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Metcalfe RK, Dobischok S, Bansback N, MacDonald S, Byres D, Lajeunesse J, Harrison S, Koch B, Topping B, Brock T, Foreman J, Schechter M, Oviedo-Joekes E. Client preferences for the design and delivery of injectable opioid agonist treatment services: Results from a best-worst scaling task. Addiction 2024. [PMID: 39054406 DOI: 10.1111/add.16620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/19/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND AIMS Clinical trials support injectable opioid agonist treatment (iOAT) for individuals with opioid use disorder (OUD) for whom other pharmacological management approaches are not well-suited. However, despite substantial research indicating that person-centered care improves engagement, retention and health outcomes for individuals with OUD, structural requirements (e.g. drug policies) often dictate how iOAT must be delivered, regardless of client preferences. This study aimed to quantify clients' iOAT delivery preferences to improve client engagement and retention. DESIGN Cross-sectional preference elicitation survey. SETTING Metro Vancouver, British Columbia, Canada. PARTICIPANTS 124 current and former iOAT clients. MEASUREMENTS Participants completed a demographic questionnaire package and an interviewer-led preference elicitation survey (case 2 best-worst scaling task). Latent class analysis was used to identify distinct preference groups and explore demographic differences between preference groups. FINDINGS Most participants (n = 100; 81%) were current iOAT clients. Latent class analysis identified two distinct groups of client preferences: (1) autonomous decision-makers (n = 73; 59%) and (2) shared decision-makers (n = 51; 41%). These groups had different preferences for how medication type and dosage were selected. Both groups prioritized access to take-home medication (i.e. carries), the ability to set their own schedule, receiving iOAT in a space they like and having other services available at iOAT clinics. Compared with shared decision-makers, fewer autonomous decision-makers identified as a cis-male/man and reported flexible preferences. CONCLUSIONS Injectable opioid agonist treatment (iOAT) clients surveyed in Vancouver, Canada, appear to prefer greater autonomy than they currently have in choosing OAT medication type, dosage and treatment schedule.
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Affiliation(s)
- Rebecca Kathleen Metcalfe
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
| | - Sophia Dobischok
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- Department of Education and Counselling Psychology, McGill University, Montreal, Canada
| | - Nick Bansback
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - David Byres
- Provincial Health Services Authority, Vancouver, Canada
| | | | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Bryce Koch
- Doctor Peter Center, Vancouver, BC, Canada
| | - Blue Topping
- Downtown Community Health Centre, Vancouver, Canada
| | - Terry Brock
- Lookout Housing and Health Society, Surrey, Canada
| | - Julie Foreman
- Hope to Health Research and Innovation Centre, Vancouver, Canada
| | - Martin Schechter
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Magel T, Arreola LAG, Guh D, MacDonald S, Harrison S, Schechter M, Oviedo-Joekes E. Building Capacity for Injectable Diacetylmorphine and Hydromorphone for the Treatment of Opioid Use Disorder: Identifying Typical Doses. J Psychoactive Drugs 2024:1-14. [PMID: 38590251 DOI: 10.1080/02791072.2024.2338734] [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: 09/14/2023] [Accepted: 02/22/2024] [Indexed: 04/10/2024]
Abstract
Identifying typical doses of existing opioid use disorder medications, such as injectable opioid agonist treatment (iOAT), can support client and program needs, and potentially increase iOAT expansion. Longitudinal data from participants in a cohort study (n = 131), along with clinic dispensation records from August 2014 to April 2020, were used to examine physician prescribed as well as used doses of injectable diacetylmorphine and hydromorphone. Dosage groups, by medication and prescribed dose per session, were created for both hydromorphone and diacetylmorphine. A total of 534, 522 injections were registered during the study period among 129 participants. Mean received diacetylmorphine doses ranged from 106 to 989 mg per day, with most clients using 125-262 mg per session (mean 192.99 mg) and attending 2.40 sessions per day. Mean received hydromorphone doses ranged from 51.09 to 696.06 mg per day, with the majority using 88-154 mg per session (mean 121.32 mg; 2.43 sessions). Average daily doses remained stable overtime and, while mid-range doses were most typical, participants used the whole spectrum of allowable dose prescriptions. Evidence supporting typical doses of iOAT can be integrated into program planning to better allow providers and prescribers to anticipate program needs and engage in individualized care.
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Affiliation(s)
- Tianna Magel
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Daphne Guh
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Scott Harrison
- Providence Health Care, Urban Health and Substance Use, Vancouver, BC, Canada
| | - Martin Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada
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Beaumont S, Magel T, MacDonald S, Harrison S, Schechter M, Oviedo-Joekes E. Shared decision-making and client-reported dose satisfaction in a longitudinal cohort receiving injectable opioid agonist treatment (iOAT). Subst Abuse Treat Prev Policy 2024; 19:1. [PMID: 38172882 PMCID: PMC10763140 DOI: 10.1186/s13011-023-00585-4] [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: 09/30/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Across different types of oral Opioid Agonist Treatment for people with Opioid Use Disorder, receiving a dose that meets their needs is associated with better outcomes. Evidence also shows patients are more likely to receive an "adequate dose" when their prescribers are involving them in decision making. Neither of these findings have been studied in the context of injectable Opioid Agonist Treatment, which is the purpose of this study. METHODS This study was a retrospective analysis of an 18-month prospective longitudinal cohort study of 131 people receiving injectable Opioid Agonist Treatment. In the 18-month study, observations were collected every two months for one year, and then once more at 18 months. At 6 months, participants were asked whether their dose was satisfactory to them (outcome variable). Generalized Estimating Equations were used, to account for multiple observations from each participant. The final multivariate model was built using a stepwise approach. RESULTS Five hundred forty-five participant-observations were included in the analysis. Participant-observations were grouped by "dose is satisfactory" and "wants higher dose". From unadjusted analyses, participants were less likely to report being satisfied with their dose if they: were Indigenous, had worse psychological or physical health problems, had ever attempted suicide, were younger when they first injected any drug, were a current smoker, felt troubled by drug problems, gave their medication a lower "drug liking" score, and felt that their doctor was not including them in decisions the way they wanted to be. In the final multivariate model, all previously significant associations except for "current smoker" and "troubled by drug problems" were no longer significant after the addition of the "drug liking" score. CONCLUSIONS Patients in injectable Opioid Agonist Treatment who are not satisfied with their dose are more likely to: be troubled by drug problems, be a current smoker, and report liking their medication less than dose-satisfied patients. Prescribers' practicing shared decision-making can help patients achieve dose-satisfaction and possibly alleviate troubles from drug problems. Additionally, receiving a satisfactory dose may be dependent on patients being able to access an opioid agonist medication (and formulation) that they like.
