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McHugh RK, Votaw VR, Barlow DH, Fitzmaurice GM, Greenfield SF, Weiss RD. Development of an integrated cognitive behavioral therapy for anxiety and opioid use disorder: Study protocol and methods. Contemp Clin Trials 2017; 60:105-112. [PMID: 28689852 PMCID: PMC5553551 DOI: 10.1016/j.cct.2017.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 01/17/2023]
Abstract
Opioid use disorder is a highly disabling psychiatric disorder, and is associated with both significant functional disruption and risk for negative health outcomes such as infectious disease and fatal overdose. Even among those who receive evidence-based pharmacotherapy for opioid use disorder, many drop out of treatment or relapse, highlighting the importance of novel treatment strategies for this population. Over 60% of those with opioid use disorder also meet diagnostic criteria for an anxiety disorder; however, efficacious treatments for this common co-occurrence have not be established. This manuscript describes the rationale and methods for a behavioral treatment development study designed to develop and test an integrated cognitive-behavioral therapy for those with co-occurring opioid use disorder and anxiety disorders. The aims of the study are (1) to develop and pilot test a new manualized cognitive behavioral therapy for co-occurring opioid use disorder and anxiety disorders, (2) to test the efficacy of this treatment relative to an active comparison treatment that targets opioid use disorder alone, and (3) to investigate the role of stress reactivity in both prognosis and recovery from opioid use disorder and anxiety disorders. Our overarching aim is to investigate whether this new treatment improves both anxiety and opioid use disorder outcomes relative to standard treatment. Identifying optimal treatment strategies for this population are needed to improve outcomes among those with this highly disabling and life-threatening disorder.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Victoria R Votaw
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - David H Barlow
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02116, USA
| | - Garrett M Fitzmaurice
- Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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Heikman PK, Muhonen LH, Ojanperä IA. Polydrug abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicine. BMC Psychiatry 2017; 17:245. [PMID: 28683783 PMCID: PMC5501578 DOI: 10.1186/s12888-017-1415-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/02/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Polydrug abuse is a known problem among opioid-dependent patients receiving opioid maintenance treatment (OMT). However, improved laboratory diagnostics is required to reveal polydrug abuse in its current scope. Furthermore, there are few studies focusing on the relationship between polydrug abuse and adequacy of the dose of OMT medicine. This study aimed to evaluate the polydrug abuse among opioid-dependent patients receiving OMT with inadequate (Group IA) and adequate (Group A) doses of OMT medicine as experienced by the patients. Craving for opioids and withdrawal symptoms were evaluated as indicators of the adequacy rating. METHODS This is a retrospective register-based study of 60 OMT patients on either methadone or sublingual buprenorphine/naloxone medication, whose polydrug abuse was studied from urine samples by means of a comprehensive high-resolution mass spectrometry method. RESULTS Inadequate doses of the OMT medicines were associated with higher subjective withdrawal scores and craving for opioids. Six groups of abused substances (benzodiazepines, amphetamines, opioids, cannabis, new psychoactive substances, and non-prescribed psychotropic medicines) were found among OMT patients. Group IA patients showed significantly more abuse of benzodiazepines and amphetamines than the Group A patients. All the new psychoactive substances and most of the non-prescribed psychotropic medicines were detected from the Group IA patients. There was no difference in the doses of the OMT medicine between Groups IA and A patients. CONCLUSIONS Polydrug abuse, detected by definitive laboratory methods, was widespread and more common among Group IA than Group A patients, emphasizing the requirement for individual OMT medicine dose adjustment.
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Affiliation(s)
- Pertti Kalevi Heikman
- University of Helsinki and Helsinki University Central Hospital, Psychiatry, P.O. Box 22, Välskärinkatu 12 A, FI-00014 Helsinki, Finland
| | - Leea Hellevi Muhonen
- University of Helsinki and Helsinki University Central Hospital, Psychiatry, P.O. Box 22, Välskärinkatu 12 A, FI-00014 Helsinki, Finland
| | - Ilkka Antero Ojanperä
- University of Helsinki, Forensic Medicine, P.O. Box 40, Kytösuontie 11, FI-00014 Helsinki, Finland
- National Institute for Health and Welfare, Forensic Toxicology Unit, P.O. Box 30, Mannerheimintie 166, FI-00271 Helsinki, Finland
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Miller KL, Puet BL, Roberts A, Hild C, Carter J, Black DL. Urine drug testing results and paired oral fluid comparison from patients enrolled in long-term medication-assisted treatment in Tennessee. J Subst Abuse Treat 2017; 76:36-42. [DOI: 10.1016/j.jsat.2017.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/13/2017] [Accepted: 01/18/2017] [Indexed: 01/23/2023]
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Dunlop AJ, Brown AL, Oldmeadow C, Harris A, Gill A, Sadler C, Ribbons K, Attia J, Barker D, Ghijben P, Hinman J, Jackson M, Bell J, Lintzeris N. Effectiveness and cost-effectiveness of unsupervised buprenorphine-naloxone for the treatment of heroin dependence in a randomized waitlist controlled trial. Drug Alcohol Depend 2017; 174:181-191. [PMID: 28371689 DOI: 10.1016/j.drugalcdep.2017.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Access to opioid agonist treatment can be associated with extensive waiting periods with significant health and financial burdens. This study aimed to determine whether patients with heroin dependence dispensed buprenorphine-naloxone weekly have greater reductions in heroin use and related adverse health effects 12-weeks after commencing treatment, compared to waitlist controls and to examine the cost-effectiveness of this strategy. METHODS An open-label waitlist RCT was conducted in an opioid treatment clinic in Newcastle, Australia. Fifty patients with DSM-IV-TR heroin dependence (and no other substance dependence) were recruited. The intervention group (n=25) received take-home self-administered sublingual buprenorphine-naloxone weekly (mean dose, 22.7±5.7mg) and weekly clinical review. Waitlist controls (n=25) received no clinical intervention. The primary outcome was heroin use (self-report, urine toxicology verified) at weeks four, eight and 12. The primary cost-effectiveness outcome was incremental cost per additional heroin-free-day. RESULTS Outcome data were available for 80% of all randomized participants. Across the 12-weeks, treatment group heroin use was on average 19.02days less/month (95% CI -22.98, -15.06, p<0.0001). A total 12-week reduction in adjusted costs including crime of $A5,722 (95% CI 3299, 8154) in favor of treatment was observed. Excluding crime, incremental cost per heroin-free-day gained from treatment was $A18.24 (95% CI 4.50, 28.49). CONCLUSION When compared to remaining on a waitlist, take-home self-administered buprenorphine-naloxone treatment is associated with significant reductions in heroin use for people with DSM-IV-TR heroin dependence. This cost-effective approach may be an efficient strategy to enhance treatment capacity.
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Affiliation(s)
- Adrian J Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Brain and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Amanda L Brown
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Brain and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Christopher Oldmeadow
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Clinical Research Design, IT and Statistical Support (CRεDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Anthony Harris
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia.
| | - Anthony Gill
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Craig Sadler
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Alcohol and Drug Unit, Calvary Mater Newcastle, Waratah, NSW, Australia.
| | - Karen Ribbons
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Clinical Research Design, IT and Statistical Support (CRεDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Medicine, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia.
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Peter Ghijben
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia.
| | - Jennifer Hinman
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
| | - Melissa Jackson
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
| | - James Bell
- Addictions Department, Institute of Psychiatry, Kings College London, London, United Kingdom; Drug Health Services, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Surry Hills, NSW, Australia; Central Clinical School,Discipline of Addiction Medicine, University of Sydney, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Krause D, Plörer D, Koller G, Martin G, Winter C, Adam R, Canolli M, Al-Iassin J, Musselmann R, Walcher S, Schäfer F, Pogarell O. High Concomitant Misuse of Fentanyl in Subjects on Opioid Maintenance Treatment. Subst Use Misuse 2017; 52:639-645. [PMID: 28157415 DOI: 10.1080/10826084.2016.1246571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Concomitant opioid misuse is an increasing problem in opioid maintenance treatment as it interferes with treatment success. OBJECTIVE Therefore, the rates of concomitant fentanyl misuse in opioid maintained patients were investigated. METHODS We conducted a cross-sectional study which consisted in collecting data via urine samples and questionnaires in Germany. Urine samples of patients on opioid maintenance treatment were gathered and fentanyl concentrations were measured from 2008 to 2012. An anonymous questionnaire provided data on the consumption of fentanyl as concomitant drug. Data were analyzed with descriptive statistics and group differences were calculated using the Chi-Square test. RESULTS Among the total sample (urine probes of 960 patients), 6.8% opioid maintained patients had positive urine samples for fentanyl and 37.9% reported concomitant fentanyl misuse (401 of these patients filled out the questionnaire). A significant age-related association of concomitant fentanyl misuse was identified in the urine analyses (χ2 = 7.489; p = .024) and also in the questionnaire data (χ2 = 11.899, p = .003), indicating that young age increased the probability of fentanyl consumption. Patients receiving methadone had the highest rates of concomitant fentanyl misuse with 18.4% according to urine analysis. In addition, the results show that patients who are on diamorphine are significantly less likely to misuse fentanyl. CONCLUSIONS Fentanyl is a frequently used concomitant drug. Especially young patients and patients taking methadone are at high risk. Because of the life-threatening consequences of fentanyl overdose, patients taking fentanyl should be intensively medically surveilled.
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Affiliation(s)
- Daniela Krause
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Diana Plörer
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Gabriele Koller
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Gabi Martin
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Catja Winter
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Roland Adam
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Minavere Canolli
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Jori Al-Iassin
- b Outpatient Clinic for Opioid Substitution , Munich , Germany
| | | | | | | | - Oliver Pogarell
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
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Lee CS, Liebschutz JM, Anderson BJ, Stein MD. Hospitalized opioid-dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge. Am J Addict 2017; 26:667-672. [PMID: 28324627 DOI: 10.1111/ajad.12533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Few studies have explored predictors of entry into and retention in buprenorphine treatment following linkage from an acute medical hospitalization. METHODS This secondary analysis of a completed clinical trial focuses on medically hospitalized, opioid-dependent patients (n = 72) who were randomized to an intervention including buprenorphine induction and dose stabilization during hospitalization followed by post-discharge transition to office-based buprenorphine treatment (OBOT). Predictors included demographics, days hospitalized, prior buprenorphine/methadone treatment, PTSD symptoms, social support, and readiness for drug use cessation. Outcome variables were treatment entry and retention (number of days in OBOT). RESULTS Previous buprenorphine treatment, more days hospitalized, and higher PTSD symptoms predicted OBOT entry. Prior treatment, older age, and non-minority status were associated with a higher mean number of days in OBOT. CONCLUSIONS OBOT may appeal to patients who have tried buprenorphine in other settings. Linking hospitalized patients to OBOT may improve utilization of addiction treatment. SCIENTIFIC SIGNIFICANCE Prior substance treatment, longer hospital stay, and mental health should be examined in future linkage studies. (Am J Addict 2017;26:667-672).
