract
This cross-sectional study examines the trends in initiation of buprenorphine treatment for opioid use disorder during emergency department visits in the United States.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - David A. Fiellin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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176
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Wenzel K, Fishman M. Mobile van delivery of extended-release buprenorphine and extended-release naltrexone for youth with OUD: An adaptation to the COVID-19 emergency. J Subst Abuse Treat 2020; 120:108149. [PMID: 33303086 DOI: 10.1016/j.jsat.2020.108149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/31/2020] [Accepted: 09/21/2020] [Indexed: 02/05/2023]
Abstract
The Youth Opioid Recovery Support (YORS) intervention is a novel treatment for young adults with opioid use disorder (OUD) that uses developmentally informed strategies to reduce barriers to treatment engagement. YORS strategies, such as home delivery of extended-release buprenorphine and extended-release naltrexone for OUD, are designed to increase engagement in treatment, but with the COVID-19 pandemic these strategies increase risk of virus exposure and spread to patients and staff entering homes. We present mobile van service delivery as a potential solution to continuing to provide low-barrier care for young adults with OUD while reducing risk associated with COVID-19. Initial feedback from patients and staff is positive and lays the groundwork to test feasibility and acceptability of this intervention rigorously in future work. Mobile van delivery of extended-release medications for OUD may be a promising treatment modification for mitigating risk of COVID-19, as well as a useful option for ongoing enhancement of care.
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Affiliation(s)
- Kevin Wenzel
- Mountain Manor Treatment Center/Maryland Treatment Centers, 3800 Frederick Ave, Baltimore, MD 21229, USA.
| | - Marc Fishman
- Mountain Manor Treatment Center/Maryland Treatment Centers, 3800 Frederick Ave, Baltimore, MD 21229, USA; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N Wolfe St, Baltimore, MD 21205, USA
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177
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Haffajee RL, Andraka-Christou B, Attermann J, Cupito A, Buche J, Beck AJ. A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder. Subst Abuse Treat Prev Policy 2020; 15:69. [PMID: 32928272 PMCID: PMC7491096 DOI: 10.1186/s13011-020-00312-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Evidence demonstrates that medications for treating opioid use disorder (MOUD) -namely buprenorphine, methadone, and extended-release naltrexone-are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. METHODS To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. RESULTS Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers-such as a lack of addiction treatment specialists-as additional barriers to prescribing medications to treat OUD. CONCLUSIONS Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.
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Affiliation(s)
- Rebecca L. Haffajee
- From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI USA
- RAND Corporation, Boston, MA USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MA USA
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI USA
| | - Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, Orlando, FL USA
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL USA
| | - Jeremy Attermann
- the National Council for Behavioral Health, Washington, D.C, USA
| | - Anna Cupito
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Jessica Buche
- From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Angela J. Beck
- From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI USA
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
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Long KQ, Thinh OP, Thao TTK, Van Huy N, Lan VTH, Mai VQ, Van Minh H. Relationship between family functioning and health-related quality of life among methadone maintenance patients: a Bayesian approach. Qual Life Res 2020; 29:3333-3342. [PMID: 32766941 DOI: 10.1007/s11136-020-02598-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To examine the relationship of family functioning on health-related quality of life (HRQoL) among methadone maintenance patients using the Bayesian approach. METHODS A cross-sectional study was conducted on 182 patients at Go Vap Methadone Clinic, Ho Chi Minh City, Vietnam. Family functioning and HRQoL were measured by the APGAR scale and World Health Organization Quality of Life short-form instrument (WHOQoL-BREF), respectively. Directed Acyclic Graphs were used to present the conceptual framework and to identify a set of confounders of the relationship between family functioning and HRQoL. Bayesian multivariable linear regressions were fitted with four different priors to determine the effect size of the relationship of interest. RESULTS The mean score of APGAR was 6.0 (SD = 3.3), and the mean scores of HRQoL were from 47.1 (SD = 17.6) in the social relationships dimension to 69.0 (SD = 10.3) in the environment dimension. Patients with a higher score of family functioning were likely to have a higher score of HRQoL, with coefficients and 95% highest density interval (HDI) greater than 0 in all priors. Family functioning had the most substantial impact on the psychological health dimension, with 99.9% to 100% and 44.6% to 83.7% of posterior distribution greater than 1 and 2, in different priors, respectively. CONCLUSION Family functioning is intimately associated with HRQoL. Treatment plans for patients undergoing methadone maintenance treatment should aim to involve the families appropriately and effectively to maximize the benefits for patients and improve their overall well-being.
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Affiliation(s)
| | | | - Trinh Thi Kim Thao
- University of Medicine and Pharmacy At Ho Chi Minh City, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam.
