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Tata V, Majd Z, Talwar A, Bapat S, Cruz ADL, Essien JE, Thornton JD. Differences in Perceived Threat and Efficacy in Managing Opioid Use Disorder versus Alcohol Use Disorder. Subst Use Misuse 2023; 58:1187-1195. [PMID: 37271735 DOI: 10.1080/10826084.2023.2212075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Background: Efforts to increase the availability of Medication Assisted Treatment for alcohol use disorder (AUD) and opioid use disorder (OUD) may be futile if patients lack motivation for recovery and are unwilling to seek treatment. Objectives: In this cross-sectional, online survey, we used the Extended Parallel Process Model (EPPM) to assess how participants at risk of AUD or OUD react to their perceived threat and assess their response to pharmacotherapy as a potential treatment. EPPM constructs were assessed using the Risk Based Diagnosis Scale. Descriptive statistics measure the proportion of treated vs untreated participants. Untreated participants were sorted into one of three groups categorizing perceived threat - low threat appraisal, and danger or fear control. Results: Of 411 total responses, most (n = 293[71.29%]) sorted into the AUD cohort and 118(28.71%) into the OUD cohort. Overall, 104(25.30%) had received treatment and 307(74.70%) didn't. Within the OUD cohort, there were 67 untreated participants - 16(23.88%) exhibited low threat appraisal, 13(19.40%) were likely to undergo fear control, and 38(56.72%) were likely to undergo danger control. Within the AUD cohort, there were 240 untreated participants - 75(31.25%) exhibited low threat appraisal, 100(41.67%) were likely to experience fear control, and 65(27.08%) were likely to experience danger control. Participants in the OUD cohort were more likely to undergo danger control than those in the AUD cohort (χ2 = 19.26, p < 0.05). Conclusions: This study identified perceived threat and efficacy when an individual was at risk of a SUD, but more insight into potential early interventions is needed - particularly in those individuals with polysubstance use disorder.
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Affiliation(s)
- Vaishnavi Tata
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Zahra Majd
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
| | - Ashna Talwar
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
| | - Shweta Bapat
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Austin De La Cruz
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, Texas, USA
| | - James E Essien
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
| | - J Douglas Thornton
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, Texas, USA
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Liebrenz M, Gamma A, Buadze A, Schleifer R, Baggio S, Schwartz B, Schneeberger A, Uchtenhagen A. Fifteen years of heroin-assisted treatment in a Swiss prison-a retrospective cohort study. Harm Reduct J 2020; 17:67. [PMID: 33046103 PMCID: PMC7552491 DOI: 10.1186/s12954-020-00412-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/09/2020] [Indexed: 11/28/2022] Open
Abstract
Background In the context of the current US opioid crisis and the compelling fact that a quarter to a third of all those addicted to heroin pass through its prisons and jails each year, the care of incarcerated opioid-using individuals (OUI) needs to be improved. Aims Little has been published on the effectiveness or outcomes of heroin-assisted treatment (HAT), a treatment option for severely dependent OUI delivered in a prison setting. The aim of this study was therefore to evaluate such treatment since its implementation. The primary objective was to investigate whether heroin-assisted treatment was associated with severe detrimental health outcomes. The secondary objective was to compare the heroin-assisted treatment group with the general prison population in terms of occupational functioning. Design Retrospective cohort study Setting An open prison with 120 places Subjects Data on 1885 male prisoners with a total of 2239 imprisonment periods between 2000 and 2015 was available. Ninety-seven inmates in heroin-assisted treatment were compared with 1788 inmates from the general prison population (reference group). Measurements Mortality, medical complications (including overdoses), and work performance (days worked, sick days, and monthly wages earned). Findings Inmates receiving HAT were on average 1 year younger (33.8 vs. 34.9 years), had longer prison stays (7.3 vs. 3.0 months), were more often of Swiss nationality (68.0% vs. 28.9%), and had committed more drug- and property-related offenses (49.5% vs. 23.2% and 63.9% vs. 38.3%, respectively) compared to the reference group. No serious heroin-related medical complication occurred during the 15-year window of observation among inmates with heroin-assisted treatment. Their work performance was comparable to that of the reference group. Conclusions This study shows that heroin-assisted treatment can be a valuable treatment option for severely dependent OUI during imprisonment, can be delivered safely by prison health staff over extended periods of time, and allows OUI in treatment to achieve work performance rates comparable to that of the general prison population.
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Affiliation(s)
- Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 18, 3012, Bern, Switzerland.
| | - Alex Gamma
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 18, 3012, Bern, Switzerland
| | - Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Roman Schleifer
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 18, 3012, Bern, Switzerland
| | - Stéphanie Baggio
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 18, 3012, Bern, Switzerland.,Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Bruce Schwartz
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Andres Schneeberger
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.,Psychiatrische Dienste Graubünden (PDGR), Chur, Switzerland
| | - Ambros Uchtenhagen
- Swiss Research Institute for Public Health and Addiction ISGF, University of Zurich, Zurich, Switzerland
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Witcraft SM, Veronica Smith C, Ann Pollard M, Dixon LJ. Is Greek affiliation a prescription for drug abuse? Examining misuse of prescription stimulants and downers in high school and college. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:678-682. [PMID: 31210591 DOI: 10.1080/07448481.2019.1623803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/07/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Abstract
Objective: Compared to nonaffiliated students, Greek students engage in higher rates of prescription drug abuse (PDA). We examined PDA among Greek students compared to non-Greek students, and whether PDA in high school predicted joining a Greek organization in college.Participants: From November to December 2014, 509 undergraduate students at a large, southeastern institution participated in an online survey.Methods: Stratified random sampling with academic classification as the strata; chi-square analyses were conducted to test study hypotheses.Results: Greek students were no more likely than non-Greek students to ever engage in overall PDA. However, Greek students were significantly more likely to report abuse of stimulants, but not downers, in college and in high school.Conclusions: Future research to examine individual types of prescription drugs abused in high school and their affiliation with PDA among Greek students, compared to non-Greek students, in college is warranted.
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Affiliation(s)
- Sara M Witcraft
- Department of Psychology, University of Mississippi, University, Mississippi, USA
| | - C Veronica Smith
- Department of Psychology, University of Mississippi, University, Mississippi, USA
| | - M Ann Pollard
- School of Law, University of Georgia, Athens, Georgia, USA
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, University, Mississippi, USA
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Gupta S, Bhatia G, Sarkar S, Chatterjee B, Balhara YPS, Dhawan A. Adult attention-deficit hyperactivity disorders and its correlates in patients with opioid dependence: An exploratory study. Indian J Psychiatry 2020; 62:501-508. [PMID: 33678830 PMCID: PMC7909024 DOI: 10.4103/psychiatry.indianjpsychiatry_705_19] [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] [Received: 11/17/2019] [Revised: 02/07/2020] [Accepted: 06/17/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Adult attention-deficit hyperactivity disorder (ADHD) often remains undiagnosed and undertreated among patients with substance use disorders (SUDs). Research is lacking with regard to adult ADHD in individuals with SUD. The current work was intended to study the prevalence of adult ADHD among individuals with opioid dependence and its correlates, and to assess the attitude of the individuals with adult ADHD toward its treatment. METHODS This cross-sectional survey was conducted in 132 consecutive inpatients with opioid-dependence syndrome. Patients were assessed using the Mini International Neuropsychiatric Interview. 5.0, adult ADHD Self-Report Screening Scale, and Maudsley Addiction Profile. Those who screened positive for adult ADHD (ADHD+) were compared with those screened negative (ADHD-) on a number of sociodemographic, substance use, and clinical variable. Furthermore, attitude toward the treatment for ADHD was assessed among the ADHD+ individuals. RESULTS About a fifth (n=24, 18.2%) of the patients with opioid dependence screened positive for adult ADHD. One-third of the participants (n=8, 33.3%) were willing for the treatment of any kind, and only a half (n=3) was willing to pay. Earlier age of onset of opioid use (relative risk: 0.01; 95% confidence interval: 0.003, 0.85; P = 0.036) had higher likelihood to ADHD+ status. CONCLUSION Despite a high rate of ADHD screen positivity among individuals with opioid dependence, a majority were not willing to receive the treatment. Sensitization of: (1) addiction psychiatrist to routinely screen for ADHD, especially in the presence of certain correlates and (2) patients-caregivers about the potential benefit of treatment in effectively addressing the symptoms of ADHD effectively in this population.
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Affiliation(s)
- Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Gayatri Bhatia
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Biswadip Chatterjee
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Dhawan
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Kaufman AR, Hersh ED. The political consequences of opioid overdoses. PLoS One 2020; 15:e0236815. [PMID: 32750079 PMCID: PMC7402477 DOI: 10.1371/journal.pone.0236815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 11/21/2022] Open
Abstract
The United States suffered a dramatic and well-documented increase in drug-related deaths from 2000 to 2018, primarily driven by prescription and non-prescription opioids, and concentrated in white and working-class areas. A growing body of research focuses on the causes, both medical and social, of this opioid crisis, but little work as yet on its larger ramifications. Using novel public records of accidental opioid deaths linked to behavioral political outcomes, we present causal analyses showing that opioid overdoses have significant political ramifications. Those close to opioid victims vote at lower rates than those less affected by the crisis, even compared to demographically-similar friends and family of other unexpected deaths. Moreover, among those friends and family affected by opioids, Republicans are 25% more likely to defect from the party than the statewide average Republican, while Democrats are no more likely to defect; Independents are moderately more likely to register as Democrats. These results illustrate an important research design for inferring the effects of tragic events and speak to the broad social and political consequences of what is becoming the largest public health crisis in modern United States history.
