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Witte TH, Jaiswal J, Mumba MN, Mugoya GCT. Stigma Surrounding the Use of Medically Assisted Treatment for Opioid Use Disorder. Subst Use Misuse 2021; 56:1467-1475. [PMID: 34116605 DOI: 10.1080/10826084.2021.1936051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study sought to determine whether certain factors influenced public stigma toward the use of medication to treat opioid use disorders (MOUD). Method: In a series of 3 studies using between-subjects designs, hypothetical MOUD patients matched in age and educational status with the participants were varied in systematic ways to determine whether certain factors influenced stigmatizing views of the patients. Results: Study 1 (n = 142) determined that stigma levels were elevated for hypothetical patients receiving agonist medication for OUD compared to other medications or no medication at all. Study 2 (n = 144) found that hypothetical patients receiving opioid agonist medication for either heroin or pain pills were equally stigmatized and stigmatized more than hypothetical patients on nicotine agonist medication. Study 3 (n = 151) showed that stigmatizing attitudes did not change as a result of enhanced treatment services for hypothetical MOUD patients (i.e. therapy as a supplement to medication). Conclusions/Importance: Results indicate that patients receiving agonist medication for an OUD may be the target of public stigma. Public education on the efficacy of agonist medications for OUD is urgently needed to help reduce such stigma, which may facilitate treatment delivery, treatment adherence, and treatment success.
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152
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Evaluating the effectiveness of concurrent opioid agonist treatment and physician-based mental health services for patients with mental disorders in Ontario, Canada. PLoS One 2020; 15:e0243317. [PMID: 33338065 PMCID: PMC7748134 DOI: 10.1371/journal.pone.0243317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Abstract
Objective The objective of this study was to evaluate the relationship between concurrent physician-based mental health services, all-cause mortality, and acute health service use for individuals enrolled in Opioid Agonist Treatment in Ontario, Canada. Methods A cohort study of patients enrolled in opioid agonist treatment in Ontario was conducted between January 1, 2011, and December 31, 2015, in Ontario with an inverse probability of treatment weights using the propensity score to estimate the effect of physician-based mental health services. Treatment groups were created based on opioid agonist treatment patients’ utilization of physician-based mental health services. Propensity score weighted odds ratios were calculated to assess the relationship between the treatment groups and the outcomes of interest. The outcomes included all-cause mortality using data from the Registered Persons Database, Emergency Department visits from the National Ambulatory Care Database, and hospitalizations using data from the Discharge Abstract Database. Encrypted patient identifiers were used to link across databases. Results A total of 48,679 individuals in OAT with mental disorders. Opioid agonist treatment alone was associated with reduced odds of all-cause mortality (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3–0.4). Patients who received mental health services from a psychiatrist and primary care physician while engaged in OAT, the estimated rate of ED visits per year was higher (OR = 1.3, 95% CI 1.2–1.4) and the rate of hospitalizations (OR = 0.5, 95% CI 0.4–0.6) than in the control group. Conclusion Our findings support the view that opioid agonist treatment and concurrent mental health services can improve clinical outcomes for complex patients, and is associated with enhanced use of acute care services.
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153
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Moe J, Doyle-Waters MM, O'Sullivan F, Hohl CM, Azar P. Effectiveness of micro-induction approaches to buprenorphine initiation: A systematic review protocol. Addict Behav 2020; 111:106551. [PMID: 32739588 DOI: 10.1016/j.addbeh.2020.106551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Buprenorphine is first-line opioid agonist therapy for opioid use disorder. Standard regimens require that patients be in opioid withdrawal prior to induction, which is a barrier for many. Micro-induction is a novel induction approach that does not require patients to be in withdrawal. Our primary objective is to synthesize available evidence on the effectiveness of micro-inductions on patient and clinical outcomes compared to standard dosing or other approaches, or evaluated without a comparator group. Secondary objectives are to synthesize evidence on clinical factors that influence micro-induction effectiveness, and to summarize micro-induction regimens described in the literature. METHODS We will search MEDLINE, Embase, CINAHL, Psycinfo, Science Citation Index, and the grey literature for studies that include adolescents or adults with opioid use disorder who received a buprenorphine micro-induction regimen. We will consider any patient or clinical outcomes defined by study authors. We will include controlled and non-controlled interventional studies, observational studies, case reports/series and reports from relevant organizations or guidelines pertinent to our third objective. We will select studies, extract data and assess study quality (using the Downs and Black, and Cochrane Risk of Bias tools) in duplicate. We will narratively synthesize our results, and will meta-analyze outcome measures if multiple studies report common outcomes with acceptably low heterogeneity. DISCUSSION Our review will include the most up-to-date available data on buprenorphine micro-inductions. We anticipate limitations relating to study heterogeneity and quality. We will disseminate study results widely to inform updated guidelines for opioid agonist therapy prescribers.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada; Department of Emergency Medicine, Vancouver General Hospital, Vancouver, Canada.
| | | | - Fiona O'Sullivan
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada; Department of Emergency Medicine, Vancouver General Hospital, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada.
| | - Pouya Azar
- Department of Psychiatry, University of British Columbia, Vancouver, Canada; Complex Pain and Addictions Services, Vancouver General Hospital, Vancouver, Canada
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154
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Moe J, Badke K, Pratt M, Cho RY, Azar P, Flemming H, Sutherland KA, Harvey B, Gurney L, Lockington J, Brasher P, Gill S, Garrod E, Bath M, Kestler A. Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study. J Am Coll Emerg Physicians Open 2020; 1:1712-1722. [PMID: 33392580 PMCID: PMC7771760 DOI: 10.1002/emp2.12289] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Emergency department (ED)-initiated buprenorphine may prevent overdose. Microdosing is a novel approach that does not require withdrawal, which can be a barrier to standard inductions. We aimed to evaluate the feasibility of an ED-initiated buprenorphine/naloxone program providing standard-dosing and microdosing take-home packages and of randomizing patients to either intervention. METHODS We broadly screened patients ≥18 years old for opioid use disorder at a large, urban ED. In a first phase, we provided consecutive patients with 3-day standard-dosing packages, and then we provided a subsequent group with 6-day microdosing packages. In a second phase, we randomized patients to standard dosing or microdosing. We attempted 7-day telephone follow-ups and 30-day in-person community follow-ups. The primary feasibility outcome was number of patients enrolled and accepting randomization. Secondary outcomes were numbers screened, follow-up rates, and 30-day opioid agonist therapy retention. RESULTS We screened 3954 ED patients and identified 94 with opioid use disorders. Of the patients, 26 (27.7%) declined participation: 10 identified a negative prior experience with buprenorphine/naloxone as the reason, 5 specifically cited precipitated withdrawal, and none cited randomization. We enrolled 68 patients. A total of 14 left the ED against medical advice, 8 were excluded post-enrollment, 21 received standard dosing, and 25 received microdosing. The 7-day and 30-day follow-up rates were 9/46 (19.6%) and 15/46 (32.6%), respectively. At least 5/21 (23.8%) provided standard dosing and 8/25 (32.0%) provided microdosing remained on opioid agonist therapy at 30 days. CONCLUSIONS ED-initiated take-home standard-dosing and microdosing buprenorphine/naloxone programs are feasible, and a randomized controlled trial would be acceptable to our target population.
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Affiliation(s)
- Jessica Moe
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Katherin Badke
- Department of Pharmaceutical SciencesVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Megan Pratt
- Social WorkVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Raymond Y Cho
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Pouya Azar
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Complex Pain and Addiction ServicesVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Heather Flemming
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - K. Anne Sutherland
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Barbara Harvey
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Lara Gurney
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Julie Lockington
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Penny Brasher
- Centre for Clinical Epidemiology and EvaluationVancouverBritish ColumbiaCanada
| | - Sam Gill
- Rapid Access Addiction ClinicSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Emma Garrod
- Urban Health Program, Providence Health CareVancouverBritish ColumbiaCanada
| | - Misty Bath
- Regional PreventionVancouver Coastal Health AuthorityVancouverBritish ColumbiaCanada
| | - Andy Kestler
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineSt. Paul's HospitalVancouverBritish ColumbiaCanada
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155
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Evaluation of Opioid Overdose Reports in Patients Treated with Extended-Release Naltrexone: Postmarketing Data from 2006 to 2018. Drug Saf 2020; 44:351-359. [PMID: 33258068 PMCID: PMC7892734 DOI: 10.1007/s40264-020-01020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 10/26/2022]
Abstract
INTRODUCTION After treatment with naltrexone extended-release injectable suspension (XR-NTX), a µ-opioid receptor antagonist, opioid tolerance is reduced from pretreatment baseline. Patients may be vulnerable to opioid overdose if they attempt to override the blockade during treatment, at the end of a dosing interval, after missing a dose, or after discontinuing treatment. OBJECTIVE We analyzed postmarketing data to characterize reporting rates of opioid overdose during treatment with and after discontinuation of XR-NTX. METHODS Postmarketing adverse event reports within the XR-NTX safety database, received 2006-2018, for patients treated with XR-NTX for any indication were reviewed for opioid overdose cases. Assessable cases were categorized by timing of the event from the last dose of XR-NTX (latency): ≤28 days (on treatment), 29-56 days, and >56 days from last dose of XR-NTX. Within each latency group, cases were further classified as serious and, of those, cases that had a fatal outcome. RESULTS During the 12-year period, an estimated 495,602 patients received XR-NTX. Opioid overdose was reported in 161 cases; of these, 66 contained sufficient information to determine latency. Reporting rates of opioid overdose per 10,000 patients treated were similar among latency groups: 0.54 for ≤28 days (0.24 fatal), 0.34 for 29-56 days (0.16 fatal), and 0.44 for >56 days (0.40 fatal) from the last dose of XR-NTX. CONCLUSIONS Over the 12-year period, the reporting rates of opioid overdose were similar during treatment with or after discontinuation of XR-NTX and <10/10,000 patients exposed. Our findings are limited by the nature of spontaneously reported safety data.