| | - Nguyen Van Huy
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | | | - Vu Quynh Mai
- Hanoi University of Public Health, Hanoi, Vietnam
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Bergman BG, Ashford RD, Kelly JF. Attitudes toward opioid use disorder medications: Results from a U.S. national study of individuals who resolved a substance use problem. Exp Clin Psychopharmacol 2020; 28:449-461. [PMID: 31556675 PMCID: PMC7096254 DOI: 10.1037/pha0000325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The attitudes of individuals who receive, provide, or influence opioid use disorder (OUD) medication services, also called stakeholders, may enhance or hinder their dissemination and adoption. Individuals who have resolved a significant alcohol or other drug (AOD) problem are a group of key stakeholders whose OUD medication attitudes are not well understood empirically. This group subsumes, but is not limited to, individuals who identify as being "in recovery." Analyses leveraged the National Recovery Study, a geo-demographically representative survey of U.S. adults who resolved a significant AOD problem (N = 1,946). We examined the prevalence of positive, neutral, and negative attitudes toward agonists, such as buprenorphine/naloxone and methadone, and antagonists, such as oral and extended-release depot injection naltrexone. Single-predictor logistic regression models tested for demographic, clinical, and recovery-related correlates of these attitudes and, for those significant at the .1 level, multivariable-predictor logistic regression models tested unique associations between these correlates and attitudes. Results showed that participants were equally likely to hold positive (21.4 [18.9-24.0]%) and negative agonist (23.8 [21.2-26.7]%) attitudes but significantly more likely to hold negative (30.3 [27.4-33.3]%) than positive antagonist attitudes (18.0 [15.9-20.4]%). Neutral attitudes were most commonly endorsed for both agonists (54.8 [51.6-57.9]%) and antagonists (51.7 [48.5-54.8]%). For agonists, more recent AOD problem resolution was a unique predictor of positive attitude, whereas Black and Hispanic races/ethnicities, compared with White, were unique predictors of negative attitude. For antagonists, older age group (45-59 and 60 + vs. 18-29 years), lifetime opioid antagonist medication prescription, and past 90-day non-12-step mutual-help attendance were unique predictors of positive attitude, whereas greater spirituality was a unique predictor of negative attitude. This population-level study of U.S. adults who resolved an AOD problem showed that agonist attitudes may be more positive than anecdotal evidence suggests. Certain characteristics and experiences, however, highlight a greater likelihood of negative attitudes, suggesting these factors may be potential barriers to OUD medication adoption. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Nakhaeizadeh M, Abdolahinia Z, Sharifi H, Mirzazadeh A, Haghdoost AA, Shokoohi M, Baral S, Karamouzian M, Shahesmaeili A. Opioid agonist therapy uptake among people who inject drugs: the findings of two consecutive bio-behavioral surveillance surveys in Iran. Harm Reduct J 2020; 17:50. [PMID: 32698875 PMCID: PMC7373839 DOI: 10.1186/s12954-020-00392-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/26/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Opioid agonist therapy (OAT) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OAT uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran. METHODS Data were obtained from two national bio-behavioral surveillance surveys (N2010 = 1783 and N2014 = 2166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression models were built to determine the correlates of OAT uptake for the 2014 survey, and adjusted odds ratios (AORs) along with 95% confidence intervals (CI) were reported. RESULTS The prevalence of OAT uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P value = 0.033). OAT uptake varied across the studied cities ranging from 0.0 to 69.3% in the 2010 survey and 3.2 to 75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI 1.08, 2.50) were associated with OAT uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI 0.51, 0.86) were less likely to uptake OAT. CONCLUSIONS Although OAT uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remain significant disparities across urban settings in Iran. Importantly, the OAT services appear to be serving high-risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes associated with OAT across Iran.
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Affiliation(s)
- Mehran Nakhaeizadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Zahra Abdolahinia
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran.
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Abraham R, Wilkinson E, Jabbarpour Y, Bazemore A. Family Physicians Play Key Role in Bridging the Gap in Access to Opioid Use Disorder Treatment. Am Fam Physician 2020; 102:10. [PMID: 32603069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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182
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Abstract
The diagnosis of opioid use disorder (OUD) is often overlooked or inadequately managed during the inpatient admission. When recognized, a common strategy is opioid detoxification, an approach that is often ineffective and can be potentially dangerous because of loss of tolerance and subsequent risk for overdose. Medication for addiction treatment (MAT), including methadone and buprenorphine, is effective and can be dispensed in the hospital for both opioid withdrawal and initiation of maintenance treatment. Hospitalists should be knowledgeable about diagnosing and managing patients with OUD, including how to manage acute pain or MAT during the perioperative setting.
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Affiliation(s)
- Michael Herscher
- Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, USA.
| | - Matthew Fine
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Reema Navalurkar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Leeza Hirt
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Linda Wang
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, USA
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183
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Abstract
The treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with μ-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and α2-adrenergic receptor agonists (eg, clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.
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Affiliation(s)
- A Benjamin Srivastava
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA.
| | - John J Mariani
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - Frances R Levin
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
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Fang CP, Liu TH, Chung RH, Tsou HH, Kuo HW, Wang SC, Liu CC, Liu SC, Chen ACH, Liu YL. Genetic variants in NECTIN4 encoding an adhesion molecule are associated with continued opioid use. PLoS One 2020; 15:e0234549. [PMID: 32555608 PMCID: PMC7302666 DOI: 10.1371/journal.pone.0234549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 05/28/2020] [Indexed: 01/17/2023] Open
Abstract
Methadone is a synthetic opioid used as maintenance treatment for patients addicted to heroin. Skin irritation is one of the adverse events caused by opioid use. 344 methadone maintenance treatment (MMT) patients were recruited with records and measurements on methadone dose, plasma methadone concentrations, and treatment emergent symptom scales (TESS). 15 patients reported with skin irritation. Five SNPs located within the NECTIN4 genetic region were genotyped. The NECTIN4 gene within the adherens junction interaction pathway was associated with methadone dose in pathway-based genome wide association analyses (P = 0.0008). Three highly-linked SNPs, rs11265549, rs3820097, and rs4656978, were significantly associated with methadone dose (P = 0.0003), plasma concentrations of R,S-methadone (P = 0.0004) and TNF-α (P = 0.010) in all 344 MMT patients, and with self-report skin irritation symptom scores (P = 0.010) in the 15 MMT patients who reported with skin irritation. To identify the possible roles of plasma level of Nectin-4 in the responses to MMT and opioid use, additional age- and gender-matched 51 controls and 83 methadone-free abstinent former heroin users were recruited. Plasma level of Nectin-4 was the highest in MMT patients among the three groups. The results suggest involvement of genetic variants on NECTIN4 in methadone dose. Plasma Nectin-4 level is likely an indicator for continued use of opioids.