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Affiliation(s)
- Aaron R. Kaufman
- Division of Social Sciences, New York University Abu Dhabi, Saadiyat Island, Abu Dhabi, United Arab Emirates
| | - Eitan D. Hersh
- Department of Political Science, Tufts University, Medford, Massachusetts, United States of America
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Treatment for Individuals With Severe Mental Illness Who Use Illicit Drugs While Maintained on Methadone: Mindfulness and Modification Therapy. J Nerv Ment Dis 2019; 207:1005-1011. [PMID: 31658241 DOI: 10.1097/nmd.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Substantial research has noted the serious consequences of 1) co-occurring severe mental illness (SMI) and substance use disorders, and 2) use of illicit drugs while maintained on methadone for opioid dependence. However, treatment needs of individuals who meet both of the above criteria remain largely unmet. This pilot study investigated the feasibility and acceptability of a 12-week, transdiagnostic group therapy (mindfulness and modification therapy [MMT]) tailored for opioid-dependent individuals (N = 6) with SMI and illicit drug use. Retention was 83%. At posttreatment and 2-month follow-up, participants rated the treatment as highly helpful (9 of 10; 8.67 of 10, respectively), reported routinely practicing the guided-mindfulness exercises, and reported high confidence that they would continue to practice. Assessments revealed clinically meaningful decreases in reported days of illicit drug use at posttreatment and follow-up, with large effect sizes. Preliminary evidence suggests that MMT may be a feasible and acceptable therapy that may improve treatment engagement in this underserved population.
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Reckers-Droog VT, Goorden M, Dijkgraaf MGW, Van Eeren HV, McCollister KE, Hakkaart-van Roijen L. Unit Costs of Delinquent Acts for Use in Economic Evaluations. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2019; 22:71-79. [PMID: 31319377 PMCID: PMC6839943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Youth mental health interventions aimed at reducing substance use and delinquency in adolescents compete with other types of interventions for reimbursement from public funding. Within the youth mental health domain, delinquent acts impose high costs on society. These costs should be included in economic evaluations conducted from a societal perspective. Although the relevance of these costs is recognized, they are often left out because the unit costs of delinquent acts are unknown. AIMS OF THE STUDY This study aims to provide a method for estimating the unit costs per perpetrator of 14 delinquent acts common in the Netherlands and included in self reported delinquency questionnaires: robbery/theft with violence, simple theft/pickpocketing, receiving stolen goods, destruction/vandalism of private or public property, disorderly conduct/discrimination, arson, cybercrime, simple and aggravated assault, threat, forced sexual contact, unauthorised driving, driving under the influence, dealing in soft drugs, and dealing in hard drugs. METHODS Information on government expenditures and the incidence of crimes, number of perpetrators, and the percentage of solved and reported crimes was obtained from the national database on crime and justice of the Research and Documentation Centre of the Ministry of Justice and Security, Statistics Netherlands, and the Council for the Judiciary in the Netherlands. We applied a top-down micro costing approach to calculate the point estimate of the unit costs for each of the delinquent acts and, subsequently, estimated the mean (SD) unit costs for each of the delinquent acts by taking random draws from a triangular distribution while taking into account a 10% uncertainty associated with the associated point estimate. RESULTS The mean (SD) unit costs per delinquent act per perpetrator ranged between EUR495 (EUR1.30) for "Driving under the influence" and EUR33,813 (EUR78.30) for a "Cybercrime". These unit costs may be considered as outliers as most unit costs ranged between EUR 2,600 and EUR 13,500 per delinquent act per perpetrator. DISCUSSION This study is the first to estimate the unit costs per delinquent act per perpetrator in the Netherlands. The results of this study enable the inclusion of government expenditures associated with crime and justice in economic evaluations conducted from a societal perspective. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Youth mental health interventions aimed at reducing substance use and delinquency in adolescents are increasingly subjected to economic evaluations. These evaluations are used to inform decisions concerning the allocation of scarce healthcare resources and should cover all the costs and benefits for society, including those associated with delinquent acts. IMPLICATIONS FOR HEALTH POLICIES The results of this study facilitate economic evaluations of youth mental health interventions aimed at reducing substance use and delinquency in adolescents, conducted from a societal perspective. IMPLICATIONS FOR FURTHER RESEARCH Based on health-economic evaluations conducted in the field of youth mental health and the results of the current study, we recommend including the estimated unit costs in guidelines for health-economic evaluations conducted from a societal perspective. Future research could aim at examining whether these unit costs require regular updating. The methodology applied in this study allows for this.
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Affiliation(s)
- Vivian T Reckers-Droog
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands,
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Orpana HM, Lang JJ, Baxi M, Halverson J, Kozloff N, Cahill L, Alam S, Patten S, Morrison H. Canadian trends in opioid-related mortality and disability from opioid use disorder from 1990 to 2014 through the lens of the Global Burden of Disease Study. Health Promot Chronic Dis Prev Can 2018; 38:234-243. [PMID: 29911819 PMCID: PMC6034967 DOI: 10.24095/hpcdp.38.6.03] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Several regions in Canada have recently experienced sharp increases in opioid overdoses and related hospitalizations and deaths. This paper describes opioidrelated mortality and disability from opioid use disorder in Canada from 1990 to 2014 using data from the Global Burden of Disease (GBD) study. Methods: We used data from the GBD study to describe temporal trends (1990–2014) in opioid-related mortality and disability from opioid use disorder using common metrics: disability-adjusted life years (DALY), deaths, years of life lost (YLL) and years lived with disability (YLD). We also compared age-standardized YLL and DALY rates per 100 000 population between Canada, the USA and other regions. Results: The age-standardized opioid-related DALY rate in Canada was 355.5 per 100 000 population in 2014, which was higher than the global rate of 193.2, but lower than the rate of 767.9 in the United States. Between 1990 and 2014, the age-standardized opioid-related YLL rate in Canada increased by 142.2%, while globally this rate decreased by 10.1%. In comparison with YLL, YLD accounted for a larger proportion of the overall opioid-related burden across all age groups. Health loss was greater for males than females, and highest among those aged 25 to 29 years. Conclusion: The health burden associated with opioid-related mortality and disability from opioid use disorder in Canada is significant and has increased dramatically from 1990 to 2014. These data point to a need for public health action including enhanced monitoring of a range of opioid-related harms.
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Affiliation(s)
- Heather M Orpana
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin J Lang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Maulik Baxi
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samiah Alam
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Federal and State Policy Efforts to Address Maternal Opioid Misuse: Gaps and Challenges. Womens Health Issues 2018; 28:130-136. [DOI: 10.1016/j.whi.2017.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/20/2022]
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10
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Enns B, Krebs E, DeBeck K, Hayashi K, Milloy MJ, Richardson L, Wood E, Nosyk B. The costs of crime associated with stimulant use in a Canadian setting. Drug Alcohol Depend 2017; 180:304-310. [PMID: 28942287 PMCID: PMC6154799 DOI: 10.1016/j.drugalcdep.2017.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Costs attributable to criminal activity are a major component of the economic burden of substance use disorders, yet there is a paucity of empirical evidence on this topic. Our aim was to estimate the costs of crime associated with different forms and intensities of stimulant use. METHODS Retrospective cohort study, including individuals from three prospective cohorts in Vancouver, Canada, measured biannually (2011-2015), reporting stimulant use at baseline assessment. Monthly crime costs included policing, court, corrections, and criminal victimization (2016 CAD). We estimated monthly crime costs associated with mutually exclusive categories of crack, cocaine, methamphetamine, and polystimulant use, stratified by daily/non-daily use, relative to stimulant abstinence, as well as the independent effects of treatment (opioid agonist (OAT) and other addiction treatment). We used a two-part model, capturing the probability of criminal activity and costs of crime with generalized linear logistic and gamma regression models, respectively, controlling for age, gender, education, homelessness, mental health issues, employment, prior incarceration, alcohol and opioid use. RESULTS The study sample included 1599 individuals (median age 39, 65.9% male) assessed over 5299 biannual interviews. Estimates of associated monthly crime costs ranged from $5449 [95% C.I.: $2180, $8719] for non-daily polystimulant use, to $8893 [$4196, $13,589] for daily polystimulant use. Cost differences between daily/non-daily use, injection/non-injection, and stimulant type were not statistically significant. Drug treatment was not associated with lower monthly crime costs in our sample. CONCLUSIONS Substantial crime-related costs were associated with stimulant use, emphasizing the urgency for development and implementation of efficacious treatment regimens.