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Jacobson N, Horst J, Wilcox-Warren L, Toy A, Knudsen HK, Brown R, Haram E, Madden L, Molfenter T. Organizational Facilitators and Barriers to Medication for Opioid Use Disorder Capacity Expansion and Use. J Behav Health Serv Res 2020; 47:439-448. [PMID: 32347426 PMCID: PMC7578054 DOI: 10.1007/s11414-020-09706-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Medication for opioid use disorder (MOUD) is a key strategy for addressing the opioid use disorder crisis, yet gaps in MOUD provision impede this strategy's benefits. The research reported here sought to understand what distinguishes low- and high-performing organizations in building and using capacity to provide MOUD. As part of a mixed methods MOUD implementation trial, semi-structured telephone interviews were conducted with personnel from low- and high-performing MOUD-providing organizations. Seventeen individuals from 17 organizations were interviewed. Findings demonstrate the importance of individual, organization, and community-level factors in supporting the building and use of MOUD capacity. Low- and high-performing organizations showed different patterns of facilitators and barriers during the implementation process. The key difference between low- and high-performing organizations was the level of organizational functioning. A better understanding of an organization's assets and deficits at the individual, organizational, and community levels would allow decision-makers to tailor their approaches to MOUD implementation.
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Affiliation(s)
- Nora Jacobson
- University of Wisconsin, Institute for Clinical and Translational Research, Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53703, USA.
| | - Julie Horst
- University of Wisconsin Center for Health Enhancement Systems Studies, Mechanical Engineering Building, 1513 University Ave, Madison, WI, 53703, USA
| | - Liam Wilcox-Warren
- University of Wisconsin Center for Health Enhancement Systems Studies, Mechanical Engineering Building, 1513 University Ave, Madison, WI, 53703, USA
| | - Alex Toy
- University of Wisconsin Center for Health Enhancement Systems Studies, Mechanical Engineering Building, 1513 University Ave, Madison, WI, 53703, USA
| | - Hannah K Knudsen
- Robert Straus Behavioral Science Laboratory, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Randy Brown
- University of Wisconsin Center for Health Enhancement Systems Studies, Mechanical Engineering Building, 1513 University Ave, Madison, WI, 53703, USA
| | - Eric Haram
- Haram Counseling, 66 Baribeau Dr Ste 8, Brunswick, ME, 04011, USA
| | - Lynn Madden
- Yale School of Medicine, APT Foundation, One Long Wharf Drive, Suite 321, New Haven, CT, 06511, USA
| | - Todd Molfenter
- University of Wisconsin Center for Health Enhancement Systems Studies, Mechanical Engineering Building, 1513 University Ave, Madison, WI, 53703, USA
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157
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Gregory VL, Ellis RJB. Cognitive-behavioral therapy and buprenorphine for opioid use disorder: A systematic review and meta-analysis of randomized controlled trials. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:520-530. [PMID: 32960649 DOI: 10.1080/00952990.2020.1780602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Recent systematic reviews have questioned the ability of psychosocial intervention to add substantive benefit to buprenorphine therapy. Objectives: The purpose of the present meta-analysis was to test the random effects model (REM) null hypothesis that, for opioid use disorder (OUD) and opioid biological sample outcomes, the summary effect of cognitive-behavioral therapy (CBT) + buprenorphine randomized controlled trials (RCTs) = 0. Methods: A systematic review was conducted searching electronic databases and the reference lists of included studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria were used to guide this review and the REM meta-analysis. Results: The initial meta-analytic model (k = 4) was insignificant (REM Hedges' g =.22, Z = 1.27, p =.206, 95% CI: -0.12-0.56) and heterogeneous (I2 = 53.47). A pre-specified categorical moderator analysis explained the heterogeneity via CBT modality. Categorical moderator analysis (k = 4) showed non-individual CBT RCTs (k = 2) to have a REM Hedges' g summary effect of.598 (p =.006) and individual-CBT RCTs (k = 2) to have a REM Hedges' g summary effect of -0.010 (p = .936). The difference between these two subgroups was significant (Q = 5.85, df = 1, p = .016). Conclusion: The evidence cautiously suggests that for OUD, there may be some benefit to adding non-individual CBT to buprenorphine therapy.
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158
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Ford JA, McCabe SE, Schepis TS. Sources of prescription opioids and tranquilizers for misuse among U.S. young adults: differences between high school dropouts and graduates and associations with adverse outcomes. J Addict Dis 2020; 39:54-65. [PMID: 32921294 DOI: 10.1080/10550887.2020.1814122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background and Objectives: Prior research has identified that sources of prescription drugs for misuse vary based on educational attainment, which is important as certain sources are associated with adverse outcomes. The current research addressed limitations of the extant literature by creating distinct categories of push factors for high school dropout (e.g., negative school performance/experiences), pull factors for high school dropout (e.g., starting a family or getting a job), and high school graduates who did not attend college.Methods: Using data from the 2009-2014 National Survey on Drug Use and Health, prevalence of sources were estimated and design-based multivariable logistic regression investigated the association between sources and educational attainment. Additionally, multivariable logistic regression assessed the associations between sources and adverse outcomes (i.e., substance use, substance use disorders, and mental health) separately for each educational category.Results: College respondents were more likely to report "physician" and free from "friend/relative" and less likely to report "purchased" as sources. For most educational categories, "purchasing" prescription drugs was associated with adverse outcomes. Additionally, "theft/fake" prescription emerged as a source associated with adverse outcomes for college respondents, while "friend/relative" was associated with adverse outcomes for high school graduates that did not go on to college.Conclusions: This research has important clinical implications as it identified young adults with a college education as being less likely to obtain prescription drugs from sources known to be associated with adverse outcomes. It also highlighted how associations between sources and adverse outcomes vary based on educational attainment.
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Affiliation(s)
- Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, Michigan, USA
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, Texas, USA
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159
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O'Donnell J, Gladden RM, Mattson CL, Hunter CT, Davis NL. Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants - 24 States and the District of Columbia, January-June 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1189-1197. [PMID: 32881854 PMCID: PMC7470457 DOI: 10.15585/mmwr.mm6935a1] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Provisional estimates indicate that drug overdose deaths increased in 2019 after a slight decrease in 2018. In 2018, overdose deaths primarily involved opioids, with continued increases in deaths involving illicitly manufactured fentanyls (IMFs). Deaths involving stimulants such as cocaine and methamphetamine are also increasing, mainly in combination with opioids. Methods CDC analyzed data on drug overdose deaths during January–June 2019 from 24 states and the District of Columbia (DC) in the State Unintentional Drug Overdose Reporting System to describe characteristics and circumstances of opioid- and stimulant-involved overdose deaths. Results Among 16,236 drug overdose deaths in 24 states and DC, 7,936 (48.9%) involved opioids without stimulants, 5,301 (32.6%) involved opioids and stimulants, 2,056 (12.7%) involved stimulants without opioids, and 943 (5.8%) involved neither opioids nor stimulants. Approximately 80% of overdose deaths involved one or more opioid, and IMFs were involved in three of four opioid-involved overdose deaths. IMFs, heroin, cocaine, or methamphetamine (alone or in combination) were involved in 83.8% of overdose deaths. More than three in five (62.7%) overdose deaths had documentation of at least one potential opportunity for overdose prevention intervention. Conclusions and implications for public health practice Identifying opportunities to intervene before an overdose death and implementing evidence-based prevention policies, programs, and practices could save lives. Strategies should address characteristics of overdoses involving IMFs, such as rapid overdose progression, as well as opioid and stimulant co-involvement. These efforts should be complemented by efforts to prevent initiation of prescription opioid and stimulant misuse and illicit drug use.
