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Nguyen HTT, Dinh DX. Treatment non-adherence among methadone maintenance patients and associated factors: a multicenter, cross-sectional study in Vietnam. Harm Reduct J 2024; 21:129. [PMID: 38961458 PMCID: PMC11220942 DOI: 10.1186/s12954-024-01040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE This multicenter, cross-sectional study was conducted to investigate the prevalence of treatment non-adherence and its associated factors among methadone maintenance patients in Vietnam. METHODS This secondary data analysis was conducted using the data from a previous study. Six hundred patients were interviewed face-to-face to collect data on their demographic characteristics and social support. Information about the treatment characteristics and patients' non-adherence was gathered from medical records and books monitoring their treatment process. Treatment non-adherence was defined as missing at least one methadone dose in the last three months. RESULTS The overall prevalence of non-adherence was 45.7%. The average social support score of patients who completely adhered to treatment was significantly higher than that of those who did not (p < 0.001). In the multivariate logistic regression model, for each one-unit increase in social support (one score), treatment time (a year), and patient's monthly income (one million Vietnam dongs), the odds of non-adherence decreased by 28% (aOR = 0.72, 95%CI 0.59-0.88, p = 0.002), 15% (aOR = 0.85, 95%CI 0.80-0.91, p < 0.001) and 9% (aOR = 0.91, 95%CI 0.85-0.97, p = 0.004), respectively. Patients living in Son La (a mountainous province) were 1.72 times (95%CI 1.09-2.71) more likely to be non-adherent as compared to those in other areas (p = 0.020). As per univariate analyses, other associated factors could be age, education level, family monthly income, occupation, and opioid relapse (p < 0.001). CONCLUSIONS A high non-adherence rate was found among Vietnamese methadone maintenance patients. Interventions involving social support, occupation, income, and education are needed to improve their treatment adherence.
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Affiliation(s)
- Huong Thi Thanh Nguyen
- Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi City, 111000, Vietnam
| | - Dai Xuan Dinh
- Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi City, 111000, Vietnam.
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Hui J, Reddon H, Fairbairn N, Choi J, Milloy MJ, Socias ME. Prevalence and Correlates of Heavy Alcohol use among People Living with HIV who use Unregulated Drugs in Vancouver, Canada. AIDS Behav 2024; 28:2427-2437. [PMID: 38662276 DOI: 10.1007/s10461-024-04341-y] [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] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
Among people living with HIV (PLWH), heavy alcohol use is associated with many negative health consequences. However, the impacts of heavy alcohol use are not well described for PLWH who use drugs. Thus, we investigated the prevalence and correlates of heavy alcohol use among a cohort of people who use drugs (PWUD) living with HIV in Vancouver, Canada. We accessed data from an ongoing community-recruited prospective cohort of PLWH who use drugs with linked comprehensive HIV clinical monitoring data. We used generalized linear mixed-effects modeling to identify factors longitudinally associated with periods of heavy alcohol use between December 2005 and December 2019. Of the 896 participants included, 291 (32.5%) reported at least one period with heavy alcohol use. Periods of recent incarceration (Adjusted Odds Ratio [AOR] = 1.48, 95% Confidence Interval [CI]: 1.01-2.17), encounters with police (AOR = 1.87, 95% CI: 1.37-2.56), and older age (AOR = 1.05, 95% CI: 1.02-1.07) were positively associated with heavy alcohol use. Engagement in drug or alcohol treatment (AOR = 0.54, 95% CI: 0.42-0.70) and male gender (AOR = 0.46; 95% CI: 0.27-0.78) were negatively associated with heavy alcohol use. We observed that heavy alcohol use was clearly linked to involvement with the criminal justice system. These findings, together with the protective effects of substance use treatment, suggest the need to expand access for drug and alcohol treatment programs overall, and in particular through the criminal justice system to reduce alcohol-related harms among PLWH who use drugs.
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Affiliation(s)
- Jeremy Hui
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Hudson Reddon
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - JinCheol Choi
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - M-J Milloy
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Maria Eugenia Socias
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
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Schmidt RA, Kaminski N, Kryszajtys DT, Rudzinski K, Perri M, Guta A, Benoit AC, Bayoumi AM, Challacombe L, Hales J, Kenny K, Kolla G, O'Reilly E, Sereda A, Rai N, Strike C. 'I don't chase drugs as much anymore, and I'm not dead': Client reported outcomes associated with safer opioid supply programs in Ontario, Canada. Drug Alcohol Rev 2023; 42:1825-1837. [PMID: 37718646 DOI: 10.1111/dar.13745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION The ongoing opioid overdose crisis, which has killed over 30,000 people in Canada since 2016, is driven by the volatility of an unregulated opioid drug supply comprised primarily of fentanyl. The Canadian government has recently funded safer opioid supply (SOS) programs, which include off-label prescriptions of pharmaceutical-grade opioids to high risk individuals with the goal of reducing overdose deaths. METHODS In 2021, we examined the implementation and adaption of four SOS programs in Ontario. These programs use a primary care model and serve communities experiencing marginalisation. We conducted semi-structured interviews with program clients. We present the results of a thematic analysis with the aim of describing clients' self-reported impact of these programs on their health and well-being. RESULTS We interviewed 52 clients between June and October 2021 (mean age 47 years, 56% men, 17% self-identified Indigenous, 14% living with HIV). Our results indicate multifaceted pathways to improved self-reported health and well-being among clients including changes to drug use practices, fewer overdoses, reduced criminalised activity, improved trust and engagement in health care, and increased social stability (e.g., housing). DISCUSSION AND CONCLUSION Most clients reported that the intervention saved their life because of the reduced frequency of overdoses. Findings suggest that SOS programs improved clients' health outcomes and increase opportunities for engagement in health services. Our results provide insight into the mechanisms behind some of the emergent evidence on the impact of safer supply prescribing.