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Affiliation(s)
- Benjamin Enns
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Emanuel Krebs
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kora DeBeck
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Kanna Hayashi
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - M-J Milloy
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC, Canada
| | - Lindsey Richardson
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC, Canada
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
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Linton SL, Haley DF, Hunter-Jones J, Ross Z, Cooper HLF. Social causation and neighborhood selection underlie associations of neighborhood factors with illicit drug-using social networks and illicit drug use among adults relocated from public housing. Soc Sci Med 2017; 185:81-90. [PMID: 28554162 DOI: 10.1016/j.socscimed.2017.04.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 12/20/2022]
Abstract
Theories of social causation and social influence, which posit that neighborhood and social network characteristics are distal causes of substance use, are frequently used to interpret associations among neighborhood characteristics, social network characteristics and substance use. These associations are also hypothesized to result from selection processes, in which substance use determines where people live and who they interact with. The potential for these competing selection mechanisms to co-occur has been underexplored among adults. This study utilizes path analysis to determine the paths that relate census tract characteristics (e.g., economic deprivation), social network characteristics (i.e., having ≥ 1 illicit drug-using network member) and illicit drug use, among 172 African American adults relocated from public housing in Atlanta, Georgia and followed from 2009 to 2014 (7 waves). Individual and network-level characteristics were captured using surveys. Census tract characteristics were created using administrative data. Waves 1 (pre-relocation), 2 (1st wave post-relocation), and 7 were analyzed. When controlling for individual-level sociodemographic factors, residing in census tracts with prior economic disadvantage was significantly associated with illicit drug use at wave 1; illicit drug use at wave 1 was significantly associated with living in economically-disadvantaged census tracts at wave 2; and violent crime at wave 2 was associated with illicit drug-using social network members at wave 7. Findings from this study support theories that describe social causation and neighborhood selection processes as explaining relationships of neighborhood characteristics with illicit drug use and illicit drug-using social networks. Policies that improve local economic and social conditions of neighborhoods may discourage substance use. Future studies should further identify the barriers that prevent substance users from obtaining housing in less disadvantaged neighborhoods.
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Affiliation(s)
- Sabriya L Linton
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Danielle F Haley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd CB#7030, Chapel Hill, NC 27599, USA
| | - Josalin Hunter-Jones
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, 120 N Aurora Street, Suite 3A, Ithaca, NY 14850, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
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12
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Moeller J, Farmer J, Quiñonez C. Patterns of analgesic use to relieve tooth pain among residents in British Columbia, Canada. PLoS One 2017; 12:e0176125. [PMID: 28459825 PMCID: PMC5411044 DOI: 10.1371/journal.pone.0176125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 04/05/2017] [Indexed: 11/17/2022] Open
Abstract
The use of prescription opioids has increased dramatically in Canada in recent decades. This rise in opioid prescriptions has been accompanied by increasing rates of opioid-related abuse and addiction, creating serious public health challenges in British Columbia (BC), one of Canada's most populated provinces. Our study explores the relationship between dental pain and prescription opioid use among residents in BC. We used data from the 2003 Canadian Community Health Survey (CCHS), which asked respondents about their use of specific analgesic medications, including opioids, and their history of tooth pain in the past month. We used logistic regression, controlling for potential confounding variables, to identify the predictive value of socioeconomic factors, oral health-related variables, and dental care utilization indicators. The Relative Index of Inequality (RII) was calculated to assess the magnitude of socioeconomic inequalities in the use of particular analgesics by incorporating income-derived ridit values into a binary logistic regression model. Our results showed that conventional non-opioid based analgesics (such as aspirin or Tylenol) and opioids were more likely to be used by those who had experienced a toothache in the past month than those who did not report experiencing a toothache. The use of non-opioid painkillers to relieve tooth pain was associated with more recent and more frequent dental visits, better self-reported oral health, and a greater income. Conversely, a lower household income was associated with a preference for opioid use to relieve tooth pain. The RII for recent opioid use and conventional painkiller use were 2.06 (95% CI: 1.75-2.37) and 0.62 (95% CI: 0.35-0.91), respectively, among those who experienced recent tooth pain, suggesting that adverse socioeconomic conditions may influence the need for opioid analgesics to relieve dental pain. We conclude that programs and policies targeted at improving the dental health of the poor may help to reduce the use of prescription opioids, thereby narrowing health inequalities within the broader society.
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Affiliation(s)
- Jamie Moeller
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Julie Farmer
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Quiñonez
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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Krebs E, Urada D, Evans E, Huang D, Hser YI, Nosyk B. The costs of crime during and after publicly funded treatment for opioid use disorders: a population-level study for the state of California. Addiction 2017; 112:838-851. [PMID: 27981691 PMCID: PMC5382102 DOI: 10.1111/add.13729] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/19/2016] [Accepted: 12/12/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Treatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly funded treatment for OUD to compare total costs of crime during a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification. DESIGN Retrospective, administrative data-based cohort study with comprehensive information on drug treatment and criminal justice systems interactions. SETTING Publicly funded drug treatment facilities in California, USA (2006-10). PARTICIPANTS A total of 31 659 individuals admitted for the first time to treatment for OUD, and who were linked with criminal justice and mortality data, were followed during a median 2.3 years. Median age at first treatment admission was 32, 35.8% were women and 37.1% primarily used prescription opioids. MEASUREMENTS Daily costs of crime (US$2014) were calculated from a societal perspective and were composed of the costs of policing, court, corrections and criminal victimization. We estimated the average marginal effect of treatment engagement in OAT or detoxification adjusting for potential fixed and time-varying confounders, including drug use and criminal justice system involvement prior to treatment initiation. FINDINGS Daily costs of crime during treatment compared with after treatment were $126 lower for OAT [95% confidence interval (CI) = $116, $136] and $144 lower for detoxification (95% CI = $135, $154). Summing the costs of crime during and after treatment over a hypothetical 6-month period using the observed median durations of OAT (161 days) and detoxification (19 days), we estimated that enrolling an individual in OAT as opposed to detoxification would save $17 550 ($16 840, $18 383). CONCLUSIONS In publicly funded drug treatment facilities in California, USA, engagement in treatment for opioid use disorders is associated with lower costs of crime in the 6 months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment.
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Affiliation(s)
| | | | | | | | | | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS
- UCLA Integrated Substance Abuse Programs
- Faculty of Health Sciences, Simon Fraser University
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Abstract
`Drug treatment courts' (DTCs) are a new institution in North American criminal justice for dealing with drug offenders. There are currently two DTC pilot trials in implementation in Canada. Based on a `therapeutic jurisprudence' approach, DTCs claim to rehabilitate rather than punish drug-addicted offenders, and thus to reduce drug use, recidivism and social cost. Given the current enthusiasm about DTCs, this article provides a critique of DTCs' rationale, practices and implications from evaluative, social and legal perspectives. It focuses on the Canadian experience where possible. The analysis examines: the limitations of the evidence and methods behind the claims of DTCs' effectiveness; the ontological and practical challenges of the proposed `bridging' of punishment and treatment; the legal and penological implications of `therapeutic jurisprudence' practices; as well as potential explanations for DTCs' rise in popularity despite the limited evidence for their positive impact. The article concludes with reflections on the implications of DTCs for the government of drug use as deviance in contemporary social contexts, as well as for political efforts towards less punitive drug control. DTCs may reinforce the hegemony of punitive drug use control—partly by coopting treatment strategies—and thus fundamentally protect the legitimacy of prohibition politics.
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Affiliation(s)
- Benedikt Fischer
- University of Toronto and Centre for Addiction and Mental Health, Toronto
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15
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Smith-Rohrberg D, Bruce RD, Altice FL. Research Note — Review of Corrections-Based Therapy for Opiate-Dependent Patients: Implications for Buprenorphine Treatment among Correctional Populations. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260403400210] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inmates with a history of opiate dependence represent a substantial proportion of the correctional population in the United States. Opiate use has negative consequences for both the inmate and society, including increased recidivism rates, increased infectious disease prevalence, avoidable emergency room use, decreased access to primary care services, and overdose. While there have been great successes in community-based treatment of opiate dependence, these successes have not yet been achieved in correctional settings. This paper reviews the pharmacological treatment options for opiate-dependent inmates, along with potential application for community-to-correctional approaches. The recent approval by the Food and Drug Administration (FDA) of physician-prescribed buprenorphine and the new opportunities it presents to corrections-based treatment are also explored in depth. Successful implementation of such strategies is likely to result in desirable health and social outcomes for both the inmate and the community at large.
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16
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Naji L, Dennis BB, Bawor M, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Thabane L, Samaan Z. A Prospective Study to Investigate Predictors of Relapse among Patients with Opioid Use Disorder Treated with Methadone. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:9-18. [PMID: 27103815 PMCID: PMC4827793 DOI: 10.4137/sart.s37030] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Concomitant opioid abuse is a serious problem among patients receiving methadone maintenance treatment (MMT) for opioid use disorder. This is an exploratory study that aims to identify predictors of the length of time a patient receiving MMT for opioid use disorder remains abstinent (relapse-free). METHODS Data were collected from 250 MMT patients enrolled in addiction treatment clinics across Southern Ontario. The impact of certain clinical and socio-demographic factors on the outcome (time until opioid relapse) was determined using a Cox proportional hazard model. RESULTS History of injecting drug use behavior (hazard ratio (HR): 2.26, P = 0.042), illicit benzodiazepine consumption (HR: 1.07, P = 0.002), and the age of onset of opioid abuse (HR: 1.10, P < 0.0001) are important indicators of accelerated relapse among MMT patients. Conversely, current age is positively associated with duration of abstinence from illicit opioid use, serving as a protective factor against relapse (HR: 0.93, P = 0.003). CONCLUSION This study helps to identify patients at increased risk of relapse during MMT, allowing health care providers to target more aggressive adjunct therapies toward high-risk patients.