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Affiliation(s)
- Julie O'Donnell
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC
| | - R Matt Gladden
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC
| | - Christine L Mattson
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC
| | - Calli T Hunter
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC
| | - Nicole L Davis
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC
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160
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Aas CF, Vold JH, Skurtveit S, Lim AG, Ruths S, Islam K, Askildsen JE, Løberg EM, Fadnes LT, Johansson KA. Health-related quality of life of long-term patients receiving opioid agonist therapy: a nested prospective cohort study in Norway. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:68. [PMID: 32883319 PMCID: PMC7469909 DOI: 10.1186/s13011-020-00309-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/25/2020] [Indexed: 01/26/2023]
Abstract
Background Opioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. There is limited knowledge on the health-related quality of life (HRQoL) of long-term patients in OAT. This study measures HRQoL and self-perceived health of long-term patients on OAT, compares the scores to a Norwegian reference population, and assesses changes in these scores at 1-year follow up. Methods We conducted a nested prospective cohort study among nine OAT outpatient clinics in Norway. 609 OAT patients were included, 245 (40%) followed-up one year later. Data on patient characteristics, HRQoL, and self-perceived health was collected. HRQoL was assessed with the EQ-5D-5L, which measures five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) on a five-point Likert scale (from “no problems” to “extreme problems”). An UK value set was applied to calculate index values (from 0 to 1) for the EQ-5D-5L and compare them to a Norwegian reference population. Self-perceived health was measured with EQ-VAS (from 0 to 100). Results Mean (standard deviation (SD)) EQ-5D-5L index value at baseline was 0.699 (0.250) and EQ-VAS 57 (22) compared to 0.848 (0.200) and 80(19) for the Norwegian reference population. There were large variations in EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The lowest EQ-5D-5L index values were observed for female patients, age groups older than 40 years and for methadone users. At follow-up, improvements in HRQoL were observed across almost all dimensions and found significant for mobility and pain/discomfort. Mean (SD) overall index value and EQ-VAS at follow up were 0.729 (0.237) and 59 (22) respectively. Conclusion The average HRQoL and self-perceived health of OAT patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions. Around 34% had very good HRQoL, higher than average Norwegian values, and around 5% had extremely poor HRQoL.
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Affiliation(s)
- Christer Frode Aas
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Jørn Henrik Vold
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.,Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sabine Ruths
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Kamrul Islam
- Department of Social Sciences, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Economics, University of Bergen, Bergen, Norway
| | | | - Else-Marie Løberg
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway.,Department of Clinical Psychology, Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, N-5012, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Dale LM, Nosyk B. Commentary on Krawczyk et al. (2020): Reinforcing the case for evidence-based treatment of opioid use disorder. Addiction 2020; 115:1695-1696. [PMID: 32293770 DOI: 10.1111/add.15045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Laura M Dale
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Coflumbia, Canada
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162
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Paulus MP, Stewart JL. Neurobiology, Clinical Presentation, and Treatment of Methamphetamine Use Disorder: A Review. JAMA Psychiatry 2020; 77:959-966. [PMID: 32267484 PMCID: PMC8098650 DOI: 10.1001/jamapsychiatry.2020.0246] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The prevalence of and mortality associated with methamphetamine use has doubled during the past 10 years. There is evidence suggesting that methamphetamine use disorder could be the next substance use crisis in the United States and possibly worldwide. OBSERVATION The neurobiology of methamphetamine use disorder extends beyond the acute effect of the drug as a monoaminergic modulator and includes intracellular pathways focused on oxidative stress, neurotoxic and excitotoxic effects, and neuroinflammation. Similarly, the clinical picture extends beyond the acute psychostimulatory symptoms to include complex cardiovascular and cerebrovascular signs and symptoms that need to be identified by the clinician. Although there are no pharmacologic treatments for methamphetamine use disorder, cognitive behavioral therapy, behavioral activation, and contingency management show modest effectiveness. CONCLUSIONS AND RELEVANCE There is a need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets. Parsing the disorder into different processes (eg, craving or mood-associated alterations) and targeting the neural systems and biological pathways underlying these processes may lead to greater success in identifying disease-modifying interventions. Finally, mental health professionals need to be trained in recognizing early cardiovascular and cerebrovascular warning signs to mitigate the mortality associated with methamphetamine use disorder.
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Affiliation(s)
- Martin P. Paulus
- Scientific Director and President Laureate Institute for Brain Research 6655 S Yale Ave, Tulsa, OK 74136-3326,Department of Community Medicine, University of Tulsa, Tulsa OK 74104
| | - Jennifer L. Stewart
- Scientific Director and President Laureate Institute for Brain Research 6655 S Yale Ave, Tulsa, OK 74136-3326,Department of Community Medicine, University of Tulsa, Tulsa OK 74104
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Shearer RD, Howell BA, Bart G, Winkelman TNA. Substance use patterns and health profiles among US adults who use opioids, methamphetamine, or both, 2015-2018. Drug Alcohol Depend 2020; 214:108162. [PMID: 32652380 PMCID: PMC8147519 DOI: 10.1016/j.drugalcdep.2020.108162] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Methamphetamine use, with and without opioids, has increased substantially, but little is known about the sociodemographic characteristics, substance use patterns, or health profiles of individuals who use methamphetamine. To design effective public health interventions, health care professionals and policymakers need data describing individuals who are using methamphetamine in the midst of the opioid crisis. METHODS We used 2015-2018 data from the National Survey on Drug Use and Health and included non-elderly adults aged 18-64 years. We categorized respondents into three groups: use of opioids without methamphetamine use, use of methamphetamine without opioid use, or use of both opioids and methamphetamine. Multiple logistic regression models controlling for sociodemographic factors were used to compare substance use characteristics and measures of individual health between the three groups. RESULTS People who used any methamphetamine were more likely to be unstably housed, low-income, and live in rural areas. Use of both opioids and methamphetamine was associated with a 132 % higher prevalence of injection needle use, and a nearly twofold higher prevalence of viral hepatitis compared with opioid use alone. One third of individuals reporting use of both opioids and methamphetamine had a severe mental illness, a 55 % higher prevalence than those using opioids alone. CONCLUSIONS Individuals who used opioids and methamphetamine had more complex substance use and health profiles than individuals who used opioids alone. These findings suggest public health and harm reduction approaches designed to address opioid use remain important in an era of rising methamphetamine use.
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Affiliation(s)
- Riley D Shearer
- University of Minnesota Medical School, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN, 55455, USA.
| | - Benjamin A Howell
- National Clinician Scholars Program, Yale School of Medicine, 333 Cedar Street, Sterling Hall of Medicine I-456, New Haven, CT, 06520, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Gavin Bart
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, 914 S 8thSt, Shapiro 1.400, Minneapolis, MN, 55415 USA; Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN, 55415, USA
| | - Tyler N A Winkelman
- Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN, 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, 716 S 7thSt, Minneapolis, MN, 55415, USA
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Bech AB, Clausen T, Waal H, Vindenes V, Edvardsen HE, Frost J, Skeie I. Post-mortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations. Addiction 2020; 116:845-855. [PMID: 32738014 DOI: 10.1111/add.15211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
AIMS To present the substances and their concentrations detected post-mortem in patients receiving opioid agonist treatment (OAT) stratified by cause of death, estimate the pooled opioid and benzodiazepine concentrations using established conversion factors for blood concentrations from the Norwegian Road Traffic Act, and explore the association between drug-induced cause of death and the pooled opioid and benzodiazepine concentrations. DESIGN Cross-sectional nationwide study. SETTING Norway. PARTICIPANTS One hundred and seven patients who died during OAT (i.e. within 5 days after the last intake of OAT medication) between 1 January 2014 and 31 December 2015, with post-mortem femoral blood available for toxicology. Data were collected from hospital records, the Norwegian Cause of Death Registry and autopsy reports. MEASUREMENTS Presence of alcohol and non-alcohol substances in the bloodstream at time of death, determined through records of toxicology of post-mortem femoral blood. FINDINGS A median of four substances was detected across the causes of death. At least one benzodiazepine was detected in 81 (76%) patients. The median pooled opioid concentration was significantly higher in drug-induced deaths compared with other causes of death (362 ng/mL versus 182 ng/mL, P < 0.001), in contrast to the pooled benzodiazepine concentration (5466 versus 5701 ng/mL, P = 0.353). The multivariate regression analysis showed that only increasing pooled opioid concentration (ng/ML) was associated with increased odds of a drug-induced cause of death (odds ratio, 1.003; 95% confidence interval: 1.001-1.006). CONCLUSIONS In Norway, overall opioid concentration seems to play an important role in drug-induced deaths during opioid agonist treatment in patients prescribed methadone or buprenorphine. Patients prescribed buprenorphine tend to replace their agonist with full agonists, while patients prescribed methadone tend to have high opioid concentrations from methadone as the only opioid.