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Affiliation(s)
- Rose A Schmidt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Nat Kaminski
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David T Kryszajtys
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Social Work, University of Windsor, Windsor, Canada
| | - Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
| | - Anita C Benoit
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | | | - Jessica Hales
- Regent Park Community Health Centre, Toronto, Canada
| | - Kathleen Kenny
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Emmet O'Reilly
- South Riverdale Community Health Centre, Toronto, Canada
| | | | - Nanky Rai
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Parkdale Queen West Community Health Centre, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Racha S, Patel SM, Bou Harfouch LT, Berger O, Buresh ME. Safety of rapid inpatient methadone initiation protocol: A retrospective cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209004. [PMID: 36931605 DOI: 10.1016/j.josat.2023.209004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/01/2022] [Accepted: 02/27/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Current methadone titration guidelines recommend low initial doses (15-40 mg) and slow increases (10-20 mg every 3 to 7 days) to prevent dose accumulation and oversedation until reaching a target therapeutic dose between 60 and 120 mg. These guidelines were created primarily for outpatient settings in the pre-fentanyl era. Methadone initiations are becoming more common in hospitals, but no titration guidelines exist specific to this treatment setting, which has capacity for increased monitoring. Our objective was to assess the safety of rapid inpatient methadone initiation with regard to mortality, overdose, and serious adverse outcomes both in-hospital and postdischarge. METHODS This is a retrospective, observational, cohort study conducted at an urban, academic medical center in the United States. We queried our electronic medical record for hospitalized adults with moderate to severe opioid use disorder admitted between July 1, 2018, and November 30, 2021. Included patients were rapidly initiated on methadone with 30 mg as the initial dose and 10 mg increases daily until reaching 60 mg. The study extracted thirty-day post-discharge opioid overdose and mortality data from the CRISP database. RESULTS Twenty-five hospitalized patients received rapid methadone initiation during the study period. The study had no major adverse events including in-hospital or thirty-day post-discharge overdoses or deaths. The study did have two instances of sedation, but neither led to methadone dose holds. There were no instances of QTc prolongation. The study had one patient-directed discharge. CONCLUSIONS This study demonstrated that a small subset of hospitalized patients tolerated rapid methadone initiation. More rapid titrations can be utilized in a monitored inpatient setting to retain patients in the hospital and allow providers to account for increased tolerance in the fentanyl era. Guidelines should be updated to reflect the capabilities of inpatient settings to safely initiate and rapidly titrate methadone. Further work should determine optimal methadone initiation protocols in the fentanyl era.
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Affiliation(s)
- Savitha Racha
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
| | - Sapan M Patel
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Johns Hopkins University, Krieger School of Arts and Sciences, United States of America.
| | - Layal T Bou Harfouch
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Johns Hopkins University, Krieger School of Arts and Sciences, United States of America.
| | - Olivia Berger
- Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States of America.
| | - Megan E Buresh
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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Gaeta Gazzola M, Carmichael ID, Christian NJ, Zheng X, Madden LM, Barry DT. A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States. Subst Abus 2023; 44:62-72. [PMID: 37226909 DOI: 10.1177/08897077231167291] [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] [Indexed: 05/26/2023]
Abstract
BACKGROUND Homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement. METHODS Using data from the 2016 to 2018 U.S. Treatment Episode Dataset Discharges (TEDS-D), patient demographic, social, and clinical characteristics were compared between episodes of outpatient MOUD where homelessness was reported at treatment enrollment versus independent housing using pairwise tests adjusted for multiple testing. A logistic regression model examined the relationship between homelessness and treatment length and treatment completion while accounting for covariates. RESULTS There were 188 238 eligible treatment episodes. Homelessness was reported in 17 158 episodes (8.7%). In pairwise analysis, episodes involving homelessness were significantly different from those involving independent living on most demographic, social, and clinical characteristics, with significantly greater social vulnerability in most SDOH variables (P's < .05). Homelessness was significantly and negatively associated with treatment completion (coefficient = -0.0853, P < 0.001, 95% CI = [-0.114, -0.056], OR = 0.918) and remaining in treatment for greater than 180 days (coefficient = -0.3435, P < 0.001, 95% CI = [-0.371, -0.316], OR = 0.709) after accounting for covariates. CONCLUSIONS Patients reporting homelessness at treatment entry in outpatient MOUD in the U.S. represent a clinically distinct and socially vulnerable population from those not reporting homelessness. Homelessness independently predicts poorer engagement in MOUD confirming that homelessness may be an independent predictor for MOUD treatment discontinuation nationally.