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Affiliation(s)
- Leen Naji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brittany B Dennis
- St. George's University of London, London, United Kingdom.; Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada
| | - Monica Bawor
- St. George's University of London, London, United Kingdom
| | - Carolyn Plater
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada
| | - Andrew Worster
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada.; Department of Medicine, Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Jeff Daiter
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada
| | - David C Marsh
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada.; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada.; Centre for Evaluation of Medicine, Hamilton, ON, Canada.; System Linked Research Unit, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada.; Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, ON, Canada.; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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17
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Senker S, Green G. Understanding recovery: the perspective of substance misusing offenders. DRUGS AND ALCOHOL TODAY 2016. [DOI: 10.1108/dat-07-2015-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to critically regard the concept of recovery from the perspective of substance misusing offenders. It intended to understand how these individuals came to define recovery by asking “what does recovery mean to you?”
Design/methodology/approach
– In total, 35 semi-structured interviews were undertaken with individuals with a history of heroin and crack cocaine use as well as convictions for a range of offences. Interviews took place in both prison and community settings, reflecting a spectrum of experience.
Findings
– Whilst the constellation of recovery varied, it was at times made up of the same “stars” – and some re-occurring themes emerged; recovery was transient, fragile and unpredictable, it was ongoing, lacking a definitive end, it was more than abstinence and often involved a total psychological overhaul, recovery was about reintegrating with society and feeling “normal”.
Practical implications
– Practitioners and services need to value the individual interpretations of recovery rather than being prescriptive around what it “should” look like. The components of recovery that were raised by participants permit specific recommendations for practice to be made.
Originality/value
– This study sought the perspectives of those actually affected by and experiencing drug treatment in the Criminal Justice System. It allowed participants to tell their story without preconceived ideas or hypotheses, putting their voice at the centre of the stage. The study uses feedback from the ground to make informed recommendations for practice.
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18
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Reimer J, Wright N, Somaini L, Roncero C, Maremmani I, McKeganey N, Littlewood R, Krajci P, Alho H, D'Agnone O. The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert Consensus. Eur Addict Res 2016; 22:99-106. [PMID: 26426530 DOI: 10.1159/000438988] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Opioid substitution treatment (OST) improves outcomes in opioid dependence. However, controlled drugs used in treatment may be misused or diverted, resulting in negative treatment outcomes. This review defines a framework to assess the impact of misuse and diversion. METHODS A systematic review of published studies of misuse and diversion of OST medicines was completed; this evidence was paired with expert real-world experience to better understand the impact of misuse and diversion on the individual and on society. RESULTS Direct impact to the individual includes failure to progress in recovery and negative effects on health (overdose, health risks associated with injecting behaviour). Diversion of OST has impacts on a community that is beyond the intended OST recipient. The direct impact includes risk to others (unsupervised use; unintended exposure of children to diverted medication) and drug-related criminal behavior. The indirect impact includes the economic costs of untreated opioid dependence, crime and loss of productivity. CONCLUSION While treatment for opioid dependence is essential and must be supported, it is vital to reduce misuse and diversion while ensuring the best possible care. Understanding the impact of OST misuse and diversion is key to defining strategies to address these issues.
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Affiliation(s)
- Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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19
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Bawor M, Dennis BB, Bhalerao A, Plater C, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Steiner M, Anglin R, Pare G, Thabane L, Samaan Z. Sex differences in outcomes of methadone maintenance treatment for opioid use disorder: a systematic review and meta-analysis. CMAJ Open 2015; 3:E344-51. [PMID: 26457294 PMCID: PMC4596116 DOI: 10.9778/cmajo.20140089] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Opioid use disorder is a serious international concern with limited treatment success. Men and women differ in their susceptibility to opioid use disorder and response to methadone treatment and can therefore benefit from sex-specific treatment. We performed a systematic review of the literature on outcomes of methadone maintenance treatment for opioid use disorder in men and women related to drug use, health status and social functioning. METHODS We searched PubMed, Embase, PsycINFO and CINAHL for observational or randomized controlled studies involving adults 18 years of age or older undergoing methadone treatment for opioid use disorder. Studies were included if they investigated sex differences in methadone treatment outcomes. Two authors independently reviewed and extracted data. Meta-analyses were performed when possible; risk of bias and quality of evidence were also assessed. RESULTS Twenty studies with 9732 participants were included, of which 18 were observational and 2 were randomized controlled trials. Men and women differed significantly in alcohol use (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31 to 0.86), amphetamine use (OR 1.47, 95% CI 1.12 to 1.94), legal involvement (OR 0.63, 95% CI 0.47 to 0.84) and employment during treatment (OR 0.39, 95% CI 0.21 to 0.73). Opioid use patterns were similar among men and women. Risk of bias was moderate, and quality of evidence was generally low. INTERPRETATION Sex differences were evident in polysubstance use, legal involvement and employment status among men and women receiving methadone treatment for opioid use disorders. Although the quality of evidence was low, our review highlights the need for improved implementation of sex-specific treatment strategies.
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Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Brittany B Dennis
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Anuja Bhalerao
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Carolyn Plater
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Andrew Worster
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Michael Varenbut
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Jeff Daiter
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - David C Marsh
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Dipika Desai
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Meir Steiner
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Rebecca Anglin
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Guillaume Pare
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Lehana Thabane
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Zainab Samaan
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
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Lin SH, Chen KC, Lee SY, Chiu NT, Lee IH, Chen PS, Yeh TL, Lu RB, Chen CC, Liao MH, Yang YK. The association between heroin expenditure and dopamine transporter availability--a single-photon emission computed tomography study. Psychiatry Res 2015; 231:292-7. [PMID: 25659472 DOI: 10.1016/j.pscychresns.2015.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/16/2014] [Accepted: 01/11/2015] [Indexed: 11/25/2022]
Abstract
One of the consequences of heroin dependency is a huge expenditure on drugs. This underlying economic expense may be a grave burden for heroin users and may lead to criminal behavior, which is a huge cost to society. The neuropsychological mechanism related to heroin purchase remains unclear. Based on recent findings and the established dopamine hypothesis of addiction, we speculated that expenditure on heroin and central dopamine activity may be associated. A total of 21 heroin users were enrolled in this study. The annual expenditure on heroin was assessed, and the availability of the dopamine transporter (DAT) was assessed by single-photon emission computed tomography (SPECT) using [(99m)TC]TRODAT-1. Parametric and nonparametric correlation analyses indicated that annual expenditure on heroin was significantly and negatively correlated with the availability of striatal DAT. After adjustment for potential confounders, the predictive power of DAT availability was significant. Striatal dopamine function may be associated with opioid purchasing behavior among heroin users, and the cycle of spiraling dysfunction in the dopamine reward system could play a role in this association.
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Affiliation(s)
- Shih-Hsien Lin
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Nan Tsing Chiu
- Department of Nuclear Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Tzung Lieh Yeh
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chieh Chen
- Institute of Nuclear Energy Research, Atomic Energy Council, Executive Yuan, Taoyuan, Taiwan
| | - Mei-Hsiu Liao
- Institute of Nuclear Energy Research, Atomic Energy Council, Executive Yuan, Taoyuan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.
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Brabant M, Brissette S, Lauzon P, Marsan S, Ouellet-Plamondon C, Pelletier MC. Les troubles liés à l’utilisation des opioïdes prescrits médicalement. SANTE MENTALE AU QUEBEC 2014. [DOI: 10.7202/1027835ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Épidémiologie Au cours des 10 à 15 dernières années, le Canada est devenu le deuxième plus grand consommateur d’opioïdes de prescription (OP), principalement pour le traitement de la douleur. Cette augmentation a été plus marquée chez les 55 ans et plus. Même si personne ne conteste le droit des patients à recevoir des traitements adéquats pour la douleur, il n’en demeure pas moins que cette disponibilité accrue a entraîné son lot de problèmes : augmentation des visites à l’urgence et des décès liés aux opioïdes ainsi que du trouble lié à l’utilisation (TLU) des opioïdes, trouble qui est d’ailleurs associé à une prévalence accrue, de l’ordre de 40 %, de divers problèmes psychiatriques, dont les troubles dépressifs majeurs.
Neuroscience De nouvelles connaissances issues des neurosciences nous permettent de mieux comprendre la réaction du cerveau lors de l’exposition à ces substances et le caractère chronique du TLU des opioïdes. Quoique historiquement perçu comme une faiblesse de caractère ou un vice, le TLU des opioïdes est maintenant reconnu comme une condition chronique résultant d’une interaction complexe entre une substance, des facteurs d’environnement et un génotype individuel. Malheureusement, ces évidences scientifiques ne sont pas encore largement appliquées à la clinique et la majorité des médecins n’ont pas les habiletés nécessaires pour diagnostiquer et traiter le TLU des opioïdes.
Guides de pratique clinique Des recommandations et guides de pratique peuvent nous aider à identifier les personnes plus vulnérables à un mésusage, et à mieux encadrer la prescription et la gestion de la médication. Il ne s’agit pas de se désintéresser de ces patients et de les abandonner à leur sort mais plutôt de leur offrir des soins inspirés des meilleures pratiques et appuyés sur des évidences scientifiques de qualité.
