Easy-access Services in Low-threshold Opiate Agonist Maintenance

Methadone maintenance therapy service components linked to improvements in HIV care cascade outcomes: A systematic review of trials and observational studies

BACKGROUND

The beneficial links between engagement in methadone maintenance therapy (MMT) and HIV treatment outcomes have been extensively described. Nevertheless, people who use drugs (PWUD) continue to experience suboptimal HIV treatment outcomes. In this systematic review, we sought to identify components of MMT service provision that are associated with improvements in HIV care outcomes across the HIV care cascade.

METHODS

We searched for peer-reviewed studies in online databases. To be eligible for inclusion in this review, studies must have involved a population or sub-population of PWUD engaged in MMT; report improved uptake of HIV testing, exposure to ART, or HIV-1 RNA plasma viral load suppression; provide details on MMT services; and be published in English between 1 January 2006 until 31 December 2018.

RESULTS

Out of the 5594 identified records, 22 studies were eligible for this systematic review. Components of MMT services associated with HIV care cascade outcomes described in the studies were classified in three categories of care models: 1) standard MMT care with adequate doses, 2) standard MMT care and alongside additional medical component(s), and 3) standard MMT care, additional medical component(s) as well as informational or instrumental social support.

CONCLUSION

The few studies identified reflect a scarcity of evidence on the role of social support to increase the benefits of MMT for PWUD who are living with HIV. Further research is needed to assess the role of medical and social service components in MMT care delivery in advancing PWUD along the HIV care cascade.

Psychosocial intervention utilization and substance abuse treatment outcomes in a multisite sample of individuals who use opioids

BACKGROUND

There are several relatively safe and effective FDA-approved medications for Opioid Use Disorder (OUD). Despite the existence of these medications, the rate of returning to opioid use after treatment is relatively high, underscoring the need for continued enhancement of treatments. Adjunctive psychosocial interventions paired with medication have been shown to improve OUD treatment outcomes. However, studies have yet to conclusively examine the distinct effects of the most widely utilized psychosocial treatment modalities. The current study will investigate the relationship between individual counseling, group therapy, and 12-Step participation and illicit opioid abstinence at the end of treatment, 1 and 3 months after treatment.

METHOD

A secondary analysis was conducted with data from a sample of 570 individuals diagnosed with OUD who were recruited from eight substance abuse treatment centers in the United States. Participants were enrolled in a two-group randomized, controlled trial testing buprenorphine-naloxone versus extended-release naltrexone for OUD. A two-level hierarchical linear growth model was used to examine the effects of individual counseling, group therapy, and 12-Step participation on illicit opioid abstinence (urinanalyses) 1- and 3-months post-treatment.

RESULTS

Hours of individual counseling and 12-Step participation significantly predicted abstinence at follow-up (p < .001, b = -0.59, 95% CI [0.42, 0.74]; p < .01, b = -0.05, 95% CI [0.92, 0.98]). There was a significant interaction between individual counseling and 12-Step participation (p < .01, b = -0.06, 95% CI [1.02, 1.10]). Additionally, participant age and employment status were significant predictors of illicit opioid abstinence (p < .01, b = -0.02, 95% CI [0.97, 0.99]; p < .01, b = -0.38, 95% CI [0.52, 0.90]). Hours of group therapy was not found to significantly predict illicit opioid abstinence.

CONCLUSIONS

Findings suggest that greater levels of individual therapy and 12-Step participation may be beneficial for individuals receiving medication treatment for OUD.

Numbers and narratives. Relations between patient satisfaction, retention, outcome and program factors in outpatient substance abuse treatment

Aims

Research on substance abuse treatment suggests patient satisfaction is linked to use of services and abstinence. However, patient perspectives on treatment are rarely examined. This study used mixed methods to examine correlations between patients’ treatment satisfaction, retention and abstinence from drugs and provide a transpersonal account of patient perspectives on treatment.

Data and Methods

Eight Danish outpatient substance abuse treatment centres participated in the study. Data was collected from 186 patients. Quantitative measures were used at baseline screenings and at 6 months follow-up interviews, including the Client Satisfaction Questionnaire-8 (CSQ-8). Qualitative measures were used for patient descriptions of treatment at follow-up.

Results

Patient satisfaction with treatment was linked to retention, abstinence and program differences. The qualitative data described patient's views on high or low treatment satisfaction.

Conclusion

The CSQ-8 is a valuable tool for monitoring patient engagement and treatment effect in substance abuse treatment services. The inclusion of patient perspectives underlined the importance of a more contextual understanding of program components.