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Affiliation(s)
- Chiu-Ping Fang
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Tung-Hsia Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Ren-Hua Chung
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Hsiao-Hui Tsou
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Hsiang-Wei Kuo
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chia-Chen Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Shu Chih Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Andrew C. H. Chen
- Department of Psychiatry, the Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, United States of America
- The Feinstein Institute for Medical Research, Hofstra Northwell School of Medicine at Hofstra University, Manhasset, New York, United States of America
| | - Yu-Li Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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185
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Yang S, Gao B, Gu J, Gong Y, Yu B, Han J, Dong P, Jia P, Yang S. Relationship between social capital and heroin use behaviors among patients in methadone maintenance treatment in Sichuan Province, China: A cross-sectional study. Medicine (Baltimore) 2020; 99:e19963. [PMID: 32541447 PMCID: PMC7302679 DOI: 10.1097/md.0000000000019963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Covertly using heroin during methadone maintenance treatment (MMT) is very common among heroin-dependent patients, which has posed threats to the physical health of heroin-dependent patients and social safety. Covertly using heroin may be influenced by many factors, especially social capital. Therefore, we aimed to investigate the relationship between behaviors of covertly using heroin during MMT and social capital heroin-dependent patients in Sichuan Province, China. A cross-sectional study was conducted between October and November 2018, with a total of 581 heroin-dependent patients participating in the study. In addition to socio-demographic characteristics and heroin use related behaviors, the questionnaire also included the measures of social capital: social network (SN), social support (SP), community participation (CP) and social trust (ST). Multivariate logistic regression analyses were used to estimate the association between different measures of social capital and heroin use. The prevalence of covertly using heroin of heroin during MMT was 31.0% among our participants in the 6 months before the study. After adjusting for socio-demographic factors and heroin-use related variables, SN (OR = 0.85, 95% CI: 0.76-0.95), SP (OR = 0.89, 95% CI: 0.83-0.95), and ST (OR = 0.88, 95% CI: 0.81-0.95) were significantly associated with heroin use. Results suggest that social capital may have a protective effect on behavior of covertly using heroin during MMT, which should be consider in the interventions for heroin-dependent patients, in order to reduce the incidence of heroin use during MMT as well as improve the compliance of MMT.
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Affiliation(s)
- Shifan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Bo Gao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou
| | - Yi Gong
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jiayu Han
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peijie Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peng Jia
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
- Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
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186
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Radley A, de Bruin M, Inglis SK, Donnan PT, Hapca A, Barclay ST, Fraser A, Dillon JF. Clinical effectiveness of pharmacist-led versus conventionally delivered antiviral treatment for hepatitis C virus in patients receiving opioid substitution therapy: a pragmatic, cluster-randomised trial. Lancet Gastroenterol Hepatol 2020; 5:809-818. [PMID: 32526210 DOI: 10.1016/s2468-1253(20)30120-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Highly effective direct-acting antiviral drugs provide the opportunity to eliminate hepatitis C virus (HCV) infection, but established pathways can be ineffective. We aimed to examine whether a community pharmacy care pathway increased treatment uptake, treatment completion, and cure rates for people receiving opioid substitution therapy, compared with conventional care. METHODS This cluster-randomised trial was done in Scottish community pharmacies. Before participants were recruited, pharmacies were randomly assigned (1:1) to refer patients with evidence of HCV antibodies to conventional care or offered them care in the pharmacy (pharmacist-led care). Pharmacies were stratified by location. All pharmacies were trained to offer dried blood spot testing. All eligible participants had received opioid substitution therapy for approximately 3 months, and those eligible to receive treatment in the pharmacist-led care pathway were HCV PCR positive, were infected with HCV genotype 1 or 3, and were willing to have a pharmacist supervise their antiviral drug administration. Neither pharmacists nor patients were masked to treatment allocation. In both groups, assessment blood samples were taken, infection with HCV was confirmed, and daily oral ledipasvir-sofosbuvir (90 mg ledipasivir plus 400 mg sofosbuvir) for 8 weeks for genotype 1 or daily oral sofosbuvir (400 mg) plus oral daclatasvir (60 mg) for 12 weeks for genotype 3 was prescribed by a nurse (conventional care group) or pharmacist (pharmacist-led care group). In the conventional care group, the patient received care at a treatment centre. Once prescribed, medication in both groups was delivered as daily modified directly observed therapy alongside opioid substitution therapy in the participants' pharmacy where treatment was observed on 6 days per week. The primary outcome was the number of patients with sustained virological response 12 weeks after completion of treatment (SVR12) as a proportion of the number of people receiving opioid substitution therapy at participating pharmacies. Participants were monitored at each visit for nausea and fatigue; other adverse events were recorded as free text. Secondary outcomes compared key points on treatment pathway between the two groups. These key points were the proportion of patients having dry blood spot testing, the proportion of patients initiating HCV treatment, the proportion of patients completing the 8 or 12 week HCV course of treatment, and the proportion of patients with sustained virological response at 12 months. This study is registered with ClinicalTrials.gov, NCT02706223. FINDINGS 56 pharmacies were randomly assigned (28 to each group; one pharmacy withdrew from the conventional care group). The 55 participating pharmacies included 2718 patients receiving opioid substitution therapy (1365 in the pharmacist-led care group and 1353 in the conventional care group). More patients met the primary endpoint of SVR12 in the pharmacist-led care group (98 [7%] of 1365) than in the conventional care group (43 [3%] of 1353; odds ratio 2·375, 95% CI 1·555-3·628, p<0·0001). More users of opioid substitution therapy in the pharmacist-led care group versus the conventional care group agreed to dry blood spot testing (245 [18%] of 1365 vs 145 [11%] of 1353, 2·292, 0·968-5·427, p=0·059); initiated treatment (112 [8%] of 1365 vs 61 [4%] of 1353, 1·889, 1·276-2·789, p=0·0015) and completed treatment (108 [8%] of 1365 vs 58 [4%] of 1353, 1·928, 1·321-2·813, p=0·0007). The data for sustained virological response at 12 months are not reported in this study: patients remain in follow-up for this outcome. No serious adverse events were recorded. INTERPRETATION Using pharmacists to deliver an HCV care pathway made testing and treatment more accessible for patients, improved engagement, and maintained high treatment success rates. The use of this pathway could be a key part of an integrated and effective approach to HCV elimination at a community level. FUNDING Partnership between the Scottish Government, Gilead Sciences, and Bristol-Myers Squib.