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Affiliation(s)
- Christina S Lee
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Jane M Liebschutz
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Bradley J Anderson
- Department of Behavioral Medicine, Butler Hospital, Providence, Rhode Island
| | - Michael D Stein
- Department of Behavioral Medicine, Butler Hospital, Providence, Rhode Island.,Boston University School of Public Health, Boston, Massachusetts
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Miranda A, Taca A. Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: a multisite, retrospective assessment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:56-63. [PMID: 28301217 DOI: 10.1080/00952990.2017.1295459] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Finding an effective, non-pharmacological approach to treat opioid withdrawal could remove some of the barriers associated with pharmacotherapy. The BRIDGE® is a noninvasive, percutaneous electrical nerve field stimulator developed to target pain. OBJECTIVES This pilot study aimed to determine (1) the effects of the BRIDGE on withdrawal scores during the induction phase of opioid withdrawal therapy, (2) the percentage of subjects who successfully transitioned to medication assisted therapy (MAT). METHODS Adult patients treated with the BRIDGE during medically supervised withdrawal were included in this open label, uncontrolled, and retrospective study. The clinical opioid withdrawal scale (COWS) scores were prospectively recorded at different intervals (20, 30, and 60 min) and analyzed retrospectively. A subset of patients had scores recorded 5-days post-BRIDGE. Those who returned to the clinic and received their first dose of maintenance medication were considered to be successfully transitioned. RESULTS In this cohort (n=73), 65% were male. The mean COWS score prior to BRIDGE placement was 20.1 (±6.1). Twenty minutes after BRIDGE placement, the mean score was reduced to 7.5 (±5.9) (62.7% reduction, p<0.001). The scores further decreased after 30 minutes 4.0 (±4.4) and 60 minutes 3.1 (±3.4) (84.6% reduction, p<0.001). No rescue medications were administered during this period. The mean withdrawal score on day 5 was 0.6 (97.1% reduction, p<0.001) (n=33). Overall, 64/73 patients (88.8%) successfully transitioned to MAT. CONCLUSIONS Neurostimulation with the BRIDGE is associated with a reduction in opioid withdrawal scores. This effect persisted during the induction period and allowed for effective transition to MAT.
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Affiliation(s)
- Adrian Miranda
- a Department of Pediatrics, Division of Gastroenterology and Hepatology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Arturo Taca
- b St. Louis University School of Medicine , St. Louis , MO , USA.,c INSynergy Treatment Program , St. Louis , MO , USA
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Kowalchuk AA, Gonzalez SJ, Zoorob RJ. Substance Use Issues Among the Underserved: United States and International Perspectives. Prim Care 2017; 44:113-125. [PMID: 28164811 DOI: 10.1016/j.pop.2016.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Substance use affects people of all ages, cultures, and socioeconomic levels. Most underserved populations have lower rates of substance use than the general population in a given society, excluding tobacco use. The impact of substance use is more severe, however, in the underserved, with higher rates of incarceration, job loss, morbidity, and mortality. Innovative solutions are being developed to address these differences. Working together, underserved patients with substance use problems can be helped on their journeys toward health and wholeness.
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Affiliation(s)
- Alicia Ann Kowalchuk
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA.
| | - Sandra J Gonzalez
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA
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Ruadze E, Todadze K. Retention in Georgia opioid substitution therapy program and associated factors. Harm Reduct J 2016; 13:35. [PMID: 27931232 PMCID: PMC5146853 DOI: 10.1186/s12954-016-0124-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/29/2016] [Indexed: 11/30/2022] Open
Abstract
Background Substance abuse has been considered as a growing challenge in Georgia that is closely linked with human immune deficiency virus (HIV) and hepatitis C transmission due to unsafe injection and other uncontrolled behaviors. Methadone maintenance therapy is one of the major treatment options for opioid-dependent individuals. It has proven efficacy in decreasing illegal opioid consumption and criminal behavior as well as reducing the level of HIV infection, mortality, HCV infection, and increasing social functioning. Methods The data was initially extracted from the electronic database, as of October 30, 2015, for the patients undergoing methadone maintenance therapy in 2014 and 2015. We used two types of statistical analysis: binary regression and time-to-event analysis (Kaplan-Meier). For binary regression analysis, patients who initiated the treatment 12, 9, 6, and 3 months prior to October 30, 2015, respectively, were eligible for >12-, >9-, >6-, and >3-month retention analysis. We identified two types of the retention periods: (I) “the program specific retention period” (the time spent (uninterruptedly) in the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (GFATM) opioid substitution treatment (OST) program after the clients’ last entry) and (II) “being on OST retention period” (the time spent (uninterruptedly) on OST since the clients’ last entry). For time-to-event analysis, the two different endpoints were investigated: (i) dropouts and (ii) being detained. Results The analysis showed that at each time point, “being on OST retention” rates are slightly higher than “program specific retention” rates. The percentages of patients retained in OST treatment after 3, 6, 9, and 12 months from the initiation of the treatment, respectively, were 89, 86, 85, and 83% and the percentages of patients retained in the GFATM program at the same time points were 88, 83, 82, and 80%. Patients older than 40 years are twice as likely to stay in the program compared to younger individuals. Gender is only associated with >9 and >12 months retention with approximately three times the odds for men compared to women. The strength of the association between hepatitis C status and “program specific” retention increases with time spent in the program as p values decrease from 0.07 for >3- and >6-month retention to 0.01 for >9- and >12-month retention. The younger age group was more likely to get dropouts and be detained. HIV status and social status did not show statistically significant association with retention. Conclusions These findings identify the need for more support for younger patients as they are more vulnerable to dropouts and detention compared to the older age group, especially during the early stage of treatment.
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Affiliation(s)
- Ekaterine Ruadze
- The National Center for Disease Control and Public Health, 9 Asatiani Street, Tbilisi, Georgia.
| | - Khatuna Todadze
- Center for Mental Health and Prevention of Addiction, 21 Kavtaradze Street, Tbilisi, Georgia.,Addiction Department, Tbilisi State Medical University, 7 Asatiani Street, Tbilisi, Georgia
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Suzuki J, Zinser J, Klaiber B, Hannon M, Grassi H, Spinosa M, Ramirez A, Issa M, Chin Feman SP. Feasibility of Implementing Shared Medical Appointments (SMAs) for Office-Based Opioid Treatment With Buprenorphine: A Pilot Study. Subst Abus 2016; 36:166-9. [PMID: 25738320 DOI: 10.1080/08897077.2014.998400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Shared medical appointments (SMAs) are designed to improve patient satisfaction and increase access to treatment. In a typical SMA, 6-12 patients with similar diagnoses attend a group appointment with their health care providers, often lasting 60-120 minutes. All components of an individual visit are completed, and additional time is spent providing education and facilitating peer support. The aim of this study was to report on patient and program outcomes after implementation of SMA-based office-based opioid treatment with buprenorphine. METHODS The study was conducted at a hospital-based outpatient psychiatric clinic that previously did not offer any office-based opioid treatment with buprenorphine. Demographic and clinical data (treatment retention, depression, anxiety, craving scores, and urine toxicology results) were extracted from the medical records. Patients were recruited to complete a survey assessing their experience. RESULTS Ninety-three patients enrolled in the program, and 52.7% remained in treatment at 6 months. The proportion of aberrant opioid urine results, depression, anxiety, and craving decreased significantly from baseline to 6 months. Twenty-two patients completed the survey, who generally agreed that the SMA format allowed for more time with physicians, more support from peers, better coordination of care, and more predictable times for visits. CONCLUSIONS Implementation of an SMA-based buprenorphine program was feasible, with treatment outcomes comparable to traditional models of care. More research is needed to explore the impact of SMA on buprenorphine treatment.
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Affiliation(s)
- Joji Suzuki
- a Department of Psychiatry , Brigham and Women's Hospital , Boston , Massachusetts , USA
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Evren C, Karabulut V, Can Y, Bozkurt M, Umut G, Evren B. Predictors of Outcome During a 6-Month Follow-Up Among Heroin Dependent Patients Receiving Buprenorphine/Naloxone Maintenance Treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20140310072258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Cuneyt Evren
- Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul - Turkey
| | - Vahap Karabulut
- Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul - Turkey
| | - Yesim Can
- Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul - Turkey
| | - Muge Bozkurt
- Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul - Turkey
| | - Gokhan Umut
- Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul - Turkey
| | - Bilge Evren
- Baltalimani Training and Research Hospital for Muskuloskeletal Disorders, Department of Psychiatry, Istanbul - Turkey
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Cushman PA, Liebschutz JM, Anderson BJ, Moreau MR, Stein MD. Buprenorphine Initiation and Linkage to Outpatient Buprenorphine do not Reduce Frequency of Injection Opiate Use Following Hospitalization. J Subst Abuse Treat 2016; 68:68-73. [PMID: 27431049 PMCID: PMC5018431 DOI: 10.1016/j.jsat.2016.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/11/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Buprenorphine has established effectiveness for outpatient treatment of opioid use disorder. Our previously published STOP (Suboxone Transition to Opiate Program) trial showed that buprenorphine induction, stabilization, and linkage to outpatient treatment in opioid-dependent inpatients (injection and non-injection drug users) decreased illicit opioid use over 6months. The present study was a planned subgroup analysis of injection opiate users from STOP. OBJECTIVE To determine if inpatient buprenorphine initiation and linkage to outpatient buprenorphine reduce injection opiate users' frequency of injection opiate use (IOU). METHODS Inpatient injection opiate users at a safety-net hospital were randomized to buprenorphine linkage (induction, stabilization, bridge prescription, and facilitated referral to outpatient treatment) or detoxification (5-day inpatient buprenorphine taper). Conditional fixed-effects Poisson regression was used to estimate the effects of intervention on 30-day (self-report) at 1, 3, and 6months, measured using 30-day timeline follow-back. The secondary outcome was linkage effectiveness, measured as % presenting to initial outpatient buprenorphine visits after hospital discharge. RESULTS Analysis was limited to persons (n=62 randomized to detoxification and n=51 to linkage) with baseline IOU. There were no significant differences in age, ethnicity, or baseline IOU frequency. At follow-up, linkage patients (70.6%) were significantly more likely (p<0.001) to present to initial buprenorphine visits than detoxification patients (9.7%). However, there was no significant between group difference in the rate of IOU at 1- (IRR=0.73, p=0.32), 3- (IRR=1.20, p=0.54), or 6-month (IRR=0.73, p=0.23) follow-ups. Using person-day analysis, participants self-reported IOU on 5.8% of follow-up days in which they used prescription buprenorphine and 37.5% of non-buprenorphine days. Using a generalized estimating equation, the estimated odds of IOU was 4.57 times higher (p<0.001) on non-buprenorphine days. CONCLUSIONS Despite STOP's success in linking patients who inject opiates to outpatient buprenorphine, the intervention did not significantly decrease their IOU frequency. Injection opiate users will require a more intensive protocol to sustain outpatient buprenorphine treatment and decrease injection with its attendant risks.
