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Chung YCE, Tung YC, Wang SC, Huang CL, Chen LY, Chen WJ. Assessing the impact of public funding in alleviating participant reduction and improving the retention rate in methadone maintenance treatment clinics in Taiwan: an interrupted time series analysis. Implement Sci 2024; 19:18. [PMID: 38389082 PMCID: PMC10885479 DOI: 10.1186/s13012-024-01351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Given the steady decline in patient numbers at methadone maintenance treatment (MMT) clinics in Taiwan since 2013, the government initiated Patients' Medical Expenditure Supplements (PMES) in January 2019 and the MMT Clinics Accessibility Maintenance Program (MCAM) in September 2019. This study aims to evaluate the impact of the PMES and MCAM on the enrollment and retention of patients attending MMT clinics and whether there are differential impacts on MMT clinics with different capacities. METHODS The monthly average number of daily participants and 3-month retention rate from 2013 to 2019 were extracted from MMT databases and subjected to single interrupted time series analysis. Pre-PMES (from February 2013 to December 2018) was contrasted with post-PMES, either from January 2019 to December 2019 for clinics funded solely by the PMES or from January 2019 to August 2019 for clinics with additional MCAM. Pre-MCAM (from January 2019 to August 2019) was contrasted with post-MCAM (from September 2019 to December 2019). Based on the monthly average number of daily patients in 2018, each MMT clinic was categorized as tiny (1-50), small (51-100), medium (101-150), or large (151-700) for subsequent stratification analysis. RESULTS In terms of participant numbers after the PMES intervention, a level elevation and slope increase were detected in the clinics at every scale except medium in MMT clinics funded solely by PMES. In MMT clinics with subsequent MCAM, a level elevation was only detected in small-scale clinics, and a slope increase in the participant numbers was detected in tiny- and small-scale clinics. The slope decrease was also detected in medium-scale clinics. In terms of the 3-month retention rate, a post-PMES level elevation was detected at almost every scale of the clinics, and a slope decrease was detected in the overall and tiny-scale clinics for both types of clinics. CONCLUSIONS Supplementing the cost of a broad treatment repertoire enhances the enrollment of people with heroin use in MMTs. Further funding of human resources is vital for MMT clinics to keep up with the increasing numbers of participants and their retention.
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Affiliation(s)
- Yu-Chu Ella Chung
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chieh-Liang Huang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Lian-Yu Chen
- Department of Mental Health, Ministry of Health and Welfare, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei J Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Hall NY, Le L, Abimanyi-Ochom J, Mihalopoulos C. Measuring the importance of different barriers to opioid agonist treatment using best-worst scaling in an Australian setting. Health Policy 2023; 138:104939. [PMID: 37949002 DOI: 10.1016/j.healthpol.2023.104939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Opioid agonist treatment (OAT) is an effective treatment for opioid use disorder (OUD), however several client barriers to OAT are reported. Client importance of these barriers using economic preference elicitation measures have not been identified. This paper determines the most important OAT barriers using best-worst scaling (BWS) and compares the results of BWS to Likert scale. METHODS Cross-sectional self-completed survey with 191 opioid dependent clients who attended Australian needle and syringe sites. Participants were presented 15 Likert scale barriers and 15 BWS barrier scenarios. The BWS data was presented using count analysis, multinomial logit and mixed logit models. The ranking of barrier items was completed using three BWS methods and one Likert scale method, with share preference results (BWS) or mean scores (Likert) used to rank the 15 barriers. RESULTS The most important client barriers were 'enjoy using opioids', 'lack of support services' and 'hard to access'. The four ranking methods produced different barrier rankings for the most important barriers, but similar results for the least important barriers. CONCLUSION Policies around OAT as a harm reduction approach, increased support services and increased availability of OAT services would be beneficial in improving OAT uptake. Comparing BWS and Likert methods produced different highest ranked barriers, indicating the method used to identify preferences has significant implications on the type of intervention prioritised.
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Affiliation(s)
| | - Long Le
- Public Health and Preventative Medicine, Monash University, Australia
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Hall NY, Le L, Abimanyi-Ochom J, Teesson M, Mihalopoulos C. Identifying the most common barriers to opioid agonist treatment in an Australian setting. Aust J Prim Health 2023; 29:445-454. [PMID: 36934460 DOI: 10.1071/py22269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/20/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Opioid use disorder is a public health concern in Australia. Opioid agonist treatment (OAT) is effective at treating and minimising harm from opioid use disorder, yet is underused in Australia due to client barriers. Although these barriers have been reported, the barriers that are most important to clients is unclear. The aim of this paper was to determine the most important OAT barriers to Australian clients. METHODS A cross-sectional, self-completed survey was given to 204 opioid-dependent clients who attended needle and syringe sites in Australia. Participants were given 15 OAT barrier statements, which they answered using a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree and 5=strongly agree). The Likert scale data are presented using the count method and the mean Likert scores (for the whole sample and for subgroups). RESULTS The two methods determined that the four most important barriers to OAT were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescription opioids (compared with heroin) were female or non-binary (compared with male), were not currently using OAT (compared with current OAT), were younger (compared with older) and had high dependence scores (compared with low dependence scores) were impacted more by certain OAT barriers. CONCLUSIONS Policies around improving support services, reducing stigma and increasing flexibility would be beneficial to reduce barriers to OAT in Australia. Second, certain groups were more vulnerable to OAT barriers, emphasising the importance to better tailor opioid treatment programs to these specific populations to increase treatment engagement.
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Affiliation(s)
- Natasha Yvonne Hall
- School of Health and Social Development, Deakin University, Burwood, Vic., Australia
| | - Long Le
- Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia
| | - Julie Abimanyi-Ochom
- School of Health and Social Development, Deakin University, Burwood, Vic., Australia
| | - Maree Teesson
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Cathy Mihalopoulos
- Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia
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Thakrar AP, Pytell JD, Stoller KB, Walters V, Weiss RD, Chander G. Transitioning off methadone: A qualitative study exploring why patients discontinue methadone treatment for opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209055. [PMID: 37088398 PMCID: PMC10330232 DOI: 10.1016/j.josat.2023.209055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Patients who discontinue methadone for opioid use disorder are at increased risk of overdose and death. We know little about how patients make the decision to stop treatment. This study explored reasons why patients discontinue methadone treatment. METHODS We conducted 20 individual semi-structured patient interviews and two staff focus groups, each with five participants, at two opioid treatment programs in Baltimore, MD, in the United States from June 2021 to May 2022. Patient interviews and staff focus groups covered three domains: 1) reasons why patients may want to discontinue methadone; 2) perspectives about the ideal length of methadone treatment; and 3) changes that could improve retention. We used a modified grounded theory approach to code interviews, identify emergent themes, and develop a conceptual model. RESULTS We identified three themes related to patients' internal relationships to methadone: patients (1) viewed methadone as a bridge to opioid-free recovery, (2) believed that long-term methadone damages the body, and (3) felt that methadone increases craving for cocaine; and three themes related to their external relationships with opioid treatment programs and society at large: patients (4) viewed daily dosing as burdensome, (5) feared methadone inaccessibility could trigger relapse, and (6) experienced stigma from friends, family, and peers. Patients with internal reasons planned to stop as soon as possible and asked for education about perceived side effects and treatment for cocaine craving to promote retention. Patients with external reasons were willing to continue for longer and asked for adaptive take-home policies and reduced societal stigma around methadone. CONCLUSIONS Patients want to discontinue methadone either because of their internal relationship to methadone and its real or perceived side effects, or because of their external experiences with opioid treatment programs and societal stigma of methadone. To improve retention, clinical and policy changes should consider responses to both of these categories of reasons.
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Affiliation(s)
- Ashish P Thakrar
- National Clinician Scholars Program at the Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, United States of America; Leonard Davis Institute of Health Economics University of Pennsylvania, Philadelphia, United States of America.
| | - Jarratt D Pytell
- Department of Medicine, University of Colorado School of Medicine, Aurora, United States of America.
| | - Kenneth B Stoller
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States of America.
| | | | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Geetanjali Chander
- Department of Medicine, University of Washington, United States of America.
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Choi S, O’Grady MA, Cleland CM, Knopf E, Hong S, D’Aunno T, Bao Y, Ramsey KS, Neighbors CJ. Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes. PLoS One 2023; 18:e0286859. [PMID: 37294821 PMCID: PMC10256218 DOI: 10.1371/journal.pone.0286859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. METHODS AND ANALYSIS We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases-Medicaid, treatment registry, THD reporting-with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. DISCUSSION This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE-particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Elizabeth Knopf
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Sueun Hong
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Thomas D’Aunno
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports (OASAS), New York, NY, United States of America
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
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Adams A, Blawatt S, MacDonald S, Finnick R, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. Provider experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic: A qualitative systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104058. [PMID: 37182352 PMCID: PMC10165059 DOI: 10.1016/j.drugpo.2023.104058] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Historical restrictions on take-home medications for opioid use disorder have generated considerable debate. The COVID-19 pandemic shifted the perceived risks and benefits of daily clinic attendance and led to widespread policy reform, creating an unprecedented opportunity to explore the impact of more flexible prescribing. We conducted a qualitative systematic review to synthesize the evidence on providers' experiences with relaxing restrictions on take-home doses of medications prescribed for opioid use disorder during the COVID-19 pandemic. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42022360589; https://www.crd.york.ac.uk/prospero/). From Sept.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, the Cochrane Register of Controlled Trials, and the grey literature from 2020 onward. Studies were eligible for inclusion if they used qualitative methods to investigate providers' experiences with relaxed restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic. We appraised study quality using the CASP qualitative checklist and used thematic synthesis and GRADE-CERQual to synthesize the results. RESULTS We retrieved 13 articles representing 11 studies. Six were conducted in the United States and most focused on changes to methadone treatment. Providers' experiences with increased flexibilities around take-homes were broadly positive, despite widespread initial concern over client safety and the potential for medication misuse. For a small number of providers, concerns about diversion were a specific manifestation of more general unease with loss of control over clients and the treatment process. Most providers appreciated increased flexibilities and described them as enabling more individualized, person-centered care. CONCLUSION Our findings support the continuation of flexibilities around take-homes and demonstrate that regulations and policies that reduce flexibility around take-homes conflict with person-centered approaches to care. Stronger guidance and support from professional regulatory agencies may help increase uptake of flexibilities around take-homes.
