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Mariottini C, Häkkinen M, Kriikku P, Ojanperä I. Buprenorphine deaths confirmed by toxicology reveal a low proportion of opioid agonist treatment before death in Finland. Int J Legal Med 2024:10.1007/s00414-024-03273-5. [PMID: 38910139 DOI: 10.1007/s00414-024-03273-5] [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: 01/20/2024] [Accepted: 06/13/2024] [Indexed: 06/25/2024]
Abstract
We studied opioid agonist treatment (OAT) status before buprenorphine-related death in Finland, where buprenorphine is the principal OAT medicine and also the most misused opioid, through a retrospective population-based study using medico-legal cause-of-death investigation and OAT patient records. The study included all death cases (N = 570) between 2018 and 2020 with a buprenorphine or norbuprenorphine finding in post-mortem toxicology and with known drug misuse history or concomitant findings of illicit drugs. Of the deceased, 10% had received OAT in the year before death. Less than 1% of individuals < 25 years had received OAT, whereas the proportion in individuals ≥ 25 years was 13% (p < 0.001). There were significantly more females and more fatal poisonings (p < 0.001) among those < 25 years than among those ≥ 25 years. OAT medication at the time of death was sublingual buprenorphine-naloxone in 74% and subcutaneous buprenorphine in 23%. Except for significantly fewer benzodiazepine findings among those receiving OAT, minimal differences were found in terms of age, gender, cause and manner of death, or concomitant substance use between the deceased in and outside of OAT. Concomitant misuse of benzodiazepines, psychostimulants, alcohol, and gabapentinoids was frequent both in and outside of OAT and likely contributed to the death. These results suggest that access to OAT especially for young people and treatment of multiple addictions should be improved. Comprehensive information from medico-legal cause-of-death investigation as a starting point, combined with subsequent ante-mortem patient records, proved to be a successful approach to shed light on the Finnish scene of buprenorphine mortality.
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Affiliation(s)
- Claudia Mariottini
- Department of Forensic Medicine, University of Helsinki, P.O. Box 21(Haartmaninkatu 3), Helsinki, 00014, Finland.
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, 00271, Finland.
| | - Margareeta Häkkinen
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, 00271, Finland
- A-Clinic Ltd, Kuortaneenkatu 2, Helsinki, 00510, Finland
| | - Pirkko Kriikku
- Department of Forensic Medicine, University of Helsinki, P.O. Box 21(Haartmaninkatu 3), Helsinki, 00014, Finland
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, 00271, Finland
| | - Ilkka Ojanperä
- Department of Forensic Medicine, University of Helsinki, P.O. Box 21(Haartmaninkatu 3), Helsinki, 00014, Finland
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, 00271, Finland
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2
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Parkin S, Neale J, Strang J. Non-Prescribed Substance Use during the First Month of Treatment by People Receiving Depot Buprenorphine for Opioid Use Disorder. Subst Use Misuse 2023; 58:1696-1706. [PMID: 37571999 DOI: 10.1080/10826084.2023.2244064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants' reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients' initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.
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Affiliation(s)
- Stephen Parkin
- Institute of Psychiatry, National Addiction Centre, King's College London, London, UK
| | - Joanne Neale
- Institute of Psychiatry, National Addiction Centre, King's College London, London, UK
- Centre for Social Research in Health, University of New South Wales, Kensington, Australia
| | - John Strang
- Institute of Psychiatry, National Addiction Centre, King's College London, London, UK
- South London & Maudsley (SLaM), NHS Foundation Trust, London, UK
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3
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Smith CL, Keever A, Bowden T, Olson K, Rodin N, McDonell MG, Roll JM, Smoody G, LeBrun J, Miguel AQ, McPherson SM. Patient Feedback on a Mobile Medication Adherence Application for Buprenorphine/Naloxone: Feasibility and Acceptability Study (Preprint). JMIR Form Res 2022; 7:e40437. [PMID: 37074780 PMCID: PMC10157459 DOI: 10.2196/40437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/09/2023] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Opioid use disorders impact the health and well-being of millions of Americans. Buprenorphine and naloxone (BUP and NAL) can reduce opioid overdose deaths, decrease misuse, and improve quality of life. Unfortunately, poor medication adherence is a primary barrier to the long-term efficacy of BUP and NAL. OBJECTIVE We aimed to examine patient feedback on current and potential features of a Bluetooth-enabled pill bottle cap and associated mobile app for patients prescribed BUP and NAL for an opioid use disorder, and to solicit recommendations for improvement to effectively and appropriately tailor the technology for people in treatment for opioid use disorder. METHODS A convenience sample of patients at an opioid use