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Affiliation(s)
- Phoebe A Cushman
- General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Crosstown 2nd Floor, 801 Massachusetts Ave, Boston, MA, USA, 02118.
| | - Jane M Liebschutz
- General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Crosstown 2nd Floor, 801 Massachusetts Ave, Boston, MA, USA, 02118.
| | - Bradley J Anderson
- General Internal Medicine, Butler Hospital, 345 Blackstone Blvd., Providence, RI, USA, 02906.
| | - Merredith R Moreau
- General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Crosstown 2nd Floor, 801 Massachusetts Ave, Boston, MA, USA, 02118.
| | - Michael D Stein
- General Internal Medicine, Butler Hospital, 345 Blackstone Blvd., Providence, RI, USA, 02906; Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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Marcovitz DE, McHugh RK, Volpe J, Votaw V, Connery HS. Predictors of early dropout in outpatient buprenorphine/naloxone treatment. Am J Addict 2016; 25:472-7. [PMID: 27442456 DOI: 10.1111/ajad.12414] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/08/2016] [Accepted: 07/09/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Identifying predictors of early drop out from outpatient treatment of opioid use disorder (OUD) with buprenorphine/naloxone (BN) may improve care for subgroups requiring more intensive engagement to achieve stabilization. However, previous research on predictors of dropout among this population has yielded mixed results. The aim of the present study was to elucidate these mixed findings by simultaneously evaluating a range of putative risk factors that may predict dropout in BN maintenance treatment. METHODS Outpatient medical records and weekly supervised urine toxicology results were retrospectively reviewed for patients at two community psychiatric clinics (n = 202): a private hospital clinic (n = 84) and a federally qualified health center (n = 118). A forward stepwise logistic regression was utilized to investigate the association between early dropout (i.e., discontinuing treatment or buprenorphine non-adherence within the first 3 months of clinic entry) and extracted sociodemographic, clinical, substance use, and treatment history variables. RESULTS Overall, 56 of 202 participants (27.7%) dropped out of treatment. The multivariable analysis indicated that age under 25 (B = 1.47, SEB = .52, p < .01) and opioid use in month 1 (B = 1.50, SEB = .41, p < .001) were significantly associated with early dropout; those with a history of suicide attempt were significantly less likely to drop out (B = -1.44, SEB = .67, p < .05). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Consistent with previous research, younger age and use of opioids during the first month of treatment predicted early dropout. Having a history of prior suicide attempt was associated with 3-month BN treatment retention, which has not been previously reported. (Am J Addict 2016;25:472-477).
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Affiliation(s)
- David E Marcovitz
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts.,Massachusetts General Hospital/McLean Adult Psychiatry Residency, Boston/Belmont, Massachusetts
| | - R Kathryn McHugh
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts.,McLean Hospital, Belmont, Massachusetts
| | - Julie Volpe
- Community Health Services, Hartford, Connecticut
| | | | - Hilary S Connery
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts.,McLean Hospital, Belmont, Massachusetts
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Prakash S, Balhara Y. Perceptions Related to Pharmacological Treatment of Opioid Dependence Among Individuals Seeking Treatment at a Tertiary Care Center in Northern India: A Descriptive Study. Subst Use Misuse 2016; 51:861-9. [PMID: 27100203 DOI: 10.3109/10826084.2016.1155615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Perceptions of individuals with opioid dependence regarding medications used for long-term management of the condition have been explored only by a handful of studies. Interestingly, no study had compared the perceptions regarding buprenorphine, buprenorphine-naloxone, and oral naltrexone in the opioid-dependent subjects from the same setting. OBJECTIVES The present study aimed to examine the perceptions related to treatment of opioid dependence with buprenorphine, buprenorphine-naloxone, and oral naltrexone among individuals seeking help at a tertiary care center. METHODS This was a cross-sectional, observational study with consecutive sampling. Sociodemographic data, Drug Abuse Monitoring System questionnaire, perceptions questionnaire, clinical interview to elicit drug use history, treatment history and details of prior abstinence attempts were completed. RESULTS Eighty-five subjects were recruited in the study. Fear of becoming dependent (35.3%) was the most common harm reported while withdrawal control (82.4%) was the most common benefit reported with buprenorphine preparations. Precipitated withdrawals (21.2%) were the most common harm reported and prevention of relapse (53%) was the most common benefit reported with oral naltrexone. While patients who believed that buprenorphine or naltrexone were harmful reported durations of treatment that were much shorter than those who did not so believe, there was no statistically significant difference in the actual duration and period of abstinence (p = .34; p = .62). Sociodemographic profile, perceptions related to dosing, nature of medication, expectations from treatment, and duration of illness were also described.
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Affiliation(s)
- Sathya Prakash
- a Department of Psychiatry , All India Institute of Medical Sciences , New Delhi , India
| | - Yatan Balhara
- b National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
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Mutlu C, Demirci AC, Yalcin O, Kilicoglu AG, Topal M, Karacetin G. One-Year Follow-Up of Heroin-Dependent Adolescents Treated with Buprenorfine/Naloxone for the First Time in a Substance Treatment Unit. J Subst Abuse Treat 2016; 67:1-8. [PMID: 27296655 DOI: 10.1016/j.jsat.2016.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
Abstract
The aims of the present study were to evaluate 1-year retention in program and buprenorphine/naloxone (BUP/NAL) treatment, and abstinence of heroin-dependent adolescents. The present study included the follow-up information of 112 heroin dependent adolescents who took BUP/NAL treatment for the first time in a specific inpatient unit. Retention and abstinence were assessed by self-report and urine drug screen at each visit. Mean age was 16.9 years, with 101 (90.2%) male. Program retention was 81.3% at day 30, and 24.1% at 1 year, while retention in BUP/NAL treatment was 69.6% at day 30 and 16.1% at 1 year. Rates of abstinence were 69.0% at day 30 and 10.3% at 1 year. There was a significant positive correlation between duration of inpatient treatment and program retention, treatment retention, abstinence (p < 0.05 for all), and between the dose and treatment retention, abstinence (p < 0.05 for both). Patients with comorbid psychiatric disease were more likely to be retained in treatment for 3 months, and in program for 6 months (p < 0.05, for all). Patients who completed inpatient treatment were more likely to be retained in treatment for 1 year, and in program for 9 months, and to be abstinent for 1 year (p < 0.05, for all). Findings suggested that starting BUP/NAL treatment in an inpatient unit might result in better outcomes compared to literature. Duration of inpatient treatment, the completion of inpatient treatment, BUP/NAL dose, and having a comorbid psychiatric disease seemed to be important factors for heroin-dependent adolescents in retention and abstinence within 1-year period.
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Affiliation(s)
- Caner Mutlu
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - Arzu Ciftci Demirci
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ozhan Yalcin
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ali Guven Kilicoglu
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Melike Topal
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Gul Karacetin
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Mogali S, Khan NA, Drill ES, Pavlicova M, Sullivan MA, Nunes E, Bisaga A. Baseline characteristics of patients predicting suitability for rapid naltrexone induction. Am J Addict 2016; 24:258-264. [PMID: 25907815 DOI: 10.1111/ajad.12180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/19/2014] [Accepted: 10/31/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Extended-release (XR) injection naltrexone has proved promising in the treatment of opioid dependence. Induction onto naltrexone is often accomplished with a procedure known as rapid naltrexone induction. The purpose of this study was to evaluate pre-treatment patient characteristics as predictors of successful completion of a rapid naltrexone induction procedure prior to XR naltrexone treatment. METHODS A chart review of 150 consecutive research participants (N = 84 completers and N = 66 non-completers) undergoing a rapid naltrexone induction with the buprenorphone-clonidine procedure were compared on a number of baseline demographic, clinical and psychosocial factors. Logistic regression was used to identify client characteristics that may predict successful initiation of naltrexone after a rapid induction-detoxification. RESULTS Patients who failed to successfully initiate naltrexone were younger (AOR: 1.040, CI: 1.006, 1.075), and using 10 or more bags of heroin (or equivalent) per day (AOR: 0.881, CI: 0.820, 0.946). Drug use other than opioids was also predictive of failure to initiate naltrexone in simple bivariate analyses, but was no longer significant when controlling for age and opioid use level. CONCLUSIONS Younger age, and indicators of greater substance dependence severity (more current opioid use, other substance use) predict difficulty completing a rapid naltrexone induction procedure. Such patients might require a longer period of stabilization and/or more gradual detoxification prior to initiating naltrexone. SCIENTIFIC SIGNIFICANCE Our study findings identify specific characteristics of patients who responded positively to rapid naltrexone induction.