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Affiliation(s)
- Scott Beaumont
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 77 E Hastings St, Vancouver, BC, V6A 2R7, Canada
| | - Scott Harrison
- Urban Health and Substance Use, Providence Health Care, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Martin Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Advancing Health Outcomes, 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 Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
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Fox AD, Riback L, Perez-Correa A, Ohlendorf E, Ghiroli M, Behrends CN, López-Castro T. High Interest in Injectable Opioid Agonist Treatment With Hydromorphone Among Urban Syringe Service Program Participants. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:44-53. [PMID: 38258851 DOI: 10.1177/29767342231210552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Injectable opioid agonist treatment with hydromorphone (iOAT-H) is effective for persons who inject drugs (PWID) with opioid use disorder (OUD) but remains unavailable in the United States. Our objective was to determine interest in iOAT-H among syringe services program (SSP) participants. METHODS We recruited PWID with OUD from SSPs in New York City. Interest in iOAT-H was assessed on a 4-point scale. We compared participants who were and were not interested in iOAT-H regarding sociodemographic characteristics and self-reported variables (past 30 days): heroin use, public injection practices, and participation in illegal activity other than drug possession. Participants reported their preferred OUD treatment and reasons for these preferences. RESULTS Of 108 participants, most were male (69%), Hispanic (68%), and median age was 42 years. The median number of prior OUD treatment episodes was 6 (interquartile range: 2-12). Most (65%) were interested in iOAT-H. Interested participants (vs not interested) reported, over the prior 30 days, greater heroin use days (mean, 26.4 vs 22.3), injecting in public more times (median, 15 vs 6), and a higher percentage having participated in illegal activity (40% vs 16%). Preferences for OUD treatment were: iOAT-H (43%), methadone (39%), and buprenorphine (9%). Participants who preferred iOAT-H to conventional OUD treatments reported preferring injection as a route of administration and that available OUD treatments helped them insufficiently. CONCLUSIONS SSP participants with OUD reported high interest in iOAT-H. Participants had attempted conventional treatments but still used heroin almost daily. We identified PWID at risk for opioid-related harms who potentially could benefit from iOAT-H.
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Affiliation(s)
- Aaron D Fox
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Lindsey Riback
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Andres Perez-Correa
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | | | - Megan Ghiroli
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
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Blawatt S, Harrison S, Byres D, Foreman J, Amara S, Burdge W, MacDonald S, Schechter MT, Oviedo-Joekes E. The mobilization of nurse-client therapeutic relationships in injectable opioid agonist treatment: Autonomy, advocacy and action. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209154. [PMID: 37652211 DOI: 10.1016/j.josat.2023.209154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/07/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Injectable opioid agonist treatment (iOAT) is an evidence-based treatment that serves an important minority of people with opioid use disorder who require specialized care. Unique to iOAT care is the consistency with which clients access treatment (up to three times daily), a condition that creates repeated opportunities for health care engagement. To date, no study has examined therapeutic relationships in this life saving, nurse-led treatment that can have lasting implications in the equitable delivery of other forms of addictions care. METHODS This study used grounded theory to generate a dynamic framework for therapeutic relationship building in iOAT. Researchers collected semi-structured interviews from registered nurses working in iOAT sites (n=24) form January 2020 through June 2022. The study analyzed collected data through a constant comparative analysis; explored through open, axial, and selective coding; and assessed in a conditional relationship matrix. The team reviewed key findings with stakeholders through formalized processes of engagement to confirm saturation of coding categories. Throughout data collection and analysis, researchers integrated feedback from additional knowledge users and member checking. Reported findings adhered to the COREQ1 standardized checklist. RESULTS We identified five interrelated categories that created a distinct culture of care for iOAT nurses: Ways of Knowing, Personal Investment, Leveraging Empathy, Finding Flexibility, and Collaborating to Overcome. Through creating a safe, nonjudgmental environment, nurses establish therapeutic relationships that build trust to identify client needs outside of medication administration. In turn, nurses participate in team-based problem solving to advocate for client needs. If nurses cannot find flexibility within and outside of the health care system to improve client engagement, tensions can arise and therapeutic relationships can be strained. CONCLUSIONS Therapeutic relationships are an integral part of building and maintaining trust with a population that has been precariously involved with other forms of health care. Nurses make a substantial effort to create a safe and nonjudgmental environment to manifest a culture of care that bridges client needs and program access. Without the expansion of access to iOAT programs and their embedded services, nurses are limited in their ability to provide individualized care for clients with diverse needs.