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Affiliation(s)
- Andrew Radley
- NHS Tayside, Directorate of Public Health, Kings Cross Hospital, Dundee, UK; University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | - Marijn de Bruin
- Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, Netherlands; University of Aberdeen, Institute of Applied Health Sciences, Aberdeen, UK
| | - Sarah K Inglis
- University of Dundee, Tayside Clinical Trials Unit, Dundee, UK
| | - Peter T Donnan
- University of Dundee, Tayside Clinical Trials Unit, Dundee, UK
| | - Adrian Hapca
- University of Dundee, Tayside Clinical Trials Unit, Dundee, UK
| | - Stephen T Barclay
- NHS Greater Glasgow and Clyde, Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK; Glasgow Caledonian University, Department of Life Sciences, Glasgow, UK
| | - Andrew Fraser
- NHS Grampian, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - John F Dillon
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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187
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Affiliation(s)
- Rebecca Dresser
- Daniel Noyes Kirby Professor of Law Emerita, Washington University in St. Louis. I am grateful to Travis Rieder and an anonymous reviewer for helpful comments on an earlier draft
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188
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Abstract
OBJECTIVE The aim of the study was to explore and describe the structure and design elements of addiction medicine consult (AMC) services within selected US hospitals. METHODS As part of a larger mixed methods study, 10 qualitative semi-structured telephone interviews were completed with board-certified addiction medicine physicians affiliated with the Addiction Medicine Foundation's Addiction Medicine Fellowship Programs at 9 US hospitals. Interviews were transcribed, coded, and analyzed using a directed content analysis. RESULTS Interviews completed with established AMC services in 9 hospitals probed AMC structure and design commonalities and differences across 4 domains: (1) availability and coverage, (2) team composition, (3) scope and responsibility, and (4) financing. Only 1 service provided weekend consults and most services did not provide coverage in the emergency department. Interprofessional teams were common with a variety of discipline combinations. AMC service scope and responsibility, generally, included 3 types of activities: (1) education and culture change, (2) the delivery of psychosocial and medical services, and (3) hospital guidance document development. Finally, most AMC services existed within a fragile financial environment with idiosyncratic arrangements. CONCLUSIONS As opioid use disorder (OUD)-related hospitalizations increase stakeholders look to innovative care delivery mechanisms to improve care and outcomes for persons with OUD. The implementation of an AMC service may be an organizational intervention for achieving these aims. Understanding the shared and different approaches to AMC service structure and design is an important first step for delivery systems interested in implementing or expanding these services.
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Affiliation(s)
- Kelsey C. Priest
- Oregon Health & Science University (OHSU) and Portland State University School of Public Health, Portland, Oregon, 97239, USA
- MD/PhD Program, School of Medicine, OHSU, Portland, Oregon, 97239, USA
| | - Dennis McCarty
- Oregon Health & Science University (OHSU) and Portland State University School of Public Health, Portland, Oregon, 97239, USA
- Department of Psychiatry, School of Medicine, OHSU, Portland, Oregon, 97239, USA
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189
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Warner NS. A Surgeon Saved My Life: A Story of Addiction. Mayo Clin Proc 2020; 95:658-659. [PMID: 32247340 DOI: 10.1016/j.mayocp.2019.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Nafisseh S Warner
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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190
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Socias ME, Wood E, Dong H, Brar R, Bach P, Murphy SM, Fairbairn N. Slow release oral morphine versus methadone for opioid use disorder in the fentanyl era (pRESTO): Protocol for a non-inferiority randomized clinical trial. Contemp Clin Trials 2020; 91:105993. [PMID: 32194251 PMCID: PMC7919741 DOI: 10.1016/j.cct.2020.105993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND North America is facing an unprecedented public health crisis of opioid-related morbidity and mortality, increasingly as a result of the introduction of illicitly manufactured fentanyl into the street drug market. Although the treatment of opioid use disorder (OUD) is a key element in the response to the opioid overdose epidemic, currently available pharmacotherapies (e.g., methadone, buprenorphine) may not be acceptable to or effective in all patients. Available evidence suggests that slow-release oral morphine (SROM) has similar efficacy rates as methadone with respect to promoting abstinence, and with improvements in a number of patient-reported outcomes among persons using heroin. However, little is known about the relative effectiveness and acceptability of SROM compared to methadone in the context of fentanyl use. This study aims to address this research gap. METHODS pRESTO is a 24-week, open-label, two arm, non-inferiority, randomized controlled trial comparing SROM versus methadone for the treatment of OUD. Participants will be 298 clinically stable, non-pregnant adults with OUD, recruited from outpatient clinics in Vancouver, Canada, where the majority of the illicit opioids are contaminated with fentanyl. The primary outcome is suppression of illicit opioid use, measured by bi-weekly urine drug screens. Secondary outcomes include: treatment retention, medication safety, overdose events, treatment satisfaction, psychological functioning, changes in drug-related problems, changes in quality of life, opioid cravings, other substance use, and cost-effectiveness. DISCUSSION pRESTO will be among the first studies to evaluate treatment options for individuals primarily using synthetic street opioids, providing important evidence to guide treatment strategies for this population.