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Affiliation(s)
- Shanthi Mogali
- Division of Substance Abuse, New York State Psychiatric Institute, New York, NY
| | - Nabil A Khan
- Division of Substance Abuse, New York State Psychiatric Institute, New York, NY
| | - Esther S Drill
- Department of Biostatistics, Columbia University, New York, NY
| | | | | | - Edward Nunes
- Division of Substance Abuse, New York State Psychiatric Institute, New York, NY.,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Adam Bisaga
- Division of Substance Abuse, New York State Psychiatric Institute, New York, NY.,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
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Proctor SL, Copeland AL, Kopak AM, Hoffmann NG, Herschman PL, Polukhina N. Outcome predictors for patients receiving methadone maintenance treatment: findings from a retrospective multi-site study. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1118564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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68
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Springer SA, Brown SE, Di Paola A, Altice FL. Correlates of retention on extended-release naltrexone among persons living with HIV infection transitioning to the community from the criminal justice system. Drug Alcohol Depend 2015; 157:158-65. [PMID: 26560326 PMCID: PMC4675147 DOI: 10.1016/j.drugalcdep.2015.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The acceptability of and retention on extended-release naltrexone (XR-NTX), an FDA-approved medication for the treatment of alcohol and opioid use disorders, among persons living with HIV disease (PLH) under criminal justice setting (CJS) supervision has not been evaluated to date. METHODS Two double-blind placebo-controlled randomized trials of XR-NTX for inmates with HIV disease transitioning to the community with (1) alcohol use disorders (AUDs) or (2) opioid use disorders, are underway. Reasons for not accepting XR-NTX and an evaluation of differences in demographic features between those who were retained on study drug and those who did not return for their second injection post-release are discussed. RESULTS 70% of eligible persons consented to participate; almost 90% received their first injection; and almost 60% returned for their first injection after release. Variables found to be associated (p<0.10) with returning for the second injection included: not meeting criteria for hazardous drinking (p=0.035; OR 0.424 (CI 0.191-0.941)); being prescribed antiretroviral therapy (p=0.068; OR 2.170 (CI 0.943-4.992)); expressing experiencing serious depression 30 days prior to incarceration (p=0.068; OR 1.889 (CI 0.955-3.737)); not having a positive cocaine urine screen on the day of release (DOR) (p=0.011; OR 0.258 (CI 0.091-0.729)); and not meeting criteria for an AUD plus any substance use disorder (p=0.068; OR 0.521 (CI 0.259-1.048)). Only positive cocaine urine test on DOR was statistically significant after multivariate regression analyses (p=0.005; OR 0.207 (CI 0.068-0.623)). CONCLUSION CJS based XR-NTX programs are highly acceptable among PLH, however retention on XR-NTX after release is negatively impacted by relapse to cocaine use.
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Affiliation(s)
- Sandra A Springer
- Yale AIDS Program, Yale School of Medicine, Section of Infectious Disease, 135 College Street, Suite 323, New Haven, CT 06511, United States.
| | - Shan-Estelle Brown
- Yale AIDS Program, Yale School of Medicine, Section of Infectious Disease, 135 College Street, Suite 323, New Haven, CT 06511, United States
| | - Angela Di Paola
- Yale AIDS Program, Yale School of Medicine, Section of Infectious Disease, 135 College Street, Suite 323, New Haven, CT 06511, United States
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Brogly SB, Hahn KA, Diaz SH, Werler M. Confounding of the Comparative Safety of Prenatal Opioid Agonist Therapy. JOURNAL OF ADDICTION RESEARCH & THERAPY 2015; 6:252. [PMID: 27547489 PMCID: PMC4991778 DOI: 10.4172/2155-6105.1000252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Prenatal opioid agonist therapy with methadone or buprenorphine prevents maternal illicit opioid use and withdrawal and improves pregnancy outcomes compared to heroin use alone. Historically, methadone has been the first-line opioid agonist therapy for pregnant opioid dependent women; in recent years buprenorphine has become first-line treatment for some opioid dependent pregnant women. While there is some evidence of better outcomes in neonates exposed to buprenorphine vs. methadone, the effect of confounding from differences in women who use buprenorphine and methadone has not been carefully examined in most studies. This review explores mechanisms by which confounding can arise in measuring associations between prenatal buprenorphine vs. methadone exposure on neonatal outcomes using a graphical approach, directed acyclic graphs. The goal of this paper is to facilitate better understanding of the factors influencing neonatal abstinence syndrome and accurate assessment of the comparative safety of opioid agonist therapies on the neonate.
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Affiliation(s)
- Susan B Brogly
- Departments of Surgery and of Medicine, Queen’s University, Canada
| | - Kristen A Hahn
- Department of Epidemiology, Boston University School of Public Health, USA
| | | | - Martha Werler
- Department of Epidemiology, Boston University School of Public Health, USA
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Jacobs P, Ang A, Hillhouse MP, Saxon AJ, Nielsen S, Wakim PG, Mai BE, Mooney LJ, S Potter J, Blaine JD. Treatment outcomes in opioid dependent patients with different buprenorphine/naloxone induction dosing patterns and trajectories. Am J Addict 2015; 24:667-75. [PMID: 26400835 PMCID: PMC5322942 DOI: 10.1111/ajad.12288] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/24/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Induction is a crucial period of opioid addiction treatment. This study aimed to identify buprenorphine/naloxone (BUP) induction patterns and examine their association with outcomes (opioid use, retention, and related adverse events [AEs]). METHODS The secondary analysis of a study of opioid-dependent adults seeking treatment in eight treatment settings included 740 participants inducted on BUP with flexible dosing. RESULTS Latent class analysis models detected six distinctive induction trajectories: bup1-started and remained on low; bup2-started low, shifted slowly to moderate; bup3-started low, shifted quickly to moderate; bup4-started high, shifted to low; bup5-started and remained on moderate; bup6-started moderate, shifted to high dose (Fig. 1). Baseline characteristics, including Clinical Opioid Withdrawal Scale (COWS), were important predictors of retention. When controlled for the baseline characteristics, bup6 participants were three times less likely to drop out the first 7 days than bup1 participants (adjusted hazard ratio (aHR) = .28, p = .03). Opioid use and AEs were similar across trajectories. Participants on ≥16 mg BUP compared to those on <16 mg at Day 28 were less likely to drop out (aHR = .013, p = .001) and less likely to have AEs during the first 28 days (aOR = .57, p = .03). DISCUSSION AND CONCLUSIONS BUP induction dosing was guided by an objective measure of opioid withdrawal. Participants with higher baseline COWS whose BUP doses were raised more quickly were less likely to drop out in the first 7 days than those whose doses were raised slower. SCIENTIFIC SIGNIFICANCE This study supports the use of an objective measure of opioid withdrawal (COWS) during BUP induction to improve retention early in treatment.
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Affiliation(s)
| | | | | | | | - Suzanne Nielsen
- University of New South Wales, National Drug and Alcohol Research Centre, Sydney, Australia
| | - Paul G Wakim
- NIDA Center for the Clinical Trials Network, Rockville, Maryland
| | - Barbara E Mai
- The Uniformed Services University of the Health Sciences, Bethesda, Maryland
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The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone. Drug Alcohol Depend 2015; 154:38-45. [PMID: 26187456 PMCID: PMC4536087 DOI: 10.1016/j.drugalcdep.2015.05.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Evidence suggests that the cannabinoid system is involved in the maintenance of opioid dependence. We examined whether dronabinol, a cannabinoid receptor type 1 partial agonist, reduces opioid withdrawal and increases retention in treatment with extended release naltrexone (XR-naltrexone). METHODS Opioid dependent participants were randomized to receive dronabinol 30mg/d (n=40) or placebo (n=20), under double-blind conditions, while they underwent inpatient detoxification and naltrexone induction. Before discharge all participants received an injection of XR-naltrexone, with an additional dose given four weeks later. Dronabinol or placebo was given while inpatient and for 5 weeks afterwards. The primary outcomes were the severity of opioid withdrawal, measured with the Subjective Opioid Withdrawal Scale, and retention in treatment at the end of the inpatient phase and at the end of the 8-week trial. RESULTS The severity of opioid withdrawal during inpatient phase was lower in the dronabinol group relative to placebo group (p=0.006). Rates of successful induction onto XR-naltrexone (dronabinol 66%, placebo 55%) and completion of treatment (dronabinol 35%, placebo 35%) were not significantly different. Post hoc analysis showed that the 32% of participants who smoked marijuana regularly during the outpatient phase had significantly lower ratings of insomnia and anxiety and were more likely to complete the 8-week trial. CONCLUSION Dronabinol reduced the severity of opiate withdrawal during acute detoxification but had no effect on rates of XR-naltrexone treatment induction and retention. Participants who elected to smoke marijuana during the trial were more likely to complete treatment regardless of treatment group assignment.
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Progression to regular heroin use: examination of patterns, predictors, and consequences. Addict Behav 2015; 45:287-93. [PMID: 25765913 DOI: 10.1016/j.addbeh.2015.02.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/15/2015] [Accepted: 02/16/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The present study retrospectively evaluated the chronology and predictors of substance use progression in current heroin-using individuals. METHODS Out-of-treatment heroin users (urinalysis-verified; N=562) were screened for laboratory-based research studies using questionnaires and urinalysis. Comprehensive substance use histories were collected. Between- and within-substance use progression was analyzed using stepwise linear regression models. RESULTS The strongest predictor of onset of regular heroin use was age at initial heroin use, accounting for 71.8% of variance. The strongest between-substance predictors of regular heroin use were ages at regular alcohol and tobacco use, accounting for 8.1% of variance. Earlier onset of regular heroin use (≤20 years) vs. older onset (≥30 years) was associated with a more rapid progression from initial to regular use, longer duration of heroin use, more lifetime use-related negative consequences, and greater likelihood of injecting heroin. The majority of participants (79.7%) reported substance use progression consistent with the gateway hypothesis. Gateway-inconsistent individuals were more likely to be African-American and to report younger age at initial use, longer duration of heroin use, and more frequent past-month heroin use. CONCLUSIONS Our findings demonstrate the predictive validity and clinical relevance of evaluating substance use chronology and the gateway hypothesis pattern of progression.
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Worley MJ, Shoptaw SJ, Bickel WK, Ling W. Using behavioral economics to predict opioid use during prescription opioid dependence treatment. Drug Alcohol Depend 2015; 148:62-8. [PMID: 25622776 PMCID: PMC4666717 DOI: 10.1016/j.drugalcdep.2014.12.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/09/2014] [Accepted: 12/13/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Research grounded in behavioral economics has previously linked addictive behavior to disrupted decision-making and reward-processing, but these principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction. METHODS Secondary analyses examined participants with prescription opioid dependence who received 12 weeks of buprenorphine-naloxone and counseling in a multi-site clinical trial (N=353). Baseline measures assessed opioid source and indices of drug reinforcement value, including the total amount and proportion of income spent on drugs. Weekly urine drug screens measured opioid use. RESULTS Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid use history, and opioid source frequency, patients who spent a greater total amount (OR=1.30, p<.001) and a greater proportion of their income on drugs (OR=1.31, p<.001) were more likely to use opioids during treatment. CONCLUSIONS Individual differences in drug reinforcement value, as indicated by pre-treatment allocation of economic resources to drugs, reflects propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this population.