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Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Rhys Finnick
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC V6H 4C1, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
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Scott G, Turner S, Lowry N, Hodge A, Ashraf W, McClean K, Kelleher M, Mitcheson L, Marsden J. Patients' perceptions of self-administered dosing to opioid agonist treatment and other changes during the COVID-19 pandemic: a qualitative study. BMJ Open 2023; 13:e069857. [PMID: 36944465 PMCID: PMC10032386 DOI: 10.1136/bmjopen-2022-069857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES During the COVID-19 pandemic, addiction treatment services received official guidance asking them to limit face-to-face contact with patients and to prescribe opioid agonist treatment (OAT) medication flexibly. With the aim for most patients to receive take-home supplies for self-administration rather than attendance for observed daily dosing. DESIGN This was a theory-driven, clinically applied qualitative study, with data for thematic analysis collected by semi-structured, audio-recorded, telephone interviews. PARTICIPANTS Twenty-seven adults (aged ≥18 years) enrolled in sublingual (tablet) buprenorphine and oral (liquid) methadone OAT. SETTING Community addictions centre in the London Borough of Lambeth operated by South London and Maudsley NHS Trust. RESULTS Three major themes were identified: (1) dissatisfaction and perceived stigma with OAT medication dispensing arrangements before the pandemic; (2) positive adaptations in response to COVID-19 by services; (3) participants recommended that, according to preference and evidence of adherence, OAT should be personalised to offer increasing medication supplies for self-administration from as early as 7 days after commencement of maintenance prescribing. CONCLUSIONS In an applied qualitative study of patients enrolled in OAT during the COVID-19 pandemic, participants endorsed their opportunity to take medication themselves at home and with virtual addiction support. Most patients described a preference for self-administration with increased dispensing supplies, from as early as 7 days into maintenance treatment, if they could demonstrate adherence to their prescription.
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Affiliation(s)
- Gemma Scott
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sophie Turner
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
| | - Natalie Lowry
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Annette Hodge
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
| | - Waniya Ashraf
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
| | - Katie McClean
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mike Kelleher
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
| | - Luke Mitcheson
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
| | - John Marsden
- Lambeth Addiction, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Yan R, Liu J, Dong Z, Peng Q. Nanomaterials-mediated photodynamic therapy and its applications in treating oral diseases. BIOMATERIALS ADVANCES 2022; 144:213218. [PMID: 36436431 DOI: 10.1016/j.bioadv.2022.213218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Oral diseases, such as dental caries, periodontitis and oral cancer, have a very high morbidity over the world. Basically, many oral diseases are commonly related to bacterial infections or cell malignant proliferation, and usually located on the superficial positions. These features allow the convenient and efficient application of photodynamic therapy (PDT) for oral diseases, since PDT is ideally suitable for the diseases on superficial sites and has been widely used for antimicrobial and anticancer therapy. Photosensitizers (PSs) are an essential element in PDT, which induce the generation of a large number of reactive oxygen species (ROS) upon absorption of specific lights. Almost all the PSs are small molecules and commonly suffered from various problems in the PDT environment, such as low solubility and poor stability. Recently, reports on the nanomedicine-based PDT have been well documented. Various functionalized nanomaterials can serve either as the PSs carriers or the direct PSs, thus enhancing the PDT efficacy. Herein, we aim to provide a comprehensive understanding of the features of different oral diseases and discuss the potential applications of nanomedicine-based PDT in the treatment of some common oral diseases. Also, the concerns and possible solutions for nanomaterials-mediated PDT are discussed.
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Affiliation(s)
- Ruijiao Yan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jianhong Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zaiquan Dong
- Mental Health Center of West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Qiang Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Watson DP, Staton MD, Grella CE, Scott CK, Dennis ML. Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic. Subst Abuse Treat Prev Policy 2022; 17:22. [PMID: 35303913 PMCID: PMC8931576 DOI: 10.1186/s13011-022-00449-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.
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Affiliation(s)
- Dennis P. Watson
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Monte D. Staton
- grid.185648.60000 0001 2175 0319Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL 60613 USA
| | - Christine E. Grella
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Christy K. Scott
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Michael L. Dennis
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761 USA
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10
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Meacham MC, Nobles AL, Tompkins DA, Thrul J. "I got a bunch of weed to help me through the withdrawals": Naturalistic cannabis use reported in online opioid and opioid recovery community discussion forums. PLoS One 2022; 17:e0263583. [PMID: 35134074 PMCID: PMC8824349 DOI: 10.1371/journal.pone.0263583] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
A growing body of research has reported on the potential opioid-sparing effects of cannabis and cannabinoids, but less is known about specific mechanisms. The present research examines cannabis-related posts in two large online communities on the Reddit platform (“subreddits”) to compare mentions of naturalistic cannabis use by persons self-identifying as actively using opioids versus persons in recovery. We extracted all posts mentioning cannabis-related keywords (e.g., “weed”, “cannabis”, “marijuana”) from December 2015 through August 2019 from an opioid use subreddit and an opioid recovery subreddit. To investigate how cannabis is discussed at-scale, we identified and compared the most frequent phrases in cannabis-related posts in each subreddit using term-frequency-inverse document frequency (TF-IDF) weighting. To contextualize these findings, we also conducted a qualitative content analysis of 200 random posts (100 from each subreddit). Cannabis-related posts were about twice as prevalent in the recovery subreddit (n = 908; 5.4% of 16,791 posts) than in the active opioid use subreddit (n = 4,224; 2.6% of 159,994 posts, p < .001). The most frequent phrases from the recovery subreddit referred to time without using opioids and the possibility of using cannabis as a “treatment.” The most frequent phrases from the opioid subreddit referred to concurrent use of cannabis and opioids. The most common motivations for using cannabis were to manage opioid withdrawal symptoms in the recovery subreddit, often in conjunction with anti-anxiety and GI-distress “comfort meds,” and to enhance the “high” when used in combination with opioids in the opioid subreddit. Despite limitations in generalizability from pseudonymous online posts, this examination of reports of naturalistic cannabis use in relation to opioid use identified withdrawal symptom management as a common motivation. Future research is warranted with more structured assessments that examines the role of cannabis and cannabinoids in addressing both somatic and affective symptoms of opioid withdrawal.
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Affiliation(s)
- Meredith C. Meacham
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - Alicia L. Nobles
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - D. Andrew Tompkins
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States of America
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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11
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Andersson L. A transition of power in opioid substitution treatment: Clinic managers' views on the consequences of a patient choice reform. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:279-300. [PMID: 35720521 PMCID: PMC9152230 DOI: 10.1177/14550725221075003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: Opioid substitution treatment (OST) is often described as a strict and highly regulated treatment method, in which patients have limited influence over their treatment. In 2014, a reform was introduced by the regional council of Skåne in southern Sweden, which allowed OST patients to choose their treatment provider, thus transferring power from care providers to patients. The aim of this study was to examine what this increase in patient influence has meant for the clinics that provide OST in Skåne, and how these clinics have dealt with the new competitive situation that has arisen following the introduction of the reform. Methods: The study is based on two waves of semi-structured interviews with clinic managers at all OST clinics in Skåne. Results: The clinic managers described the increase in patient influence as a positive change, which had led to the patients being treated with more respect. The competition among clinics was expressed, among other things, in the form of differing views on the prescription of benzodiazepines, which initially gave rise to dissatisfaction among clinics with a more restrictive approach to such prescriptions. The reform did not lead to any clear diversity between clinics, apart from different approaches to the prescription of benzodiazepines. The incentive for competition-based diversity is, however, limited by the strict national regulatory system and by the reimbursement system, which restricts the ways in which clinics can conduct treatment activities. Conclusion: OST-clinic managers were largely positive about the increased patient empowerment and the shift in power balance associated with the patient choice reform. The introduction of the reform did not lead to any clear diversity between treatment providers, apart from differing views on the prescription of benzodiazepines, which by some managers was regarded as unfair competition.
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12
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Welsh C, Doyon S, Hart K. Methadone Exposures Reported to Poison Control Centers in the United States Following the COVID-19-Related Loosening of Federal Methadone Regulations. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103591. [PMID: 35085855 PMCID: PMC8769878 DOI: 10.1016/j.drugpo.2022.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Abstract
Background Methods Results Conclusions
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13
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Kiang MV, Barnett ML, Wakeman SE, Humphreys K, Tsai AC. Robustness of estimated access to opioid use disorder treatment providers in rural vs. urban areas of the United States. Drug Alcohol Depend 2021; 228:109081. [PMID: 34600256 PMCID: PMC8595811 DOI: 10.1016/j.drugalcdep.2021.109081] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Effective, evidence-based treatments for opioid use disorder are not equally accessible to Americans. Recent studies have found urban/rural disparities in the driving times to the nearest opioid treatment providers. These disparities may be even worse than currently reported in the literature because patients may not be able to obtain appointments with their nearest provider. We examine the robustness of the opioid treatment infrastructure by estimating how driving times to treatment change as provider availability decreases. METHODS We used public data from the federal government to estimate the driving time from each census tract centroid to the nearest 15 treatment providers. We summarized the median and interquartile range of driving times to increasingly distant providers (i.e., nearest, second nearest, etc.), stratified by urban/rural classification. RESULTS The median driving time to the nearest provider was greater in rural areas than urban areas for both opioid treatment programs (12 min vs 61 min) and buprenorphine-waivered prescribers (5 min vs 21 min). Importantly, driving times in rural areas increased more steeply as nearer providers became unavailable. For example, the increase in driving time between the nearest provider and the fifth nearest provider was much greater in rural areas than in urban areas for both buprenorphine-waivered prescribers (23 min vs 4 min) and for opioid treatment programs (54 min vs 22 min). CONCLUSIONS Access to treatment for opioid use disorder is more robust in urban areas compared with rural areas. This disparity must be eliminated if the opioid overdose crisis is to be resolved.