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Affiliation(s)
- M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Rupinder Brar
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sean M Murphy
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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191
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Pro G, Utter J, Haberstroh S, Baldwin JA. Dual mental health diagnoses predict the receipt of medication-assisted opioid treatment: Associations moderated by state Medicaid expansion status, race/ethnicity and gender, and year. Drug Alcohol Depend 2020; 209:107952. [PMID: 32172130 PMCID: PMC7537819 DOI: 10.1016/j.drugalcdep.2020.107952] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups. METHODS MAT treatment discharges were identified using the Treatment Episodes Dataset-Discharges (TEDS-D; 2014-2017) (n = 1,400,808). We used multivariate logistic regression to model MAT receipt using interactions and adjusted for several potential confounders. RESULTS Nearly one-third of OUD treatment discharges received MAT. Dual MHDs in both expansion and non-expansion states were positively associated with MAT uptake over time. Dual MHDs were negatively associated with MAT receipt only among American Indian/Alaska Native women residing in Medicaid expansion states (aOR = 0.58, 95 % CI = 0.52-0.66, p < 0.0001). CONCLUSION Disparities in MAT utilization are nuanced and vary widely depending on dual MHD status, Medicaid expansion, and race/ethnicity/gender. Medicaid is beneficial but not a universal treatment panacea. Clinical decisions to initiate MAT are dependent on multiple factors and should be tailored to meet the needs of high-risk, historically disadvantaged clients.
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Affiliation(s)
- George Pro
- Northern Arizona University, Center for Health Equity Research, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA.
| | - Jeff Utter
- University of Colorado, Department of Family Medicine, Colorado University Anschutz, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Shane Haberstroh
- Northern Arizona University, Department of Educational Psychology, 801 South Knoles Drive, Flagstaff, AZ, 86011, USA.
| | - Julie A Baldwin
- Northern Arizona University, Center for Health Equity Research, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA.
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192
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Abstract
OPINION STATEMENT The opioid epidemic is one of the most important public health crises as opioid-related deaths have become a leading cause of accidental death in the USA. Various efforts have been made to understand how to safely and appropriately prescribe opioids for patients with chronic pain, including those with cancer-related pain. We find the guidelines proposed by the Expert Consensus White Paper on the use of methadone to be current, comprehensive, and practical. While methadone is a complex medication with unique pharmacokinetics and pharmacodynamics, it remains a superior choice for many patients with cancer pain given its cost and applicability in a variety of situations. Methadone should be prescribed in the context of experienced clinicians as well as an interdisciplinary team. At a critical time when preventing opioid-related deaths is a priority, we recommend implementing additional precautions for monitoring including universal screening for risk of non-medical opioid use, education on proper storage and disposal, as well as discussing a plan with patients and caregivers in the case of serious complications such as opioid overdose.
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Affiliation(s)
- Yvonne Heung
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX, 77030, USA
| | - Akhila Reddy
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX, 77030, USA.
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Schmidbauer C, Schubert R, Schütz A, Schwanke C, Luhn J, Gutic E, Pirker R, Lang T, Reiberger T, Haltmayer H, Gschwantler M. Directly observed therapy for HCV with glecaprevir/pibrentasvir alongside opioid substitution in people who inject drugs-First real world data from Austria. PLoS One 2020; 15:e0229239. [PMID: 32155165 PMCID: PMC7064180 DOI: 10.1371/journal.pone.0229239] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background Directly acting antivirals (DAA) against hepatitis C virus (HCV) infection have facilitated sustained virologic response (SVR) rates >90% in clinical studies. Yet, real life data regarding DAA treatment in people who inject drugs (PWIDs) are scarce. We evaluated the effectiveness of glecaprevir/pibrentasvir (G/P) in difficult-to-treat PWIDs with presumed high risk of non-adherence to DAA therapy using the concept of directly observed therapy involving their opioid substitution therapy (OST) facility. Methods N = 145 patients (m/f: 91/54; median age: 41.1 (IQR 19.5) years; HCV-genotype (GT) 1/2/3/4: 82/1/56/5, GT3: 38.6%; cirrhosis: n = 6; 4.1%) treated with G/P were included. PWIDs at high risk for non-adherence to DAA therapy received HCV treatment together with their OST under the supervision of medical staff ("directly observed therapy", DOT). The effectiveness of G/P given as DOT in PWIDs with presumed high risk of non-adherence to DAA therapy was compared to patients with suspected “excellent compliance” in the "standard setting" (SS) of G/P prescription at a tertiary care center and self-managed G/P intake at home. Treatment duration was 8–16 weeks according to the G/P drug label. Results DOT-patients (n = 74/145; 51.0%) were younger than SS-patients (median 38.7, IQR 12.5 vs. median 50.6, IQR 20.3 years), all had psychiatric co-morbidities and most had a poor socioeconomic status. 50/74 (67.6%) reported ongoing intravenous drug use (IDU). SVR was achieved in n = 70/74 (94.6%) patients with n = 3 being lost to follow-up (FU) and n = 1 showing nonresponse to therapy. SS-patients achieved SVR in 97.2% (69/71) with n = 1 patient being lost to FU and n = 1 patient with GT3 showing HCV relapse. Conclusion G/P given as DOT along with OST in PWIDs with high risk of non-adherence to DAA therapy resulted in similarly high SVR rates (94.6%) as in patients with presumed “excellent compliance” under standard drug intake.