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Affiliation(s)
- Matthew J Worley
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, United States.
| | - Steven J Shoptaw
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, United States
| | - Warren K Bickel
- Addiction Recovery Research Center (ARRC), Virginia Tech Carillion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States
| | - Walter Ling
- Integrated Substance Abuse Program, University of California, Los Angeles, 1640 S. Sepulveda, Ste. 120, Los Angeles, CA 90024, United States
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McDermott KA, Griffin ML, Connery HS, Hilario EY, Fiellin DA, Fitzmaurice GM, Weiss RD. Initial response as a predictor of 12-week buprenorphine-naloxone treatment response in a prescription opioid-dependent population. J Clin Psychiatry 2015; 76:189-94. [PMID: 25562462 PMCID: PMC4352119 DOI: 10.4088/jcp.14m09096] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Initial medication response has been shown to predict treatment outcome across a variety of substance use disorders, but no studies have examined the predictive power of initial response to buprenorphine-naloxone in the treatment of prescription opioid dependence. We therefore conducted a secondary analysis of data from the Prescription Opioid Addiction Treatment Study to determine whether initial response to buprenorphine-naloxone predicted 12-week treatment outcome in a prescription opioid-dependent population. METHOD Using data from a multisite, randomized controlled trial of buprenorphine-naloxone plus counseling for DSM-IV prescription opioid dependence (June 2006-July 2009), we conducted a secondary analysis to investigate the relationship between initial medication response and 12-week treatment outcome to establish how soon the efficacy of buprenorphine-naloxone could be predicted (N = 360). Outcomes were determined from the Substance Use Report, a self-report measure of substance use, and confirmatory urinalysis. Predictive values were calculated to determine the importance of abstinence versus use at various time points within the first month of treatment (week 1, weeks 1-2, 1-3, or 1-4) in predicting successful versus unsuccessful treatment outcome (based on abstinence or near-abstinence from opioids) in the last 4 weeks of buprenorphine-naloxone treatment (weeks 9-12). RESULTS Outcome was best predicted by medication response after 2 weeks of treatment. Two weeks of initial abstinence was moderately predictive of treatment success (positive predictive value = 71%), while opioid use in both of the first 2 weeks was strongly predictive of unsuccessful treatment outcome (negative predictive value [NPV] = 84%), especially when successful outcome was defined as total abstinence from opioids in weeks 9-12 (NPV = 94%). CONCLUSIONS Evaluating prescription opioid-dependent patients after 2 weeks of buprenorphine-naloxone treatment may help determine the likelihood of successful outcome at completion of the current treatment regimen. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00316277.
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Affiliation(s)
| | - Margaret L. Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Hilary S. Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - E. Yvette Hilario
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
| | - David A. Fiellin
- Department of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Garrett M. Fitzmaurice
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA,Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Roger D. Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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75
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Northrup TF, Stotts AL, Green C, Potter JS, Marino EN, Walker R, Weiss RD, Trivedi M. Opioid withdrawal, craving, and use during and after outpatient buprenorphine stabilization and taper: a discrete survival and growth mixture model. Addict Behav 2015; 41:20-8. [PMID: 25282598 DOI: 10.1016/j.addbeh.2014.09.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/30/2014] [Accepted: 09/17/2014] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Most patients relapse to opioids within one month of opioid agonist detoxification, making the antecedents and parallel processes of first use critical for investigation. Craving and withdrawal are often studied in relationship to opioid outcomes, and a novel analytic strategy applied to these two phenomena may indicate targeted intervention strategies. METHODS Specifically, this secondary data analysis of the Prescription Opioid Addiction Treatment Study used a discrete-time mixture analysis with time-to-first opioid use (survival) simultaneously predicted by craving and withdrawal growth trajectories. This analysis characterized heterogeneity among prescription opioid-dependent individuals (N=653) into latent classes (i.e., latent class analysis [LCA]) during and after buprenorphine/naloxone stabilization and taper. RESULTS A 4-latent class solution was selected for overall model fit and clinical parsimony. In order of shortest to longest time-to-first use, the 4 classes were characterized as 1) high craving and withdrawal, 2) intermediate craving and withdrawal, 3) high initial craving with low craving and withdrawal trajectories and 4) a low initial craving with low craving and withdrawal trajectories. Odds ratio calculations showed statistically significant differences in time-to-first use across classes. CONCLUSIONS Generally, participants with lower baseline levels and greater decreases in craving and withdrawal during stabilization combined with slower craving and withdrawal rebound during buprenorphine taper remained opioid-free longer. This exploratory work expanded on the importance of monitoring craving and withdrawal during buprenorphine induction, stabilization, and taper. Future research may allow individually tailored and timely interventions to be developed to extend time-to-first opioid use.
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Affiliation(s)
- Thomas F Northrup
- Department of Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin Street, JJL 324, Houston, TX 77030, USA.
| | - Angela L Stotts
- Department of Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin Street, JJL 324, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, 1941 East Road, Houston, TX 77054, USA
| | - Charles Green
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, 1941 East Road, Houston, TX 77054, USA; Department of Pediatrics, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 3.020, Houston, TX 77030, USA
| | - Jennifer S Potter
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, Mail Code 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA; McLean Hospital, Division of Alcohol and Drug Abuse & Harvard Medical School, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA
| | - Elise N Marino
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, Mail Code 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Robrina Walker
- University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA
| | - Roger D Weiss
- McLean Hospital, Division of Alcohol and Drug Abuse & Harvard Medical School, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA
| | - Madhukar Trivedi
- University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA
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76
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Soyka M. New developments in the management of opioid dependence: focus on sublingual buprenorphine-naloxone. Subst Abuse Rehabil 2015; 6:1-14. [PMID: 25610012 PMCID: PMC4293937 DOI: 10.2147/sar.s45585] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Opioid maintenance therapy is a well-established first-line treatment approach in opioid dependence. Buprenorphine, a partial opioid agonist, has been found by numerous studies to be an effective and safe medication in the treatment of opioid dependence. At present, buprenorphine is available as a monodrug or in a fixed 4:1 ratio combination with naloxone. A diminished risk of diversion and abuse for the buprenorphine-naloxone combination is likely but not firmly established. Conventional formulations are given sublingually to avoid the hepatic first-pass effect. A novel film tablet is available only in the US and Australia. Other novel, sustained-release formulations (implant, depot) are currently being developed and tested. Recent studies, including a Cochrane meta-analysis, suggest that the retention with buprenorphine is lower than for methadone, but that buprenorphine may be associated with less drug use. Higher doses of buprenorphine are associated with better retention rates. Buprenorphine has a ceiling effect at the opioid receptor with regard to respiratory depression, and may cause fewer fatal intoxications than methadone. Possible antidepressant effects of buprenorphine and its use in comorbid psychiatric patients has not been studied in much detail. Clinical implications are discussed.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Private Hospital Meiringen, Meiringen, Switzerland
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77
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Woodcock EA, Lundahl LH, Greenwald MK. Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers. Drug Alcohol Depend 2015; 146:89-96. [PMID: 25479914 PMCID: PMC4272885 DOI: 10.1016/j.drugalcdep.2014.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Buprenorphine (BUP) is effective for treating opioid use disorder. Individuals' heroin-use characteristics may predict their responses to BUP, which could differ during maintenance and dose-taper phases. If so, treatment providers could use pre-treatment characteristics to personalize level of individual care and possibly improve treatment outcomes. METHODS Non-treatment-seeking heroin-dependent volunteers (N=34) initiated outpatient BUP maintenance (8-mg/day) and submitted urine samples thrice weekly tested for opioids (non-contingent result). After completing three programmatically-related inpatient behavioral pharmacology experiments (while maintained on 8-mg/day BUP), participants were discharged and underwent a double-blind BUP dose taper (4-mg/day, 2-mg/day and 0-mg/day during weeks 1-3, respectively) with an opioid-abstinence incentive ($30 per consecutive opioid-negative urine specimen, obtained thrice weekly). RESULTS Participants who reported less pre-study (past-month) heroin use and shorter lifetime duration of heroin use were more likely to submit an opioid-negative urine sample during initial outpatient BUP maintenance. Participants who reported more lifetime heroin-quit attempts and provided any opioid-free urine sample during initial outpatient maintenance sustained longer continuous opioid-abstinence during the BUP dose taper. Participants who reported >3 lifetime quit attempts abstained from opioid use nearly one week longer (14 days vs. 8 days to opioid-lapse) and nearly half (46.7%) refrained from opioid use during dose taper. CONCLUSIONS Number of prior heroin quit attempts may predict BUP dose taper response and provide a metric for stratifying heroin-dependent individuals by relative risk for opioid lapse. This metric may inform personalized relapse prevention care and improve treatment outcomes.
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Affiliation(s)
- Eric A. Woodcock
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
,Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA
| | - Leslie H. Lundahl
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Mark K. Greenwald
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
,Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA
,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
,Corresponding author at: Department of Psychiatry and Behavioral Neurosciences, Tolan Park Medical Building, Suite 2A, 3901 Chrysler Drive, Detroit, MI 48201, USA, Tel.: +1 313 993 3965; fax: +1 313 993 1372.