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Affiliation(s)
- Michel Brabant
- Service de médecine des toxicomanies CHUM
- Professeur adjoint de clinique, Département de médecine familiale et médecine d’urgence (DMFMU), Université de Montréal
| | - Suzanne Brissette
- Service de médecine des toxicomanies et Centre de recherche CHUM
- Professeur agrégé de clinique, Département de médecine familiale et médecine d’urgence (DMFMU), Université de Montréal
| | - Pierre Lauzon
- Service de médecine des toxicomanies CHUM
- Chargé d’enseignement de clinique, Département de médecine familiale et médecine d’urgence (DMFMU), Université de Montréal
| | - Stéphanie Marsan
- Service de médecine des toxicomanies CHUM
- Chargé d’enseignement de clinique, Département de médecine familiale et médecine d’urgence (DMFMU), Université de Montréal
| | - Clairélaine Ouellet-Plamondon
- Unité de psychiatrie des toxicomanies CHUM
- Professeur adjoint de clinique, Département de psychiatrie, Université de Montréal
| | - Marie-Chantal Pelletier
- Service de médecine des toxicomanies CHUM
- Chargé d’enseignement de clinique, Département de médecine familiale et médecine d’urgence (DMFMU), Université de Montréal
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Dynamics in the costs of criminality among opioid dependent individuals. Drug Alcohol Depend 2014; 144:193-200. [PMID: 25282307 PMCID: PMC4456021 DOI: 10.1016/j.drugalcdep.2014.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research into the avoided crime-related costs associated with methadone maintenance treatment (MMT) is sparse. Our objective was to characterize the dynamics in crime-related costs associated with MMT effectiveness among opioid dependent individuals in Vancouver, Canada. METHODS We considered individuals enrolled in a prospective study between December, 2011 and May, 2013. Monthly crime-related costs (2013 CAD) were derived from self-reported criminal activity. On the basis of MMT receipt and illicit opioid use, individuals were classified in mutually exclusive health states: (i) MMT high effectiveness; (ii) MMT low effectiveness; (iii) opioid abstinence; or (iv) relapse. We classified individuals as daily, non-daily or non-stimulant users and controlled for demographic and socio-economic characteristics. A two-part multiple regression model was constructed; the first part modeled non-zero cost probability, the second estimated the level of costs. Avoided costs were estimated for each health state and stratified by stimulant use intensity. RESULTS Our study included 982 individuals (median age 47, 38% female) for 2232 observations. Individuals on MMT with high effectiveness incurred lower monthly costs of criminality (avoided costs of $6298; 95% C.I. ($1578, $11,017)), as did opioid abstinent individuals ($6563 ($1564, $11,561)). Avoided costs for daily stimulant users were greater than for non-daily users, both for individuals on MMT with high effectiveness ($12,975 vs. $4125) and opioid abstinent ($12,640 vs. $4814). CONCLUSION Using longitudinal data on individuals with a history of MMT, we found substantially lower costs of criminality associated with high effect to MMT. Avoided costs were highest among daily stimulant users that were on MMT with high effectiveness or those opioid abstinent.
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Dennis BB, Naji L, Bawor M, Bonner A, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Samaan Z, Thabane L. The effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment comparison protocol. Syst Rev 2014; 3:105. [PMID: 25239213 PMCID: PMC4171401 DOI: 10.1186/2046-4053-3-105] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/03/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Opioids are psychoactive analgesic drugs prescribed for pain relief and palliative care. Due to their addictive potential, effort and vigilance in controlling prescriptions is needed to avoid misuse and dependence. Despite the effort, the prevalence of opioid use disorder continues to rise. Opioid substitution therapies are commonly used to treat opioid dependence; however, there is minimal consensus as to which therapy is most effective. Available treatments include methadone, heroin, buprenorphine, as well as naltrexone. This systematic review aims to assess and compare the effect of all available opioid substitution therapies on the treatment of opioid dependence. METHODS/DESIGN The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. The title, abstract, and full-text screening will be completed in duplicate. When appropriate, multiple treatment comparison Bayesian meta-analytic methods will be performed to deduce summary statistics estimating the effectiveness of all opioid substitution therapies in terms of retention and response to treatment (as measured through continued opioid abuse). DISCUSSION Using evidence gained from this systematic review, we anticipate disseminating an objective review of the current available literature on the effectiveness of all opioid substitution therapies for the treatment of opioid use disorder. The results of this systematic review are imperative to the further enhancement of clinical practice in addiction medicine. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006507.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
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Referral for substance abuse treatment and depression improvement among patients with co-occurring disorders seeking behavioral health services in primary care. J Subst Abuse Treat 2014; 46:106-12. [DOI: 10.1016/j.jsat.2013.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 08/05/2013] [Accepted: 08/14/2013] [Indexed: 11/20/2022]
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Samaan Z, Bawor M, Dennis BB, Plater C, Varenbut M, Daiter J, Worster A, Marsh DC, Tan C, Desai D, Thabane L, Pare G. Genetic influence on methadone treatment outcomes in patients undergoing methadone maintenance treatment for opioid addiction: a pilot study. Neuropsychiatr Dis Treat 2014; 10:1503-8. [PMID: 25187714 PMCID: PMC4149396 DOI: 10.2147/ndt.s66234] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Treatment of opioid addiction with methadone is effective; however, it is known to produce interindividual variability. This may be influenced in part by genetic variants, which can increase the initial risk of developing opioid addiction as well as explain differences in response to treatment. This pilot study aimed to assess the feasibility of conducting a full-scale genetic analysis to identify genes that predict methadone treatment outcomes in this population. METHODS This was a cross-sectional observational study of patients admitted to a methadone maintenance treatment program for opioid addiction. We obtained demographic and clinical characteristics in addition to blood and urine samples, for the assessment of treatment outcomes. RESULTS The recruitment process yielded 252 patients, representing a 20% recruitment rate. We conducted genetic testing based on a 99.6% rate of provision of DNA samples. The average retention in treatment was 3.4 years, and >50% of the participants reported psychiatric and medical comorbidities. BDNF rs6265 and DRD2 rs1799978 were the common single nucleotide polymorphisms (SNPs) selected for the feasibility study. DISCUSSION This study met our predetermined feasibility criteria; recruitment, response rates, and genetic testing were feasible; treatment duration was sufficient for follow up; and the prevalence of comorbid conditions indicated the need for reliable psychiatric and chronic pain measures. The study strengths included effective collaboration with clinics and the generalizability of sample population. Key learning points show the need for assessment of treatment outcomes on multiple domains, implementation of follow up, and the development of standardized training for the study clinical staff.
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada ; MiNDS Neuroscience Program, McMaster University, Hamilton, Ontario, Canada
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada ; MiNDS Neuroscience Program, McMaster University, Hamilton, Ontario, Canada
| | - Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Michael Varenbut
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Jeffrey Daiter
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Andrew Worster
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada ; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada ; Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Charlie Tan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, McMaster University, Hamilton, Ontario, Canada ; System Linked Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Pare
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Dunn KE, Defulio A, Everly JJ, Donlin WD, Aklin WM, Nuzzo PA, Leoutsakos JMS, Umbricht A, Fingerhood M, Bigelow GE, Silverman K. Employment-based reinforcement of adherence to oral naltrexone treatment in unemployed injection drug users. Exp Clin Psychopharmacol 2013. [PMID: 23205722 PMCID: PMC3641088 DOI: 10.1037/a0030743] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oral naltrexone has high potential for use as a relapse prevention pharmacotherapy for opiate dependence yet suffers from notoriously poor adherence. This study evaluated whether entry to a therapeutic workplace could reinforce adherence with oral naltrexone. Opiate-dependent and cocaine-using injection drug users were detoxified, inducted onto oral naltrexone, and randomly assigned to a contingency (n = 35) or prescription (n = 32) group for a 26-week period. Contingency participants were required to ingest naltrexone under staff observation to gain access to the therapeutic workplace. Prescription participants received a take-home supply of naltrexone and could access the workplace independent of naltrexone ingestion. Primary outcome measures were percent of urine samples positive for naltrexone at 30-day assessments and negative for opiates and cocaine at 30-day assessments. Contingency participants provided significantly more urine samples that were positive for naltrexone compared with prescription participants (72% vs. 21%, p < .01); however, no effect of experimental group was observed on percent opiate-negative (71% vs. 60%, p = .19.) or cocaine-negative (56% vs. 53%, p = .82) samples in the contingency and prescription groups, respectively. Opiate-positive samples were significantly more likely to occur in conjunction with cocaine (p < .001) and when not protected by naltrexone (p < .02), independent of experimental group. Overall, these results show that contingent access to a therapeutic workplace significantly promoted adherence to oral naltrexone, and that the majority of opiate use occurred in conjunction with cocaine use, suggesting that untreated cocaine use may limit the effectiveness of oral naltrexone in promoting opiate abstinence.
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Affiliation(s)
- Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, W142, Baltimore, MD 21224, USA
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Jozaghi E. Science versus politics: The need for supervised injection facilities in Montreal, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:420-1. [DOI: 10.1016/j.drugpo.2012.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 11/26/2022]
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Wood E, McKinnon M, Strang R, Kendall PR. Improving community health and safety in Canada through evidence-based policies on illegal drugs. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2012; 6:e35-40. [PMID: 22567081 PMCID: PMC3329118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/17/2011] [Accepted: 10/17/2011] [Indexed: 11/24/2022]
Abstract
Illegal drug use remains a serious threat to community health in Canada, yet there has been a remarkable discordance between scientific evidence and policy in this area, with most resources going to drug use prevention and drug law enforcement activities that have proven ineffective. Conversely, evidence-based drug treatment programs have been chronically underfunded, despite their cost-effectiveness. Similarly, various harm reduction strategies, such as needle exchange, supervised injecting programs and opioid substitution therapy, have also proven effective at reducing drug-related harm but receive limited government support. Accordingly, Canadian society would greatly benefit from reorienting its drug policies on addiction, with consideration of addiction as a health issue, rather than primarily a criminal justice issue. In this context, and in light of the simple reality that drug prohibition has not effectively reduced the availability of most illegal drugs and has instead contributed to a vast criminal enterprise and related violence, among other harms, alternatives should be prioritized for evaluation.