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Affiliation(s)
- Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA,Correspondence: Mathew V. Kiang, ScD, Stanford University School of Medicine, Center for Population Health Sciences, 1701 Page Mill Road, Palo Alto, California 94304,
| | - Michael L. Barnett
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E. Wakeman
- Harvard Medical School, Boston, Massachusetts, USA,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA,Veterans Affairs Health Care System, Palo Alto, California, USA
| | - Alexander C. Tsai
- Harvard Medical School, Boston, Massachusetts, USA,Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts USA
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14
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Treatment-seeking behaviour among people with opioid use disorder in the high-income countries: A systematic review and meta-analysis. PLoS One 2021; 16:e0258620. [PMID: 34653220 PMCID: PMC8519451 DOI: 10.1371/journal.pone.0258620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 09/01/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives To determine treatment seeking behaviour in those with opioid use disorder (OUD) in the high-income countries. Methods Five databases were searched in November 2019 for quantitative studies that reported OUD treatment seeking behaviour. Data analysis involved determining an overall pooled proportion estimate of treatment seeking behaviour for the two base groups, lifetime treatment and past 12-month or less treatment using the IVhet effect model. Subgroup analysis included heroin OUD, prescription OUD and general OUD. The sensitivity analysis included removal of outliers, separating adults and adolescents and the metaXL sensitivity analysis (studies are excluded if outside the pooled proportion confidence interval of the base case). Systematic review Prospero database registration number [CRD42020159531]. Results There were 13 quantitative studies included in the systematic review, with all studies being from the United States of America (USA). IVhet models showed that 40% (95% CI: 23%, 58%) and 21% (95% CI: 16%, 26%) sought treatment in their lifetime and past 12 months respectively. Sub-group analysis found that lifetime treatment seeking for prescription OUD, 29% (95% CI: 27%, 31%), was less than for heroin plus combined OUD, 54% (95% CI: 26%, 82%). Most of the pooled results had high heterogeneity statistics except for results of lifetime treatment seeking for prescription OUD and past 12-month treatment seeking for prescription OUD. Conclusion All included studies in this meta-analysis were from the USA and indicate modest levels of treatment seeking for those with OUD. In particular, this review found that in the USA one in five people with OUD sought OUD treatment in the previous 12 months and two in five people with OUD sought OUD treatment in their lifetime. Further research is urgently required to explore the barriers and facilitators that can improve this low treatment seeking in those with OUD.
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15
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Lukey R, Gray B, Morris C. 'We're just seen as people that give out the methadone…': exploring the role of community pharmacists in the opioid substitution treatment team. J Prim Health Care 2021; 12:358-367. [PMID: 33349324 DOI: 10.1071/hc20108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION People receiving opioid substitution treatment are a vulnerable population who experience significant health inequities and stigma, but have regular interactions with community pharmacists. Many pharmacists now work collaboratively with other health providers to ensure effective and safe use of medicines, as well as being involved in the prevention and management of chronic health conditions. AIM To explore the role of New Zealand community pharmacists in the provision of opioid substitution treatment and how they perceive their role as part of the wider opioid substitution treatment team. METHODS Semi-structured video interviews with a purposive sample of 13 diverse pharmacists explored their current practices in providing opioid substitution treatment, and their perceived role in the treatment team. Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed using an inductive thematic approach. RESULTS This study found that pharmacists are providing accessible support to a population with known barriers to accessing health care. However, participants also identified challenges with communication and a perceived lack of understanding of the pharmacist role as barriers to collaboration with the wider opioid substitution treatment team. DISCUSSION Collaboration within health-care teams has been shown to improve health outcomes, and pharmacists are well placed to provide health-care services as well as offer valuable insight into clients' mental and physical wellbeing. Improved communication channels that facilitate information sharing, as well as the opioid substitution treatment team's recognition of a pharmacist's role, may facilitate collaboration and, in turn, improve the quality of health care provided to this vulnerable population.
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Affiliation(s)
- Rebecca Lukey
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand; and Corresponding author.
| | - Ben Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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16
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Lachapelle É, Archambault L, Blouin C, Perreault M. Perspectives of people with opioid use disorder on improving addiction treatments and services. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2020.1833837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | - Michel Perreault
- Douglas Hospital Research Centre, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
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17
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Marchand K, Palis H, Guh D, Lock K, MacDonald S, Brissette S, Marsh DC, Harrison S, Schechter MT, Oviedo-Joekes E. A multi-methods and longitudinal study of patients' perceptions in injectable opioid agonist treatment: Implications for advancing patient-centered methodologies in substance use research. J Subst Abuse Treat 2021; 132:108512. [PMID: 34098207 DOI: 10.1016/j.jsat.2021.108512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/13/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients' perceptions are vital to the delivery and evaluation of substance use treatment. They are most frequently collected at one time-point and measured using patient satisfaction questionnaires or qualitative methodologies. Interestingly, the findings of these studies often diverge, as satisfaction scores tend to be highly positive, while qualitative findings suggest dissatisfaction and areas for improvement. This divergence limits current understandings of patients' perceptions and their potential change over time in treatment. OBJECTIVE This study explores the relationship between open-ended positive and negative perceptions of treatment and patient satisfaction scores over time. METHODS The RUTH (Research on the Utilization of Therapeutic Hydromorphone) prospective cohort study included 131 participants receiving injectable diacetylmorphine or hydromorphone in Canada's first injectable opioid agonist treatment (iOAT) program. The study collected the Client Satisfaction Questionnaire (CSQ-8) at eight time-points over an 18-month period. Following a multi-methods approach, the study complemented the CSQ-8 with open-ended positive and negative comments of iOAT. The research team analyzed these comments thematically at each time-point to develop positive and negative perception themes. We then used growth curve modeling to explore the relationship between positive and negative perception themes and patient satisfaction over time. FINDINGS Over the eight time-points, six positive and eight negative perception themes emerged, broadly reflecting structural (e.g., expansion of iOAT), process (e.g., schedules), relational (e.g., interactions with providers), and outcome-related (e.g., met/unmet needs) perceptions of iOAT. On average, participants reported high satisfaction (grand mean = 29.2 out of 32), and scores did not significantly change over time. However, we did find significant unexplained variation within participants in their satisfaction trajectories and between participants in their initial satisfaction scores. In conditional growth curve models, the theme "unfavorable interactions with providers" had the strongest independent effect on overall satisfaction trajectories. CONCLUSIONS This study provides an example of how open-ended comments can be integrated with patient satisfaction questionnaire data to gather a comprehensive and patient-centered evaluation of substance use treatment. Considering the iOAT context specifically, relational dynamics and daily treatment access were significant predictors of patient satisfaction over time and may be attributes of iOAT that require further investigation.
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Affiliation(s)
- Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Suzanne Brissette
- Centre Hospitalier de l'Université de Montréal (CHUM), 1000 Sanguinet, Montréal, QC H2X 0C1, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada; Canadian Addiction Treatment Centres, 300-175 Commerce Valley West, Markham, ON L3T 7P6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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18
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Watson DP, Weathers T, McGuire A, Cohen A, Huynh P, Bowes C, O’Donnell D, Brucker K, Gupta S. Evaluation of an emergency department-based opioid overdose survivor intervention: Difference-in-difference analysis of electronic health record data to assess key outcomes. Drug Alcohol Depend 2021; 221:108595. [PMID: 33610095 PMCID: PMC8026710 DOI: 10.1016/j.drugalcdep.2021.108595] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years, a number of emergency department (ED)-based interventions have been developed to provide supports and/or treatment linkage for people who use opioids. However, there is limited research supporting the effectiveness of the majority of these interventions. Project POINT is an ED-based intervention aimed at providing opioid overdose survivors with naloxone and recovery supports and connecting them to evidence-based medications for opioid use disorder (MOUD). An evaluation of POINT was conducted. METHODS A difference-in-difference analysis of electronic health record data was completed to understand the difference in outcomes for patients admitted to the ED when a POINT staff member was working versus times when they were not. The observation window was January 1, 2012 to July 6, 2019, which included N = 1462 unique individuals, of which 802 were in the POINT arm. Outcomes of focus include MOUD opioid prescriptions dispensed, active non-MOUD opioid prescriptions dispensed, naloxone access, and drug poisonings. RESULTS The POINT arm had a significant increase in MOUD prescriptions dispensed, non-MOUD prescriptions dispensed, and naloxone access (all p-values < 0.001). There was no significant effect related to subsequent drug poisoning-related hospital admissions. CONCLUSIONS The results support the assertion that POINT is meeting its two primary goals related to increasing naloxone access and connecting patients to MOUD. Generalization of these results is limited; however, the evaluation contributes to a nascent area of research and can serve a foundation for future work.
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Affiliation(s)
- Dennis P. Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W. Walton St., Chicago, IL 60610
| | - Tess Weathers
- Indiana University Richard M. Fairbanks School of Public Health, Department of Social and Behavioral Sciences, 1050 Wishard Blvd., Indianapolis, IN, 46202, United States.
| | - Alan McGuire
- Richard L. Roudebush VAMC, Health Services Research and Development, 1481 W. 10th St (11H) Rm. C8108, Indianapolis, IN, 46202, United States; Indiana University Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., Indianapolis, IN, 46202, United States.
| | - Alex Cohen
- GiveWell, 1714 Franklin Street, Oakland, CA, 94612, United States.
| | - Philip Huynh
- Wayne State University, School of Social Work, Center for Behavioral Health and Justice, 5201 Cass Avenue Suite 226, Detroit, MI, 48202, United States.
| | - Clay Bowes
- Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, United States.
| | - Daniel O’Donnell
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Ave., Indianapolis, IN 46202
| | | | - Sumedha Gupta
- Department of Economics, Indiana University Purdue University Indianapolis, United States.