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Affiliation(s)
- 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 Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC V6H 4C1, Canada
| | - Julie Foreman
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Sherif Amara
- Fraser Health, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Wistaria Burdge
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, 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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6
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Friedmann Z, Kinkel HT, Kühner C, Zsolnai A, Mick I, Binder A. Supervised on-site dosing in injectable opioid agonist treatment-considering the patient perspective. Findings from a cross-sectional interview study in two German cities. Harm Reduct J 2023; 20:162. [PMID: 37915058 PMCID: PMC10619267 DOI: 10.1186/s12954-023-00896-6] [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: 05/11/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) is an effective option to support people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral OAT. However, iOAT has been criticised based on theoretical and practical grounds for its dosing policies: Current regulations demand supervised, on-site application and require patients to frequently visit their treatment facility. The current study aims to investigate how patients experience on-site application and derive strategies to enhance the acceptability and effectiveness of iOAT-delivery. METHODS This article is based on semi-structured interviews with 27 individuals currently or previously in iOAT in two German outpatient iOAT-clinics. We undertook an inductive qualitative content analysis, which included blinded, independent coding and the analysis of individual cases. RESULTS Comments regarding on-site application and daily visits to the clinic were grouped into positive and negative aspects, iOAT as the best alternative option, facilitators of daily visits, and suggestions for improvement. Positive aspects took the factors stability and social support in regard. Negative aspects ranged from general inconveniences to major impediments to individuals' daily lives and towards achieving psychosocial goals. Participants reported rigorous adherence to iOAT's treatment regime, often due to a perceived lack of alternative options. Meeting iOAT's demands was eased by the patients' coping-strategies and through facilitating measures implemented by iOAT-clinics. Despite acknowledgement of the potential detriments from easing regulations, take-home arrangements were frequently suggested by participants to improve iOAT. CONCLUSIONS Being required to attend the clinic for supervised iOAT-application is not experienced uniformly. While clinics can support their patients to cope with strict regulations, alternative approaches to iOAT-application should be considered to accommodate patients' individual needs. Examples from other treatment modalities (e.g., remote supervision and delivery services) might aid to reconcile individualisation while providing adequate safety measures and improve iOAT in the long term.
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Affiliation(s)
- Zoe Friedmann
- Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany.
| | - Hans-Tilmann Kinkel
- Praxiskombinat Neubau, Schwerpunktpraxis für Suchtmedizin (Outpatient Clinic for Addiction Medicine), Ruschestraße 103, 10365, Berlin, Germany
| | - Claudia Kühner
- Schwerpunktpraxis für Suchtmedizin Stuttgart (Outpatient Clinic for Addiction Medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Andreas Zsolnai
- Schwerpunktpraxis für Suchtmedizin Stuttgart (Outpatient Clinic for Addiction Medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany
| | - Annette Binder
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, University of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
- DZPG (German Centre for Mental Health), Tuebingen, Germany
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Oviedo-Joekes E, Dobischok S, Carvajal J, MacDonald S, McDermid C, Klakowicz P, Harrison S, LaJeunesse J, Chow N, Brown M, Gill S, Schechter M. Clients' experiences on North America's first take-home injectable opioid agonist treatment (iOAT) program: a qualitative study. BMC Health Serv Res 2023; 23:553. [PMID: 37237256 DOI: 10.1186/s12913-023-09558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND To support public health measures during the COVID-19 pandemic, oral opioid agonist treatment (OAT) take-home doses were expanded in Western countries with positive results. Injectable OAT (iOAT) take-home doses were previously not an eligible option, and were made available for the first time in several sites to align with public health measures. Building upon these temporary risk-mitigating guidelines, a clinic in Vancouver, BC continued to offer two of a possible three daily doses of take-home injectable medications to eligible clients. The present study explores the processes through which take-home iOAT doses impacted clients' quality of life and continuity of care in real-life settings. METHODS Three rounds of semi-structured qualitative interviews were conducted over a period of seventeen months beginning in July 2021 with eleven participants receiving iOAT take-home doses at a community clinic in Vancouver, British Columbia. Interviews followed a topic guide that evolved iteratively in response to emerging lines of inquiry. Interviews were recorded, transcribed, and then coded using NVivo 1.6 using an interpretive description approach. RESULTS Participants reported that take-home doses granted them the freedom away from the clinic to have daily routines, form plans, and enjoy unstructured time. Participants appreciated the greater privacy, accessibility, and ability to engage in paid work. Furthermore, participants enjoyed greater autonomy to manage their medication and level of engagement with the clinic. These factors contributed to greater quality of life and continuity of care. Participants shared that their dose was too essential to divert and that they felt safe transporting and administering their medication off-site. In the future, all participants would like more accessible treatment such as access longer take-home prescriptions (e.g., one week), the ability to pick-up at different and convenient locations (e.g., community pharmacies), and a medication delivery service. CONCLUSIONS Reducing the number of daily onsite injections from two or three to only one revealed the diversity of rich and nuanced needs that added flexibility and accessibility in iOAT can meet. Actions such as licencing diverse opioid medications/formulations, medication pick-up at community pharmacies, and a community of practice that supports clinical decisions are necessary to increase take-home iOAT accessibility.
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Affiliation(s)
- 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.
| | - Sophia Dobischok
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - José Carvajal
- 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
| | - Cheryl McDermid
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Piotr Klakowicz
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Julie LaJeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Nancy Chow
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Murray Brown
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Sam Gill
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Martin 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
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Jaffe K, Blawatt S, Lehal E, Lock K, Easterbrook A, MacDonald S, Harrison S, Lajeunesse J, Byres D, Schechter M, Oviedo-Joekes E. "As long as that place stays open, I'll stay alive": Accessing injectable opioid agonist treatment during dual public health crises. Harm Reduct J 2023; 20:51. [PMID: 37060027 PMCID: PMC10104430 DOI: 10.1186/s12954-023-00779-w] [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: 02/16/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider-client interaction-treatment components made difficult by the pandemic. METHODS Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software. RESULTS Qualitative analysis revealed the ways in which the pandemic shaped clients' lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses. CONCLUSION Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.