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78
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Soyka M. Alcohol use disorders in opioid maintenance therapy: prevalence, clinical correlates and treatment. Eur Addict Res 2015; 21:78-87. [PMID: 25413371 DOI: 10.1159/000363232] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Maintenance therapy with methadone or buprenorphine is an established and first-line treatment for opioid dependence. Clinical studies indicate that about a third of patients in opioid maintenance therapy show increased alcohol consumption and alcohol use disorders. Comorbid alcohol use disorders have been identified as a risk factor for clinical outcome and can cause poor physical and mental health, including liver disorders, noncompliance, social deterioration and increased mortality risk. The effects of opioid maintenance therapy on alcohol consumption are controversial and no clear pattern has emerged. Most studies have not found a change in alcohol use after initiation of maintenance therapy. Methadone and buprenorphine appear to carry little risk of liver toxicity, but further research on this topic is required. Recent data indicate that brief intervention strategies may help reduce alcohol intake, but the existing evidence is still limited. This review discusses further clinical implications of alcohol use disorders in opioid dependence.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany; Private Hospital Meiringen, Willigen, Meiringen, Switzerland
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79
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Teruya C, Schwartz RP, Mitchell SG, Hasson AL, Thomas C, Buoncristiani SH, Hser YI, Wiest K, Cohen AJ, Glick N, Jacobs P, McLaughlin P, Ling W. Patient perspectives on buprenorphine/naloxone: a qualitative study of retention during the starting treatment with agonist replacement therapies (START) study. J Psychoactive Drugs 2014; 46:412-26. [PMID: 25364994 PMCID: PMC4220245 DOI: 10.1080/02791072.2014.921743] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study examines the barriers and facilitators of retention among patients receiving buprenorphine/naloxone at eight community-based opioid treatment programs across the United States. Participants (n = 105) were recruited up to three and a half years after having participated in a randomized clinical trial comparing the effect of buprenorphine/naloxone and methadone on liver function. Semi-structured interviews were conducted with 67 patients provided with buprenorphine/naloxone who had terminated early and 38 patients who had completed at least 24 weeks of the trial. Qualitative data were analyzed using the constant comparison method. Barriers to buprenorphine/naloxone retention that emerged included factors associated with: (1) the design of the clinical trial; (2) negative medication or treatment experience; and (3) personal circumstances. The facilitators comprised: (1) positive experience with the medication; (2) personal determination and commitment to complete; and (3) staff encouragement and support. The themes drawn from interviews highlight the importance of considering patients' prior experience with buprenorphine/naloxone and methadone, medication preference, personal circumstances, and motivation to abstain from illicit use or misuse of opioids, as these may influence retention. Ongoing education of patients and staff regarding buprenorphine/naloxone, especially in comparison to methadone, and support from staff and peers are essential.
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Affiliation(s)
- Cheryl Teruya
- Investigator, UCLA Integrated Substance Abuse Programs, Los Angeles, CA
| | | | - Shannon Gwin Mitchell
- Research Scientist, Friends Medical Research Institute, Inc., Mid-Atlantic Node, Baltimore, MD
| | - Albert L. Hasson
- Project Director, UCLA Integrated Substance Abuse Programs, Los Angeles, CA
| | | | | | - Yih-Ing Hser
- Professor-in-Residence, UCLA Integrated Substance Abuse Programs, Los Angeles, CA
| | | | - Allan J. Cohen
- Director of Research and Training, Bay Area Addiction Research & Treatment, San Francisco, CA
| | - Naomi Glick
- Research Associate, UCLA Integrated Substance Abuse Programs, Los Angeles, CA
| | - Petra Jacobs
- Assistant Director, National Institute on Drug Abuse, Center for the Clinical Trials Network, Bethesda, MD
| | | | - Walter Ling
- Professor and Founding Director, UCLA Integrated Substance Abuse Programs, Los Angeles, CA
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80
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Pombo S, Costa NFD, Figueira ML. Are the binary typology models of alcoholism valid in polydrug abusers ? REVISTA BRASILEIRA DE PSIQUIATRIA 2014; 37:40-8. [DOI: 10.1590/1516-4446-2014-1384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/31/2014] [Indexed: 11/21/2022]
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81
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Soyka M, Backmund M, Schmidt P, Apelt S. Buprenorphine-naloxone treatment in opioid dependence and risk of liver enzyme elevation: results from a 12-month observational study. Am J Addict 2014; 23:563-9. [PMID: 25251050 DOI: 10.1111/j.1521-0391.2014.12131.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/22/2013] [Accepted: 11/10/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Some case series mention possible liver toxicity in opioid-dependent patients under buprenorphine treatment. METHODS This 12-month prospective observational follow-up study in opioid-dependent patients under buprenorphine-naloxone treatment assessed outcome and safety issues. At baseline, 337 eligible datasets were available; 181 patients completed the 12-month study. Liver enzymes were tested at baseline and after 12, 24, and 52 weeks' treatment. RESULTS One to two percent of patients showed mostly discrete elevations of liver enzymes, but no patient met the criteria for drug-induced liver injury. No serious liver-related adverse events occurred, but two non-serious cases of liver enzyme increase were recorded. No patient dropped out of treatment for liver-related disorders. CONCLUSION This study is in line with some recent studies and provides further evidence that buprenorphine-naloxone is relatively safe with respect to liver injury.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany; Private Hospital Meiringen, Meiringen, Switzerland
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Soyka M. Buprenorphine–naloxone buccal soluble film for the treatment of opioid dependence: current update. Expert Opin Drug Deliv 2014; 12:339-47. [DOI: 10.1517/17425247.2014.953479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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83
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Petrushevska T, Velik Stefanovska V. Patients on Opioid Substitution Treatment in the Republic of Macedonia: What Do Treatment Demand Data Tell Us? Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The aim of the survey is to analyze national data from opioid substitution treatment (OST) medical records and to compare it with the data from EU countries.MATERIAL AND METHODS: The survey is quantitative analytical cross-sectional study conducted in the period September - December 2013. Medical records from all patients on OST at national level during the year 2012 were analyzed. EMCDDA questionnaire from treatment protocol 3.0 was used. Data for OST patients on MMT was take from all 12 public treatment facilities, three private centers and 3 prisons. Data for OST patients on buprenorphine was taken from public clinic as the only one responsible for this type of treatment.RESULTS: A comprehensive network, diverse models of treatment intervention exists in the MKD. Total number of OST patients in 2012 in all treatment facilities was 1857 (1356 are in public, 141 in private, 360 in prison settings) 10% are on Buprenorphine and 90% are on Methadone, 52% in age group 20-34. Ratio of male to female heroin clients is 9:1; 162 are female (9 %); 107(66%) are in treatment in the age group 20-34. Average number of OST patients is 0.1% of the total population in each of the 10 cities analyzed. The mean age at first heroin use is 18 years. 40% of patients haven’t high school. With their family lives 65% of OST patients; 487 patients (36%) have children; 80% of patients use of benzodiazepines.CONCLUSION: Although treatment network of drug addiction is quite developed, perceived need for further capacity building and increase the quality of medical care implies increasing the availability, diversification in terms of sensitivity to cultural differences, gender, age, ethnicity, as well as the treatment of dependence of different types of psychoactive substances.
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Lambdin BH, Masao F, Chang O, Kaduri P, Mbwambo J, Magimba A, Sabuni N, Bruce RD. Methadone treatment for HIV prevention-feasibility, retention, and predictors of attrition in Dar es Salaam, Tanzania: a retrospective cohort study. Clin Infect Dis 2014; 59:735-42. [PMID: 24855149 DOI: 10.1093/cid/ciu382] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) in Dar es Salaam, Tanzania, have an estimated human immunodeficiency virus (HIV) prevalence of 42%-50% compared with 6.9% among the general population. Extensive evidence supports methadone maintenance to lower morbidity, mortality, and transmission of HIV and other infectious diseases among PWID. In 2011, the Tanzanian government launched the first publicly funded methadone clinic on the mainland of sub-Saharan Africa at Muhimbili National Hospital. METHODS We conducted a retrospective cohort study of methadone-naive patients enrolling into methadone maintenance treatment. Kaplan-Meier survival curves were constructed to assess retention probability. Proportional hazards regression models were used to evaluate the association of characteristics with attrition from the methadone program. RESULTS Overall, 629 PWID enrolled into methadone treatment during the study. At 12 months, the proportion of clients retained in care was 57% (95% confidence interval [CI], 53%-62%). Compared with those receiving a low dose (<40 mg), clients receiving a medium (40-85 mg) (adjusted hazard ratio [aHR], 0.50 [95% CI, .37-.68]) and high (>85 mg) (aHR, 0.41 [95% CI, .29-.59]) dose of methadone had a lower likelihood of attrition, adjusting for other characteristics. Older clients (aHR, 0.53 per 10 years [95% CI, .42-.69]) and female clients (aHR, 0.50 [95% CI, .28-.90]) had a significantly lower likelihood of attrition, whereas clients who reported a history of sexual abuse (aHR, 2.84 [95% CI, 1.24-6.51]) had a significantly higher likelihood of attrition. CONCLUSIONS Patient retention in methadone maintenance is comparable to estimates from programs in North America, Europe, and Asia. Future implementation strategies should focus on higher doses and flexible dosing strategies to optimize program retention and strengthened efforts for clients at higher risk of attrition.
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Affiliation(s)
- Barrot H Lambdin
- Department of Global Health, University of Washington, Seattle Pangaea Global AIDS Foundation, Oakland, California
| | - Frank Masao
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Olivia Chang
- Pangaea Global AIDS Foundation, Oakland, California
| | - Pamela Kaduri
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ayoub Magimba
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Norman Sabuni
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - R Douglas Bruce
- Pangaea Global AIDS Foundation, Oakland, California School of Medicine, Yale University, New Haven, Connecticut
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Emerging adult age status predicts poor buprenorphine treatment retention. J Subst Abuse Treat 2014; 47:202-12. [PMID: 24953168 DOI: 10.1016/j.jsat.2014.04.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/28/2014] [Accepted: 04/14/2014] [Indexed: 11/23/2022]
Abstract
Emerging adults (18-25 years old) are often poorly retained in substance use disorder treatment. Office-based buprenorphine often enhances treatment retention among people with opioid dependence. In this study, we examined the records of a collaborative care buprenorphine treatment program to compare the treatment retention rates of emerging adults versus older adults. Subjects were 294 adults, 71 (24%) aged 18-25, followed in treatment with buprenorphine, nurse care management, and an intensive outpatient program followed by weekly psychosocial treatment. Compared to older adults, emerging adults remained in treatment at a significantly lower rate at 3 months (56% versus 78%) and 12 months (17% versus 45%), and were significantly more likely to test positive for illicit opioids, relapse, or drop out of treatment. Further research into factors associated with buprenorphine treatment retention among emerging adults is needed to improve treatment and long-term outcomes in this group.