Received View of Addiction, Relapse and Treatment

It is important to highlight that attempts at understanding and explaining addiction have been made for centuries. It is, however, just five decades ago, with the growth of science and technology that more interest has been observed in this field. This chapter examines different views and theories that have been posited to understand and explain addiction. More attention will be given to prominent views that seem to draw consensus among researchers and medical practitioners. The first section of the chapter introduces the addiction debate, the different theories that have been provided to explain it from different perspectives and disciplines such as neurosciences, philosophy and psychology. Then, the chapter discusses different views on the role of relapse and what it entails in understanding addiction. The second section discusses different proposed and used forms of treating addiction. Thus, the chapter discusses the received view of addiction, the understanding of relapse as a critical element in addiction and treatments.

Opioid substitution therapy: Lowering the treatment thresholds

BACKGROUND

Opioid substitution therapy (OST) has been established as the gold standard in treating opioid use disorders. Nevertheless, there is still a debate regarding the qualitative characteristics that define the optimal OST intervention, namely the treatment threshold. The aim of this review is twofold: first, to provide a summary and definition of "treatment thresholds", and second, to outline these thresholds and describe how they related to low and high threshold treatment characteristics and outcomes.

METHOD

We searched the main databases of Medline, PubMed, PsycInfo, EMBASE, CINAHL and the Cochrane Library. Original published research papers, reviews, and meta-analyses, containing the eligible keywords: "opioid substitution", "OST", "low threshold", "high threshold" were searched alone and in combination, up to June, 2015.

RESULTS

Treatment thresholds were defined as barriers a patient may face prior to and during treatment. The variables of these barriers were classified into treatment accessibility barriers and treatment design barriers. There are increasing numbers of studies implementing low threshold designs with an increasing body of evidence suggesting better treatment outcomes compared to high threshold designs.

CONCLUSION

Clinical characteristics of low threshold treatments that were identified to increase the effectiveness of OST intervention include increasing accessibility so as to avoid waiting lists, using personalized treatment options regarding medication choice and dose titration, flexible treatment duration, a treatment design that focuses on maintenance and harm reduction with emphasis on the retention of low adherence patients.

A Pressing Need for Pharmacotherapy Development to Treat Drug Addiction: An Editorial from a Legal Perspective

Only three FDA-approved pharmacological treatments exist for treating opiate dependence, all of which are underprescribed and underused. No FDA-approved pharmacological treatments exist for cocaine or methamphetamine dependence. More evidence-based, FDA-approved treatments are needed for treating drug dependence, but pharmaceutical companies are unlikely to pursue such research without government incentives. Today pharmaceutical companies primarily conduct research and development (R&D) related to "blockbuster" and rare diseases; drug dependence does not fall into either category. Further compounding the problem, pharmaceutical companies have been recently slashing risky areas of research, rather than adopting new areas. Fortunately, the government has a number of options to incentivize pharmaceutical R&D relating to drug dependence treatment, including the following: market exclusivity for new medications, tax breaks, priority review vouchers, liability reduction, and an advanced market commitment.

Drop-in access to specialist services for eating disorders: a qualitative study of patient experiences

Lack of patient motivation and dropout are common problems in the treatment of eating disorders. The present study explored patient experiences with open access to specialist eating disorder services through a drop-in program aiming to enable early identification of eating disorders, address motivational problems, and strengthen the therapeutic alliance. Semi-structured qualitative interviews were used to explore the experiences of 11 individuals attending the program. Results suggest that drop-in access may strengthen the therapeutic alliance, motivate engagement in treatment, and reduce dropout. Strengths and weaknesses of the program are discussed and the need for more systematic research is elaborated.

Addiction research centres and the nurturing of creativity. The Centre for Alcohol and Drug Research: social science alcohol and drug research in Denmark

AIMS

The purpose of this paper is to introduce the social science alcohol and drug research undertaken by the Centre for Alcohol and Drug Research (CRF) and at the same time offer an insight into the development in Danish alcohol and drug research throughout the past 15-20 years.

METHOD

A review of articles, books and reports published by researcher from CRF from the mid-1990s until today and an analysis of the policy-making in the Danish substance use and misuse area.

RESULTS

CRF is a result of the discussions surrounding social, health and allocation policy questions since the mid-1980s. Among other things, these discussions led to the formal establishment of the Centre in 1991 under the Aarhus University, the Faculty of Social Science. Since 2001 the Centre has received a permanent basic allocation, which has made it possible to appoint tenured senior researchers; to work under a more long-term research strategy; to function as a milieu for educating PhD students; and to diversify from commissioned research tasks to initiating projects involving more fundamental research. Research at the Centre is today pivoted around four core areas: consumption, policy, prevention and treatment.

CONCLUSION

The emergence, continuation, financing and character of the research taking place at CRF can be linked closely to the specific Danish drug and alcohol discourse and to the division of the responsibility for alcohol and drug research into separate Ministries.