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Affiliation(s)
- Anne Berit Bech
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, P.O. Box 104, 2381, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318, Oslo, Norway
| | - Helge Waal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318, Oslo, Norway
- National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Sognsvannsveien 21, Bygg 6, P.O. Box 4959 Nydalen, 0424, Oslo, Norway
| | - Vigdis Vindenes
- Department of Forensic Sciences, Oslo University Hospital, P. O. Box 4950, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P. O. Box 1171 Blindern, 0318, Oslo, Norway
| | - Hilde Erøy Edvardsen
- Department of Forensic Sciences, Oslo University Hospital, P. O. Box 4950, 0424, Oslo, Norway
| | - Joachim Frost
- Department of Clinical Pharmacology, St. Olav's Hospital Trondheim University Hospital, P.O. Box 3250 Torgarden, 7006, Trondheim, Norway
| | - Ivar Skeie
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, P.O. Box 104, 2381, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318, Oslo, Norway
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Land ME, Wetzel M, Geller RJ, Steck AR, Grunwell JR. Adult opioid poisonings by drug, intent, and resource use from the United States National Poison Data System from 2005-2018. Clin Toxicol (Phila) 2020; 59:142-151. [PMID: 32673123 DOI: 10.1080/15563650.2020.1781150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Deaths due to an opioid overdose nearly doubled from 2013 to 2017. Our objective is to describe the trends in intent, healthcare resource use, and clinical outcomes among adults with opioid exposures. MATERIALS AND METHODS This study is a retrospective analysis of data from the 55 U.S. poison control centers. Adults, >19 years, with an opioid as the primary poisoning agent between 2005 and 2018 were included. These years were divided into three epochs (2005-2009, 2010-2014, and 2015-2018) to describe the trends in frequency, intent, severity, healthcare resource use, and regional differences in U.S. adults affected by prescription and illicit opioid exposures. RESULTS A total of 546,049 (54.4%) of the 1,002,947 opioid-related cases reported to the U.S. poison centers met inclusion criteria. The percentage of patients with a moderate/major clinical effect increased in each epoch (24.4, 29.13, and 35.3%) as did the proportion of patients with illicit opioids (coded as heroin) as their primary substance (2.89, 5.47, and 13.95%). Illicit opioid use was associated with increased frequency of moderate/major clinical effects (54.2 vs. 27.4%), need for an ICU procedure (11.4 vs. 6.8%), and death (3.9 vs. 1.2%) compared with prescription opioid use. Suicidal intent (34.88%) followed by misuse/abuse (26.26%) were the most frequent intents. Misuse/abuse increased in frequency over each epoch in the study period (23.1 vs. 26.12 vs. 30.3%). Discussion and conclusions: The severity of clinical effects and death following acute opioid poisonings increased over the study period, driven by suicidal intent and an increasing proportion of illicit opioid cases. This study highlights the importance of developing strategies to address suicide prevention in addition to the continued focus on opioid use disorder.
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Affiliation(s)
- Megan E Land
- Division of Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - Martha Wetzel
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Emory + Children's Pediatric Research Biostatistics Core, Atlanta, USA
| | - Robert J Geller
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Georgia Poison Center, Atlanta, USA
| | - Alaina R Steck
- Georgia Poison Center, Atlanta, USA.,Department of Emergency Medicine, Emory University School of Medicine, Atlanta, USA
| | - Jocelyn R Grunwell
- Division of Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
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Miles J, Howell J, Sheridan D, Braucht G, Mericle A. Supporting individuals using medications for opioid use disorder in recovery residences: challenges and opportunities for addressing the opioid epidemic. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:266-272. [PMID: 32091262 DOI: 10.1080/00952990.2020.1719410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Full and partial opioid agonists and opioid antagonist medications play an important role in containing the opioid epidemic. However, these medications have not been used to their full extent. Recovery support services, such as recovery residences (RRs), also play a key role. RRs may increase an individual's recovery capital, facilitate social support for abstinence, and foster a sense of community among residents. These processes may be critical for individuals with opioid use disorder (OUD). In combination these two recovery pathways have the potential to enhance one another and improve outcomes among residents with OUD. Barriers to doing so have resulted in a limited supply of residences that can support residents using opioid agonist and antagonist medications. This perspective describes key interpersonal and structural barriers to medication use among individuals with an OUD seeking support from a recovery residence and discusses measures for reducing these barriers. These measures include workforce development to address stigma and attitudinal barriers and enhancing residence capability to ensure resident safety and reduce potential diversion. The perspective also highlights the need for additional research to facilitate the identification of best practices to improve outcomes among residents treated with medications living in recovery residences.
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Affiliation(s)
- Jennifer Miles
- The Heller School for Social Policy and Management, Brandeis University , Waltham, MA, USA
| | - Jason Howell
- National Alliance for Recovery Residences , St. Paul, MN, USA
| | - Dave Sheridan
- National Alliance for Recovery Residences , St. Paul, MN, USA
| | - George Braucht
- National Alliance for Recovery Residences , St. Paul, MN, USA
| | - Amy Mericle
- Public Health Institute, Alcohol Research Group , Emeryville, CA, USA
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Mark TL, Parish WJ, Zarkin GA. Association of Formulary Prior Authorization Policies With Buprenorphine-Naloxone Prescriptions and Hospital and Emergency Department Use Among Medicare Beneficiaries. JAMA Netw Open 2020; 3:e203132. [PMID: 32310285 PMCID: PMC7171554 DOI: 10.1001/jamanetworkopen.2020.3132] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Prior authorization requirements may be a barrier to accessing medications for opioid use disorder treatment and may, therefore, be associated with poor health care outcomes. OBJECTIVE To determine the association of prior authorization with use of buprenorphine-naloxone and health care outcomes. DESIGN, SETTING, AND PARTICIPANTS This comparative interrupted time series analysis examined enrollment and insurance claims data from Medicare beneficiaries with an opioid use disorder diagnosis or who filled a prescription for an opioid use disorder medication between 2012 and 2017. Over this period, 775 874 members were in 1479 Part D plans that always required prior authorization, 113 286 members were in 206 plans that removed prior authorization, 189 461 members were in 489 plans that never required prior authorization, and 619 919 members were in 485 plans that added prior authorization. Data analysis was performed from April 2019 to February 2020. EXPOSURES Removal or addition of prior authorization and new prescriptions filled for buprenorphine-naloxone. MAIN OUTCOMES AND MEASURES Buprenorphine-naloxone use, inpatient admissions, emergency department visits, and prescription drug and medical expenditures. RESULTS The study population in 2012 included 949 206 Medicare beneficiaries (mean [SD] age, 57 [15] years; 550 445 women [58%]). Removal of prior authorization was associated with an increase of 17.9 prescriptions (95% CI, 1.1 to 34.7 prescriptions) filled for buprenorphine-naloxone per plan per year, which is a doubling of the number of prescriptions, on average. Each prescription filled was associated with statistically significant decreases in adverse health care outcomes: substance use disorder-related inpatient admissions decreased by 0.1 admission per plan per year (95% CI, -0.2 to -0.1 admission per plan per year), and substance use disorder-related emergency department visits decreased by 0.1 visit per plan per year (95% CI, -0.13 to -0.03 visit per plan per year) (all P < .001). Combining these results, removal of prior authorization was associated with a reduction in substance use disorder-related inpatient admissions by 2.0 admissions per plan per year (95% CI, -4.3 to -0.1 admissions per plan per year) and substance use disorder-related emergency department visits by 1.4 visits per plan per year (95% CI, -3.2 to -0.1 visits per plan per year). CONCLUSIONS AND RELEVANCE Removing prior authorization for buprenorphine-naloxone was associated with an increase in the medication use and decreases in health care utilization and expenditures.