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19
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Hall NY, Le L, Majmudar I, Mihalopoulos C. Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective. Drug Alcohol Depend 2021; 221:108651. [PMID: 33667783 DOI: 10.1016/j.drugalcdep.2021.108651] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To update the existing evidence to identify specific barriers to initiation of opioid substitution therapy (OST) for those with opioid use disorder (OUD). METHODS The review follows Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA) guidelines. Six databases were initially searched in November 2019, with the search updated on 11 November 2020, for qualitative or quantitative studies reporting the barriers to initiating OST from the client with OUD perspective. Thematic analysis of the barriers to OST was undertaken to determine barrier themes and subthemes. RESULTS There were 37 studies included in the review; 18 were qualitative, 15 were quantitative and four were mixed methods. The barrier themes identified were stigma and fear, regulatory, logistical, attitudinal and social factors. Within these barrier themes 19 barrier subthemes were identified. The most reported OST barrier subthemes were negative treatment perceptions, cost, stigma and lack of flexibility. CONCLUSION This review discusses important barriers to OST and examines reported barriers from the client perspective. OST guidelines and programs would benefit by introducing programs that reduce stigma, increase treatment knowledge and health literacy, reduce treatment costs, increase treatment flexibility and allow for easier treatment access.
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Affiliation(s)
- Natasha Yvonne Hall
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Long Le
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Ishani Majmudar
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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20
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Curcija K, Zittleman L, Fisher M, Nease DE, Dickinson LM, de la Cerda D, Sutter C, Ancona J, Rank J, Westfall JM. Does a Rural Community-Based Intervention Improve Knowledge and Attitudes of Opioid Use Disorder and Medication-Assisted Treatment? A Report From the IT MATTTRs Study. J Rural Health 2020; 38:120-128. [PMID: 33244841 PMCID: PMC9290687 DOI: 10.1111/jrh.12545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose Understanding knowledge of and attitudes toward medication‐assisted treatment (MAT) for opioid use disorder (OUD) is important to changing the conversation about this devastating public health problem. While several studies report clinician knowledge and attitudes and training, less is known about community member perspectives. As part of the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study (IT MATTTRs), this study describes the implementation of community‐based interventions developed by rural community members and researchers to increase awareness and promote positive attitudes toward MAT for OUD and explores changes in community members’ OUD and MAT knowledge and beliefs. Methods Using the Boot Camp Translation process, the High Plains Research Network and Colorado Research Network MAT Advisory Councils developed multicomponent interventions on MAT for OUD. Baseline and postintervention surveys were administered using venue‐based sampling of community members in rural communities. Findings Surveys were completed by 789 community members at baseline and 798 at postintervention. Nearly half (49%) reported exposure to at least 1 intervention product. Greater exposure to intervention materials was associated with beliefs that using opioids to get high in rural communities is a problem (P < .0001), that opioid addiction is a chronic disease (P = .0032), and that OUD can be treated locally (P = .0003). Conclusions Partnering with local community members resulted in the successful development and implementation of community‐based interventions, exposure to which was associated with OUD knowledge and beliefs. Locally created interventions should be included in comprehensive approaches to stem the OUD epidemic.
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Affiliation(s)
- Kristen Curcija
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mary Fisher
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Donald E Nease
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - L Miriam Dickinson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Dionisia de la Cerda
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christin Sutter
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jen Ancona
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - James Rank
- High Plains Research Network Community Advisory Council, Colorado, USA
| | - John M Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Robert Graham Center, Washington, DC, USA
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21
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Trujols J, Larrabeiti A, Sànchez O, Madrid M, De Andrés S, Duran-Sindreu S. Increased flexibility in methadone take-home scheduling during the COVID-19 pandemic: Should this practice be incorporated into routine clinical care? J Subst Abuse Treat 2020; 119:108154. [PMID: 33032860 PMCID: PMC7532346 DOI: 10.1016/j.jsat.2020.108154] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/12/2020] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
Abstract
In the context of the COVID-19 pandemic and the state of emergency that the government of Spain declared, the rapid adaptation of health services is of paramount importance to preserve access to and continuity of service delivery. This research note underscores the importance of ensuring a sufficient quantity of methadone take-home doses for patients on methadone maintenance treatment (MMT) to maximize their adherence to government-imposed lockdown restrictions and social distancing measures designed to curtail the spread of SARS-CoV-2. We evaluate the impact of COVID-19 on take-home medication (number of days provided) in a methadone clinic in Barcelona (Catalonia, Spain). This work conveys that we should consider maintaining the take-home practices that we adopted in response to the pandemic, even after the pandemic has abated.
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Affiliation(s)
- Joan Trujols
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Antonio Larrabeiti
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Oriol Sànchez
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Maite Madrid
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Sandra De Andrés
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Santiago Duran-Sindreu
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Smith LR, Mittal ML, Wagner K, Copenhaver MM, Cunningham CO, Earnshaw VA. Factor structure, internal reliability and construct validity of the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS). Addiction 2020; 115:354-367. [PMID: 31478272 PMCID: PMC7089617 DOI: 10.1111/add.14799] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/07/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Experience of stigma towards methadone maintenance treatment (MMT) may be a barrier to the use of this treatment by people with opioid use disorder. We evaluated the factor structure, internal reliability, construct and criterion validity of a theory-based stigma measure, the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS) and compared this with the Substance Use Stigma Mechanism Scale (SU-SMS). DESIGN Surveys at the beginning and end of a prospective study together with records of drug use and treatment attendance during that study. SETTING Community methadone clinic in the Northeastern USA. PARTICIPANTS Ninety-three participants who were receiving MMT; the average daily methadone dose was 84.8 mg/day (standard deviation = 28.39 mg/day). MEASUREMENTS The MMT-SMS uses a self-report questionnaire to assess three dimensions reflecting experiences of anticipated (nine items), enacted (nine items) and internalized stigma (seven items) specifically related to receiving MMT. Anticipated and enacted scales include three stigma source subscales (family, employers, health care workers; three items each). Responses are recorded on a five-point Likert-type scale, then averaged to produce the MMT-SMS scale/subscale scores. The SU-SMS is a self-report questionnaire to assess experiences of anticipated, enacted and internalized stigma regarding substance use history. Both scales were administered at the final parent study visit. Other measures included were assessed in the parent study and used to assess life-time and recent MMT (e.g. current MMT dose) and drug use experiences (e.g. past 30-day heroin injection). FINDINGS The MMT-SMS demonstrated good internal reliability (α = 0.806-0.952 for components). Confirmatory factor analysis supported the seven-factor scale structure, distinguishing between experiences of anticipated, enacted and internalized stigma, and anticipated and enacted stigma source subscales (family, employers, health care workers) [root mean square error of approximation (RMSEA) = 0.076, 90% confidence interval (CI) = 0.061-0.090, P-close = 0.003; confirmatory fit index (CFI) = 0.974; Tucker-Lewis index (TLI) = 0.971]. Construct validity helped to distinguish the MMT-SMS from established substance use stigma constructs. Criterion validity observed associations with substance use experiences while on MMT, likely to predict future MMT success. Internalized MMT stigma was uniquely associated with daily MMT dose. Regarding criterion validity: anticipated MMT and enacted substance use stigma were associated with past 30-day heroin injection, MMT stigma uniquely associated with opioid use behaviors while receiving MMT, and substance use stigma broadly associated with injection-related behaviors. CONCLUSIONS The Methadone Maintenance Treatment Stigma Mechanisms Scale appears to be a reliable measure of methadone maintenance treatment stigma with robust validity in a sample of people with opioid use disorders receiving methadone maintenance treatment.
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Affiliation(s)
- Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Karla Wagner
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | | | - Chinazo O Cunningham
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
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Marchand K, Foreman J, MacDonald S, Harrison S, Schechter MT, Oviedo-Joekes E. Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment. Subst Abuse Treat Prev Policy 2020; 15:7. [PMID: 31959189 PMCID: PMC6971856 DOI: 10.1186/s13011-020-0253-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants' experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants' self-reported treatment outcomes. METHODS A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America's first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved. RESULTS "Building healthcare provider relationships for patient-centered care in iOAT" was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: 'Opening up' was attributed to the positive environment, and to feeling understood and supported by healthcare providers. 'Being a part of care' emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs. CONCLUSIONS The core concept suggested that therapeutic relationships were fundamental to experiences of patient-centered care in iOAT. When relationships were respectful and understanding, participants received individualized and holistic care in iOAT. These findings offer a valuable example of how therapeutic relationships can be strengthened in other substance use treatment settings, particularly when responding to the diverse treatment needs of clients.
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Affiliation(s)
- Kirsten Marchand
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Julie Foreman
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
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Lea T, Amada N, Jungaberle H, Schecke H, Klein M. Microdosing psychedelics: Motivations, subjective effects and harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 75:102600. [PMID: 31778967 DOI: 10.1016/j.drugpo.2019.11.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/11/2019] [Accepted: 11/10/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND In recent years there has been growing media attention on microdosing psychedelics (e.g., LSD, psilocybin). This refers to people routinely taking small doses of psychedelic substances to improve mental health and wellbeing, or to enhance cognitive performance. Research evidence is currently limited. This paper examines microdosing motivations, dosing practices, perceived short-term benefits, unwanted effects, and harm reduction practices. METHODS An international online survey was conducted in 2018 examining people's experiences of using psychedelics. Eligible participants were aged 16 years or older, had used psychedelics and could comprehend written English. This paper focuses on 525 participants who were microdosing psychedelics at the time of the survey. RESULTS Participants were primarily motivated to microdose to improve mental health (40%), for personal development (31%) and cognitive enhancement (18%). Most were microdosing with psilocybin (55%) or LSD/1P-LSD (48%). Principal components analysis generated three factors examining perceived short-term benefits of microdosing: improved mood and anxiety, enhanced connection to others and environment, and cognitive enhancement; and three factors examining negative and potentially unwanted effects: stronger-than-expected psychedelic effects, anxiety-related effects, and physical adverse effects. Most participants (78%) reported at least one harm reduction practice they routinely performed while microdosing. CONCLUSION Our findings suggest that people microdosing are commonly doing so as a self-managed therapy for mental health, either as an alternative or adjunct to conventional treatments. This is despite psychedelics remaining prohibited substances in most jurisdictions. Recent findings from clinical trials with standard psychedelic doses for depression and anxiety suggest that a neurobiological effect beyond placebo is not unreasonable. Randomised controlled trials are needed, complemented by mixed methods social science research and the development of novel resources on microdosing harm reduction.