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Affiliation(s)
- Evan Wood
- Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
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Zábranský T, Csémy L, Grohmannová K, Janíková B, Brenza J. Mortality of cohort of very young injecting drug users in Prague, 1996-2010. Cent Eur J Public Health 2011; 19:152-7. [PMID: 22026292 DOI: 10.21101/cejph.a3681] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To determine the mortality in a cohort of very young injecting drug users (IDUs), and the factors associated with it. DESIGN A database linkage prospective (follow-up) cohort study. SETTING A convenience sample of clients of 2 low-threshold facilities, 1 drug treatment clinic, and one special facility for children with severe behavioural disorders, who were all younger than 19 and older than 15, was interviewed one or more times in 1996-8 and asked to agree with their being interviewed again after 10 or more years. PARTICIPANTS 151 (65 male, 86 female) IDUs recruited in October 1996 - December 1998. MEASUREMENT Database linkage study compared unique identifiers (IDs) of the recruited subjects with the general register of deaths to determine the life status, and the causes of death of those deceased. Where necessary, we examined the death protocols directly. FINDINGS Altogether, 8 deaths were registered between recruitment and 31st December 2008 (1,660 person-years). All the deceased were male, and all their deaths were "unnatural"--that is, caused by drug overdose or accident. This translates into the crude mortality rates for the whole cohort being 4.8 deaths per 1,000 person-years (PY), and into a specific mortality ratio in the males SMR=14.4 with the peak at the age of 15-20 (SMR=60.1), declining to SMR=8.2 at the age of 25-30. Except gender, we found no "predictors of death" in this high-risk cohort. CONCLUSION The overall mortality in the cohort was substantially higher than in the general population; in the male part of the cohort of young injecting drug users it was excessively high in the first three years after recruitment, and caused by external causes exclusively; the mortality in the female sub-cohort was zero, i.e. lower than in the general population of the same age range. Our findings suggest a need to develop targeted prevention of overdoses and other unnatural deaths in young male drug injectors.
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Affiliation(s)
- Tomás Zábranský
- Centre for Addictology, Department of Psychiatry, First Faculty of Medicine, Charles University in Prague, Czech Republic.
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Lang K, El-Aneed A, Berenbaum S, Dell CA, Wright J, McKay ZT. Qualitative assessment of crisis services among persons using injection drugs in the city of Saskatoon. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.606350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Degenhardt L, Bucello C, Calabria B, Nelson P, Roberts A, Hall W, Lynskey M, Wiessing L, Mora MEM, Clark N, Thomas J, Briegleb C, McLaren J. What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews. Drug Alcohol Depend 2011; 117:85-101. [PMID: 21377813 DOI: 10.1016/j.drugalcdep.2010.11.032] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 11/10/2010] [Accepted: 11/11/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND We systematically reviewed availability and quality of data on the prevalence of use and dependence on meth/amphetamine, cannabis, cocaine and opioids. METHODS Multiple search strategies: (a) peer-reviewed literature searches (1990-2008) using methods recommended by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group; (b) systematic searches of online databases; (c) Internet searches to find other published evidence of drug use; (d) repeated consultation and feedback from experts around the globe; (e) a viral email sent to lists of researchers in the illicit drug and HIV fields. Data were extracted and graded according to predefined variables reflecting quality of data source. RESULTS Qualitative evidence of illicit drug use and dependence was found for most countries, which hold over 98% of the world's population aged 15-64 years. Countries where use was identified but prevalence estimates had not been made (evidence of drug supply, trafficking, reports of use, treatment data) were mainly from Asia, Africa, the Middle East, and Oceania. Estimates of the prevalence of use were located in 77 countries for meth/amphetamine, 95 for cannabis, 86 for cocaine and 89 for opioids. Dependence prevalence estimates existed in very few countries; 9 meth/amphetamine dependence estimates, 7 cannabis dependence estimates, 5 cocaine dependence estimates, and 25 opioid dependence estimates were located. CONCLUSIONS Data on the extent of meth/amphetamine, cannabis, cocaine and opioid use and dependence must be improved in quality and coverage. Dependence estimates are lacking even in high income countries that have required resources. Responses to illicit drug dependence require better estimates of its scale.
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Affiliation(s)
- Louisa Degenhardt
- Burnet Research Institute, GPO Box 2284, Melbourne, Victoria 3001, Australia.
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Methadone use among HIV-positive injection drug users in a Canadian setting. J Subst Abuse Treat 2010; 39:174-9. [PMID: 20598827 DOI: 10.1016/j.jsat.2010.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/22/2010] [Accepted: 05/03/2010] [Indexed: 11/21/2022]
Abstract
We examined methadone maintenance therapy (MMT) use among HIV-positive injection drug users (IDU) in Vancouver. Among 353 participants, 199 (56.3%) were on MMT at baseline, and 48 initiated MMT during follow-up. Female gender (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI] = 1.14-2.62) and antiretroviral therapy use (AOR = 2.04, 95% CI = 1.46-2.86) were positively associated with MMT use, whereas frequent heroin injection (AOR = 0.34, 95% CI = 0.23-0.50), public injection (AOR = 0.76, 95% CI = 0.59-0.97), syringe borrowing (AOR = 0.54, 95% CI = 0.32-0.90), and nonfatal overdose (AOR = 0.58, 95% CI = 0.36-0.92) were negatively associated with MMT use. The rate of discontinuation of MMT was 12.46 (95% CI = 8.28-18.00) per 100 person years. Frequent heroin use (adjusted hazards ratio = 4.49, 95%CI = 1.81-11.13) was positively associated with subsequent discontinuation of MMT. These findings demonstrate the benefits of MMT among HIV-positive IDU and the need to improve access to and retention in MMT.
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El‐Aneed A, Alaghehbandan R, Gladney N, Collins K, Macdonald D, Fischer B. Prescription drug abuse and methods of diversion: The potential role of a pharmacy network. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890802446087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fischer B, Patra J, Cruz MF, Gittins J, Rehm J. Comparing heroin users and prescription opioid users in a Canadian multi-site population of illicit opioid users. Drug Alcohol Rev 2009; 27:625-32. [PMID: 19378446 DOI: 10.1080/09595230801956124] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND AIMS Recent data suggest increasing prescription opioid and decreasing heroin use among street drug users, yet little is known on possible differential use characteristics and outcomes associated with these drugs. [While we recognise that, correctly, these populations would need to be labelled as opioid 'abusers' or 'non-medical users', we rely on the simpler terms 'use' and 'users' for the population under study within the wider context of them being engaged overall in illicit opioid use activities.] This study compared drug use, health, and socio-economic characteristics between heroin (H)-only, prescription opioid (PO)-only and mixed heroin and prescription (PO & H) users in a Canadian multi-site cohort of illicit opioid and other drug users (OPICAN). DESIGN AND METHODS Data from the most recent (2005) multi-component assessment of the H-only (n = 94), PO-only (n = 304) and PO & H (n = 86) cohort sub-samples were analysed. Based on bivariate analyses of variables of interest, a multinomial logistic regression analysis (MLRA) model was computed, comparing PO-only and PO & H groups to the H-only reference group, respectively. RESULTS H-only users were found in two of the seven study sites. Based on the MLRA, PO-only and PO & H users, compared to H-only users, were more likely to: be older, use benzodiazepines and cocaine, use drop-in shelters and less likely to use walk-in clinics. PO-only users were also more likely to: be white; receive legal income; use drugs by non-injection; have physical health problems; and use private physician services. DISCUSSION AND CONCLUSIONS Our study underscores the increasing prevalence of PO compared to heroin use in the study population. Differences between PO-only and H-only users were more pronounced than differences between PO-only and PO & H users. PO-only use may be associated with lowered health risks and social burdens, yet concerns regarding polysubstance use and drug sourcing arise. Challenges for targeted interventions are discussed.
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Affiliation(s)
- Benedikt Fischer
- Centre for Addictions Research of British Columbia, University of Victoria, Canada.
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Gartry CC, Oviedo-Joekes E, Laliberté N, Schechter MT. NAOMI: The trials and tribulations of implementing a heroin assisted treatment study in North America. Harm Reduct J 2009; 6:2. [PMID: 19159475 PMCID: PMC2639576 DOI: 10.1186/1477-7517-6-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Accepted: 01/21/2009] [Indexed: 01/15/2023] Open
Abstract
Background Opioid addiction is a chronic, relapsing disease and remains a major public health challenge. Despite important expansions of access to conventional treatments, there are still significant proportions of affected individuals who remain outside the reach of the current treatment system and who contribute disproportionately to health care and criminal justice costs as well as to public disorder associated with drug addiction. The NAOMI study is a Phase III randomized clinical trial comparing injectable heroin maintenance to oral methadone. The study has ethics board approval at its Montréal and Vancouver sites, as well as from the University of Toronto, the New York Academy of Medicine and Johns Hopkins University. The main objective of the NAOMI Study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade opioid agonist is more effective than methadone alone in recruiting, retaining, and benefiting chronic, opioid-dependent, injection drug users who are resistant to current standard treatment options. Methods The case study submitted chronicles the challenges of getting a heroin assisted treatment trial up and running in North America. It describes: a brief background on opioid addiction; current standard therapies for opioid addiction; why there is/was a need for a heroin assisted treatment trial; a description of heroin assisted treatment; the beginnings of creating the NAOMI study in North America; what is the NAOMI study; the science and politics of the NAOMI study; getting NAOMI started in Canada; various requirements and restrictions in getting the study up and running; recruitment into the study; working with the media; a status report on the study; and a brief conclusion from the authors' perspectives. Results and conclusion As this is a case study, there are no specific results or main findings listed. The case study focuses on: the background of the study; what it took to get the study started in Canada; the unique requirements and conditions of getting a site, and the study, approved; working with the media; recruitment into the study; a brief status report on the study; and a brief conclusion from the authors' perspectives. Trail Registration ClinicalTrials.gov registration number: NCT00175357
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Affiliation(s)
- Candice C Gartry
- CIHR Canadian HIV Trials Network and the Centre for Health Evaluation & Outcome Sciences (CHEOS), Vancouver, BC, Canada.