disorder outpatient clinic were asked about medication adherence, opioid cravings, experience with technology, motivation for treatment, and their existent support system through a brief e-survey. Patients also provided detailed feedback on current features and features being considered for inclusion in a technology designed to increase medication adherence (eg, inclusion of a personal motivational factor, craving and stress tracking, incentives, and web-based coaching). Participants were asked to provide suggestions for improvement and considerations specifically applicable to people in treatment for opioid use disorder with BUP and NAL. RESULTS Twenty people with an opioid use disorder who were prescribed BUP and NAL participated (mean age 34, SD 8.67 years; 65% female; 80% White). Participants selected the most useful, second-most useful, and least useful features presented; 42.1% of them indicated that motivational reminders would be most useful, followed by craving and stress tracking (26.3%) and web-based support forums (21.1%). Every participant indicated that they had at least 1 strong motivating factor for staying in treatment, and half (n=10) indicated children as that factor. All participants indicated that they had, at some point in their lives, the most extreme craving a person could have; however, 42.1% indicated that they had no cravings in the last month. Most respondents (73.7%) stated that tracking cravings would be helpful. Most respondents (84.2%) also indicated that they believed reinforcers or prizes would help them achieve their treatment goals. Additionally, 94.7% of respondents approved of adherence tracking to accommodate this feature using smart packaging, and 78.9% of them approved of selfie videos of them taking their medication. CONCLUSIONS Engaging patients taking treatment for opioid use disorder with BUP and NAL allowed us to identify preferences and considerations that are unique to this treatment area. As the technology developer of the pill cap and associated mobile app is able to take into consideration or integrate these preferences and suggestions, the smart cap and associated mobile app will become tailored to this population and more useful for them, which may encourage patient use of the smart cap and associated mobile app.
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Affiliation(s)
- Crystal L Smith
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Abigail Keever
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Theresa Bowden
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | | | - Nicole Rodin
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - John M Roll
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Gillian Smoody
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
| | | | - Andre Qc Miguel
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Sterling M McPherson
- Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, United States
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
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Mariottini C, Gergov M, Ojanperä I. Determination of buprenorphine, norbuprenorphine, naloxone, and their glucuronides in urine by liquid chromatography-tandem mass spectrometry. Drug Test Anal 2021; 13:1658-1667. [PMID: 34047070 DOI: 10.1002/dta.3104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 11/06/2022]
Abstract
A liquid chromatography-tandem mass spectrometry method for the simultaneous quantification of buprenorphine (BUP), norbuprenorphine (NBUP), naloxone (NAL), and their glucuronide conjugates BUP-G, NBUP-G, and NAL-G in urine samples was developed. The method, omitting a hydrolysis step, involved non-polar solid-phase extraction, liquid chromatography on a C18 column, electrospray positive ionization, and mass analysis by multiple reaction monitoring. Quantification was based on the corresponding deuterium-labelled internal standards for each of the six analytes. The limit of quantification was 0.5 μg/L for BUP and NAL, 1 μg/L for NAL-G, and 3 μg/L for NBUP, BUP-G, and NBUP-G. Using the developed method, 72 urine samples from buprenorphine-dependent patients were analysed to cover the concentration ranges encountered in a clinical setting. The median (maximum) concentration was 4.2 μg/L (102 μg/L) for BUP, 74.7 μg/L (580 μg/L) for NBUP, 0.9 μg/L (85.5 μg/L) for NAL, 159.5 μg/L (1370 μg/L) for BUP-G, 307.5 μg/L (1970 μg/L) for NBUP-G, and 79.6 μg/L (2310 μg/L) for NAL-G.
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Affiliation(s)
- Claudia Mariottini
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.,Forensic Toxicology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Merja Gergov
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ilkka Ojanperä
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.,Forensic Toxicology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Mielau J, Vogel M, Gutwinski S, Mick I. New Approaches in Drug Dependence: Opioids. CURRENT ADDICTION REPORTS 2021; 8:298-305. [PMID: 34055568 PMCID: PMC8149259 DOI: 10.1007/s40429-021-00373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
Purpose of Review This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches. Recent Findings Currently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce. Summary Maintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.