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168
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Riblet NB, Gottlieb DJ, Shiner B, Cornelius SL, Watts BV. Associations between Medication Assisted Therapy Services Delivery and Mortality in a National Cohort of Veterans with Posttraumatic Stress Disorder and Opioid Use Disorder. J Dual Diagn 2020; 16:228-238. [PMID: 31852392 PMCID: PMC7192001 DOI: 10.1080/15504263.2019.1701218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Opioid use disorder (OUD) is a notable concern in the United States (US) and strongly associated with mortality. There is a high prevalence of OUD in patients with posttraumatic stress disorder (PTSD) and the mortality associated with OUD may be exacerbated in patients with PTSD. Medication-assisted treatment (MAT) for OUD has become standard of care for OUD and has been shown to reduce mortality. However, there has been little study of MAT and mortality in patients with PTSD and OUD. Methods: We conducted a retrospective cohort study in U.S. veterans who had newly engaged in PTSD treatment, were diagnosed with OUD and were provided MAT for at least one day between 2004 and 2013. We assessed mortality for one year following the index diagnosis date. We calculated all-cause mortality as well as death by external cause, overdose plus suicide, overdose, and suicide rates per 100,000. We used hazard ratios (HR) and 95% confidence intervals (CI) to compare death rates between patients with high versus low adherence to MAT. We evaluated the impact of high versus low exposure to general substance abuse care. We considered a confidence interval that did not cross one to be significant. Results: A total of 5,901 patients met inclusion criteria. Most patients were men and the average age was 43.3 years (SD = 13.8). The all-cause mortality rate was 1,370 per 100,000 patients. High adherence to MAT resulted in a non-significant, decreased risk for death due to all-cause (HR = 0.73, 95% CI [0.47, 1.13]), external cause (HR = 0.71, 95% CI [0.38, 1.35]), and overdose or suicide (HR = 0.66, 95% CI [0.33, 1.35]). Patients with high exposure (≥ 60 days) to general substance abuse care were significantly less likely to die due to external cause (HR = 0.39, 95% CI [0.18, 0.85]) and overdose or suicide (HR = 0.31, 95% CI [0.12, 0.77]). Conclusions: In patients with PTSD and OUD, improved adherence to MAT and greater exposure to general substance abuse care may result in lower mortality. Studies with longer follow-up and larger sample sizes to assess the impact of MAT on suicide are needed to confirm our findings.
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Affiliation(s)
- Natalie B Riblet
- Department of Mental Health, Veterans Affairs Medical Center, White River Junction, VT, USA.,Department of Mental Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Mental Health, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Daniel J Gottlieb
- Department of Mental Health, Veterans Affairs Medical Center, White River Junction, VT, USA.,Department of Mental Health, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Brian Shiner
- Department of Mental Health, Veterans Affairs Medical Center, White River Junction, VT, USA.,Department of Mental Health, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Department of Mental Health, National Center for PTSD, White River Junction, VT, USA
| | - Sarah L Cornelius
- Department of Mental Health, Veterans Affairs Medical Center, White River Junction, VT, USA
| | - Bradley V Watts
- Department of Mental Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Systems Redesign and Improvement, VA Office of Systems Redesign and Improvement, White River Junction, VT, USA
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Nestadt PS, Bohnert ASB. Clinical Perspective on Opioids in the Context of Suicide Risk. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:100-105. [PMID: 33162847 PMCID: PMC7587892 DOI: 10.1176/appi.focus.20200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psychiatrists are on the front lines of two simultaneous public health crises: the increasing rates of suicide and opioid-related deaths. In this review, the authors discuss ways in which these two classes of preventable deaths may be linked, with an emphasis on identifying and preventing both outcomes through increased understanding of their shared risk factors. As clinicians, it is crucial to maintain awareness of the ways in which opioid use may contribute to depression and suicidality, as well as how mood disorders may complicate opioid use. In light of this interplay, interventions which target risk factors for both suicide and overdose are key. Interventions include early treatment of substance dependence and depression, as well as harm reduction measures, such as provision of naloxone, medication-assisted treatments for dependency, and multidisciplinary approaches to chronic pain that do not rely solely on escalating opioid doses. It is also important to address social determinants of health, which may increase risk for both accidental and intentional overdose. The roads to overdose and suicide overlap considerably and cannot be considered separately.
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Affiliation(s)
- Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Nestadt); Department of Psychiatry, University of Michigan, and U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Bohnert)
| | - Amy S B Bohnert
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Nestadt); Department of Psychiatry, University of Michigan, and U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Bohnert)
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170
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Hjelmström P, Banke Nordbeck E, Tiberg F. Optimal dose of buprenorphine in opioid use disorder treatment: a review of pharmacodynamic and efficacy data. Drug Dev Ind Pharm 2020; 46:1-7. [DOI: 10.1080/03639045.2019.1706552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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171
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Beyond Parity: Medicaid Policy and Improving Access to Effective Substance Use Disorder Treatment. Med Care 2020; 58:99-100. [PMID: 31895309 DOI: 10.1097/mlr.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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172
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von Bernuth K, Seidel P, Krebs J, Lehmann M, Neumann B, Konrad N, Opitz-Welke A. Prevalence of Opioid Dependence and Opioid Agonist Treatment in the Berlin Custodial Setting: A Cross-Sectional Study. Front Psychiatry 2020; 11:794. [PMID: 32903474 PMCID: PMC7435061 DOI: 10.3389/fpsyt.2020.00794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Among people living in detention, substance use is highly prevalent, including opioid dependence. Opioid agonist treatment (OAT) has been established as an evidence-based, first-line treatment for opioid dependence. Despite high prevalence of opioid dependence, conclusive data regarding its prevalence and the OAT practice in German prisons is scarce; rather, the existing data widely diverges concerning the rates of people in detention receiving OAT. MATERIALS AND METHODS We conducted a cross-sectional survey of all detention facilities in Berlin. On the date of data collection, a full census of the routine records was completed based on the medical documentation system. For each opioid dependent individual, we extracted sociodemographic data (i.e., age, sex, and non-/German nationality, whether people experienced language-related communication barriers), information about OAT, comorbidities (HIV, hepatitis C, schizophrenia), and the detention center, as well as the anticipated imprisonment duration and sentence type. The data was first analyzed descriptively and secondly in an evaluative-analytical manner by analyzing factors that influence the access to OAT of people living in detention. RESULTS Among the 4,038 people in detention in the Berlin custodial setting under investigation, we identified a 16% prevalence of opioid dependence. Of the opioid-dependent individuals, 42% received OAT; 31% were treated with methadone, 55% were treated with levomethadone, and 14% were treated with buprenorphine. Access to OAT seemed mainly dependent upon initial receipt of OAT at the time of imprisonment, detention duration, the prisons in which individuals were detained, German nationality, and sex. The overall prevalence of HIV was 4-8%, hepatitis C was 31-42%, and schizophrenia was 5%. CONCLUSIONS The prevalence of opioid dependence and access to OAT remains a major health issue in the custodial setting. OAT implementation must be especially intensified among male, non-German, opioid-dependent individuals with a short detention period. Treatment itself must be diversified regarding the substances used for OAT, and institutional treatment differences suggest the need for a consistent treatment approach and the standardized implementation of treatment guidelines within local prison's standard operating procedures. Testing for infectious diseases should be intensified among opioid-dependent people living in detention to address scarcely known infection statuses and high infection rates.
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Affiliation(s)
- Kira von Bernuth
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Seidel
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Julia Krebs
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Marc Lehmann
- Prison Hospital Berlin, Plötzensee Prison, Berlin, Germany
| | - Britta Neumann
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Norbert Konrad
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Annette Opitz-Welke
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Patel P, Ramaswamy R, Mardam Bey R. Persisting gaps in M-OUD coverage at post-discharge recovery houses necessitate our continued advocacy. Subst Abus 2019; 41:11-13. [DOI: 10.1080/08897077.2019.1695038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Pious Patel
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Rahul Ramaswamy
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Ramzi Mardam Bey
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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174
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Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review. PLoS Med 2019; 16:e1003002. [PMID: 31891578 PMCID: PMC6938347 DOI: 10.1371/journal.pmed.1003002] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Worldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration. METHODS AND FINDINGS We systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273-131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27-960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15-1,557) and 44 (range 27-382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36-55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research. CONCLUSIONS In this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional preventive strategies such as the distribution of NLX kits to at-risk individuals upon release greatly decrease the occurrence of opioid-related overdose and mortality. In an effort to mitigate the impact of the opioid-related overdose crisis, it is crucial to scale up OAT and opioid-related overdose prevention strategies (e.g., NLX) within a continuum of treatment before, during, and after incarceration.
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175
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Lambdin BH, Bluthenthal RN, Zibbell JE, Wenger L, Simpson K, Kral AH. Associations between perceived illicit fentanyl use and infectious disease risks among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:299-304. [PMID: 31733979 DOI: 10.1016/j.drugpo.2019.10.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Over the last several years, fentanyl has been introduced into the illicit drug supply in the United States. While the impact of fentanyl on overdose fatalities is clear, the increase in fentanyl use may also be affecting drug use practices with implications for infectious disease transmission. We conducted a cross-sectional survey to explore associations of perceived illicit fentanyl use with opioid use frequency, injection frequency and syringe sharing among people who inject drugs in two California cities. METHODS People who inject drugs (PWID) were recruited from community settings in Los Angeles and San Francisco, CA from June 2017 to September 2018. Multivariable logistic regression was used to explore adjusted associations between perceived illicit fentanyl use and high frequency opioid use, high frequency injection and syringe sharing. RESULTS Among the 395 study participants, the median age of participants was 44 years; 74% of participants were cisgender male; 73% reported to be homeless; 61% lived in San Francisco and 39% in Los Angeles. The prevalence of perceived illicit fentanyl use in the past six months was 50.4% (95% confidence interval (CI): 45.4%-55.3%) among PWID. Findings from our adjusted logistic regression models suggested that people reporting perceived illicit fentanyl use had a greater odds of high frequency opioid use (adjusted odds ratio (aOR) = 2.36; 95% CI: 1.43-3.91; p = 0.001), high frequency injection (aOR = 1.84; 95% CI: 1.08-3.13; p = 0.03) and receptive syringe sharing (aOR = 2.16; 95% CI: 1.06-4.36; p = 0.03), as compared to people using heroin and other street drugs but not fentanyl. CONCLUSION People reporting perceived illicit fentanyl use were at increased risk for injection-related infectious disease risks. Actions must be taken to reduce these risks, including improved access to syringe service programs and opioid treatment and consideration of innovative approaches, such as supervised consumption services.