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Affiliation(s)
- Caroline Schmidbauer
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Raphael Schubert
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Angelika Schütz
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Cornelia Schwanke
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Julian Luhn
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Enisa Gutic
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
| | - Roxana Pirker
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
| | - Tobias Lang
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Hans Haltmayer
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Michael Gschwantler
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
- * E-mail:
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Singh D, Yeou Chear NJ, Narayanan S, Leon F, Sharma A, McCurdy CR, Avery BA, Balasingam V. Patterns and reasons for kratom (Mitragyna speciosa) use among current and former opioid poly-drug users. J Ethnopharmacol 2020; 249:112462. [PMID: 31816368 DOI: 10.1016/j.jep.2019.112462] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/07/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Kratom (Mitragyna speciosa) is a native medicinal plant of Southeast Asia widely reported to be used to reduce opioid dependence and mitigate withdrawal symptoms. There is also evidence to suggest that opioid poly-drug users were using kratom to abstain from opioids. AIM OF THE STUDY To determine the patterns and reasons for kratom use among current and former opioid poly-drug users in Malaysia. MATERIALS AND METHODS A total of 204 opioid poly-drug users (142 current users vs. 62 former users) with current kratom use history were enrolled into this cross-sectional study. A validated UPLC-MS/MS method was used to evaluate the alkaloid content of a kratom street sample. RESULTS Results from Chi-square analysis showed that there were no significant differences in demographic characteristics between current and former opioid poly-drug users except with respect to marital status. Current users had higher odds of being single (OR: 2.2: 95%CI: 1.21-4.11; p < 0.009). Similarly, there were no significant differences in the duration (OR: 1.1: 0.62-2.03; p < 0.708), daily quantity (OR: 1.5: 0.85-2.82; p < 0.154) or frequency of kratom use between current and former opioid poly-drug users (OR: 1.1: 0.62-2.06; p < 0.680). While both current and former opioid users reported using kratom to ameliorate opioid withdrawal, current users had significantly higher likelihood of using kratom for that purpose (OR: 5.4: 95%CI: 2.81-10.18; p < 0.0001). In contrast, former opioid users were more likely to be using kratom for its euphoric (mood elevating) effects (OR: 1.9: 95%CI: 1.04-3.50; p < 0.035). Results from the UPLC-MS/MS analysis indicated the major alkaloids present in the representative kratom street sample (of approximately 300 mL of brewed kratom) were mitragynine, followed by paynantheine, speciociliatine and speciogynine, as well as low levels of 7-hydroxymitragynine. CONCLUSIONS Both current and former opioid poly-drug users regularly used kratom (three glasses or about 900 mL daily or the equivalent of 170.19 mg of mitragynine) to overcome opioid poly-drug use problems.
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Affiliation(s)
- Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia.
| | | | - Suresh Narayanan
- School of Social Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Francisco Leon
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA
| | - Christopher R McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA
| | - Bonnie A Avery
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA
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Louis JS, Eden AR, Morgan ZJ, Barreto TW, Peterson LE, Phillips RL. Maternity Care and Buprenorphine Prescribing in New Family Physicians. Ann Fam Med 2020; 18:156-158. [PMID: 32152020 PMCID: PMC7062488 DOI: 10.1370/afm.2504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/25/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022] Open
Abstract
The American Board of Family Medicine routinely surveys its Diplomates in each national graduating cohort 3 years out of training. These data were used to characterize early career family physicians whose services include management of pregnancy and prescribing buprenorphine. A total of 261 (5.1%) respondents both provide maternity care and prescribe buprenorphine. Family physicians who care for pregnant women and also prescribe buprenorphine represented 50.4% of all buprenorphine prescribers. The family physicians in this group were trained in a small number of residency programs, with only 15 programs producing at least 25% of graduates who do this work.
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Affiliation(s)
- Joshua St Louis
- Greater Lawrence Family Health Center, Lawrence, Massachusetts
| | - Aimee R Eden
- American Board of Family Medicine, Lexington, Kentucky
| | | | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky
- Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
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Mehta D, Thomas V, Johnson J, Scott B, Cortina S, Berger L. Continuation of Buprenorphine to Facilitate Postoperative Pain Management for Patients on Buprenorphine Opioid Agonist Therapy. Pain Physician 2020; 23:E163-E174. [PMID: 32214293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acute pain management in patients on buprenorphine opioid agonist therapy (BOAT) can be challenging. It is unclear whether BOAT should be continued or interrupted for optimization of postoperative pain control. OBJECTIVES To determine an evidence-based approach for pain management in patients on BOAT in the perioperative setting, particularly whether BOAT should be continued or interrupted with or without bridging to another mu opioid agonist and to identify benefits and harms of either perioperative strategy. STUDY DESIGN Systematic literature review with qualitative data synthesis. SETTING Hospital, perioperative. METHODS The study protocol was registered on PROSPERO (Registration number 9030276355). Medline via OVID, EMBASE, CINAHL, and the Cochrane CENTRAL register of trials were searched for prospective or retrospective observational or controlled studies, case series, and case reports that described perioperative or acute pain care for patients on BOAT. References of narrative and systematic reviews addressing acute pain management in patients on BOAT and references of included articles were hand-searched to identify additional original articles for inclusion. The full text of publications were reviewed for final inclusion, and data were extracted using a standardized data extraction form. Results were summarized qualitatively. Primary outcomes were postoperative pain intensity and total opioid use and identification of benefits and harms of perioperative strategies. RESULTS Eighteen publications presenting data on the perioperative management of patients on BOAT were identified: 10 case reports, 5 case series, and 3 retrospective cohort studies. Eleven articles reported continuation of BOAT, 2 concerned bridging BOAT, and 4 articles described stopping BOAT without planned bridging. In one retrospective cohort study, BOAT was continued in half and interrupted in half of patients. Patients on BOAT may have pain that is more difficult to treat than those who are not on OAT. There is no clear evidence that one particular strategy provides superior postoperative pain control, but interruption of BOAT may result in harm, including failure to return to baseline BOAT doses, continuing non-BOAT opioid use, or relapse of opioid use disorder. LIMITATIONS There were a limited number of articles relevant to the study question consisting of case reports and retrospective observational studies. Some omitted relevant details. No prospective studies were found. CONCLUSIONS There is no clear benefit to bridging or stopping BOAT but failure to restart it may pose concerns for relapse. We recommend continuing BOAT in the perioperative period when possible and incorporating an interdisciplinary approach with multimodal analgesia. KEY WORDS Opioid use disorder, opiate substitution treatment, buprenorphine, buprenorphine-naloxone, buprenorphine opioid agonist therapy, postoperative pain, acute pain, multimodal analgesia.