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Affiliation(s)
- Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Sarin Blawatt
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Eisha Lehal
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Kurt Lock
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation and 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
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Martin Schechter
- Centre for Health Evaluation and 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 and 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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9
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Magel T, Matzinger E, Blawatt S, Harrison S, MacDonald S, Amara S, Metcalfe R, Bansback N, Byres D, Schechter M, Oviedo-Joekes E. How injectable opioid agonist treatment (iOAT) care could be improved? service providers and stakeholders’ perspectives. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2176287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Tianna Magel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Elizabeth Matzinger
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Sarah Blawatt
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Sherif Amara
- SafePoint Supervised Consumption Site, Fraser Health Authority, Surrey, Canada
| | - Rebecca Metcalfe
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - David Byres
- Provincial Health Services Authority, Vancouver, Canada
| | - Martin Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
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10
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Treatment History and Interest in Injectable Opioid Agonist Treatment With Hydromorphone Among People Who Inject Drugs. J Addict Med 2022:01271255-990000000-00101. [PMID: 36255107 DOI: 10.1097/adm.0000000000001093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Injectable opioid agonist treatment (iOAT) is a novel approach to treating opioid use disorder (OUD) that is typically reserved for treatment-experienced persons who inject drugs (PWID) with long-standing OUD. This study examined PWID's past OUD treatment histories and their attitudes toward iOAT with hydromorphone. METHODS This cross-sectional study recruited syringe services program participants with OUD in New York City. Participants self-reported past OUD care episodes (detoxification; outpatient, inpatient, or medication treatment; or mutual aid groups) and current interest in iOAT with hydromorphone (assessed on a 4-point scale with 3 or 4 considered "interested"). Participants with 2 or more treatment episodes in the past 5 years were considered treatment-experienced. We examined whether the number of past care episodes was associated with interest in iOAT. RESULTS Of 108 PWID, most participants were male (68.5%) and Hispanic (68.5%) with a mean age of 43 years (±10.8). Nearly all (98.1%) had severe OUD and had received past OUD care (96.3%), with the mean number of care episodes being 17.4 (SD, ±15.9). Most participants (59.8%) were treatment-experienced. Interest in iOAT with hydromorphone was high (64.8%), but there was no significant association between total past care episodes and expressing interest in iOAT (odds ratio, 1.02; 95% confidence interval, 0.99-1.05). CONCLUSION Participants were highly treatment-experienced, and iOAT interest was high regardless of prior OUD treatment. New OUD treatment options, such as iOAT with hydromorphone, would be welcomed by PWID whose OUD has not remitted with conventional treatment as well as other PWID.
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11
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Smart R, Reuter P. Does heroin-assisted treatment reduce crime? A review of randomized-controlled trials. Addiction 2022; 117:518-531. [PMID: 34105206 DOI: 10.1111/add.15601] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Several randomized controlled trials (RCTs) conclude that heroin-assisted-treatment (HAT) has a larger benefit-cost ratio than oral methadone because HAT more reliably and substantially reduces participants' criminal activity. This review: (1) summarizes results from RCTs concerning the comparative effectiveness of HAT for reducing criminal activity and (2) examines the role of different mechanisms for explaining changes in crime. DESIGN Systematic search of five databases for RCTs evaluating comparative effectiveness of HAT on participant crime outcomes and potential mediators of crime. Narrative synthesis with tabular comparisons of outcomes extracted across RCTs. SETTING Europe and Canada. PARTICIPANTS Twenty studies, spanning 10 RCTs with 2427 participants, met inclusion criteria. INTERVENTIONS HAT compared to other treatments for opioid use disorder, primarily oral methadone. MEASUREMENTS The primary outcome was criminal activity. Mediator outcomes included illicit heroin use, drug expenditures, employment and earnings and social functioning. FINDINGS All trials found significantly reduced criminal activity among HAT participants, and four found significantly larger reductions for HAT compared to control condition [median odds ratios (ORs) = 0.45]. Reductions in crime are concentrated in drug-related and property offenses (ORs range from 0.14 to 0.90 and from 0.12 to 1.89, respectively). Comparative efficacy of HAT for reducing illicit heroin use probably explains reductions in drug possession offenses, but does not show consistent correlation with drug dealing or property offenses. While three trials showed reductions in drug expenditures as possibly driving crime reductions, others did not report expenditures. There is little evidence that treatment effects on economic and social functioning outcomes explain within-trial changes in criminal activity. CONCLUSIONS Existing literature suggests that heroin-assisted treatment reduces criminal activity, but trials varied in whether these effects exceeded those from oral methadone treatment. Inconsistency in outcome measures across trials complicates understanding drivers of heterogeneity. More detailed information on legal and illegal income, drug expenditures and social interactions could improve our understanding of the causal mechanisms underlying the effect of heroin-assisted-treatment on crime.
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Affiliation(s)
| | - Peter Reuter
- RAND Corporation, Santa Monica, CA, USA.,Department of Criminology and School of Public Policy, University of Maryland, College Park, MD, USA
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12
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Westenberg JN, Tai AMY, Elsner J, Kamel MM, Wong JSH, Azar P, Vo DX, Moore E, Mathew N, Seethapathy V, Choi F, Vogel M, Krausz RM. Treatment approaches and outcome trajectories for youth with high-risk opioid use: A narrative review. Early Interv Psychiatry 2022; 16:207-220. [PMID: 33913589 DOI: 10.1111/eip.13155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/22/2021] [Indexed: 12/26/2022]
Abstract
AIM First use of opioids often happens in adolescence and an increasing number of opioid overdoses are being reported among youth. The purpose of this narrative review was to present the treatment approaches for youth with high-risk opioid use, determine whether the literature supports the use of opioid agonist treatment among youth and identify evidence for better treatment outcomes in the younger population. METHODS A search of the literature on PubMed using MeSH terms specific to youth, opioid use and treatment approaches generated 1436 references. Following a screening process, 137 papers were found to be relevant to the treatment of high-risk opioid use among youth. After full-text review, 19 eligible studies were included: four randomized controlled trials, nine observational studies and six reviews. RESULTS Research for the different treatment options among youth is limited. The available evidence shows better outcomes in terms of retention in care and cost-effectiveness for opioid agonist treatment than abstinence-based comparisons. Integrating psychosocial interventions into the continuum of care for youth can be an effective way of addressing comorbid psychiatric conditions and emotional drivers of substance use, leading to improved treatment trajectories. CONCLUSIONS From the limited findings, there is no evidence to deny youth with high-risk opioid use the same treatment options available to adults. A combination of pharmacological and youth-specific psychosocial interventions is required to maximize retention and survival. There is an urgent need for more research to inform clinical strategies toward appropriate treatment goals for such vulnerable individuals.