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Evans E, Grella CE, Murphy DA, Hser YI. Using administrative data for longitudinal substance abuse research. J Behav Health Serv Res 2008; 37:252-71. [PMID: 18679805 DOI: 10.1007/s11414-008-9125-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 04/26/2008] [Indexed: 10/21/2022]
Abstract
The utilization of administrative data in substance abuse research has become more widespread than ever. This selective review synthesizes recent extant research from 31 articles to consider what has been learned from using administrative data to conduct longitudinal substance abuse research in four overlapping areas: (1) service access and utilization, (2) underrepresented populations, (3) treatment outcomes, and (4) cost analysis. Despite several notable limitations, administrative data contribute valuable information, particularly in the investigation of service system interactions and outcomes among substance abusers as they unfold and influence each other over the long term. This critical assessment of the advantages and disadvantages of using existing administrative data within a longitudinal framework should stimulate innovative thinking regarding future applications of administrative data for longitudinal substance abuse research purposes.
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Affiliation(s)
- Elizabeth Evans
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025, USA.
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Werb D, Kerr T, Lai C, Montaner J, Wood E. Nonfatal overdose among a cohort of street-involved youth. J Adolesc Health 2008; 42:303-6. [PMID: 18295139 PMCID: PMC2290001 DOI: 10.1016/j.jadohealth.2007.09.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 09/17/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
Abstract
Limited data exist concerning patterns of nonfatal illicit drug overdoses among street-involved youth. We therefore evaluated factors associated with nonfatal overdose among a cohort of street-involved youth in Vancouver, Canada. Our findings indicate that nonfatal overdose was common among street-involved youth in our setting, and was associated with various forms of drug use, including methamphetamine use.
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Affiliation(s)
- Daniel Werb
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | - Calvin Lai
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada, Department of Medicine, University of British Columbia, Vancouver, Canada
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Treloar C, Holt M. Complex vulnerabilities as barriers to treatment for illicit drug users with high prevalence mental health co-morbidities. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17523280701759755] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Christie T, Groarke L, Sweet W. Virtue ethics as an alternative to deontological and consequential reasoning in the harm reduction debate. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:52-8. [PMID: 18226518 DOI: 10.1016/j.drugpo.2007.11.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 11/26/2007] [Accepted: 11/27/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is strong evidence that harm reduction interventions such as Supervised Injection Sites and Needle Exchange Programs prevent many of the negative consequences of problematic substance use. Yet many governments, including the United States and Canada, still do not endorse these interventions, claiming that they do not get people off of drugs and send a mixed message. METHODS This paper will analyze objections to harm reduction in light of the ethical theories of John Stuart Mill, Immanuel Kant and Aristotle. RESULTS The most important ethical issue in the abstinence vs. harm reduction debate is whether harm reduction - because it does not require individuals to either reduce their consumption of illicit substances or to abstain from illicit substance use - can be ethically justified. CONCLUSION Harm reduction interventions are clearly justified on Utilitarian grounds because, based on the evidence, such policies would produce the greatest good for the greatest number. However, Kant would not think that the values guiding harm reduction are ethical because the justification of harm reduction interventions focuses exclusively on examining consequences. Virtue Ethics seeks to find the proper balance between harm reduction and abstinence. We claim that the virtue of compassion would provide a defense of harm reduction.
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Fairbairn N, Wood E, Stoltz JA, Li K, Montaner J, Kerr T. Crystal methamphetamine use associated with non-fatal overdose among a cohort of injection drug users in Vancouver. Public Health 2008; 122:70-8. [PMID: 17645904 DOI: 10.1016/j.puhe.2007.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 09/07/2006] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the prevalence and correlates of non-fatal overdose among a polysubstance-using cohort of injection drug users (IDU) in Vancouver. STUDY DESIGN/METHODS We evaluated factors associated with non-fatal overdose among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS) using univariate statistics. Self-reports of the awareness of drugs taken and drug potency, polysubstance use, and assistance received at the time of non-fatal overdose were also recorded. RESULTS From 1 December 2003 to 1 June 2005, 551 participants who were active injectors were followed. In total, 37 (6.7%) individuals reported experiencing a non-fatal overdose in the previous 6 months. Factors positively associated with non-fatal overdose included public injecting (odds ratio (OR)=4.74, 95% confidence interval (CI) 2.35-9.37, P<0.001), crystal methamphetamine use (OR=4.11) and injection (OR=3.63), morphine injection (OR=3.55), non-injection opiate use (OR=3.30), frequent heroin injection (OR=2.28) and sex trade work (OR=2.12). Factors negatively associated with non-fatal overdose included participation in methadone maintenance therapy (OR=0.31) and injecting alone (OR=0.36). Sixty-two percent of individuals were unaware of drug potency, 64.9% of IDU were taking other drugs at the time of overdosing, with crack being the main drug (37.0%). Fifty-four percent were assisted by ambulance personnel, 56.8% were taken to accident and emergency or hospital, 38.1% left accident and emergency or hospital before being released, and 35.1% were given Naloxone. CONCLUSION Structural interventions are needed that seek to modify the social and contextual risks for overdose, increased access to treatment programmes, and trials of novel interventions for crystal methamphetamine users.
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Affiliation(s)
- Nadia Fairbairn
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC Canada, V6Z 146
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Monga N, Rehm J, Fischer B, Brissette S, Bruneau J, El-Guebaly N, Noël L, Tyndall M, Wild C, Leri F, Fallu JS, Bahl S. Using latent class analysis (LCA) to analyze patterns of drug use in a population of illegal opioid users. Drug Alcohol Depend 2007; 88:1-8. [PMID: 17049753 DOI: 10.1016/j.drugalcdep.2006.08.029] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 08/24/2006] [Accepted: 08/30/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective of this paper is to empirically determine a categorization of illegal opioid users in Canada in order to describe and analyze drug use patterns within this population. METHODS Drug use patterns of 679 eligible illegal opioid users outside treatment from the OPICAN study, a pan-Canadian cohort (recruited March to December, 2002) involving the cities of Toronto, Montreal, Vancouver, Edmonton and Quebec City, were empirically examined using latent class analysis. These latent classes were then further analyzed for associations using chi-square and t-test statistics. FINDINGS The opioid and other drug user sample surveyed were categorized into three latent classes. Class 1 (N=256) was characterized by the use of Tylenol 3 and benzodiazepines along with high levels of depression and self-reported pain. Class 2 (N=68) was described by the non-injection use of both heroin and crack while having a high level of homelessness. Class 3 (N=344) was shown to consist of injection drug users of heroin and cocaine exhibiting the highest levels of HIV and Hepatitis C infections amongst the classes. CONCLUSIONS Using latent class analysis we found distinct patterns of drug use amongst illegal opioid users differing in terms of type of drugs co-used, social context, and co-morbid pathologies. These data may be useful as the empirical basis for the planning of specific prevention and treatment interventions.
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Affiliation(s)
- Neerav Monga
- Centre for Addiction and Mental Health, Toronto, Ontario M5S 2S1, Canada.
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Fischer B, Rehm J, Patra J, Kalousek K, Haydon E, Tyndall M, El-Guebaly N. Crack across Canada: Comparing crack users and crack non-users in a Canadian multi-city cohort of illicit opioid users. Addiction 2006; 101:1760-70. [PMID: 17156175 DOI: 10.1111/j.1360-0443.2006.01614.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS To examine possible differences between crack users and crack non-users across Canada. DESIGN Cohort study of illicit opioid and other drug users in five cities across Canada. SETTING Vancouver, Edmonton, Toronto, Montreal and Quebec City, Canada. PARTICIPANTS Regular illicit opioid and other street drug users not in treatment at time of assessment. MEASUREMENTS Participants (n = 677) were assessed at baseline (2002) by way of an interviewer-administered questionnaire, a psychiatric diagnostic instrument (Composite International Diagnostic Interview), and salivary antibody tests for infectious disease. FINDINGS Approximately half the sample had used crack in the past 30 days, although prevalence rates differed strongly between study sites. When examined by discriminant analysis, crack users in the study population were more likely to have: no permanent housing, have illegal and sex work income, indicate physical health problems and hepatitis C virus (HCV) antibodies, use walk-in clinics, use heroin and to have been arrested and in detention (in past year). They were less likely to report depressive symptoms, and use Dilaudid (hydromorphone) and alcohol. CONCLUSION These results illustrate crack users' pronounced social marginalization (as expressed by homelessness and high involvement in illegal activities) as well as extensive health problems compared to non-crack users in the Canadian context. The development of targeted interventions-addressing the dynamics of social marginalization-of this population is urgently needed.