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Affiliation(s)
- Toby Lea
- German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Wörthstr. 10, 50668 Cologne, Germany; Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia.
| | - Nicole Amada
- The Graduate Center, City University of New York, 365 5th Ave, New York, NY 10016, USA
| | - Henrik Jungaberle
- MIND Foundation, Betahaus Berlin, Rudi-Dutschke-Straße 23, 10969 Berlin, Germany
| | - Henrike Schecke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, LVR-Klinikum Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Michael Klein
- German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Wörthstr. 10, 50668 Cologne, Germany
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Ashford RD, Brown AM, Dorney G, McConnell N, Kunzelman J, McDaniel J, Curtis B. Reducing harm and promoting recovery through community-based mutual aid: Characterizing those who engage in a hybrid peer recovery community organization. Addict Behav 2019; 98:106037. [PMID: 31330467 PMCID: PMC6708724 DOI: 10.1016/j.addbeh.2019.106037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 06/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Peer-based support services are often used within harm reduction organizations, and more recently within recovery community organizations (RCO). Identifying the characteristics of individuals who engage with these novel RCOs is needed. Additionally, conducting collaborative research with communities of people who use drugs (PWUD) or are in recovery is an effective and rewarding approach that allows individuals to take ownership and play a critical role in the study. METHODS This exploratory study employs a community-based participatory research (CBPR) framework in partnership with a peer-led hybrid recovery community organization, Rebel Recovery, in Florida. Peer staff participated in all phases of the study, helping to inform the study protocol, data collection, analysis, interpretation, and results write-up. A cross-sectional survey instrument was used to collect consumer intake data. Pearson Chi-square tests and multivariate binomial logistic regressions were used to examine relationships between consumer characteristics and service utilization. RESULTS Consumers (n = 396) of Rebel Recovery peer support services had a mean age of 35.60 years (SD = 9.74). Many were experiencing homelessness (35.4%), unemployed (69.7%), high school graduates or GED holders (68.2%) and had a last year income of less than $10,000 (58.3%). The majority were users of heroin primarily (70.7%), with intravenous use being the preferred route of administration (63.9%). Exploratory analysis found that gender, marital status, and involvement in the child welfare system were significantly related to primary substance of use. Past 30-day engagement in recovery meetings had several statistically significant predictors including primary substance of use, age, housing status, annual income level, past-30-day arrests, tobacco use, and alcohol harm perception. Process findings from the CBPR methods used reconfirm the value of including peers in research involving PWUD and individuals in recovery. CONCLUSIONS Results suggest that peer-based support services at a hybrid recovery community organization can successfully engage populations that are often underserved (i.e., experiencing homelessness, involved in drug court, intravenous users, etc.). Significant relationships identified in the exploratory analysis suggest that additional education concerning overdose and the potential benefits of recovery meetings may be useful for specific consumers. Additionally, several recommendations and benefits of engaging in community-based participatory research with peer-led organizations are made for future research.
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Affiliation(s)
- Robert D Ashford
- Substance Use Disorders Institute, University of the Sciences, Philadelphia, PA, United States of America.
| | - Austin M Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | | | | | | | - Jessica McDaniel
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, United States of America.
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Ashford RD, Brown AM, McDaniel J, Neasbitt J, Sobora C, Riley R, Weinstein L, Laxton A, Kunzelman J, Kampman K, Curtis B. Responding to the opioid and overdose crisis with innovative services: The recovery community center office-based opioid treatment (RCC-OBOT) model. Addict Behav 2019; 98:106031. [PMID: 31326776 PMCID: PMC7286074 DOI: 10.1016/j.addbeh.2019.106031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/04/2019] [Accepted: 06/20/2019] [Indexed: 11/26/2022]
Abstract
Opioid use disorder (OUD) and opioid-related overdose mortality are major public health concerns in the United States. Recently, several community-based and professional innovations - including hybrid recovery community organizations, peer-based emergency department warm handoff programs, emergency department buprenorphine induction, and low-threshold OUD treatment programs - have emerged or expanded in an effort to address significant obstacles to providing patients the care needed for OUD and to reduce the risk of overdose. Additional innovations are needed to address the crisis. Building upon the foundational frameworks of each of these recent innovations, a new model of OUD pharmacotherapy is proposed and discussed: the Recovery Community Center Office-Based Opioid Treatment model. Additionally, two potential implementation scenarios, the overdose and non-overdose event protocols, are detailed for communities, peers, and practitioners interested in implementing the model. Potential barriers to implementation of the model include service reimbursement, licensing regulations, and organizational concerns. Future research should seek to validate the model and to identify actual implementation and sustainability barriers and best practices.
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Affiliation(s)
- Robert D Ashford
- University of the Sciences, Substance Use Disorders Institute, United States of America.
| | - Austin M Brown
- Kennesaw State University, Center for Young Adult Addiction & Recovery, United States of America
| | - Jessica McDaniel
- Kennesaw State University, Center for Young Adult Addiction & Recovery, United States of America
| | | | - Chad Sobora
- Missouri Network For Opiate Reform and Recovery, United States of America
| | - Robert Riley
- Missouri Network For Opiate Reform and Recovery, United States of America
| | - Lesley Weinstein
- Missouri Network For Opiate Reform and Recovery, United States of America
| | - Aaron Laxton
- Missouri Network For Opiate Reform and Recovery, United States of America
| | | | - Kyle Kampman
- University of Pennsylvania, Center for Studies of Addiction, United States of America
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, United States of America
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Watson DP, Andraka-Christou B, Clarke T, Wiegandt J. Introduction to the special issue on innovative interventions and approaches to expand medication assisted treatment: Seizing research opportunities made available by the opioid STR program. J Subst Abuse Treat 2019; 108:1-3. [PMID: 31668689 DOI: 10.1016/j.jsat.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The 21st Century Cures Act is the most significant piece of U.S. legislation aimed at tackling the opioid epidemic to date. This special issue comprises papers reflecting medication-assisted treatment (MAT)-related research made possible through the Cures Act-authorized State Targeted Response (STR) grant mechanism. Work related to both STR evaluation and original research conducted within the context of STR activities are included in the issue, with topics including community assessments of MAT-related needs, MAT access and linkage, criminal justice-oriented MAT implementation, and adjunctive MAT supports and treatments. All of the research represented this issue is early-stage, with results reflecting data collected primarily within the first of STR's two year funding cycle. While such formative work does have inherent limitations, the gravity of the opioid epidemic requires rapid assessment and dissemination of results to inform the public health response in a manner that will have a timely and meaningful impact.
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Affiliation(s)
- Dennis P Watson
- Center for Dissemination and Implementation Research, Department of Medicine, University of Illinois College of Medicine at Chicago, 818 S. Wolcott Ave., Chicago, IL 60612, United States of America.
| | - Barbara Andraka-Christou
- Department of Health Management and Informatics, University of Central Florida, 4000 Central Florida Boulevard, Orlando, FL 32816, United States of America.
| | - Thomas Clarke
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20866, United States of America.
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Davis EL, Kelly PJ, Deane FP, Baker AL, Buckingham M, Degan T, Adams S. The relationship between patient-centered care and outcomes in specialist drug and alcohol treatment: A systematic literature review. Subst Abus 2019; 41:216-231. [DOI: 10.1080/08897077.2019.1671940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Esther L. Davis
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peter J. Kelly
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank P. Deane
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Mark Buckingham
- Kedesh Rehabilitation Services, Berkeley, New South Wales, Australia
| | - Tayla Degan
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sarah Adams
- Illawarra Shoalhaven Local Health District Drug & Alcohol Service, Wollongong, New South Wales, Australia
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Lee CS, Rosales R, Stein MD, Nicholls M, O'Connor BM, Loukas Ryan V, Davis EA. Brief Report: Low-Barrier Buprenorphine Initiation Predicts Treatment Retention Among Latinx and Non-Latinx Primary Care Patients. Am J Addict 2019; 28:409-412. [PMID: 31251426 DOI: 10.1111/ajad.12925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients are at risk of dropout while waiting for buprenorphine treatment. Study goals are to compare 3-month retention in two different methods to buprenorphine initiation among persons with opioid use disorder. METHODS We compared 3-month treatment retention rates of low-barrier buprenorphine initiation (i.e., rapid induction) (n =58) or a traditional method of buprenorphine initiation ( n = 45) for persons with opioid use disorder seen at an urban community health center. RESULTS Logistic regression revealed that low-barrier initiation had 11.11 greater odds of retention compared with traditional methods (p <0.001). Latinx patients benefited more than non-Latinx patients (OR = 14.79, p =.039). DISCUSSION AND CONCLUSIONS All patients were more likely to be retained using low-barrier initiation. A significantly larger effect on retention among Latinx patients was observed. SCIENTIFIC SIGNIFICANCE Rapid buprenorphine initiation increases treatment retention which improves treatment outcomes for persons with opioid use disorder. Study findings support a less restrictive services model that is even more effective for Latinx patients. (Am J Addict 2019;28:409-412).