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Affiliation(s)
- Barrot H Lambdin
- RTI-International, San Francisco, CA, United States; University of California San Francisco, San Francisco, CA, United States; University of Washington, Seattle, WA, United States.
| | | | | | - Lynn Wenger
- RTI-International, San Francisco, CA, United States
| | - Kelsey Simpson
- University of Southern California, Los Angeles, CA, United States
| | - Alex H Kral
- RTI-International, San Francisco, CA, United States
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176
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"You can see those concentric rings going out": Emergency personnel's experiences treating overdose and perspectives on policy-level responses to the opioid crisis in New Hampshire. Drug Alcohol Depend 2019; 204:107555. [PMID: 31542630 PMCID: PMC6924616 DOI: 10.1016/j.drugalcdep.2019.107555] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND In parallel to a substantial increase in opioid overdose deaths in New Hampshire (NH), emergency personnel experienced an increase in opioid-related encounters. To inform public health responses to this crisis, insights into the experiences and perspectives of those emergency personnel who treat opioid-related overdoses are warranted. AIMS Systematically examine emergency personnel's experiences treating opioid overdoses and obtain their perspectives on policy-level responses to the opioid crisis in NH. METHODS Semi-structured qualitative interviews were conducted with 18 first responders [firefighters (n = 6), police officers (n = 6), emergency medical service providers (n = 6)] and 18 emergency department personnel employed in six NH counties. Interviews focused on emergency personnel's perspectives on fentanyl/heroin formulations, experiences treating overdoses, harm reduction strategies, and experiences with treatment referral. Interviews were audio recorded, transcribed verbatim, and analyzed using content analysis. RESULTS Emergency personnel cited the potency and inconsistency of fentanyl-laced heroin as primary drivers of opioid overdose. Increases in overdose-related encounters took a substantial emotional toll on emergency personnel, who described a range of responses including feelings of burnout, exhaustion, and helplessness. While some emergency personnel felt conflicted about the implementation of harm reduction strategies like syringe services programs, others emphasized the necessity of these services. Emergency personnel expressed frustration with barriers to treatment referral in the state and recommended immediate treatment access after overdose events. CONCLUSIONS Findings suggest that interventions addressing trauma and burnout are necessary to support emergency personnel, while expanded harm reduction and treatment access are critical to support those who experience opioid overdose in NH.
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177
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Shaik AB, Kumar V, Bonifazi A, Guerrero AM, Cemaj SL, Gadiano A, Lam J, Xi ZX, Rais R, Slusher BS, Newman AH. Investigation of Novel Primary and Secondary Pharmacophores and 3-Substitution in the Linking Chain of a Series of Highly Selective and Bitopic Dopamine D3 Receptor Antagonists and Partial Agonists. J Med Chem 2019; 62:9061-9077. [DOI: 10.1021/acs.jmedchem.9b00607] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Anver Basha Shaik
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Vivek Kumar
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Alessandro Bonifazi
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Adrian M. Guerrero
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Sophie L. Cemaj
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Alexandra Gadiano
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
- Department of Neurology, Johns Hopkins Drug Discovery, The Johns Hopkins University School of Medicine, 855 North Wolfe Street, Baltimore, Maryland 21205, United States
| | - Jenny Lam
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
- Department of Neurology, Johns Hopkins Drug Discovery, The Johns Hopkins University School of Medicine, 855 North Wolfe Street, Baltimore, Maryland 21205, United States
| | - Zheng-Xiong Xi
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - Rana Rais
- Department of Neurology, Johns Hopkins Drug Discovery, The Johns Hopkins University School of Medicine, 855 North Wolfe Street, Baltimore, Maryland 21205, United States
| | - Barbara S. Slusher
- Department of Neurology, Johns Hopkins Drug Discovery, The Johns Hopkins University School of Medicine, 855 North Wolfe Street, Baltimore, Maryland 21205, United States
| | - Amy Hauck Newman
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse−Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
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178
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Kepple NJ, Parker A, Whitmore S, Comtois M. Nowhere to go? Examining facility acceptance levels for serving individuals using medications for opioid used disorder. J Subst Abuse Treat 2019; 104:42-50. [PMID: 31370984 DOI: 10.1016/j.jsat.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/07/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022]
Abstract
Medications for opioid use disorder (OUD) are associated with better overall outcomes for individuals managing their OUD. While much attention has focused on expanding access to these medications, this study aimed to gain further clarity on how facility-level characteristics may be contributing to availability of complementary recovery-oriented and/or recovery support services for individuals diagnosed with OUD. We created a census of 410 facilities located within a Midwestern metropolitan area that provided services aligning with the substance use disorder (SUD) continuum of care between September 2017 and March 2018. Among facilities serving individuals with opioid-related needs (N = 360), we triangulated five sources of data to measure facility-reported acceptance for individuals who are using medications for OUD. We also obtained facility rationale for their acceptance level (N = 89). We used multinomial logistic regression to identify facility-level factors associated with acceptance for medication use, and we used content analysis to identify categories of common rationales. Compared to moderate acceptance facilities, zero and low acceptance facilities were more likely to provide recovery support services or less likely to provide more than one type of SUD service. In contrast, high acceptance facilities were more likely than moderate acceptance facilities to focus primarily on mental health needs or provide multiple types of SUD services. Qualitative feedback suggests that the factors contributing to these relationships are complex and varied, providing multiple points for intervention at a facility level to increase service availability for individuals using medications for OUD. We address implications for policy and practice, highlighting the need to build an infrastructure that promotes availability of complementary recovery-oriented and recovery support service for individuals once they are prescribed medications for OUD.
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Affiliation(s)
- Nancy J Kepple
- University of Kansas, School of Social Welfare, 1545 Lilac Lane, Lawrence, KS 66045, USA.
| | - Amittia Parker
- University of Kansas, School of Social Welfare, 1545 Lilac Lane, Lawrence, KS 66045, USA
| | - Susan Whitmore
- First Call Alcohol/Drug Prevention & Recovery, 9091 State Line Rd, Kansas City, MO 64114, USA
| | - Michelle Comtois
- First Call Alcohol/Drug Prevention & Recovery, 9091 State Line Rd, Kansas City, MO 64114, USA
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179
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Bech AB, Clausen T, Waal H, Šaltytė Benth J, Skeie I. Mortality and causes of death among patients with opioid use disorder receiving opioid agonist treatment: a national register study. BMC Health Serv Res 2019; 19:440. [PMID: 31266495 PMCID: PMC6604272 DOI: 10.1186/s12913-019-4282-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/19/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Mortality rates and causes of death among individuals in opioid agonist treatment (OAT) vary according to several factors such as geographical region, age, gender, subpopulations, drug culture and OAT status. Patients in OAT are ageing due to effective OAT as well as demographic changes, which has implications for morbidity and mortality. Norway has one of the oldest OAT populations in Europe. Because of the varying mortality rates and causes of death in different subgroups and countries, research gaps still exist. The aims of this study were to describe the causes of death among OAT patients in Norway, to estimate all-cause and cause-specific crude mortality rates (CMRs) during OAT and to explore characteristics associated with drug-induced cause of death compared with other causes of death during OAT. METHODS This was a national, observational register study. Data from the Norwegian Cause of Death Registry and the Norwegian Patient Registry were combined with data from medical records. We included all patients in the Norwegian OAT programme who died not more than 5 days after the last intake of OAT medication, between 1 January 2014 and 31 December 2015. RESULTS In the 2-year observation period, 200 (1.4%) of the OAT patients died. A forensic or medical autopsy was performed in 63% of the cases. The mean age at the time of death was 48.9 years (standard deviation 8.4), and 74% were men. Somatic disease was the most common cause of death (45%), followed by drug-induced death (42%), and violent death (12%). In general, CMRs increased with age, and they were higher in men and in patients taking methadone compared with buprenorphine. Increasing somatic comorbidity, measured by the Charlson comorbidity index, reduced the odds of dying of a drug-induced cause of death compared with other causes of death. CONCLUSIONS Both somatic and drug-induced causes of death were common during OAT. Improved treatment and follow-up of chronic diseases, especially in patients aged > 40 years, and continuous measures to reduce drug-induced deaths appear to be essential to reduce future morbidity and mortality burdens in this population.
