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Siemens JMA, Bhoora U, Janse van Rensburg M. Methadone use for acute opioid withdrawal in Tshwane shelters during the COVID-19 lockdown. S Afr Fam Pract (2004) 2023; 65:e1-e7. [PMID: 37916694 PMCID: PMC10546247 DOI: 10.4102/safp.v65i1.5708] [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: 01/09/2023] [Revised: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Temporary shelters were established for street-based people during the national level 5 coronavirus disease 2019 (COVID-19) lockdown. However, street-based substance users' need to access substances was not addressed, resulting in large numbers of people experiencing withdrawal. The Community Oriented Substance Use Programme (COSUP) in Tshwane provided methadone to manage opioid withdrawal. METHODS A cross-sectional, descriptive study was conducted using the daily methadone dosing records from shelters in Tshwane between March 2020 and September 2020. RESULTS The final analysis included 495 participants, of which 64 (12.9%) were initiated on 20 mg - 30 mg of methadone, 397 (80.2%) on 40 mg - 50 mg, and 34 (6.9%) on 60 mg - 70 mg. A total of 194 (39.2%) participants continued their initiation dose for 1-2 months, after which 126 (64.9%) had their doses increased, and 68 (35.1%) had their doses decreased. Approximately 12 (2.4%) participants were weaned off methadone after 1-3 months and 46 (9.3%) after 4-6 months. In all, 100 (20.2%) participants left the shelter prematurely and did not continue with methadone. A total of 126 (25.5%) participants continued to stay in the shelters and received methadone for 6 months, with 125 (25.3%) participants leaving the shelter with continued follow-up at a COSUP site. CONCLUSION This study demonstrates variability in methadone dosing regimens among shelter residents. As the lockdown measures eased, many chose to leave the shelters, while others remained to receive methadone and other services. The COSUP appears to be effective during periods of increased vulnerability, since a large number of participants were successfully followed up.Contribution: Opioid dependence is a persistent, lifelong disease. It is multifaceted with complex environmental and individual determinants. This study highlighted the use of opioid substitution therapy during a period of increased vulnerability.
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Affiliation(s)
- Jo-Marie A Siemens
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Wang W, Lu S, Tang H, Wang B, Sun C, Zheng P, Bai Y, Lu Z, Kang Y. A Scoping Review of Drug Epidemic Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042017. [PMID: 35206206 PMCID: PMC8872096 DOI: 10.3390/ijerph19042017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023]
Abstract
The phenomenon of drug epidemics has been a global issue in the past decades, causing enormous damages to the physical and mental health of drug users and social well-being. Despite great efforts to curb drug epidemics at the governmental or social level, the total number of drug users has still been on the rise in recent years, along with illicit production and trafficking around the world. Inspired by dynamical epidemic models of infectious disease, a flourishment of promising results has been observed in the exploration of drug epidemic models. In this review, we aim to provide a scoping review of all existing drug epidemic modeling studies, and it has been shown that most studies focused on analyses of theoretical behaviors of the model systems, lacking emphasis on practical applications in real settings. We found that the drug epidemic models were characterized by a longer time scale, no incubation period, no significant prevention vaccines interfered, and population specificity. This review could assist policymakers and public health workers in gaining deeper insights into modeling tools, and help modelers improve their works, thus narrowing gaps between mathematical epidemiology and public health studies.
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Affiliation(s)
- Wei Wang
- Institute of Environmental Information, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; (W.W.); (B.W.); (C.S.)
| | - Sifen Lu
- Precision Medicine Key Laboratory of Sichuan Province and Precision Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Haoxiang Tang
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China;
| | - Biao Wang
- Institute of Environmental Information, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; (W.W.); (B.W.); (C.S.)
| | - Caiping Sun
- Institute of Environmental Information, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; (W.W.); (B.W.); (C.S.)
| | - Pai Zheng
- Department of Occupational and Environmental Health Science, School of Public Health, Peking University, Beijing 100871, China;
| | - Yi Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100871, China;
| | - Zuhong Lu
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China;
| | - Yulin Kang
- Institute of Environmental Information, Chinese Research Academy of Environmental Sciences, Beijing 100012, China; (W.W.); (B.W.); (C.S.)
- Correspondence:
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Silva TC, Andersson FB. The "black box" of treatment: Patients' perspective on what works in opioid maintenance treatment for opioid dependence. Subst Abuse Treat Prev Policy 2021; 16:41. [PMID: 33971909 PMCID: PMC8111936 DOI: 10.1186/s13011-021-00378-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A lack of conceptual modeling of how the components of opioid maintenance treatment (OMT) for opioid dependence (OD) work causes it to occasionally be labeled the "black-box" of treatment. This study had a two-fold objective: First, to analyze which factors related to OMT for OD contribute to the abstinence of problematic use of non-prescribed opioids and sustain recovery, from the patients' perspective; second, to understand which changes OMT produced in the individuals' lives might significantly contribute to relapse prevention. METHODS We used qualitative methods of design, inquiry, and analysis from a convenience sample of 19 individuals in a Swedish treatment setting. RESULTS All the participants reported previous cycles of problematic use of non-prescribed opioids and other non-prescribed psychoactive substances, treatment, abstinence, recovery, and relapse before starting the current OMT program. During the pre-treatment stage, specific events, internal processes, and social environments enhanced motivation toward abstinence and seeking treatment. During the treatment stage, participants perceived the quality of the human relationships established with primary social groups as important as medication and the individual plan of care in sustaining recovery. From the participants' perspective, OMT was a turning point in their life course, allowing them a sense of self-fulfillment and the reconstruction of personal and social identity. However, they still struggled with the stigmatization produced by a society that values abstinence-oriented over medication-assisted treatments. CONCLUSION OMT is not an isolated event in individuals' lives but rather a process occurring within a specific social context. Structural factors and the sense of acceptance and belonging are essential in supporting the transformation. Treatment achievements and the risk for relapse vary over time, so the objectives of the treatment plan must account for characteristics of the pre-treatment stage and the availability and capacity of individuals to restructure their social network, besides the opioid maintenance treatment and institutional social care.