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Affiliation(s)
- Juliane Mielau
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| | - Marc Vogel
- Department of Addictive Disorders, Psychiatric University Clinic Basel, Basel, Switzerland.,Department of Addictive Disorders, Psychiatric Services Thurgau, Muensterlingen, Switzerland
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
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6
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Rosic T, Naji L, Panesar B, Chai DB, Sanger N, Dennis BB, Marsh DC, Rieb L, Worster A, Thabane L, Samaan Z. Are patients' goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder. BMJ Open 2021; 11:e044017. [PMID: 33436476 PMCID: PMC7805377 DOI: 10.1136/bmjopen-2020-044017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Existing methods of measuring effectiveness of pharmacological treatment for opioid use disorder (OUD) are highly variable. Therefore, understanding patients' treatment goals is an integral part of patient-centred care. Our objective is to explore whether patients' treatment goals align with a frequently used clinical outcome, opioid abstinence. DESIGN Triangulation mixed-methods design. SETTING AND PARTICIPANTS We collected prospective data from 2030 participants who were receiving methadone or buprenorphine-naloxone treatment for a diagnosis of OUD in order to meet study inclusion criteria. Participants were recruited from 45 centrally-managed outpatient opioid agonist therapy clinics in Ontario, Canada. At study entry, we asked, 'What are your goals in treatment?' and used NVivo software to identify common themes. PRIMARY OUTCOME MEASURE Urine drug screens (UDS) were collected for 3 months post-study enrolment in order to identify abstinence versus ongoing opioid use (mean number of UDS over 3 months=12.6, SD=5.3). We used logistic regression to examine the association between treatment goals and opioid abstinence. RESULTS Participants had a mean age of 39.2 years (SD=10.7), 44% were women and median duration in treatment was 2.6 years (IQR 5.2). Six overarching goals were identified from patient responses, including 'stop or taper off of treatment' (68%), 'stay or get clean' (37%) and 'live a normal life' (14%). Participants reporting the goal 'stay or get clean' had lower odds of abstinence at 3 months than those who did not report this goal (OR=0.73, 95% CI 0.59 to 0.91, p=0.005). Although the majority of patients wanted to taper off or stop medication, this goal was not associated with opioid abstinence, nor were any of their other goals. CONCLUSIONS Patient goals in OUD treatment do not appear to be associated with programme measures of outcome (ie, abstinence from opioids). Future studies are needed to examine outcomes related to patient-reported treatment goals found in our study; pain management, employment, and stopping/tapering treatment should all be explored.
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Affiliation(s)
- Tea Rosic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Leen Naji
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Balpreet Panesar
- Neurosciences Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Darren B Chai
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nitika Sanger
- Medical Science Gradaute Program, McMaster University, Hamilton, Ontario, Canada
| | - Brittany B Dennis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Canadian Addiction Treatment Centres, Markham, Ontario, Canada
- ICES North, Sudbury, Ontario, Canada
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Launette Rieb
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Worster
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Research Institute at St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Mariottini C, Kriikku P, Ojanperä I. Concomitant drugs with buprenorphine user deaths. Drug Alcohol Depend 2021; 218:108345. [PMID: 33127184 DOI: 10.1016/j.drugalcdep.2020.108345] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Buprenorphine is abused in several countries notwithstanding its benefits as an analgesic and as an opioid agonist treatment medication. Benzodiazepines and alcohol have previously been associated with buprenorphine toxicity. This study elucidates the role of emerging concomitant drugs in different groups of buprenorphine user deaths. METHODS All cases in the Finnish national post-mortem toxicology database from 2016-2019 in which buprenorphine or norbuprenorphine was a laboratory finding in any post-mortem specimen and age at death of 15-64 years were investigated for cause and manner of death, concurrent drug and alcohol findings, age, and gender. RESULTS There were 792 deaths with a buprenorphine finding, of which buprenorphine was implicated in poisoning without other opioids in 271 cases (34 %). In this group of buprenorphine poisoning deaths, concomitant benzodiazepines were found in 94 % (clonazepam 53 %), illicit drugs in 63 %, gabapentinoids in 50 % (pregabalin 41 %), alcohol in 41 %, antidepressants in 32 %, and antipsychotics in 28 % of cases; only three deaths showed no benzodiazepines, alcohol, or gabapentinoids. Polydrug use was common regardless of the cause of death. In the age group 15 to 24 years, concomitant use of benzodiazepines and illicit drugs, and buprenorphine poisoning were more prevalent than in the age group 25-64 years. CONCLUSIONS The unprecedentedly high concomitant use of benzodiazepines in buprenorphine user deaths obscures other possible pharmacological risk factors for buprenorphine poisoning that could be relevant for prevention. Higher mortality in the younger age group suggests particularly unsafe drug use patterns that should be addressed.
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Affiliation(s)
- Claudia Mariottini
- Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014 Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Pirkko Kriikku
- Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014 Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Ilkka Ojanperä
- Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014 Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.