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Affiliation(s)
- Jean Nicolas Westenberg
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andy M Y Tai
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Elsner
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mostafa M Kamel
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Neuropsychiatry, Tanta University, Tanta, Egypt
| | - James S H Wong
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pouya Azar
- Complex Pain and Addiction Services, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Dzung X Vo
- Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Eva Moore
- Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Nickie Mathew
- Department of Psychiatry, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.,BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Vijay Seethapathy
- Department of Psychiatry, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.,BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Fiona Choi
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Vogel
- Psychiatric University Clinic Basel, Basel, Switzerland
| | - Reinhard M Krausz
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Wang B, Hu B, Zhong H, Zhao C. Study on the Effect of Different Doses of Hydromorphone on the Time Response and Postoperative Analgesia of Ropivacaine in Ultrasound-Guided Suprailiac Fascia Inguinal Block. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:9691062. [PMID: 34691231 PMCID: PMC8531777 DOI: 10.1155/2021/9691062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effects of different doses of hydromorphone under the guidance of ultrasound on ropivacaine blocking the superior inguinal iliac fascia and postoperative analgesia. METHODS From January 2020 to June 2021, 90 American Society of Anesthesiologists (ASA) I-II patients undergoing elective total hip arthroplasty (THA) were selected and randomly divided into 3 groups, 30 patients in each one. Ultrasound-guided superior inguinal iliac fascia block was performed in the patients of the 3 groups before operation. The L group: 0.3% ropivacaine 30 ml; the H1 group: 0.3% ropivacaine + 25 μg/kg hydromorphone 30 ml; the H2 group: 0.3% ropivacaine + 50 μg/kg hydromorphone 30 ml. The time until the occurrence of pain, pain intensity, sufentanil remedial dose, the number of PCIA presses, and effective times were compared among the 3 groups. The VAS and Ramsay scores of 3 groups were recorded at 12 h, 24 h, 36 h, and 48 h after operation. RESULTS The time from the end of surgery to the appearance of pain in the H2 group was higher than that in the H1 group and the L group, and the time in the H1 group was higher than that in the L group (P < 0.05). The VAS score in the H2 group was lower than that in the H1 group and the L group, and the VAS score in the H1 group was lower than that in the L group (P < 0.05). The VAS scores of 12 h, 24 h, 36 h, and 48 h after operation in the H2 group were lower than those of the H1 group and the L group, and the H1 group was lower than the L group (P < 0.05). The Ramsay scores at 12 h, 24 h, 36 h, and 48 h after operation in the H2 group and the H1 group were higher than those in the L group (P < 0.05), and the difference was not statistically significant in the H2 group and the H1 group (P > 0.05). The remedial dosage of sufentanil, times of PCIA compression, and effective times in the H2 group were lower than those in the H1 group and the L group, and the level in the H1 group was lower than that in the L group (P < 0.05). The incidence rates of adverse reactions in the L group, the H1 group, and the H2 group were 13.33%, 23.33%, and 30.00%, respectively. There was no significant difference in the incidence rate of adverse reactions among the 3 groups (P > 0.05). CONCLUSION 25 μg/kg and 50 μg/kg hydromorphone used in the ultrasound-guided superior inguinal iliac fascia block can enhance the time effect of ropivacaine and improve analgesic effects, with good safety. In addition, time effect and analgesic effect of 50 μg/kg hydromorphone in enhancing ropivacaine were more obvious.
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Affiliation(s)
- Baiyun Wang
- The Affiliated Nanhua Hospital, Department of Anesthesiology, Hengyang Medical College, University of South China, Hengyang 421001, Hunan, China
| | - Bingbing Hu
- The Affiliated Nanhua Hospital, Department of Anesthesiology, Hengyang Medical College, University of South China, Hengyang 421001, Hunan, China
| | - Huanhui Zhong
- The Affiliated Nanhua Hospital, Department of Anesthesiology, Hengyang Medical College, University of South China, Hengyang 421001, Hunan, China
| | - Chengda Zhao
- The Affiliated Nanhua Hospital, Department of Anesthesiology, Hengyang Medical College, University of South China, Hengyang 421001, Hunan, China
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14
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Harris MT, Seliga RK, Fairbairn N, Nolan S, Walley AY, Weinstein ZM, Turnbull J. Outcomes of Ottawa, Canada's Managed Opioid Program (MOP) where supervised injectable hydromorphone was paired with assisted housing. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103400. [PMID: 34469781 DOI: 10.1016/j.drugpo.2021.103400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Ottawa Inner City Health's Managed Opioid Program is the first, to our knowledge, to pair injectable opioid agonist hydromorphone treatment with assisted housing for people experiencing homelessness with severe opioid use disorder (OUD) and injection drug use. We aimed to describe this program and evaluate retention, health, and social wellbeing outcomes. METHODS We retrospectively assessed the first cohort of clients enrolled in the Managed Opioid Program between August 2017-2018. The primary outcome was retention at 12 months. Secondary outcomes included injectable and oral opioid dose titration, non-prescribed opioid use, overdoses, connection with behavioural health services, and social well-being. Descriptive statistics were used to summarize baseline demographics and secondary outcomes. Actuarial survival analysis was used to assess retention among participants. RESULTS The study sample included 26 participants: median age was 36 years, 14 were female, 22 were White, eight had alcohol use disorders, 25 had stimulant use disorders, and all had a history of concurrent psychiatric illness. Retention at 12 months was 77% (95% CI 62-95). Throughout the first-year participants' opioid treatment doses increased. The median daily dose of injectable hydromorphone was 36 mg [17-54 mg] and 156 mg [108-188 mg] at enrollment and one year respectively. The median daily dose of oral opioid treatment was 120-milligram morphine equivalents [83-180 mg morphine equivalents] and 330-milligram morphine equivalents [285-428 mg morphine equivalents] at enrollment and one year respectively. Over half had no overdoses and there were no deaths among participants who remained enrolled. At one year, 45% stopped non-prescribed opioid use, 96% connected to behavioral health services, 73% reconnected with estranged families, and 31% started work or vocational programs. CONCLUSION Individuals with severe OUD engaged in injectable hydromorphone treatment and housing showed high retention in care and substantive improvements in patient-centered health and social well-being outcomes.