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86
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Riksheim M, Gossop M, Clausen T. From methadone to buprenorphine: Changes during a 10year period within a national opioid maintenance treatment programme. J Subst Abuse Treat 2014; 46:291-4. [DOI: 10.1016/j.jsat.2013.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/23/2013] [Accepted: 10/04/2013] [Indexed: 11/16/2022]
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Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2014; 2014:CD002207. [PMID: 24500948 PMCID: PMC10617756 DOI: 10.1002/14651858.cd002207.pub4] [Citation(s) in RCA: 669] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Buprenorphine maintenance treatment has been evaluated in randomised controlled trials against placebo medication, and separately as an alternative to methadone for management of opioid dependence. OBJECTIVES To evaluate buprenorphine maintenance compared to placebo and to methadone maintenance in the management of opioid dependence, including its ability to retain people in treatment, suppress illicit drug use, reduce criminal activity, and mortality. SEARCH METHODS We searched the following databases to January 2013: Cochrane Drugs and Alcohol Review Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Current Contents, PsycLIT, CORK, Alcohol and Drug Council of Australia, Australian Drug Foundation, Centre for Education and Information on Drugs and Alcohol, Library of Congress, reference lists of identified studies and reviews. We sought published/unpublished randomised controlled trials (RCTs) from authors. SELECTION CRITERIA Randomised controlled trials of buprenorphine maintenance treatment versus placebo or methadone in management of opioid-dependent persons. DATA COLLECTION AND ANALYSIS We used Cochrane Collaboration methodology. MAIN RESULTS We include 31 trials (5430 participants), the quality of evidence varied from high to moderate quality.There is high quality of evidence that buprenorphine was superior to placebo medication in retention of participants in treatment at all doses examined. Specifically, buprenorphine retained participants better than placebo: at low doses (2 - 6 mg), 5 studies, 1131 participants, risk ratio (RR) 1.50; 95% confidence interval (CI) 1.19 to 1.88; at medium doses (7 - 15 mg), 4 studies, 887 participants, RR 1.74; 95% CI 1.06 to 2.87; and at high doses (≥ 16 mg), 5 studies, 1001 participants, RR 1.82; 95% CI 1.15 to 2.90. However, there is moderate quality of evidence that only high-dose buprenorphine (≥ 16 mg) was more effective than placebo in suppressing illicit opioid use measured by urinanalysis in the trials, 3 studies, 729 participants, standardised mean difference (SMD) -1.17; 95% CI -1.85 to -0.49, Notably, low-dose, (2 studies, 487 participants, SMD 0.10; 95% CI -0.80 to 1.01), and medium-dose, (2 studies, 463 participants, SMD -0.08; 95% CI -0.78 to 0.62) buprenorphine did not suppress illicit opioid use measured by urinanalysis better than placebo.There is high quality of evidence that buprenorphine in flexible doses adjusted to participant need,was less effective than methadone in retaining participants, 5 studies, 788 participants, RR 0.83; 95% CI 0.72 to 0.95. For those retained in treatment, no difference was observed in suppression of opioid use as measured by urinalysis, 8 studies, 1027 participants, SMD -0.11; 95% CI -0.23 to 0.02 or self report, 4 studies, 501 participants, SMD -0.11; 95% CI -0.28 to 0.07, with moderate quality of evidence.Consistent with the results in the flexible-dose studies, in low fixed-dose studies, methadone (≤ 40 mg) was more likely to retain participants than low-dose buprenorphine (2 - 6 mg), (3 studies, 253 participants, RR 0.67; 95% CI: 0.52 to 0.87). However, we found contrary results at medium dose and high dose: there was no difference between medium-dose buprenorphine (7 - 15 mg) and medium-dose methadone (40 - 85 mg) in retention, (7 studies, 780 participants, RR 0.87; 95% CI 0.69 to 1.10) or in suppression of illicit opioid use as measured by urines, (4 studies, 476 participants, SMD 0.25; 95% CI -0.08 to 0.58) or self report of illicit opioid use, (2 studies, 174 participants, SMD -0.82; 95% CI -1.83 to 0.19). Similarly, there was no difference between high-dose buprenorphine (≥ 16 mg) and high-dose methadone (≥ 85 mg) in retention (RR 0.79; 95% CI 0.20 to 3.16) or suppression of self-reported heroin use (SMD -0.73; 95% CI -1.08 to -0.37) (1 study, 134 participants).Few studies reported adverse events ; two studies compared adverse events statistically, finding no difference between methadone and buprenorphine, except for a single result indicating more sedation among those using methadone. AUTHORS' CONCLUSIONS Buprenorphine is an effective medication in the maintenance treatment of heroin dependence, retaining people in treatment at any dose above 2 mg, and suppressing illicit opioid use (at doses 16 mg or greater) based on placebo-controlled trials.However, compared to methadone, buprenorphine retains fewer people when doses are flexibly delivered and at low fixed doses. If fixed medium or high doses are used, buprenorphine and methadone appear no different in effectiveness (retention in treatment and suppression of illicit opioid use); however, fixed doses are rarely used in clinical practice so the flexible dose results are more relevant to patient care. Methadone is superior to buprenorphine in retaining people in treatment, and methadone equally suppresses illicit opioid use.
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Affiliation(s)
- Richard P Mattick
- University of New South WalesNational Drug and Alcohol Research CentreSydneyNew South WalesAustralia2052
| | - Courtney Breen
- University of New South WalesNational Drug and Alcohol Research CentreSydneyNew South WalesAustralia2052
| | - Jo Kimber
- University of New South WalesNational Drug and Alcohol Research CentreSydneyNew South WalesAustralia2052
| | - Marina Davoli
- Lazio Regional Health ServiceDepartment of EpidemiologyVia di Santa Costanza, 53RomeItaly00199
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Mauger S, Fraser R, Gill K. Utilizing buprenorphine-naloxone to treat illicit and prescription-opioid dependence. Neuropsychiatr Dis Treat 2014; 10:587-98. [PMID: 24741316 PMCID: PMC3984058 DOI: 10.2147/ndt.s39692] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To review current evidence on buprenorphine-naloxone (bup/nx) for the treatment of opioid-use disorders, with a focus on strategies for clinical management and office-based patient care. QUALITY OF EVIDENCE Medline and the Cochrane Database of Systematic Reviews were searched. Consensus reports, guidelines published, and other authoritative sources were also included in this review. Apart from expert guidelines, data included in this review constitute level 1 evidence. FINDINGS Bup/nx is a partial μ-opioid agonist combined with the opioid antagonist naloxone in a 4:1 ratio. It has a lower abuse potential, carries less stigma, and allows for more flexibility than methadone. Bup/nx is indicated for both inpatient and ambulatory medically assisted withdrawal (acute detoxification) and long-term substitution treatment (maintenance) of patients who have a mild-to-moderate physical dependence. A stepwise long-term substitution treatment with regular monitoring and follow-up assessment is usually preferred, as it has better outcomes in reducing illicit opioid use, minimizing concomitant risks such as human immunodeficiency virus and hepatitis C transmission, retaining patients in treatment and improving global functioning. CONCLUSION Bup/nx is safe and effective for opioid detoxification and substitution treatment. Its unique pharmaceutical properties make it particularly suitable for office-based maintenance treatment of opioid-use disorder.
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Affiliation(s)
- Sofie Mauger
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ronald Fraser
- Department of Psychiatry, McGill University, Montreal, QC, Canada ; Addictions Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Kathryn Gill
- Department of Psychiatry, McGill University, Montreal, QC, Canada ; Addictions Unit, McGill University Health Centre, Montreal, QC, Canada
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89
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Soyka M, Hillemacher T. Commentary on Hser et al. (2014): to retain or not to retain-open questions in opioid maintenance therapy. Addiction 2014; 109:88-9. [PMID: 24438113 DOI: 10.1111/add.12376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Soyka
- Department of Psychiatry, Ludwig Maximilian University, Nussbaumstr 7, 80336, Munich, Germany; Private Hospital Meiringen, PO Box 612, 3860, Meiringen, Switzerland
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90
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Buprenorphine and medication management in a community corrections population: a pilot study. J Addict Med 2013; 7:210-5. [PMID: 23609213 DOI: 10.1097/adm.0b013e31828e6b21] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS This project sought to demonstrate the feasibility and acceptability of providing on-site buprenorphine treatment to individuals under community corrections supervision. METHODS Seventeen women and 13 men were enrolled on-site over a 2-week period at a community corrections location. Study participants received open-label study medication dispensed weekly over 12 weeks, weekly medication management therapy, and returned for a 1-month follow-up. RESULTS Participants were predominantly female (56%) and white (90%) with an average age of 31.7 ± 7.4 years. More than half (53%) had hepatitis C virus infection and 75.9% reported intravenous use of opioids in the 30 days before treatment. Rates of illicit substance use was high, as 37.9% of urines were positive for benzodiazepines, 31.7% were positive for cocaine, and 13.7% were positive for alcohol across the time in the study. Although rates of positive urines for opiate use and sex with multiple partners did not change during treatment, rates of injection drug use significantly decreased during treatment. Overall, 86.7% of participants were retained through the 1-month follow-up with low rates of adverse events. CONCLUSIONS Acceptability and feasibility of this approach were demonstrated by the ability to enroll and randomize the target sample of participants over 2 weeks with high retention and low rates of adverse events through 1-month follow-up. This pilot study demonstrated that this population could be successfully engaged in treatment and show reductions in risky behaviors. However, more intensive interventions may be needed to reduce opiate use to reach this vulnerable population at their point of contact with the criminal justice system.
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91
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Dreifuss JA, Griffin ML, Frost K, Fitzmaurice GM, Potter JS, Fiellin DA, Selzer J, Hatch-Maillette M, Sonne SC, Weiss RD. Patient characteristics associated with buprenorphine/naloxone treatment outcome for prescription opioid dependence: Results from a multisite study. Drug Alcohol Depend 2013; 131:112-8. [PMID: 23333292 PMCID: PMC3638044 DOI: 10.1016/j.drugalcdep.2012.12.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/05/2012] [Accepted: 12/08/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prescription opioid dependence is a growing problem, but little research exists on its treatment, including patient characteristics that predict treatment outcome. METHODS A secondary analysis of data from a large multisite, randomized clinical trial, the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study (POATS) was undertaken to examine baseline patient characteristics (N=360) associated with success during 12-week buprenorphine/naloxone treatment for prescription opioid dependence. Baseline predictor variables included self-reported demographic and opioid use history information, diagnoses assessed via the Composite International Diagnostic Interview, and historical opioid use and related information from the Pain And Opiate Analgesic Use History. RESULTS In bivariate analyses, pre-treatment characteristics associated with successful opioid use outcome included older age, past-year or lifetime diagnosis of major depressive disorder, initially obtaining opioids with a medical prescription to relieve pain, having only used opioids by swallowing or sublingual administration, never having used heroin, using an opioid other than extended-release oxycodone most frequently, and no prior opioid dependence treatment. In multivariate analysis, age, lifetime major depressive disorder, having only used opioids by swallowing or sublingual administration, and receiving no prior opioid dependence treatment remained as significant predictors of successful outcome. CONCLUSIONS This is the first study to examine characteristics associated with treatment outcome in patients dependent exclusively on prescription opioids. Characteristics associated with successful outcome after 12 weeks of buprenorphine/naloxone treatment include some that have previously been found to predict heroin-dependent patients' response to methadone treatment and some specific to prescription opioid-dependent patients receiving buprenorphine/naloxone.