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Affiliation(s)
- Teresa C. Silva
- Department of Humanities and Social Sciences, Mid Sweden University, 10 – 85170 Holmgatan, Sundsvall, Sweden
- Risk and Crisis Research Center, Mid Sweden University, Kunskapens väg 1, Stapelmohrs väg, 831 40 Östersund, Sweden
| | - Fredrik B. Andersson
- Department of Humanities and Social Sciences, Mid Sweden University, 10 – 85170 Holmgatan, Sundsvall, Sweden
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Hayaki J, Conti MT, Bailey GL, Herman DS, Anderson BJ, Stein MD. Negative affect-associated drug refusal self-efficacy, illicit opioid use, and medication use following short-term inpatient opioid withdrawal management. J Subst Abuse Treat 2021; 126:108309. [PMID: 34116827 DOI: 10.1016/j.jsat.2021.108309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/07/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Persons with opioid use disorder (OUD) are prone to frequent relapse following brief inpatient medically managed withdrawal. This longitudinal, naturalistic study examines associations among illicit opioid use, use of medication for opioid use disorder (MOUD), and one's confidence in the ability to resist drug use in the face of negative emotions (i.e., negative affect-associated drug refusal self-efficacy). METHOD Participants were 220 adults with OUD who recently completed a short-term inpatient program and the study followed for 6 months. At baseline, participants reported demographics, illicit opioid use, recent engagement with MOUD, and negative affect-associated drug refusal self-efficacy. At follow-up (1 week and 1-, 3-, and 6-months following discharge), participants reported illicit opioid use and MOUD. RESULTS Participants averaged 30.7 years of age, 63.2% were male, and 84.1% were white. Both illicit opioid use and rates of MOUD increased during the 6-month follow-up period, although only 34.1% received MOUD. At baseline, participants reported less than 50% self-confidence to resist using opioids during negative emotional states. Baseline negative affect-associated drug refusal self-efficacy inversely predicted illicit opioid use (p = .01) at follow-up but was not associated with follow-up MOUD. CONCLUSION Among persons with OUD, lower confidence to resist using opioids in negative emotional states predicts greater use of illicit opioids in the months following medically managed withdrawal, even with receipt of MOUD.
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Affiliation(s)
- Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester, MA, USA.
| | - Micah T Conti
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA; Stanley Street Treatment and Resources, Inc., Fall River, MA, USA
| | - Genie L Bailey
- Stanley Street Treatment and Resources, Inc., Fall River, MA, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Debra S Herman
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Michael D Stein
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Jones S, Jack B, Kirby J, Wilson TL, Murphy PN. Methadone-Assisted Opiate Withdrawal and Subsequent Heroin Abstinence: The Importance of Psychological Preparedness. Am J Addict 2020; 30:11-20. [PMID: 32424883 DOI: 10.1111/ajad.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment guidelines emphasize patients' readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Psychological preparedness indicators for this transition were examined. METHODS Patients (all male) were recruited from three treatment settings: prison, an inpatient detoxification unit, and an outpatient clinic. Time 1 (T1) was admission to methadone-assisted withdrawal in all settings. Time 2 (T2) was a 6-month follow-up. With n = 24 at T1 for each group (N = 72), a battery of instruments relevant to psychological preparedness was administered. RESULTS At T1, inpatients had higher self-efficacy beliefs for successful treatment completion than prison patients. For patients contactable at T2, T1 self-efficacy positively predicted T2 opiate abstinence. No other variable improved prediction. T1 SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) ambivalence scores, age, and lifetime heroin use duration predicted maintenance of contact or not with treatment services and contactability by the researcher. Measures of mood did not differ between groups at T1 or predict T2 outcomes. DISCUSSION AND CONCLUSIONS Self-efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Ambivalence regarding change, age, and lifetime heroin use duration are potentially useful predictors of patients maintaining contact with services, and of being retained in research. SCIENTIFIC SIGNIFICANCE These findings advance existing literature and knowledge by highlighting the importance of self-efficacy in psychological preparedness for opiate abstinence, and the predictive utility to clinicians of this and other variables measurable at admission, in the clinical management of opiate users. (© 2020 The Authors. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry). (Am J Addict 2021;30:11-20).
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Affiliation(s)
- Steve Jones
- Department of Psychology, Faculty of Health, Social Care, and Medicine, Edge Hill University, Ormskirk, UK
| | - Barbara Jack
- Evidence-Based Practice Research Centre, Faculty of Health, Social Care, and Medicine, Edge Hill University, Ormskirk, UK
| | - Julie Kirby
- Faculty of Health, Social Care, and Medicine, Edge Hill University, Ormskirk, UK
| | - Thomas L Wilson
- School of Applied Social Sciences, De Montford University, Leicester, UK
| | - Philip N Murphy
- Department of Psychology, Edge Hill University, Ormskirk, UK
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