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Affiliation(s)
- Christina S Lee
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Robert Rosales
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.,Department of Behavioral & Social Sciences, Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Michael D Stein
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Mariana Nicholls
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Bridget M O'Connor
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Vanessa Loukas Ryan
- Department of Adult Medicine, South End Community Health Center, Boston, Massachusetts
| | - Elizabeth A Davis
- Department of Adult Medicine, South End Community Health Center, Boston, Massachusetts.,Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
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Truong C, Krawczyk N, Dejman M, Marshall-Shah S, Tormohlen K, Agus D, Bass J. Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City. Addict Behav 2019; 93:14-19. [PMID: 30682677 PMCID: PMC6528177 DOI: 10.1016/j.addbeh.2019.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/23/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This qualitative study identifies and describes experiences and challenges to retention of individuals with opioid use disorder (OUD) who participated in a low-threshold combined buprenorphine-peer support treatment program in Baltimore. METHODS In-depth semi-structured interviews with staff and former clients of the Project Connections Buprenorphine Program (PCBP) (9 people) and focus group discussions with current and previous clients of PCBP (7 people) were conducted. Content analysis was used to extract themes regarding barriers to enrolling and remaining in, and transitioning from the program. RESULTS Primary challenges identified by the participants included struggles with cravings and symptoms of withdrawal, comorbid mental health issues, criminal justice system involvement, medication stigma, and conflicts over level of flexibility regarding program requirements and the role of employment. CONCLUSIONS This study identified several obstacles clients face when seeking care through a combined buprenorphine-peer support model. Findings highlight potential programmatic factors that can be improved and additional resources that may support treatment retention rates and better outcomes. Despite challenges, low-threshold and community-based programs can increase access to effective maintenance treatment for OUD, especially among vulnerable populations who may not have access to formal health services.
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Affiliation(s)
- C Truong
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
| | - N Krawczyk
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States; Behavioral Health Leadership Institute, 2200 Arden Road, Baltimore, MD 21209, United States.
| | - M Dejman
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
| | - S Marshall-Shah
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
| | - K Tormohlen
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
| | - D Agus
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States; Behavioral Health Leadership Institute, 2200 Arden Road, Baltimore, MD 21209, United States.
| | - J Bass
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway, Floor 8, Baltimore, MD 21205, United States.
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Deering DEA, Adamson SJ, Sellman JD, Henderson C, Sheridan J, Pooley S, Robertson RM, Noller G, Frampton CMA. Potential risk for fatal drug overdose perceived by people using opioid drugs. Drug Alcohol Rev 2017. [DOI: 10.1111/dar.12635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daryle E. A. Deering
- National Addiction Centre, Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - Simon J. Adamson
- National Addiction Centre, Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - John D. Sellman
- National Addiction Centre, Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - Charles Henderson
- New Zealand Needle Exchange Programme (trading as Needle Exchange Services Trust); Christchurch New Zealand
| | - Janie Sheridan
- School of Pharmacy; University of Auckland; Āotearoa New Zealand
| | - Sheridan Pooley
- Community Alcohol and Drug Service; Waitemata District Health Board; Auckland New Zealand
| | - Rhonda Marie Robertson
- Salvation Army Addiction; Supportive Accommodation and Reintegration Services; Auckland New Zealand
| | - Geoff Noller
- Substance Use and Policy Analysis; Dunedin New Zealand
| | - Christopher M. A. Frampton
- National Addiction Centre, Department of Psychological Medicine; University of Otago; Christchurch New Zealand
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Lagisetty P, Klasa K, Bush C, Heisler M, Chopra V, Bohnert A. Primary care models for treating opioid use disorders: What actually works? A systematic review. PLoS One 2017; 12:e0186315. [PMID: 29040331 PMCID: PMC5645096 DOI: 10.1371/journal.pone.0186315] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 09/28/2017] [Indexed: 12/30/2022] Open
Abstract
Background Primary care-based models for Medication-Assisted Treatment (MAT) have been shown to reduce mortality for Opioid Use Disorder (OUD) and have equivalent efficacy to MAT in specialty substance treatment facilities. Objective The objective of this study is to systematically analyze current evidence-based, primary care OUD MAT interventions and identify program structures and processes associated with improved patient outcomes in order to guide future policy and implementation in primary care settings. Data sources PubMed, EMBASE, CINAHL, and PsychInfo. Methods We included randomized controlled or quasi experimental trials and observational studies evaluating OUD treatment in primary care settings treating adult patient populations and assessed structural domains using an established systems engineering framework. Results We included 35 interventions (10 RCTs and 25 quasi-experimental interventions) that all tested MAT, buprenorphine or methadone, in primary care settings across 8 countries. Most included interventions used joint multi-disciplinary (specialty addiction services combined with primary care) and coordinated care by physician and non-physician provider delivery models to provide MAT. Despite large variability in reported patient outcomes, processes, and tasks/tools used, similar key design factors arose among successful programs including integrated clinical teams with support staff who were often advanced practice clinicians (nurses and pharmacists) as clinical care managers, incorporating patient “agreements,” and using home inductions to make treatment more convenient for patients and providers. Conclusions The findings suggest that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase MAT access in primary care, but research directly comparing specific structures and processes of care models is still needed.
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Affiliation(s)
- Pooja Lagisetty
- Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Katarzyna Klasa
- University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Christopher Bush
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Michele Heisler
- Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Vineet Chopra
- Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
| | - Amy Bohnert
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- Division of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America
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Strike CJ, Guta A. Patient-centred care and patient engagement to inform the use of psychosocial interventions with opioid substitution treatment: another path for Day & Mitcheson to follow. Addiction 2017; 112:1338-1339. [PMID: 28124391 DOI: 10.1111/add.13708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Carol J Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
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Guan Q, Khuu W, Spithoff S, Kiran T, Kahan M, Tadrous M, Martins D, Leece P, Gomes T. Patterns of physician prescribing for opioid maintenance treatment in Ontario, Canada in 2014. Drug Alcohol Depend 2017; 177:315-321. [PMID: 28733101 DOI: 10.1016/j.drugalcdep.2017.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite concerns surrounding high patient volumes in methadone clinics, little is known about the practice patterns of opioid maintenance therapy (OMT) providers in Ontario. We examined the distribution of these services and how physician characteristics differ based on prescribing volume. METHODS We conducted a cross-sectional study among prescribers of methadone or buprenorphine to Ontario public drug beneficiaries in 2014 by stratifying physicians into low- (lower 50%), moderate- (51-89%) and high-volume (top 10%) prescribers. We summarized the distribution of OMT prescription days dispensed and urine drug screens (UDS) ordered using Lorenz curves and examined physician characteristics using descriptive statistics. RESULTS We identified 893 OMT prescribers in 2014. Physicians were mostly male (67.5%; N=603), and middle-aged (median was 50). High-volume methadone providers (N=57) prescribed approximately 56% (N=4,115,322) of the total days of methadone (Gini coefficient=0.76, 95% CI 0.74-0.79) while high-volume buprenorphine providers (N=64) prescribed 61% (N=589,463) of the total days of buprenorphine (Gini coefficient=0.78, 95% CI 0.75-0.80). On average, each high-volume methadone prescriber treated 435 OMT patients and billed 43 UDS per patient, while each high-volume buprenorphine prescriber treated 64 OMT patients and billed 22 UDS per patient. Daily OMT patient volume was on average 74 for high-volume methadone prescribers and 6 for high-volume buprenorphine prescribers. CONCLUSIONS OMT services are highly concentrated among a small portion of OMT providers who carry high daily patient volumes. Future research should examine the quality of primary care received by their patients to better elucidate the possible consequences of this highly unequal distribution of services.
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Affiliation(s)
- Qi Guan
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario, M5S 3M2, Canada
| | - Wayne Khuu
- The Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada
| | - Sheryl Spithoff
- Women's College Hospital, 76 Grenville St., Toronto, Ontario, M5S 1B2, Canada
| | - Tara Kiran
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada; The Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, Ontario, M5G 1V7, Canada
| | - Meldon Kahan
- Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, Ontario, M5G 1V7, Canada
| | - Mina Tadrous
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada; The Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario, M5S 3M2, Canada
| | - Diana Martins
- The Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada
| | - Pamela Leece
- Public Health Ontario, Suite 300, 480 University Ave., Toronto, Ontario, M5G 1V2, Canada; Women's College Hospital, 76 Grenville St., Toronto, Ontario, M5S 1B2, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, Ontario, M5G 1V7, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada; The Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario, M5S 3M2, Canada; The Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada.
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J-shaped relationship between supervised methadone consumption and retention in methadone maintenance treatment (MMT) in primary care: National cohort study. Drug Alcohol Depend 2017; 173:126-131. [PMID: 28232249 DOI: 10.1016/j.drugalcdep.2016.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/11/2016] [Accepted: 12/10/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Supervised consumption ensures patients take methadone as prescribed and prevents diversion, however, the influence of supervised consumption on retention is unclear. We examined association between supervised consumption and retention across multiple treatment episodes. METHODS Cohort study of persons experiencing ≥1 MMT episodes in primary care (2004-2010), excluding ongoing episodes at the start of follow-up. Length of treatment episodes based on methadone prescriptions, retention classified as no interruption in prescribed methadone lasting >7 days. When a patient did not receive a new prescription within seven days after the end of coverage of a prescription, they were considered to have ceased treatment. We evaluated the relationship between supervised consumption and time to discontinuation of treatment using proportional hazards gamma frailty models to account for recurrent MMT episodes. Age, gender, median daily methadone dose, and comorbidities included as potential confounders. RESULTS 6393 patients experienced 19,715 treatment episodes over the six-year follow-up period. A J-shaped relationship was observed; having between 20 and 60% of methadone scripts supervised (compared to <20%) associated with reduced time to discontinuation (20-39% HR=0.88, 95% CI 0.81-0.95; 40-59%: HR=0.87, 95% CI 0.81-0.94). Beyond a threshold of 60%, retention reduced (60-79% of scripts: HR=1.28, 95% CI 1.20-1.36;>80% of scripts: HR=3.59, 95% CI 3.38-3.81). Median daily dose between 60 and 120mg/per day, and multiple treatment episodes also associated with longer time to discontinuation of treatment. CONCLUSION A J-shaped relationship was observed between supervised consumption and retention in treatment. Additionally, patients experiencing multiple treatment episodes tend to stay in treatment for progressively longer periods of time.