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Affiliation(s)
- Miriam Th Harris
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Pl, Boston, MA 02118, United States; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston MA, 02118, United States.
| | - Rebecca K Seliga
- Ottawa University, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada, V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada, V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Pl, Boston, MA 02118, United States; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston MA, 02118, United States
| | - Zoe M Weinstein
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Pl, Boston, MA 02118, United States; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston MA, 02118, United States
| | - Jeffery Turnbull
- Ottawa University, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada; Ottawa Inner City Health, 5 Myrand Ave, Ottawa, ON K1N 5N7, Canada
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15
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Abstract
Between January 2016 and June 2019, there were over 13,900 apparent opioid-related deaths in Canada, solidifying the need for appropriate and effective services for people who use drugs (PWUD). Within government initiatives and policies, PWUD are often inappropriately considered a homogeneous group of individuals, with implementation of services nationally often being guided by these governmental bodies without meaningful consultation and collaboration with PWUD. However, recent harm reduction research and best practice guidelines have emphasized the importance of tailoring services to local drug scenes. Despite this, very little research on the cultural norms of PWUD exists in the literature. In an attempt to explore the local culture of drug use in Ottawa, a literature review ultimately uncovered very few articles on this topic. However, by expanding the search beyond Ottawa and using a social determinants of health framework, the factors of culture, income and social status, physical environment, and access to services were revealed as unique experiences for PWUD. Further, through four in-depth interviews with current harm reduction providers in Ottawa, the themes of (1) uncertainty and concerns surrounding the overdose crisis; (2) lack of flexibility in resources and access issues; and (3) diversity in the culture of drug use in Ottawa were explored. Recommendations surrounding partnering with PWUD, policy changes, and a safer supply were subsequently discussed. These findings helped to validate the reality of the unique drug-use culture in Ottawa, and the requirement for harm reduction services to be adapted to the local needs of PWUD.
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Affiliation(s)
- Marlene Haines
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
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16
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Haines M, O'Byrne P. Injectable opioid agonist treatment: An evolutionary concept analysis. Res Nurs Health 2021; 44:664-671. [PMID: 33993526 DOI: 10.1002/nur.22140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/05/2021] [Accepted: 05/01/2021] [Indexed: 11/09/2022]
Abstract
Canada is currently in the midst of an overdose crisis. With new and innovative approaches desperately needed, injectable opioid agonist treatment (iOAT) should be considered as an integral treatment option to prevent even more fatalities. These programs provide injectable diacetylmorphine or hydromorphone to clients with severe opioid use disorders. Currently, they remain an under-executed and under-studied treatment modality. To better understand why this may be, we performed an evolutionary concept analysis as described by Rodgers. The attributes, antecedents, consequences, and surrogate terms of iOAT were unpacked and explored. Further, four themes were identified within the literature: (1) physical and mental health, (2) illicit drug use, (3) criminal behavior, and (4) ethical considerations. Recommendations surrounding the need for additional studies that focus on the perspectives of people who use opioids (PWUO), the necessity of nursing advocacy in iOAT, and the consideration of a changing illicit drug supply were explored. Further, theoretical analysis coupled with direct input from PWUO was discussed as a necessity to move forward with iOAT.
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Affiliation(s)
- Marlene Haines
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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17
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Oviedo-Joekes E, MacDonald S, Boissonneault C, Harper K. Take home injectable opioids for opioid use disorder during and after the COVID-19 Pandemic is in urgent need: a case study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:22. [PMID: 33673847 PMCID: PMC7935000 DOI: 10.1186/s13011-021-00358-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/30/2022]
Abstract
Background In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they’re financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT. Case presentation Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics. Conclusion In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.
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Affiliation(s)
- 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.
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Charles Boissonneault
- British Columbia Centre on Substance Use, BC Centre on Substance Use (BCCSU), 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
| | - Kelli Harper
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
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18
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Oviedo-Joekes E, Palis H, Guh D, Marsh DC, MacDonald S, Harrison S, Brissette S, Anis AH, Schechter MT. Adverse Events During Treatment Induction With Injectable Diacetylmorphine and Hydromorphone for Opioid Use Disorder. J Addict Med 2020; 13:354-361. [PMID: 30747750 PMCID: PMC6791495 DOI: 10.1097/adm.0000000000000505] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/08/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The present study aims to describe a 3-day induction protocol for injectable hydromorphone (HDM) and diacetylmorphine (DAM) used in 3 Canadian studies and examine rates of opioid-related overdose and somnolence during this induction phase. METHODS The induction protocol and associated data on opioid-related overdose and somnolence are derived from 2 clinical trials and one cohort study conducted in Vancouver and Montreal (2005-2008; 2011-2014; 2014-2018). In this analysis, using the Medical Dictionary for Regulatory Activities coding system we report somnolence (ie, drowsiness, sleepiness, grogginess) and opioid overdose as adverse events. Overdoses requiring intervention with naloxone are coded as severe adverse events. RESULTS Data from the 3 studies provides a total of 1175 induction injections days, with 700 induction injection days for DAM, and 475 induction injection days for HDM. There were 34 related somnolence and adverse event (AE) overdoses (4.899 per 100 injection days) in DAM and 6 (1.467 per 100 days) in HDM. Four opioid overdoses requiring naloxone (0.571 per 100 injection days) were registered in DAM and 1 in HDM (0.211 per 100 injection days), all safely mitigated onsite. The first week maximum daily dose patients received were on average 433.62 mg [standard deviation (SD) = 137.92] and 223.26 mg (SD = 68.06) for DAM and HDM, respectively. CONCLUSIONS A 3-day induction protocol allowed patients to safely reach high doses of injectable hydromorphone and diacetylmorphine in a timely manner. These findings suggest that safety is not an evidence-based barrier to the implementation of treatment with injectable hydromorphone and diacetylmorphine.