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Affiliation(s)
- Disha Mehta
- Department of Anesthesia, Surrey Memorial Hospital, Surrey, BC Canada
| | - Vinod Thomas
- Division of Pharmacy, Southern Adelaide Local Health Network, SA Pharmacy, SA Health, Adelaide, Australia
| | - Jacinta Johnson
- Division of Pharmacy, Southern Central Adelaide Local Health Network, SA Pharmacy, SA Health, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Brooke Scott
- Library Services, Fraser Health, Maple Ridge, BC Canada
| | - Sandra Cortina
- Department of Internal Medicine, St. Paul's Hospital, Vancouver, BC Canada
| | - Landon Berger
- Department of Anesthesiology and Pain Medicine, University of Alberta, Addiction Recovery and Community Health, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Scheibe A, Shelly S, Gerardy T, von Homeyer Z, Schneider A, Padayachee K, Naidoo SB, Mtshweni K, Matau A, Hausler H, Marks M. Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa. Addict Sci Clin Pract 2020; 15:13. [PMID: 32085807 PMCID: PMC7035721 DOI: 10.1186/s13722-020-00186-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. METHODS We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. RESULTS The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). CONCLUSIONS Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.
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Affiliation(s)
- Andrew Scheibe
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
| | - Shaun Shelly
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Tara Gerardy
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Zara von Homeyer
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Andrea Schneider
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | | | | | - Klaas Mtshweni
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Ayanda Matau
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Harry Hausler
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Monique Marks
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
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Carney T, Van Hout MC, Norman I, Dada S, Siegfried N, Parry CDH. Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders. Cochrane Database Syst Rev 2020; 2:CD012254. [PMID: 32068247 PMCID: PMC7027221 DOI: 10.1002/14651858.cd012254.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Medical treatment and detoxification from opiate disorders includes oral administration of opioid agonists. Dihydrocodeine (DHC) substitution treatment is typically low threshold and therefore has the capacity to reach wider groups of opiate users. Decisions to prescribe DHC to patients with less severe opiate disorders centre on its perceived safety, reduced toxicity, shorter half-life and more rapid onset of action, and potential retention of patients. This review set out to investigate the effects of DHC in comparison to other pharmaceutical opioids and placebos in the detoxification and substitution of individuals with opiate use disorders. OBJECTIVES To investigate the effectiveness of DHC in reducing illicit opiate use and other health-related outcomes among adults compared to other drugs or placebos used for detoxification or substitution therapy. SEARCH METHODS In February 2019 we searched Cochrane Drugs and Alcohol's Specialised Register, CENTRAL, PubMed, Embase and Web of Science. We also searched for ongoing and unpublished studies via ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and Trialsjournal.com. All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials that evaluated the effect of DHC for detoxification and maintenance substitution therapy for adolescent (aged 15 years and older) and adult illicit opiate users. The primary outcomes were abstinence from illicit opiate use following detoxification or maintenance therapy measured by self-report or urinalysis. The secondary outcomes were treatment retention and other health and behaviour outcomes. DATA COLLECTION AND ANALYSIS We followed the standard methodological procedures that are outlined by Cochrane. This includes the GRADE approach to appraise the quality of evidence. MAIN RESULTS We included three trials (in five articles) with 385 opiate-using participants that measured outcomes at different follow-up periods in this review. Two studies with 150 individuals compared DHC with buprenorphine for detoxification, and one study with 235 participants compared DHC to methadone for maintenance substitution therapy. We downgraded the quality of evidence mainly due to risk of bias and imprecision. For the two studies that compared DHC to buprenorphine, we found low-quality evidence of no significant difference between DHC and buprenorphine for detoxification at six-month follow-up (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.25 to 1.39; P = 0.23) in the meta-analysis for the primary outcome of abstinence from illicit opiates. Similarly, low-quality evidence indicated no difference for treatment retention (RR 1.29, 95% CI 0.99 to 1.68; P = 0.06). In the single trial that compared DHC to methadone for maintenance substitution therapy, the evidence was also of low quality, and there may be no difference in effects between DHC and methadone for reported abstinence from illicit opiates (mean difference (MD) -0.01, 95% CI -0.31 to 0.29). For treatment retention at six months' follow-up in this single trial, the RR calculated with an intention-to-treat analysis also indicated that there may be no difference between DHC and methadone (RR 1.04, 95% CI 0.94 to 1.16). The studies that compared DHC to buprenorphine reported no serious adverse events, while the DHC versus methadone study reported one death due to methadone overdose. AUTHORS' CONCLUSIONS We found low-quality evidence that DHC may be no more effective than other commonly used pharmacological interventions in reducing illicit opiate use. It is therefore premature to make any conclusive statements about the effectiveness of DHC, and it is suggested that further high-quality studies are conducted, especially in low- to middle-income countries.