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Affiliation(s)
- Anne Berit Bech
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, P.O. Box 104, N-2381, Brumunddal, Norway. .,Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway
| | - Helge Waal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Sognsvannsveien 21, Bygg 6, P.O. Box 4959 Nydalen, N-0424, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway
| | - Ivar Skeie
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,Regional Psychiatric Centre Gjøvik, Innlandet Hospital Trust, Kyrre Grepps gate 11, N-2819, Gjøvik, Norway
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180
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Morin KA, Eibl JK, Caswell JM, Gauthier G, Rush B, Mushquash C, Lightfoot NE, Marsh DC. Concurrent psychiatry for patients enrolled in opioid agonist treatment: a propensity score matched cohort study in Ontario Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:29. [PMID: 31242949 PMCID: PMC6595572 DOI: 10.1186/s13011-019-0213-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/21/2019] [Indexed: 11/10/2022]
Abstract
Objective The objective was to characterize the relationship between geography, concurrent psychiatric services, all-cause mortality, and acute health care use for individuals enrolled in Opioid Agonist Treatment, in Ontario, Canada. Methods We conducted a propensity score matching study of patients enrolled in Opioid Agonist Treatment in Ontario for the first time between January 1, 2011, and December 31, 2015. We first compared outcomes between patients who were actively engaged and patients who were not actively engaged in Opioid Agonist Treatment. We created treatment and a control groups on the basis of an individual’s access to psychiatric care within an episode of Opioid Agonist Treatment. Relative risk and number needed to treat were calculated to determine the correlation between psychiatric care and health outcomes among patients enrolled in Opioid Agonist Treatment at two time points within an episode of care and for two geographic regions in Ontario (north and south). Results During the first year of Opioid Agonist Treatment, concurrent psychiatric care was associated with a reduction in all-cause mortality in southern Ontario (RR 0.80, 95% CI, 0.73–0.87), a reduction in emergency department visits in both northern and southern Ontario (north: RR = 0.76, 95% CI, 0.72–0.81; south: RR = 0.87, 95% CI, 0.86–0.88), and a reduction in hospitalizations (north: RR = 0.88, 95% CI. 0.82–0.94, south: RR = 0.92, 95% CI, 0.91–0.93). Conclusion Our findings have significant clinical and political implications for health system planning highlighting the need for integrated mental health and addiction services for individuals with Opioid Use Disorder. Electronic supplementary material The online version of this article (10.1186/s13011-019-0213-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Joseph K Eibl
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada
| | - Joseph M Caswell
- Institute of clinical and Evaluative Sciences, Sudbury, ON, Canada
| | - Graham Gauthier
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada
| | - Brian Rush
- , Centre for Addiction and Mental Health, Toronto, Canada
| | - Christopher Mushquash
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada.,Department of Psychology, Lakehead University, Thunder Bay, Canada
| | | | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada. .,Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada.
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181
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Amiri S, Lutz RB, McDonell MG, Roll JM, Amram O. Spatial access to opioid treatment program and alcohol and cannabis outlets: analysis of missed doses of methadone during the first, second, and third 90 days of treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 46:78-87. [PMID: 31237791 DOI: 10.1080/00952990.2019.1620261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The burden of access to opioid treatment programs (OTPs) may change as clients become eligible for take-home privileges. Our previous study showed clients who lived more than 10-miles away from an OTP were more likely to miss methadone doses during the first 30 days of treatment. Proximity to alcohol and cannabis outlets may also negatively influence treatment adherence.Objective: To examine the association between access to this OTP, alcohol and cannabis outlets, and the number of missed methadone doses during the first, second, and third 90 days of treatment.Methods: The number of missed methadone doses was calculated for 752, 689, and 584 clients who remained in treatment, respectively, for at least 3, 6, and 9 months (50% female). Distance between client's home and the OTP, alcohol, and cannabis outlets was measured. Generalized linear models were employed.Results: Shorter distance from a client's residence to the OTP was associated with a decreased number of missed methadone doses during the first 90 days of treatment. Shorter distance to the closest cannabis retail outlet was associated with an increased number of missed methadone doses during the first and second 90 days of treatment. Shorter distance to the closest off-premise alcohol outlet was associated with an increased number of missed methadone doses during the third 90 days of treatment.Conclusions: Improving spatial accessibility of OTPs are essential to ensure treatment opportunities are available for individuals so affected. Exploring to what extent residing in areas that facilitate alcohol and cannabis availability can influence treatment adherence is warranted.
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Affiliation(s)
- Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Robert B Lutz
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.,Spokane Regional Health District, Spokane, WA, USA
| | - Michael G McDonell
- Program of Excellence in Addiction Research, Washington State University, Spokane, WA, USA.,Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - John M Roll
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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182
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Affiliation(s)
- Kavita M Babu
- From the Division of Medical Toxicology and the Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (K.M.B.); the Departments of Medicine and Emergency Medicine, University of Colorado School of Medicine, and the Department of Medicine, Colorado School of Public Health - both in Aurora (J.B.); and the Division of General Internal Medicine and the Departments of Clinical Pharmacology and Toxicology and Medicine, University of Toronto, Toronto (D.N.J.)
| | - Jeffrey Brent
- From the Division of Medical Toxicology and the Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (K.M.B.); the Departments of Medicine and Emergency Medicine, University of Colorado School of Medicine, and the Department of Medicine, Colorado School of Public Health - both in Aurora (J.B.); and the Division of General Internal Medicine and the Departments of Clinical Pharmacology and Toxicology and Medicine, University of Toronto, Toronto (D.N.J.)
| | - David N Juurlink
- From the Division of Medical Toxicology and the Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (K.M.B.); the Departments of Medicine and Emergency Medicine, University of Colorado School of Medicine, and the Department of Medicine, Colorado School of Public Health - both in Aurora (J.B.); and the Division of General Internal Medicine and the Departments of Clinical Pharmacology and Toxicology and Medicine, University of Toronto, Toronto (D.N.J.)
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183
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Kinsky S, Houck PR, Mayes K, Loveland D, Daley D, Schuster JM. A comparison of adherence, outcomes, and costs among opioid use disorder Medicaid patients treated with buprenorphine and methadone: A view from the payer perspective. J Subst Abuse Treat 2019; 104:15-21. [PMID: 31370980 DOI: 10.1016/j.jsat.2019.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/24/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
Medication-assisted treatment (MAT) with methadone or buprenorphine has been shown to be more effective at reducing the use of illicit opioids, the risk of drug-related overdose, and overall healthcare costs, on average, compared to abstinence-based addiction treatments for individuals with an opioid use disorder (OUD). Individuals who are adherent to MAT are more likely to experience positive outcomes. We used physical and behavioral Medicaid claims data of individuals newly treated with methadone (n = 212) and buprenorphine (n = 972) to examine the overall predictors of adherence, differences in adherence to each medication, the relationship between adherence and ED nonfatal drug-related overdose, and differences in total cost of care between the two medications. We found that older individuals and women had significantly lower risk of non-adherence. At six months, only 3.6% of individuals who were adherent to either treatment experienced a nonfatal drug-related overdose in the ED, compared to 13.2% of individuals who were non-adherent. We found no significant difference between methadone and buprenorphine on nonfatal drug-related overdose. Non-adherence to methadone was associated with a significant increase in total cost of care. Implications for how these results could be used to improve the overall impact of MAT are discussed.
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Affiliation(s)
- Suzanne Kinsky
- UPMC Center for High-Value Health Care, US Steel Tower, 600 Grant Street, 40th Floor, Pittsburgh, PA 15219, USA.
| | - Patricia R Houck
- UPMC Health Plan, Department of Health Economics, , US Steel Tower, 600 Grant Street, 21st Floor, Pittsburgh, PA 15219, USA.
| | - Kristin Mayes
- UPMC Center for High-Value Health Care, US Steel Tower, 600 Grant Street, 40th Floor, Pittsburgh, PA 15219, USA.
| | - David Loveland
- Community Care Behavioral Health, 339 Sixth Avenue, Suite 1300, Pittsburgh, PA 15222, USA.
| | - Dennis Daley
- UPMC Health Plan, US Steel Tower, 600 Grant Street, Pittsburgh, PA 15219, USA.
| | - James M Schuster
- UPMC Insurance Services Division, US Steel Tower, 600 Grant Street, 55th Floor, Pittsburgh, PA 15219, USA.