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Affiliation(s)
- Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital (EOJ, HP, DG, AHA, MTS); School of Population and Public Health, University of British Columbia, Vancouver, BC (EOJ, HP, AHA, MTS); Northern Ontario School of Medicine, Sudbury, ON (DCM); Canadian Addiction Treatment Centres, Markham, ON (DCM); Providence Health Care, Providence Crosstown Clinic, Vancouver, BC (SH, SM); Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, CHUM Montréal, Montréal, QC, Canada (SB)
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19
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Olding M, Ivsins A, Mayer S, Betsos A, Boyd J, Sutherland C, Culbertson C, Kerr T, McNeil R. A Low-Barrier and Comprehensive Community-Based Harm-Reduction Site in Vancouver, Canada. Am J Public Health 2020; 110:833-835. [PMID: 32298171 DOI: 10.2105/ajph.2020.305612] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
"The Molson" is a low-barrier, peer-staffed, supervised consumption site located in Vancouver, Canada. In addition to overdose response, this site offers drug checking and a colocated injectable hydromorphone treatment program, and it distributes tablet and liquid hydromorphone to service users at high risk of overdose. Our evaluation suggests benefits of this program in creating service continuums and preventing overdose deaths. From September 2017 to August 2019, the site had 128 944 visits, reversed 770 overdoses, and had no overdose deaths.
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Affiliation(s)
- Michelle Olding
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
| | - Andrew Ivsins
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
| | - Samara Mayer
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
| | - Alex Betsos
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
| | - Jade Boyd
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
| | - Christy Sutherland
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
| | - Coco Culbertson
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
| | - Thomas Kerr
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
| | - Ryan McNeil
- Michelle Olding, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, and Thomas Kerr are with the BC Centre on Substance Use, Vancouver, Canada. Christy Sutherland and Coco Culbertson are with the Portland Hotel Society, Vancouver, Canada. Ryan McNeil is with the Yale University School of Medicine, New Haven, CT
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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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Fairbairn N, Ross J, Trew M, Meador K, Turnbull J, MacDonald S, Oviedo-Joekes E, Le Foll B, Goyer MÈ, Perreault M, Sutherland C. Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline. CMAJ 2019; 191:E1049-E1056. [PMID: 31548191 PMCID: PMC6763328 DOI: 10.1503/cmaj.190344] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nadia Fairbairn
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Josey Ross
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Michael Trew
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Karine Meador
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Jeff Turnbull
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Scott MacDonald
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Eugenia Oviedo-Joekes
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Bernard Le Foll
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Marie-Ève Goyer
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Michel Perreault
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Christy Sutherland
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
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22
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Belackova V, Salmon AM, Jauncey M, Bell J. Learning from the past, looking to the future - Is there a place for injectable opioid treatment among Australia’s responses to opioid misuse? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:164-168. [DOI: 10.1016/j.drugpo.2019.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/25/2019] [Accepted: 01/30/2019] [Indexed: 12/28/2022]
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Oviedo-Joekes E, Palis H, Guh D, Marchand K, Brissette S, Harrison S, MacDonald S, Lock K, Anis AH, Marsh DC, Schechter MT. Treatment with injectable hydromorphone: Comparing retention in double blind and open label treatment periods. J Subst Abuse Treat 2019; 101:50-54. [DOI: 10.1016/j.jsat.2019.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/08/2019] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
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Ivsins A, Pauly B, Brown M, Evans J, Gray E, Schiff R, Krysowaty B, Vallance K, Stockwell T. On the outside looking in: Finding a place for managed alcohol programs in the harm reduction movement. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 67:58-62. [PMID: 30959410 DOI: 10.1016/j.drugpo.2019.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/26/2019] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
Alcohol policy in North America is dominated by moderation and abstinence-based modalities that focus on controlling population-level alcohol consumption and modifying individual consumption patterns to prevent and reduce alcohol-related harms. However, conventional alcohol policies and interventions do not adequately address harms associated with high-risk drinking among individuals experiencing severe alcohol use disorder (AUD) and structural vulnerability such as poverty and homelessness. In this commentary we address this gap in alcohol harm reduction, and highlight the lack of, and distinct need for, alcohol-specific harm reduction for people experiencing structural vulnerability and severe AUD. These individuals, doubly impacted by structural oppression and severe AUD, engage in various high-risk drinking practices that contribute to a unique set of harms that conventional abstinence-based treatments and interventions fail to adequately attend to. Managed alcohol programs (MAPs) have been established to address these multiple intersecting harms, and though gaining momentum across Canada, have had a hard time finding their place within the harm reduction movement. We illustrate how MAPs play a crucial role in the harm reduction movement in their ability to not only address high-risk drinking practices among structurally marginalized individuals, but to respond to harms associated with broader structural inequities such as poverty and homelessness.
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Affiliation(s)
- Andrew Ivsins
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada.