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Liebling EJ, Yedinak JL, Green TC, Hadland SE, Clark MA, Marshall BDL. Access to substance use treatment among young adults who use prescription opioids non-medically. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:38. [PMID: 27894311 PMCID: PMC5127054 DOI: 10.1186/s13011-016-0082-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/23/2016] [Indexed: 02/03/2023]
Abstract
Background Non-medical prescription opioid (NMPO) use is a substantial public health problem in the United States, with 1.5 million new initiates annually. Only 746,000 people received treatment for NMPO use in 2013, demonstrating substantial disparities in access to treatment. This study aimed to assess correlates of accessing substance use treatment among young adult NMPO users in Rhode Island, a state heavily impacted by NMPO use and opioid overdose. Methods This analysis uses data from a study of 200 Rhode Island residents aged 18 to 29 who reported NMPO use in the past 30 days. We compared individuals who had ever successfully enrolled in a substance use treatment program without ever facing barriers, individuals who had ever attempted to enroll but were unable, and individuals who never attempted to enroll. We used multinomial logistic regression to determine the independent correlates of never attempting and unsuccessfully attempting to access substance use treatment. Results Among 200 participants, the mean age was 24.5, 65.5% were male, and 61.5% were white. Nearly half (45.5%) had never attempted to enroll in substance use treatment, while 35.0% had successfully enrolled without ever facing barriers and 19.5% were unsuccessful in at least one attempt to enroll. In multivariable models, non-white participants were more likely to never have attempted to enroll compared to white participants. Previous incarceration, experiencing drug-related discrimination by the medical community, and a monthly income of $501 - $1500 were associated with a decreased likelihood of never attempting to enroll. A history of overdose and a monthly income of $501 - $1500 were associated with an increased likelihood of unsuccessfully accessing treatment. The most commonly reported barriers to accessing treatment were waiting lists (n = 23), health insurance not approving enrollment (n = 20), and inability to pay (n = 16). Conclusions This study demonstrates significant disparities in access to treatment among young adults who report NMPO use. A history of overdose was shown to correlate with experiencing barriers to substance use treatment utilization. Interventions are needed to reduce drug-related discrimination in clinical settings and to provide mechanisms that link young adults (particularly with a history of overdose) to evidence-based treatment.
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Affiliation(s)
- Elliott J Liebling
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.,Department of Emergency Medicine, Boston University School of Medicine, 771 Albany Street, Room 1208, Boston, MA, 02118, USA.,The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI, 02903, USA
| | - Scott E Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 322, Boston, MA, 02118, USA.,Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Melissa A Clark
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.,Department of Quantitative Health Sciences & Center for Health Policy and Research, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.
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Kourounis G, Richards BDW, Kyprianou E, Symeonidou E, Malliori MM, Samartzis L. Opioid substitution therapy: Lowering the treatment thresholds. Drug Alcohol Depend 2016; 161:1-8. [PMID: 26832931 DOI: 10.1016/j.drugalcdep.2015.12.021] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/02/2015] [Accepted: 12/21/2015] [Indexed: 01/15/2023]
Abstract
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.
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Affiliation(s)
- Georgios Kourounis
- St George's University of London, Medical School at the University of Nicosia, Agiou Nikolaou Street 93, Engomi, 2408 Nicosia, Cyprus; Department of Addiction Psychiatry, Athalassa Psychiatric Hospital, Cyprus Mental Health Services, Leoforos Lemesou 199/2, 1452 Nicosia, Cyprus
| | - Brian David Wensley Richards
- St George's University of London, Medical School at the University of Nicosia, Agiou Nikolaou Street 93, Engomi, 2408 Nicosia, Cyprus; Department of Addiction Psychiatry, Athalassa Psychiatric Hospital, Cyprus Mental Health Services, Leoforos Lemesou 199/2, 1452 Nicosia, Cyprus
| | - Evdokia Kyprianou
- Cyprus Anti-Drugs Council, Leoforos Lemesou 130, City Home 81, 2015 Strovolos, Cyprus
| | - Eva Symeonidou
- Cyprus Anti-Drugs Council, Leoforos Lemesou 130, City Home 81, 2015 Strovolos, Cyprus
| | - Minerva-Melpomeni Malliori
- Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 72, 74, Vassil. Sophias Avenue, 11528 Athens, Greece
| | - Lampros Samartzis
- St George's University of London, Medical School at the University of Nicosia, Agiou Nikolaou Street 93, Engomi, 2408 Nicosia, Cyprus; Department of Addiction Psychiatry, Athalassa Psychiatric Hospital, Cyprus Mental Health Services, Leoforos Lemesou 199/2, 1452 Nicosia, Cyprus.
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Community pharmacy-based opiate substitution treatment and related health services: a study of 508 patients and 111 pharmacies. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0714-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cousins G, Boland F, Courtney B, Barry J, Lyons S, Fahey T. Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study. Addiction 2016; 111:73-82. [PMID: 26234389 DOI: 10.1111/add.13087] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/05/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess whether risk of death increases during periods of treatment transition, and investigate the impact of supervised methadone consumption on drug-related and all-cause mortality. DESIGN National Irish cohort study. SETTING Primary care. PARTICIPANTS A total of 6983 patients on a national methadone treatment register aged 16-65 years between 2004 and 2010. MEASUREMENT Drug-related (primary outcome) and all-cause (secondary outcome) mortality rates and rate ratios for periods on and off treatment; and the impact of regular supervised methadone consumption. RESULTS Crude drug-related mortality rates were 0.24 per 100 person-years on treatment and 0.39 off treatment, adjusted mortality rate ratio 1.63 [95% confidence interval (CI) = 0.66-4.00]. Crude all-cause mortality rate per 100 person-years was 0.51 on treatment versus 1.57 off treatment, adjusted mortality rate ratio 3.64 (95% CI = 2.11-6.30). All-cause mortality off treatment was 6.36 (95% CI = 2.84-14.22) times higher in the first 2 weeks, 9.12 (95% CI = 3.17-26.28) times higher in weeks 3-4, compared with being 5 weeks or more in treatment. All-cause mortality was lower in those with regular supervision (crude mortality rate 0.60 versus 0.81 per 100 person-years) although, after adjustment, insufficient evidence exists to suggest that regular supervision is protective (mortality rate ratio = 1.23, 95% CI = 0.67-2.27). CONCLUSIONS Among primary care patients undergoing methadone treatment, continuing in methadone treatment is associated with a reduced risk of death. Patients' risk of all-cause mortality increases following treatment cessation, and is highest in the initial 4-week period.
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Affiliation(s)
- Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brenda Courtney
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joseph Barry
- Trinity College Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland
| | | | - Tom Fahey
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
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Granerud A, Toft H. Opioid dependency rehabilitation with the opioid maintenance treatment programme - a qualitative study from the clients' perspective. Subst Abuse Treat Prev Policy 2015; 10:35. [PMID: 26374128 PMCID: PMC4571127 DOI: 10.1186/s13011-015-0031-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/09/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Opioid maintenance treatment (OMT) is the most widely used treatment for opioid dependence. The opioid maintenance treatment (OMT) programme represents an opportunity for people who are opioid users to minimize the many negative health and societal outcomes associated with opioid use through meeting the physiological need of their bodies for opioids. The purpose of this study is to shed some light on how clients in the Norwegian OMT programme see their level of influence on their own treatment. METHOD It is a qualitative enquiry using semi-structured interviews of seven OMT clients living in various locations in Norway. The analysis of the material utilized a grounded theory-inspired approach. RESULTS This study show that the clients who were part of the OMT programme had better lives than people with untreated addictions did. However, the participants experienced having to play by the rules of the OMT programme if they wanted to have successful treatment. This resulted in varying degrees of dissatisfaction with the treatment. CONCLUSIONS The results indicated that the clients felt objectified and disenfranchised in the OMT programme, and points out the low level of influence on their own treatment felt by the OMT clients.
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Affiliation(s)
| | - Helge Toft
- Innlandet Hospital Trust, Divisjon Psykisk Helsevern, Postboks 104, NO-2381, Brumunddal, Norway.
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Marchand K, Palis H, Peng D, Fikowski J, Harrison S, Spittal P, Schechter MT, Oviedo-Joekes E. The Role of Gender in Factors Associated With Addiction Treatment Satisfaction Among Long-Term Opioid Users. J Addict Med 2015; 9:391-8. [PMID: 26335006 PMCID: PMC4605272 DOI: 10.1097/adm.0000000000000145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/20/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To identify factors associated with Opioid Agonist Treatment (OAT) satisfaction and to determine whether these relationships are gender specific. METHODS This study was based on data collected in a cross-sectional study among long-term opioid-dependent individuals (n = 160; 46.3% women). Participants completed the Client Satisfaction Questionnaire in reference to OAT episodes. Sociodemographic, illicit substance use, health, and addiction treatment history data were collected. Multivariable linear regression was used to determine the relationship between these variables and treatment satisfaction. To explore the potential role of gender in these identified relationships stratified multivariable models were tested. Additional open-ended questions regarding positive and negative perceptions of treatment were collected, and a thematic analysis was conducted. RESULTS In the multivariable linear regression model, participants who were older, of Aboriginal ancestry, and currently receiving OAT had higher OAT satisfaction scores, whereas participants who had methadone dose preferences of 30 mg or less had lower OAT satisfaction. In stratified analyses among women, the relationship between preferred methadone dose and current OAT remained significantly associated with satisfaction. Open-ended positive and negative perceptions complemented and provided further valuable data to interpret these identified relationships. CONCLUSIONS To our knowledge, this is the first study to explore the potential role of gender in factors associated with OAT satisfaction. These findings provide valuable information to health care providers working in OAT settings regarding how to address women and men's OAT needs and improve treatment satisfaction.