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Affiliation(s)
- Benedikt Fischer
- Centre for Addiction and Mental Health/Univrersity of Toronto, Toronto, Ontario, Canada.
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Kahan M, Srivastava A, Wilson L, Gourlay D, Midmer D. Misuse of and dependence on opioids: study of chronic pain patients. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2006; 52:1081-7. [PMID: 17279218 PMCID: PMC1783735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To review the evidence on identifying and managing misuse of and dependence on opioids among primary care patients with chronic pain. QUALITY OF EVIDENCE MEDLINE was searched using such terms as "opioid misuse" and "addiction." The few studies on the prevalence of opioid dependence in primary care populations were based on retrospective chart reviews (level II evidence). Most recommendations regarding identification and management of opioid misuse in primary care are based on expert opinion (level III evidence). MAIN MESSAGE Physicians should ask all patients receiving opioid therapy about current, past, and family history of addiction. Physicians should take "universal precautions" that include careful prescribing and ongoing vigilance for signs of misuse. Patients suspected of opioid misuse can be treated with a time-limited trial of structured opioid therapy if they are not acquiring opioids from other sources. The trial should consist of daily to weekly dispensing, regular urine testing, and tapering of doses of opioids. If the trial fails or is not indicated, patients should be referred for methadone or buprenorphine treatment. CONCLUSION Misuse of and dependence on opioids can be identified and managed successfully in primary care.
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Affiliation(s)
- Meldon Kahan
- Addiction Medical Service, St Joseph's Health Centre, Toronto, Ontario, Canada.
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Fischer B, Cruz MF, Rehm J. Illicit opioid use and its key characteristics: a select overview and evidence from a Canadian multisite cohort of illicit opioid users (OPICAN). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:624-34. [PMID: 17052030 DOI: 10.1177/070674370605101002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). METHOD We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n=679) was collected in 2002. RESULTS Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in CONCLUSIONS Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.
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Affiliation(s)
- Benedikt Fischer
- Public Health and Policy Unit, Centre for Addictions Research of British Columbia, Victoria.
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Health and social services accessed by a cohort of Canadian illicit opioid users outside of treatment. Canadian Journal of Public Health 2006. [PMID: 16827399 DOI: 10.1007/bf03405577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the use of social and health services by illicit opioid users outside of treatment in five Canadian cities ('OPICAN' cohort). METHODS 677 eligible participants completed an interviewer-administered protocol and 584 supplied saliva samples for HIV and HCV antibody-testing. Chi-squared tests and multivariate analyses of variance (MANOVA) were carried out in order to determine the associations between use of services and specific factors. The explanatory variables of service utilization were determined with multiple regression analysis. RESULTS The average age of respondents was 35 years, 66% were male and 68% were Caucasian. Women and HIV-positive individuals were more likely to receive health care. Participants who had a history of injection drug use, but had not injected within the previous 30 days, visited doctors more regularly and had a higher uptake of community-based services. Those who reported mental health problems used services less frequently than others. Participants recruited in Vancouver had more visits to needle exchange programs and centres specifically for women. Toronto participants were more likely to use homeless shelters and had a higher uptake of other types of community-based services. CONCLUSION Our study found a high rate of physical and mental health problems in illicit untreated opioid users in Canada, including the transmission of infectious disease. The availability of services seems to be a predictor of use of services. Setting up, adapting and evaluating front-line services tailored to illicit opioid users outside of treatment should be a policy and program priority.
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Wood E, Stoltz JA, Montaner JSG, Kerr T. Evaluating methamphetamine use and risks of injection initiation among street youth: the ARYS study. Harm Reduct J 2006; 3:18. [PMID: 16723029 PMCID: PMC1481558 DOI: 10.1186/1477-7517-3-18] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 05/24/2006] [Indexed: 11/10/2022] Open
Abstract
Many Canadian cities are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDU). These health concerns have recently been exacerbated by the increasing availability and use of methamphetamine. The challenges of reducing health-related harms among IDU have led to an increased recognition that strategies to prevent initiation into injection drug use must receive renewed focus. In an effort to better explore the factors that may protect against or facilitate entry into injection drug use, the At Risk Youth Study (ARYS) has recently been initiated in Vancouver, Canada. The local setting is unique due to the significant infrastructure that has been put in place to reduce HIV transmission among active IDU. The ARYS study will seek to examine the impact of these programs, if any, on non-injection drug users. In addition, Vancouver has been the site of widespread use of methamphetamine in general and has seen a substantial increase in the use of crystal methamphetamine among street youth. Hence, the ARYS cohort is well positioned to examine the harms associated with methamphetamine use, including its potential role in facilitating initiation into injection drug use. This paper provides some background on the epidemiology of illicit drug use among street youth in North America and outlines the methodology of ARYS, a prospective cohort study of street youth in Vancouver, Canada.
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Affiliation(s)
- Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver BC V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, 3300 - 950 West 10th Avenue, Vancouver BC V5Z 4E3, Canada
| | - Jo-Anne Stoltz
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver BC V6Z 1Y6, Canada
| | - Julio SG Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver BC V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, 3300 - 950 West 10th Avenue, Vancouver BC V5Z 4E3, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver BC V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, 3300 - 950 West 10th Avenue, Vancouver BC V5Z 4E3, Canada
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Small D, Drucker E. Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment. Harm Reduct J 2006; 3:16. [PMID: 16670010 PMCID: PMC1557662 DOI: 10.1186/1477-7517-3-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 05/02/2006] [Indexed: 11/10/2022] Open
Abstract
A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear--and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.
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Affiliation(s)
- Dan Small
- PHS Community Services Society, 20 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
- Department of Anthropology and Sociology, University of British Columbia, Vancouver, BC, V6T 1Z1, Canada
| | - Ernest Drucker
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx NY 10467, USA
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Noël L, Fischer B, Tyndall MW, Bradet DR, Rehm J, Brissette S, Brochu S, Bruneau J, El-Guebaly N, Wild TC. Health and social services accessed by a cohort of Canadian illicit opioid users outside of treatment. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2006; 97:166-70. [PMID: 16827399 PMCID: PMC6975977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 01/03/2006] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine the use of social and health services by illicit opioid users outside of treatment in five Canadian cities ('OPICAN' cohort). METHODS 677 eligible participants completed an interviewer-administered protocol and 584 supplied saliva samples for HIV and HCV antibody-testing. Chi-squared tests and multivariate analyses of variance (MANOVA) were carried out in order to determine the associations between use of services and specific factors. The explanatory variables of service utilization were determined with multiple regression analysis. RESULTS The average age of respondents was 35 years, 66% were male and 68% were Caucasian. Women and HIV-positive individuals were more likely to receive health care. Participants who had a history of injection drug use, but had not injected within the previous 30 days, visited doctors more regularly and had a higher uptake of community-based services. Those who reported mental health problems used services less frequently than others. Participants recruited in Vancouver had more visits to needle exchange programs and centres specifically for women. Toronto participants were more likely to use homeless shelters and had a higher uptake of other types of community-based services. CONCLUSION Our study found a high rate of physical and mental health problems in illicit untreated opioid users in Canada, including the transmission of infectious disease. The availability of services seems to be a predictor of use of services. Setting up, adapting and evaluating front-line services tailored to illicit opioid users outside of treatment should be a policy and program priority.
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Affiliation(s)
- Lina Noël
- Institut national de sante publique du Québec, Beauport, QC.
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Ettner SL, Huang D, Evans E, Ash DR, Hardy M, Jourabchi M, Hser YI. Benefit-cost in the California treatment outcome project: does substance abuse treatment "pay for itself"? Health Serv Res 2006; 41:192-213. [PMID: 16430607 PMCID: PMC1681530 DOI: 10.1111/j.1475-6773.2005.00466.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine costs and monetary benefits associated with substance abuse treatment. DATA SOURCES Primary and administrative data on client outcomes and agency costs from 43 substance abuse treatment providers in 13 counties in California during 2000-2001. STUDY DESIGN Using a social planner perspective, the estimated direct cost of treatment was compared with the associated monetary benefits, including the client's costs of medical care, mental health services, criminal activity, earnings, and (from the government's perspective) transfer program payments. The cost of the client's substance abuse treatment episode was estimated by multiplying the number of days that the client spent in each treatment modality by the estimated average per diem cost of that modality. Monetary benefits associated with treatment were estimated using a pre-posttreatment admission study design, i.e., each client served as his or her own control. DATA COLLECTION Treatment cost data were collected from providers using the Drug Abuse Treatment Cost Analysis Program instrument. For the main sample of 2,567 clients, information on medical hospitalizations, emergency room visits, earnings, and transfer payments was obtained from baseline and 9-month follow-up interviews, and linked to information on inpatient and outpatient mental health services use and criminal activity from administrative databases. Sensitivity analyses examined administrative data outcomes for a larger cohort (N=6,545) and longer time period (1 year). PRINCIPAL FINDINGS On average, substance abuse treatment costs $1,583 and is associated with a monetary benefit to society of $11,487, representing a greater than 7:1 ratio of benefits to costs. These benefits were primarily because of reduced costs of crime and increased employment earnings. CONCLUSIONS Even without considering the direct value to clients of improved health and quality of life, allocating taxpayer dollars to substance abuse treatment may be a wise investment.
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Affiliation(s)
- Susan L Ettner
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1736, USA
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