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184
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Winograd RP, Presnall N, Stringfellow E, Wood C, Horn P, Duello A, Green L, Rudder T. The case for a medication first approach to the treatment of opioid use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:333-340. [DOI: 10.1080/00952990.2019.1605372] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rachel P. Winograd
- Missouri Institute of Mental Health, University of Missouri, St. Louis, USA
| | - Ned Presnall
- Clayton Behavioral, Washington University, St. Louis, USA
| | - Erin Stringfellow
- Missouri Institute of Mental Health, University of Missouri, St. Louis, USA
| | - Claire Wood
- Missouri Institute of Mental Health, University of Missouri, St. Louis, USA
| | - Phil Horn
- Missouri Institute of Mental Health, University of Missouri, St. Louis, USA
| | - Alex Duello
- Missouri Institute of Mental Health, University of Missouri, St. Louis, USA
| | - Lauren Green
- Missouri Institute of Mental Health, University of Missouri, St. Louis, USA
| | - Tim Rudder
- Missouri Department of Mental Health, Jefferson, Missouri, USA
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185
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Glanz JM, Binswanger IA, Shetterly SM, Narwaney KJ, Xu S. Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy. JAMA Netw Open 2019; 2:e192613. [PMID: 31002325 PMCID: PMC6481879 DOI: 10.1001/jamanetworkopen.2019.2613] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Attempts to discontinue opioid therapy to reduce the risk of overdose and adhere to prescribing guidelines may lead patients to be exposed to variability in opioid dosing. Such dose variability may increase the risk of opioid overdose even if therapy discontinuation is associated with a reduction in risk. OBJECTIVE To examine the association between opioid dose variability and opioid overdose. DESIGN, SETTING, AND PARTICIPANTS A nested case-control study was conducted in a large Colorado integrated health plan and delivery system from January 1, 2006, through June 30, 2018. Cohort members were individuals prescribed long-term opioid therapy. EXPOSURES Dose variability was defined as the SD of the milligrams of morphine equivalents across each patient's follow-up and categorized based on the quintile distribution of the SD in the cohort (0-5.3, 5.4-9.1, 9.2-14.6, 14.7-27.2, and >27.2 mg of morphine equivalents). MAIN OUTCOMES AND MEASURES Opioid overdose cases were identified using International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Each case patient with overdose was matched to up to 20 control patients using risk set sampling. Conditional logistic regression models were used to generate matched odds ratios and 95% CIs, adjusted for age, sex, race/ethnicity, drug or alcohol use disorder, tobacco use, benzodiazepine dispensings, medical comorbidities, mental health disorder, opioid dose, and opioid formulation. RESULTS In a cohort of 14 898 patients (mean [SD] age, 56.3 [16.0] years; 8988 [60.3%] female) prescribed long-term opioid therapy, 228 case patients with incident opioid overdose were matched to 3547 control patients. The mean (SD) duration of opioid therapy was 36.7 (33.7) months in case patients and 33.0 (30.9) months in control patients. High-dose variability (SD >27.2 mg of morphine equivalents) was associated with a significantly increased risk of overdose compared with low-dose variability (matched odds ratio, 3.32; 95% CI, 1.63-6.77) independent of opioid dose. CONCLUSIONS AND RELEVANCE Variability in opioid dose may be a risk factor for opioid overdose, suggesting that practitioners should seek to minimize dose variability when managing long-term opioid therapy.
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Affiliation(s)
- Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | - Ingrid A. Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
- Colorado Permanente Medical Group, Aurora
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | | | | | - Stan Xu
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
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Kaufman MJ, Kanayama G, Hudson JI, Pope HG. Supraphysiologic-dose anabolic-androgenic steroid use: A risk factor for dementia? Neurosci Biobehav Rev 2019; 100:180-207. [PMID: 30817935 DOI: 10.1016/j.neubiorev.2019.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 02/06/2023]
Abstract
Supraphysiologic-dose anabolic-androgenic steroid (AAS) use is associated with physiologic, cognitive, and brain abnormalities similar to those found in people at risk for developing Alzheimer's Disease and its related dementias (AD/ADRD), which are associated with high brain β-amyloid (Aβ) and hyperphosphorylated tau (tau-P) protein levels. Supraphysiologic-dose AAS induces androgen abnormalities and excess oxidative stress, which have been linked to increased and decreased expression or activity of proteins that synthesize and eliminate, respectively, Aβ and tau-P. Aβ and tau-P accumulation may begin soon after initiating supraphysiologic-dose AAS use, which typically occurs in the early 20s, and their accumulation may be accelerated by other psychoactive substance use, which is common among non-medical AAS users. Accordingly, the widespread use of supraphysiologic-dose AAS may increase the numbers of people who develop dementia. Early diagnosis and correction of sex-steroid level abnormalities and excess oxidative stress could attenuate risk for developing AD/ADRD in supraphysiologic-dose AAS users, in people with other substance use disorders, and in people with low sex-steroid levels or excess oxidative stress associated with aging.
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Affiliation(s)
- Marc J Kaufman
- McLean Imaging Center, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
| | - Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - James I Hudson
- Biological Psychiatry Laboratory, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
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187
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Morris NP, Bentzley BS. Requiring Buprenorphine Waivers for Psychiatry Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:131-134. [PMID: 30414072 DOI: 10.1007/s40596-018-1005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/05/2018] [Indexed: 06/08/2023]
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188
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Grall-Bronnec M, Laforgue EJ, Challet-Bouju G, Cholet J, Hardouin JB, Leboucher J, Guillou-Landréat M, Victorri-Vigneau C. Prevalence of Coaddictions and Rate of Successful Treatment Among a French Sample of Opioid-Dependent Patients With Long-Term Opioid Substitution Therapy: The OPAL Study. Front Psychiatry 2019; 10:726. [PMID: 31681038 PMCID: PMC6812413 DOI: 10.3389/fpsyt.2019.00726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/10/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Opioid use disorder (OUD) is a worldwide major health concern due to increased early mortality and morbidity. Opioid substitution therapy (OST) is approved in the context of a global OUD treatment (OUDT), in conjunction with psychosocial interventions. Many factors can explain why unsuccessful treatment rates remain high. While the phenomenon of addiction switching is often proposed, it is not known whether this also includes gambling addiction. The primary objective of the OPAL study was to determine the prevalence of coaddictions, including problem gambling, among patients with OUDT. Secondary objectives were to assess the rate of unsuccessful OUDT and to characterize the associated factors. Methods: For this observational transversal multicenter study, patients with OUDT including OST for at least 6 months were recruited. Clinical assessment was based on a clinically structured interview and a set of self-reported questionnaires. Coaddictions were screened using the Fagerström, the CRAFFT, and the Lie/Bet questionnaires. Unsuccessful OUDT was defined as the persistence of opioid use and/or the worsening of another substance use or gambling practice. After a descriptive analysis, a multivariate analysis was performed to identify the factors associated with unsuccessful OUDT. Results: The sample consisted of 263 patients. Prevalence of coaddictions reached 97% of the sample. Problem gambling was associated with 10% of the patients. OUDT was considered as "unsuccessful" for 60% of the patients. Associated factors included having drug-using friends, psychiatric and professional negative consequences related to opioid use, more than one OST-prescribing physician, and impulsivity, especially high scores for lack of premeditation and sensation seeking. Conclusions: This study provides further evidence of the need to consider coaddictions and the usefulness of global addictive evaluations. Poor prognostic factors must alert the clinician to initiate more sustained care. Further implications are discussed.
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Affiliation(s)
- Marie Grall-Bronnec
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,HUGOPSY Network, Nantes, France
| | - Edouard-Jules Laforgue
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
| | - Gaëlle Challet-Bouju
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France
| | - Jennyfer Cholet
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France
| | - Jean-Benoit Hardouin
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Methodology and Biostatistic Department, DRCI, CHU Nantes, Nantes, France
| | - Juliette Leboucher
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France
| | - Morgane Guillou-Landréat
- HUGOPSY Network, Nantes, France.,Addictive Medicine Department, CHU Brest, Brest, France.,Université de Bretagne Occidentale, ERCR SPURBO, Brest, France
| | - Caroline Victorri-Vigneau
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
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189
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Jarvis BP, Holtyn AF, Subramaniam S, Tompkins DA, Oga EA, Bigelow G, Silverman K. Extended-release injectable naltrexone (XR-NTX): a response to clinical issues raised by Brewer & Streel. Addiction 2019; 114:189-190. [PMID: 30345640 DOI: 10.1111/add.14462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Brantley P Jarvis
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - August F Holtyn
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shrinidhi Subramaniam
- Department of Psychology and Child Development, California State University, Stanislaus, Turlock, CA, USA
| | - D Andrew Tompkins
- Department of Psychiatry, University of California San Francisco School of Medicine Ringgold standard institution, San Francisco, CA, USA
| | - Emmanuel A Oga
- Center for Applied Public Health Research, RTI International, Rockville, MD, USA
| | - George Bigelow
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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190
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Potential Risk Window for Opioid Overdose Related to Treatment with Extended-Release Injectable Naltrexone. Drug Saf 2018; 41:979-980. [PMID: 30073490 DOI: 10.1007/s40264-018-0705-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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