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Affiliation(s)
- Jessica A Dreifuss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA.
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92
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Abstract
OBJECTIVES Dependence on prescription opioids (PO) is a growing problem. Although most research with buprenorphine has focused on heroin-dependent populations, we hypothesize that individuals dependent on PO display characteristics that may predict different outcomes in treatment, particularly in short-term taper procedures in which comorbidities such as pain conditions may complicate taper. METHODS This secondary data analysis examined differences in outcomes between PO users (n = 90) and heroin users (n = 426) after a buprenorphine taper. Data were collected in a multisite randomized clinical trial conducted by the National Drug Abuse Treatment Clinical Trials Network at 11 study sites across the United States. After a 4-week buprenorphine induction/stabilization phase, 516 opioid-dependent individuals were randomized into 1 of 2 taper lengths (7 vs 28 days) to assess the association between taper length and outcome. The primary outcome was measured by urine drug test for opioids at the end of the taper period. Craving, withdrawal, and buprenorphine dose were also examined. RESULTS After controlling for baseline demographic and drug use differences between the opioid use groups, results indicate that a higher percentage of the PO group (49%) provided an opioid-free urine drug specimen at the end of taper compared with the heroin group (36%; χ(2)(1) = 6.592, P < 0.010). CONCLUSION Short-term taper is not recommended as a stand-alone treatment; however, patients may taper from buprenorphine as part of a treatment plan. Despite greater comorbidity, PO users seem to have favorable taper outcomes compared with heroin users. Further studies are required to examine longer-term treatment outcomes.
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93
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Dupouy J, Bez J, Barsony J, Oustric S, Lapeyre-Mestre M. Cycles de traitement par médicament de substitution aux opiacés dans une cohorte de patients suivis 5 ans en médecine ambulatoire. Therapie 2013; 68:155-61. [DOI: 10.2515/therapie/2013022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 03/28/2013] [Indexed: 11/20/2022]
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Retention in methadone and buprenorphine treatment among African Americans. J Subst Abuse Treat 2013; 45:287-92. [PMID: 23566446 DOI: 10.1016/j.jsat.2013.02.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/15/2013] [Accepted: 02/20/2013] [Indexed: 11/20/2022]
Abstract
Methadone has been the most commonly used pharmacotherapy for the treatment of opioid dependence in U.S. public sector treatment, but availability of buprenorphine as an alternative medication continues to increase. Drawing data from two community-based clinical trials that were conducted nearly contemporaneously, this study examined retention in methadone versus buprenorphine treatment over 6 months among urban African Americans receiving treatment in one of four publicly-funded programs (N=478; 178 methadone; 300 buprenorphine). Adjusting for confounds related to medication selection, survival analysis revealed that buprenorphine patients are at substantially higher risk of dropout compared to methadone patients (HR=2.43; p<.001). Buprenorphine's retention disadvantage appears to be concentrated in the earlier phases of treatment (approximately the first 50 days), after which risk of subsequent dropout becomes similar for the two medications. These findings confirm a retention disparity between methadone and buprenorphine in this population, and suggest potential avenues for future research to enhance retention in buprenorphine treatment.
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95
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Brown R, Gassman M, Hetzel S, Berger L. Community-based treatment for opioid dependent offenders: a pilot study. Am J Addict 2013; 22:500-2. [PMID: 23952897 DOI: 10.1111/j.1521-0391.2013.12049.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/09/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Primary care opioid substitution treatment (OST) has not been compared to program-based OST for community-supervised offenders. OBJECTIVE The purpose of this project was to compare primary care to specialist supervised OST for opioid dependent offenders in terms of substance use and HIV risk outcomes. METHODS This project randomly assigned 15 jail diversion participants to either: (i) primary care buprenorphine OST, (ii) specialist facility buprenorphine OST, or (iii) specialist facility methadone OST. Participation lasted 13.5 months (12-month active treatment plus a post-participation visit). RESULTS All subjects endorsed 0 days of opioid use in the previous 14 at follow-up. Specialty care reduced HIV risk (Risk Assessment Battery composite score) over 6 months (-.24 ± .17) compared to primary care (.02 ± .14; p = .032). CONCLUSION Findings support primary care OST feasibility for a community-supervised offender sample. Specialist care may facilitate improvements in secondary outcomes, such as HIV risk behaviors. SCIENTIFIC SIGNIFICANCE Further research is needed to clarify (i) the role of primary care in addicted offender management, and (ii) the matching of offenders, based upon history and co-morbidity, to care coordination conditions.
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Affiliation(s)
- Randy Brown
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin 53715, USA.
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96
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Tran BX, Ohinmaa A, Mills S, Duong AT, Nguyen LT, Jacobs P, Houston S. Multilevel predictors of concurrent opioid use during methadone maintenance treatment among drug users with HIV/AIDS. PLoS One 2012; 7:e51569. [PMID: 23251580 PMCID: PMC3520938 DOI: 10.1371/journal.pone.0051569] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 11/02/2012] [Indexed: 12/04/2022] Open
Abstract
Background Ongoing drug use during methadone maintenance treatment (MMT) negatively affects outcomes of HIV/AIDS care and treatment for drug users. This study assessed changes in opioid use, and longitudinal predictors of continued opioid use during MMT among HIV-positive drug users in Vietnam, with the aim of identifying changes that might enhance program efficacy. Methods We analyze data of 370 HIV-positive drug users (mean age 29.5; 95.7% male) taking MMT at multi-sites. Opioid use was assessed at baseline, 3, 6, and 9 months using interviews and heroin confirmatory urine tests. A social ecological model was applied to explore multilevel predictors of continued opioid use, including individual, interpersonal, community and service influences. Generalized estimating equations (GEE) statistical models were constructed to adjust for intra-individual correlations. Results Over 9 month follow-up, self-reported opioid use and positive heroin urine test substantially decreased to 14.6% and 14.4%. MMT helped improve referrals and access to health care and social services. However, utilization of social integration services was small. GEE models determined that participants who were older (Adjusted Odd Ratio - AOR = 0.97 for 1 year increase), had economic dependents (AOR = 0.33), or were referred to TB treatment (AOR = 0.53) were less likely to continue opioid use. Significant positive predictors of ongoing opioid use included frequency of opioid use prior to MMT, peer pressure, living with sexual partners, taking antiretroviral treatment, other health concerns and TB treatment. Conclusion These findings show that MMT in the Vietnamese context can dramatically reduce opioid use, which is known to be associated with reduced antiretroviral (ART) adherence. Disease stage and drug interactions between antiretrovirals or TB drugs and MMT could explain some of the observed predictors of ongoing drug use; these findings could inform changes in MMT program design and implementation.
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Affiliation(s)
- Bach Xuan Tran
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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97
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Soyka M. Buprenorphine and buprenorphine/naloxone soluble-film for treatment of opioid dependence. Expert Opin Drug Deliv 2012; 9:1409-17. [DOI: 10.1517/17425247.2012.729574] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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98
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Warden D, Subramaniam GA, Carmody T, Woody GE, Minhajuddin A, Poole SA, Potter J, Fishman M, Bogenschutz M, Patkar A, Trivedi MH. Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth. Addict Behav 2012; 37:1046-53. [PMID: 22626890 DOI: 10.1016/j.addbeh.2012.04.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/29/2012] [Accepted: 04/20/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND In opioid dependent youth there is substantial attrition from medication-assisted treatment. If youth at risk for attrition can be identified at treatment entry or early in treatment, they can be targeted for interventions to help retain them in treatment. METHODS Opioid dependent adolescents and young adults (n=152), aged 15-21, were randomized to 12 weeks (BUP, n=74) or 2 weeks of detoxification (DETOX, n=78) with buprenorphine/naloxone (Bup/Nal), both in combination with 12 weeks of psychosocial treatment. Baseline and early treatment related predictors of treatment attrition were identified in each group using bivariate and multivariate logistic regression. RESULTS In the DETOX group 36% left between weeks 2 and 4, at the end of the dose taper, while in the BUP group only 8% left by week 4. In the BUP group, early adherence to Bup/Nal, early opioid negative urines, use of any medications in the month prior to treatment entry, and lifetime non-heroin opioid use were associated with retention while prior 30-day hallucinogen use was associated with attrition. In the DETOX group, only use of sleep medications was associated with retention although not an independent predictor. A broad range of other pre-treatment characteristics was unrelated to attrition. CONCLUSIONS Prompt attention to those with early non-adherence to medication or an early opioid positive urine, markers available in the first 2 weeks of treatment, may improve treatment retention. Extended Bup/Nal treatment appeared effective in improving treatment retention for youth with opioid dependence across a wide range of demographics, and pre-treatment clinical characteristics.
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Affiliation(s)
- Diane Warden
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA.
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Soyka M, Träder A, Klotsche J, Haberthür A, Bühringer G, Rehm J, Wittchen HU. Criminal Behavior in Opioid-Dependent Patients Before and During Maintenance Therapy: 6-year Follow-Up of a Nationally Representative Cohort Sample. J Forensic Sci 2012; 57:1524-30. [DOI: 10.1111/j.1556-4029.2012.02234.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 07/18/2011] [Accepted: 09/18/2011] [Indexed: 12/18/2022]
Affiliation(s)
| | - Anna Träder
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Chemnitzer Str. 46; 01187; Dresden; Germany
| | - Jens Klotsche
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Chemnitzer Str. 46; 01187; Dresden; Germany
| | - Annina Haberthür
- Private Hospital Meiringen; P.O. Box 612; 3860; Meiringen; Switzerland
| | | | - Jürgen Rehm
- Centre for Addiction and Mental Health; 33 Russell Street; Toronto; ON; Canada
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100
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Tkacz J, Severt J, Kassed C, Ruetsch C. Clinical Differences Between Opioid Abuse Classes Ameliorated After 1 Year of Buprenorphine-Medication Assisted Treatment. J Addict Dis 2012; 31:100-11. [DOI: 10.1080/10550887.2012.665729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joseph Tkacz
- a Health Analytics, LLC , Columbia , Maryland , USA
| | - Jamie Severt
- a Health Analytics, LLC , Columbia , Maryland , USA
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