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada; School of Nursing, University of Victoria, HSD Building A402A, Victoria, BC, V8P 5C2, Canada
| | - Meaghan Brown
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada
| | - Joshua Evans
- Department of Earth and Atmospheric Sciences, University of Alberta, 1-26 Earth Sciences Building, Edmonton, AB, T6G 2E9, Canada
| | - Erin Gray
- School of Social Work, MacEwan University, 9-505 Robbins Building, Box 1796, 10700-104 Avenue, Edmonton, AB, T5J 2P2, Canada
| | - Rebecca Schiff
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada
| | - Bonnie Krysowaty
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada
| | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada
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25
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Roux P, Mezaache S, Briand-Madrid L, Debrus M, Khatmi N, Maradan G, Protopopescu C, Rojas-Castro D, Carrieri P. Profile, risk practices and needs of people who inject morphine sulfate: Results from the ANRS-AERLI study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:3-9. [PMID: 29966806 DOI: 10.1016/j.drugpo.2018.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/10/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
Abstract
AIMS In France, a non-negligible proportion of opioid-dependent individuals inject morphine sulfate. Although it has not yet been officially approved as an opioid substitution treatment (OST), some physicians can prescribe its use for people in methadone or buprenorphine treatment failure. Longitudinal data from the ANRS-AERLI study, which evaluated an educational intervention for safer injection called AERLI, provided us the opportunity to better characterize the profile, risk practices and needs of people who inject morphine sulfate (MSI), through comparison with other injectors, and to identify correlates of HIV/HCV risk practices in this group. METHODS The national multisite ANRS-AERLI study assessed the impact of AERLI offered in volunteer harm reduction (HR) centers ("with intervention") (n = 113) through comparison with standard HR centers ("without intervention") (n = 127). All participants were scheduled to be followed up for 12 months and have 3 telephone interviews: at baseline, 6 months and 12 months. We compared MSI (n = 79) with other opioid injectors (n = 161) and then used a mixed logistic model to identify factors associated with HIV/HCV risk practices among MSI. FINDINGS Of the 240 eligible participants, 79 were regular MSI. They were less likely to use cocaine, crack or buprenorphine and to receive OST than other participants. Conversely, MSI were more likely to inject drugs more than three times a day and to report HIV/HCV risk practices. Among MSI, multivariate analysis showed that those receiving morphine sulfate as an OST were less likely to report such practices than other participants (aOR [95%CI] = 0.11 [0.02-0.61]). CONCLUSION Our results show that while MSI use fewer stimulants, they have more HIV/HCV risk practices than other injectors. However, when MSI are prescribed morphine sulfate as a treatment, these practices tend to decrease. Our findings suggest the importance of increasing access to morphine sulfate as a new OST in France.
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Affiliation(s)
- Perrine Roux
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France.
| | - Salim Mezaache
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Laélia Briand-Madrid
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Marie Debrus
- Médecins du Monde, Paris, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Nicolas Khatmi
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Gwenaelle Maradan
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Camélia Protopopescu
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Daniela Rojas-Castro
- Médecins du Monde, Paris, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Patrizia Carrieri
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
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Fairgrieve C, Fairbairn N, Samet JH, Nolan S. Nontraditional Alcohol and Opioid Agonist Treatment Interventions. Med Clin North Am 2018; 102:683-696. [PMID: 29933823 PMCID: PMC6650149 DOI: 10.1016/j.mcna.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite the availability of effective medications and psychosocial interventions for the management of a substance use disorder, some individuals repeatedly fail the most aggressive treatment regimens. For such individuals, alternative treatment options exist seeking to mitigate the negative consequences of the use of harmful substances. Participation in a managed alcohol program, or the use of sustained-release oral morphine or injectable opioid agonist treatment or the creation of safe injecting facilities, are examples of such nonstandard approaches. This article reviews the available evidence of these treatment modalities.
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Affiliation(s)
- Christopher Fairgrieve
- Department of Family Medicine, University of British Columbia, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; British Columbia Centre on Substance Use, Providence Health Care, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Providence Health Care, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Providence Health Care, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
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Bansback N, Guh D, Oviedo-Joekes E, Brissette S, Harrison S, Janmohamed A, Krausz M, MacDonald S, Marsh DC, Schechter MT, Anis AH. Cost-effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial. Addiction 2018; 113:1264-1273. [PMID: 29589873 DOI: 10.1111/add.14171] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/26/2017] [Accepted: 01/19/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Previous research has found diacetylmorphine, delivered under supervision, to be cost-effective in the treatment of severe opioid use disorder, but diacetylmorphine is not available in many settings. The Study to Assess Long-term Opioid Maintenance Effectiveness (SALOME) randomized controlled trial provided evidence that injectable hydromorphone is non-inferior to diacetylmorphine. The current study aimed to compare the cost-effectiveness of hydromorphone directly with diacetylmorphine and indirectly with methadone maintenance treatment. DESIGN A within-trial analysis was conducted using the patient level data from the 6-month, double-blind, non-inferiority SALOME trial. A life-time analysis extrapolated costs and outcomes using a decision analytical cohort model. The model incorporated data from a previous trial to include an indirect comparison to methadone maintenance. SETTING A supervised clinic in Vancouver, British Columbia, Canada. PARTICIPANTS A total of 202 long-term street opioid injectors who had at least two attempts at treatment, including one with methadone (or other substitution), were randomized to hydromorphone (n = 100) or diacetylmorphine (n = 102). MEASUREMENTS We measured the utilization of drugs, visits to health professionals, hospitalizations, criminal activity, mortality and quality of life. This enabled us to estimate incremental costs, quality-adjusted life years (QALYs) and cost-effectiveness ratios from a societal perspective. Sensitivity analyses considered different sources of evidence, assumptions and perspectives. FINDINGS The within-trial analysis found hydromorphone provided similar QALYs to diacetylmorphine [0.377, 95% confidence interval (CI) = 0.361-0.393 versus 0.375, 95% CI = 0.357-0.391], but accumulated marginally greater costs [$49 830 ($28 401-73 637) versus $34 320 ($21 780-55 998)]. The life-time analysis suggested that both diacetylmorphine and hydromorphone provide more benefits than methadone [8.4 (7.4-9.5) and 8.3 (7.2-9.5) versus 7.4 (6.5-8.3) QALYs] at lower cost [$1.01 million ($0.6-1.59 million) and $1.02 million ($0.72-1.51 million) versus $1.15 million ($0.71-1.84 million)]. CONCLUSIONS In patients with severe opioid use disorder enrolled into the SALOME trial, injectable hydromorphone provided similar outcomes to injectable diacetylmorphine. Modelling outcomes during a patient's life-time suggested that injectable hydromorphone might provide greater benefit than methadone alone and may be cost-saving, with drug costs being offset by costs saved from reduced involvement in criminal activity.
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Affiliation(s)
- Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Daphne Guh
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Suzanne Brissette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Scott Harrison
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - Amin Janmohamed
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Michael Krausz
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Scott MacDonald
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Martin T Schechter
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Aslam H Anis
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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