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Affiliation(s)
- Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences (KM, HP, DP, JF, PS, MTS, EOJ), Providence Health Care, St Paul's Hospital, Vancouver, BC, Canada; and School of Population and Public Health (KM, HP, JF, PS, MTS, EOJ) and School of Nursing (SH), University of British Columbia, Vancouver, BC, Canada
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Berends L, Chalmers J, Lancaster K. Trust, agency and control: Perspectives on methadone takeaway dosing in the context of the Victorian policy review. Drug Alcohol Rev 2015; 34:483-486. [PMID: 26084924 DOI: 10.1111/dar.12287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lynda Berends
- Centre for Health and Social Research, Australian Catholic University, Melbourne, Australia
| | - Jenny Chalmers
- Drug Policy Modelling Program, University of New South Wales, Sydney, Australia
| | - Kari Lancaster
- Drug Policy Modelling Program, University of New South Wales, Sydney, Australia
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Richert T, Johnson B. Long-term self-treatment with methadone or buprenorphine as a response to barriers to opioid substitution treatment: the case of Sweden. Harm Reduct J 2015; 12:1. [PMID: 25889208 PMCID: PMC4337060 DOI: 10.1186/s12954-015-0037-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/20/2015] [Indexed: 11/11/2022] Open
Abstract
Background It is well known that illicit use of methadone and buprenorphine is common among people with an opioid dependence. Less notice has been taken of the fact that these substances are also used for extended periods of self-treatment, as a way of handling barriers to OST. In this study, motives for self-treatment are investigated, as well as attitudes and perceived barriers to OST among drug users with an opioid dependence in Sweden. Method The study is based on qualitative research interviews with 27 opioid users who have treated themselves with methadone or buprenorphine for a period of at least three months. Results The duration of self-treatment among the interviewees varied from 5 months to 7 years. Self-treatment often began as a result of a wish to change their life situation or to cut back on heroin, in conjunction with perceived barriers to OST. These barriers consisted of (1) difficulties in gaining access to OST due to strict inclusion criteria, limited access to treatment or a bureaucratic and arduous assessment process, (2) difficulties remaining in treatment, and (3) ambivalence toward or reluctance to seek OST, primarily due to a fear of stigmatization or disciplinary action. Self-treatment was described as an attractive alternative to OST, as a stepping stone to OST, and as a way of handling waiting lists, or as a saving resource in case of involuntary discharge. Conclusion Illicit use of methadone and buprenorphine involve risks but may also have important roles to play for users who are unwilling or not given the opportunity to enter OST. A restrictive and strict rehabilitation-oriented treatment model may force many to manage their own treatment. More generous inclusion criteria, a less complex admission process, fewer involuntary discharges, and less paternalistic treatment may lead to increasing numbers seeking OST. Control measures are necessary to prevent diversion and harmful drug use but must be designed in such a way that they impose as few restrictions as possible on the daily life of patients.
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Affiliation(s)
- Torkel Richert
- Department of Social Work, Malmö University, Malmo, Sweden.
| | - Björn Johnson
- Department of Social Work, Malmö University, Malmo, Sweden.
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Vanderplasschen W, Naert J, Vander Laenen F, De Maeyer J. Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives. DRUGS-EDUCATION PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.981508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Larance B, Carragher N, Mattick RP, Lintzeris N, Ali R, Degenhardt L. A latent class analysis of self-reported clinical indicators of psychosocial stability and adherence among opioid substitution therapy patients: do stable patients receive more unsupervised doses? Drug Alcohol Depend 2014; 142:46-55. [PMID: 25015687 DOI: 10.1016/j.drugalcdep.2014.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 05/21/2014] [Accepted: 05/21/2014] [Indexed: 11/15/2022]
Abstract
AIMS To develop a stability typology among opioid substitution therapy patients using a range of adherence indicators derived from clinical guidelines, and determine whether stable patients receive more unsupervised doses. METHODS An interviewer-administered cross-sectional survey was used in opioid substitution therapy programmes in three Australian jurisdictions, totalling 768 patients in their current treatment episode for ≥4 weeks. A structured questionnaire collated data from patients about their demographics, treatment characteristics, past 6-month drug use and medication adherence, psychosocial stability, comorbidity, child welfare concerns and levels of supervised dosing. Latent class analysis (LCA) was used to derive a stability typology. Linear regression models examined predictors of unsupervised dosing in the past month. RESULTS LCA identified two classes: (i) a higher-adherence group (67%) who had low-moderate probabilities of endorsing the opioid substitution therapy stability indicators and (ii) a lower-adherence group (33%) who had moderate-high probabilities of endorsing the stability indicators. There was no association between adherence profile and the number of unsupervised doses. Significant predictors of receiving larger numbers of unsupervised doses included being older, living in New South Wales or South Australia (vs. Victoria), receiving methadone (vs. mono-buprenorphine), being prescribed in private clinic or general practice (vs. public clinic), reporting a longer current treatment episode, not receiving a urine drug screen in the past month, being currently employed and not having a prison history. CONCLUSIONS This study suggested that system-level factors and observable indicators of social functioning were more strongly associated with the receipt of less supervised treatment. Future research should examine this issue using prospectively collected data.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, UNSW Australia, Randwick Campus, 22-32 King Street, Sydney NSW 2052, Australia.
| | - Natacha Carragher
- National Drug and Alcohol Research Centre, UNSW Australia, Randwick Campus, 22-32 King Street, Sydney NSW 2052, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, UNSW Australia, Randwick Campus, 22-32 King Street, Sydney NSW 2052, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South Eastern Sydney Local Health District (SESLHD), 591 South Dowling Street, Surry Hills NSW 2010, Australia; Discipline of Addiction Medicine, The University of Sydney, Drug Health Services, Royal Prince Alfred Hospital, Level 6 KGV Building, 83-117 Missenden Road, Camperdown, Sydney NSW 2050, Australia
| | - Robert Ali
- Discipline of Pharmacology, The University of Adelaide, Medical School South Building, Frome Road, Adelaide SA 5005, Australia; Drug and Alcohol Services South Australia, 161 Greenhill Road, Parkside SA 5063, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Randwick Campus, 22-32 King Street, Sydney NSW 2052, Australia; School of Population and Global Health, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Department of Global Health, School of Public Health, University of Washington, USA
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Montgomery L, Sanning B, Litvak N, Peters EN. Preliminary findings on the association between clients' perceived helpfulness of substance abuse treatment and outcomes: does race matter? Drug Alcohol Depend 2014; 139:152-8. [PMID: 24767892 PMCID: PMC4522021 DOI: 10.1016/j.drugalcdep.2014.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few studies examine the helpfulness and effectiveness of substance abuse treatment from the clients' perspective. METHODS The current secondary analysis examined the perceived helpfulness of substance abuse treatment components and its relationship to treatment outcomes among 387 Black and White adults participating in a multisite randomized clinical trial (RCT) of Motivational Enhancement Therapy. Throughout the 16-week RCT, participants self-reported substance use. Upon completion of treatment, participants completed a self-report measure assessing the perceived helpfulness of treatment components. RESULTS Black participants rated 9 out of 12 treatment components (e.g., "learning skills that will help me cope with my problems") as being more helpful than their White counterparts, even after controlling for age, gender, employment status, primary drug type, and treatment assignment. However, perceived helpfulness ratings were not associated with substance use outcomes among Black or White participants. CONCLUSIONS Clients' perceived helpfulness of treatment components is an important factor to consider in improving the delivery of substance abuse treatment, especially for Black adults.
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Affiliation(s)
- LaTrice Montgomery
- University of Cincinnati, Mental Health and Substance Abuse Counseling Program, 2160 McMicken Circle, P.O. Box 210068, Cincinnati, OH 45215, USA.
| | - Blair Sanning
- University of Cincinnati, Mental Health and Substance Abuse Counseling Program 2160 McMicken Circle, P.O. Box 210068 Cincinnati, Ohio 45215, USA
| | - Nicole Litvak
- University of Cincinnati, Mental Health and Substance Abuse Counseling Program 2160 McMicken Circle, P.O. Box 210068 Cincinnati, Ohio 45215, USA
| | - Erica N. Peters
- Friends Research Institute 1040 Park Avenue, Suite 103 Baltimore, Maryland 21201, USA
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48
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Harris M, Rhodes T. Methadone diversion as a protective strategy: The harm reduction potential of ‘generous constraints’. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013. [DOI: 10.1016/j.drugpo.2012.10.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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49
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Lang K, Neil J, Wright J, Dell CA, Berenbaum S, El-Aneed A. Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:35. [PMID: 24079946 PMCID: PMC3850796 DOI: 10.1186/1747-597x-8-35] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 09/17/2013] [Indexed: 11/20/2022]
Abstract
Background People who inject drugs (PWID) often encounter barriers when attempting to access health care and social services. In our previous study conducted to identify barriers to accessing care from the perspective of PWIDs in Saskatoon, Canada: poverty, lack of personal support, discrimination, and poor knowledge and coordination of service providers among other key barriers were identified. The purpose of the present investigation was to explore what service providers perceive to be the greatest barriers for PWIDs to receive optimal care. This study is an exploratory investigation with a purpose to enrich the literature and to guide community action. Methods Data were collected through focus groups with service providers in Saskatoon. Four focus groups were held with a total of 27 service providers. Data were transcribed and qualitative analysis was performed. As a result, concepts were identified and combined into major themes. Results Four barriers to care were identified by service providers: inefficient use of resources, stigma and discrimination, inadequate education and the unique and demanding nature of PWIDs. Participants also identified many successful services. Conclusion The results from this investigation suggest poor utilization of resources, lack of continuing education of health care providers on addictions and coping skills with such demanding population, and social stigma and disparity. We recommend improvements in resource utilization through, for example, case management. In addition, sensitivity training and more comprehensive service centers designed to meet PWID’s complex needs may improve care. However, community-wide commitment to addressing injection drug issues will also be required for lasting solutions.
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Affiliation(s)
- Katherine Lang
- College of Pharmacy and Nutrition, University of Saskatchewan, Thorvaldson Building, 110 Science Place, Saskatoon, SK S7N 5C9, Canada.
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50
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Opiate-Dependent Patients on a Waiting List for Methadone Maintenance Treatment Are at High Risk for Mortality Until Treatment Entry. J Addict Med 2013; 7:177-82. [DOI: 10.1097/adm.0b013e318287cfc9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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