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Affiliation(s)
- Tara Carney
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie Van Zijl DriveTygerbergWestern CapeSouth Africa7505
| | - Marie Claire Van Hout
- Liverpool John Moores UniversityPublic Health Institute2nd Floor Henry Cotton Campus15‐21 Webster StreetLiverpoolUKL32ET
| | - Ian Norman
- King's College LondonFlorence Nightingale Faculty of Nursing and MidwiferyJames Clerk Maxwell Building , Waterloo RoadLondonUKSE1 8WA
| | - Siphokazi Dada
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie Van Zijl Drive, TygerbergCape TownWestern CapeSouth Africa7505
| | - Nandi Siegfried
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie Van Zijl Drive, TygerbergCape TownWestern CapeSouth Africa7505
| | - Charles DH Parry
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie Van Zijl DriveTygerbergWestern CapeSouth Africa7505
- University of StellenboschDepartment of PsychiatryTygerberg 7505South Africa
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Wakeman SE, Larochelle MR, Ameli O, Chaisson CE, McPheeters JT, Crown WH, Azocar F, Sanghavi DM. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Netw Open 2020; 3:e1920622. [PMID: 32022884 DOI: 10.1001/jamanetworkopen.2019.20622] [Citation(s) in RCA: 432] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although clinical trials demonstrate the superior effectiveness of medication for opioid use disorder (MOUD) compared with nonpharmacologic treatment, national data on the comparative effectiveness of real-world treatment pathways are lacking. OBJECTIVE To examine associations between opioid use disorder (OUD) treatment pathways and overdose and opioid-related acute care use as proxies for OUD recurrence. DESIGN, SETTING, AND PARTICIPANTS This retrospective comparative effectiveness research study assessed deidentified claims from the OptumLabs Data Warehouse from individuals aged 16 years or older with OUD and commercial or Medicare Advantage coverage. Opioid use disorder was identified based on 1 or more inpatient or 2 or more outpatient claims for OUD diagnosis codes within 3 months of each other; 1 or more claims for OUD plus diagnosis codes for opioid-related overdose, injection-related infection, or inpatient detoxification or residential services; or MOUD claims between January 1, 2015, and September 30, 2017. Data analysis was performed from April 1, 2018, to June 30, 2019. EXPOSURES One of 6 mutually exclusive treatment pathways, including (1) no treatment, (2) inpatient detoxification or residential services, (3) intensive behavioral health, (4) buprenorphine or methadone, (5) naltrexone, and (6) nonintensive behavioral health. MAIN OUTCOMES AND MEASURES Opioid-related overdose or serious acute care use during 3 and 12 months after initial treatment. RESULTS A total of 40 885 individuals with OUD (mean [SD] age, 47.73 [17.25] years; 22 172 [54.2%] male; 30 332 [74.2%] white) were identified. For OUD treatment, 24 258 (59.3%) received nonintensive behavioral health, 6455 (15.8%) received inpatient detoxification or residential services, 5123 (12.5%) received MOUD treatment with buprenorphine or methadone, 1970 (4.8%) received intensive behavioral health, and 963 (2.4%) received MOUD treatment with naltrexone. During 3-month follow-up, 707 participants (1.7%) experienced an overdose, and 773 (1.9%) had serious opioid-related acute care use. Only treatment with buprenorphine or methadone was associated with a reduced risk of overdose during 3-month (adjusted hazard ratio [AHR], 0.24; 95% CI, 0.14-0.41) and 12-month (AHR, 0.41; 95% CI, 0.31-0.55) follow-up. Treatment with buprenorphine or methadone was also associated with reduction in serious opioid-related acute care use during 3-month (AHR, 0.68; 95% CI, 0.47-0.99) and 12-month (AHR, 0.74; 95% CI, 0.58-0.95) follow-up. CONCLUSIONS AND RELEVANCE Treatment with buprenorphine or methadone was associated with reductions in overdose and serious opioid-related acute care use compared with other treatments. Strategies to address the underuse of MOUD are needed.
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Affiliation(s)
- Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marc R Larochelle
- Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Omid Ameli
- Integrated Programs, OptumLabs Inc, Cambridge, Massachusetts
| | | | | | | | - Francisca Azocar
- Department of Research, Optum Behavioral Health, Cambridge, Massachusetts
| | - Darshak M Sanghavi
- Department of Medicare and Retirement, United Healthcare, Minnetonka, Minnesota
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200
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Magwood O, Salvalaggio G, Beder M, Kendall C, Kpade V, Daghmach W, Habonimana G, Marshall Z, Snyder E, O’Shea T, Lennox R, Hsu H, Tugwell P, Pottie K. The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder. PLoS One 2020; 15:e0227298. [PMID: 31945092 PMCID: PMC6964917 DOI: 10.1371/journal.pone.0227298] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Substance use is disproportionately high among people who are homeless or vulnerably housed. We performed a systematic overview of reviews examining the effects of selected harm reduction and pharmacological interventions on the health and social well-being of people who use substances, with a focus on homeless populations. METHODS AND FINDINGS We searched MEDLINE, EMBASE, PsycINFO, Joanna Briggs Institute EBP, Cochrane Database of Systematic Reviews and DARE for systematic reviews from inception to August 2019. We conducted a grey literature search and hand searched reference lists. We selected reviews that synthesized evidence on supervised consumption facilities, managed alcohol programs and pharmacological interventions for opioid use disorders. We abstracted data specific to homeless or vulnerably housed populations. We assessed certainty of the evidence using the GRADE approach. Our search identified 483 citations and 30 systematic reviews met all inclusion criteria, capturing the results from 442 primary studies. This included three reviews on supervised consumption facilities, 24 on pharmacological interventions, and three on managed alcohol programs. Supervised consumption facilities decreased lethal overdoses and other high risk behaviours without any significant harm, and improved access to care. Pharmaceutical interventions reduced mortality, morbidity, and substance use, but the impact on retention in treatment, mental illness and access to care was variable. Managed alcohol programs reduced or stabilized alcohol consumption. Few studies on managed alcohol programs reported deaths. CONCLUSIONS Substance use is a common chronic condition impacting homeless populations. Supervised consumption facilities reduce overdose and improve access to care, while pharmacological interventions may play a role in reducing harms and addressing other morbidity. High quality evidence on managed alcohol programs is limited.
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Affiliation(s)
- Olivia Magwood
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Michaela Beder
- St. Michael’s Hospital, University of Toronto Dept of Psychiatry, Toronto, ON, Canada
| | - Claire Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Departments of Family Medicine & School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Victoire Kpade
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Wahab Daghmach
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Gilbert Habonimana
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Ellen Snyder
- Public Health and Preventative Medicine Residency Program, University of Ottawa, Ottawa, ON, Canada
| | - Tim O’Shea
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Helen Hsu
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin Pottie
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Departments of Family Medicine & School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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