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8
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Carlsen SEL, Lunde LH, Torsheim T. Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment. Subst Abuse Rehabil 2020; 11:9-18. [PMID: 32099510 PMCID: PMC6996215 DOI: 10.2147/sar.s221618] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Opioid maintenance treatment reduces a person’s use of heroin. However, frequent substance use in treatment is a problem. Aim To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment. Patients and Methods Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants’ social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life. Results There was a significant negative association between time in treatment and use of opioids, b =−0.89, SE = 0.19, p = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, b =−0.40, SE =0.19, p = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, b = −0.62, SE = 0.23, p = < 0.01. Social dimensions, participants’ adverse experiences, and social resources were not associated with polydrug or opioid use. Conclusion Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients’ opioid use.
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Affiliation(s)
| | - Linn-Heidi Lunde
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Torbjørn Torsheim
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Abstract
This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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10
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Keltanen TN, Heikman PK, Muhonen LH, Gunnar TO, Ojanperä IA. Enzymatic assay for urine lactose in the assessment of recent intravenous abuse of buprenorphine. Drug Test Anal 2019; 11:1412-1418. [DOI: 10.1002/dta.2654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Terhi N. Keltanen
- Forensic Toxicology UnitNational Institute for Health and Welfare Helsinki Finland
- Department of Forensic MedicineUniversity of Helsinki Helsinki Finland
| | - Pertti K. Heikman
- PsychiatryUniversity of Helsinki Helsinki Finland
- PsychiatryHelsinki University Central Hospital Helsinki Finland
| | - Leea H. Muhonen
- PsychiatryHelsinki University Central Hospital Helsinki Finland
| | - Teemu O. Gunnar
- Forensic Toxicology UnitNational Institute for Health and Welfare Helsinki Finland
| | - Ilkka A. Ojanperä
- Forensic Toxicology UnitNational Institute for Health and Welfare Helsinki Finland
- Department of Forensic MedicineUniversity of Helsinki Helsinki Finland
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11
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Capsule Commentary on Katzman et al., Army and Navy ECHO Pain Telementoring Improves Clinician Opioid Prescribing for Military Patients: An Observational Cohort Study. J Gen Intern Med 2019; 34:445. [PMID: 30623380 PMCID: PMC6420593 DOI: 10.1007/s11606-018-4762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Mravčík V, Janíková B, Drbohlavová B, Popov P, Pirona A. The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic. Harm Reduct J 2018; 15:60. [PMID: 30514306 PMCID: PMC6280526 DOI: 10.1186/s12954-018-0268-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022] Open
Abstract
Opioid agonist therapy (OAT) has been available in a standard regime in the Czech Republic since 2000. Buprenorphine is the leading medication, while methadone is available only in a few specialised centres. There is an important leakage of buprenorphine onto the illicit market, and the majority of Czech opioid users are characterised by the misuse (and injecting) of diverted buprenorphine medications. Most prescribed buprenorphine for OAT is not covered by current national health insurance schemes, and patients have to pay considerable prices to afford their treatment. This affordability barrier together with limited accessibility is likely the leading factor of limited coverage of OAT and of recent stagnation in the number of patients in the official treatment programmes in the Czech Republic. It also encourages doctor shopping and the re-selling of parts of their medication at a higher price, which represents the main factor that drives the Czech illicit market for buprenorphine, but at the same time co-finances the medication of clients in official OAT programmes. Improving access to OAT by making it financially affordable is essential to further increase OAT coverage and is one of the factors that can reduce the illicit market with OAT medications.
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Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Barbara Janíková
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Barbora Drbohlavová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Petr Popov
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Alessandro Pirona
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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High buprenorphine-related mortality is persistent in Finland. Forensic Sci Int 2018; 291:76-82. [DOI: 10.1016/j.forsciint.2018.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
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Abstract
Opioids are very addictive drugs because of their powerful effects on reward and pain pathways in the brain. Opioid addiction is currently a worldwide problem and injecting heroin presents serious health risks including death from overdose. The increase in the nonmedical use of prescription opioids and the increase in overdose deaths are worrying trends in North America. There is therefore an increasing need for access to effective treatments. The 2 major drug treatments, methadone and buprenorphine, have proven efficacy but are not necessarily administered in the most effective doses or under optimum conditions. Alternative approaches such as slow-release oral morphine, tincture of opium, and the use of the opioid antagonist naltrexone to maintain abstinence are used seemingly effectively in some countries but have yet to be fully evaluated in randomized controlled trials. Heroin-assisted treatment has proven to be a valuable and effective treatment when administered in specialized clinics but is only appropriate for those who have failed to improve on optimal methadone or buprenorphine maintenance. Recent innovations and substitution treatment as an alternative to incarceration are described. Drug treatment of opioid addiction is most effective when administered as part of a therapeutic program as demonstrated in the initial methadone evaluations and the more recent trials with heroin-assisted treatment.
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Affiliation(s)
- Alyson J Bond
- Department of Addiction, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - John Witton
- Department of Addiction, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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