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Affiliation(s)
- Marina Gaeta Gazzola
- APT Foundation, Inc., New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Emergency Medicine, NYU Langone Health/NYC Health and Hospitals Bellevue Hospital Center, New York, NY, USA
| | - Iain D Carmichael
- Department of Statistics, University of California at Berkeley, Berkeley, CA, USA
- Department of Pathology and Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Xiaoying Zheng
- APT Foundation, Inc., New Haven, CT, USA
- New York University School of Medicine, New York, NY, USA
| | - Lynn M Madden
- APT Foundation, Inc., New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, Inc., New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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6
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Selfridge M, Card K, Kandler T, Flanagan E, Lerhe E, Heaslip A, Nguyen A, Moher M, Pauly B, Urbanoski K, Fraser C. Factors associated with 60-day adherence to "safer supply" opioids prescribed under British Columbia's interim clinical guidance for health care providers to support people who use drugs during COVID-19 and the ongoing overdose emergency. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103709. [PMID: 35525052 PMCID: PMC9065674 DOI: 10.1016/j.drugpo.2022.103709] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/19/2022]
Abstract
AIMS In March 2020, British Columbia issued Risk Mitigation Guidance (RMG) to support prescribing of pharmaceutical alternatives to illicit drugs, in order to reduce risk for COVID-19, overdose, and withdrawal among people who use drugs. This study evaluated factors associated with 60-day adherence to novel opioid alternatives prescribed at an inner-city health centre in Victoria, Canada. METHODS A chart review was conducted to collect data on sociodemographic information, medical histories, and follow-up services among all clients prescribed novel opioid alternatives from March 2020-August 2020 (n = 286). Bivariable and multivariable regression were used to identify independent and adjusted factors associated with 60-day adherence. RESULTS Overall, 77% of 286 clients were still receiving opioids after 60 days of follow-up. Medications included hydromorphone (n = 274), sustained-release oral morphine (n = 2), and oxycodone (n = 9). The adjusted odds of 60-day adherence to novel opioid alternatives were significantly higher for those receiving a mental health medication (aOR = 3.49, 95%CI = 1.26, 11.00), a higher maximum daily dosage of RMG prescriptions (aOR = 1.03 per mg increase, 95%CI = 1.01, 1.04), and those with continuous receipt of OAT (aOR = 6.25, 95%CI = 2.67, 15.90). CONCLUSIONS Higher dosages and co-prescription of mental health medications and OAT may help support better adherence to this form of prescriber-based "safer supply". Further work is needed to identify optimal prescribing practices and the longer term impacts of differing implementation scenarios.
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Affiliation(s)
- Marion Selfridge
- Cool Aid Community Health Centre, Victoria, BC, Canada; Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada.
| | - Kiffer Card
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada,Simon Fraser University, Faculty of Health Sciences, Canada
| | - Taylor Kandler
- University of British Columbia, Faculty of Medicine, Canada
| | - Erin Flanagan
- University of British Columbia, Faculty of Medicine, Canada
| | - Emily Lerhe
- University of British Columbia, Faculty of Medicine, Canada
| | - Ash Heaslip
- Cool Aid Community Health Centre, Victoria, BC, Canada,University of British Columbia, Faculty of Medicine, Canada
| | - Anne Nguyen
- Cool Aid Community Health Centre, Victoria, BC, Canada,University of British Columbia, Faculty of Medicine, Canada,University of Victoria, Faculty of Medicine, Canada
| | - Matthew Moher
- Cool Aid Community Health Centre, Victoria, BC, Canada,University of British Columbia, Faculty of Medicine, Canada,University of Victoria, Faculty of Medicine, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada,University of Victoria, School of Nursing, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada,University of Victoria, School of Public Health and Social Policy, Canada
| | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, BC, Canada,University of British Columbia, Faculty of Medicine, Canada
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A cohort study examining the relationship among housing status, patient characteristics, and retention among individuals enrolled in low-barrier-to-treatment-access methadone maintenance treatment. J Subst Abuse Treat 2022; 138:108753. [DOI: 10.1016/j.jsat.2022.108753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
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Niles L, Stoller KB. Changing Policy Landscape: How a Hospital-Based Opioid Treatment Program Adapted Care for Patients With Opioid Use Disorder During the COVID-19 Pandemic. Qual Manag Health Care 2022; 31:43-45. [PMID: 38019070 DOI: 10.1097/qmh.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lauren Niles
- National Committee for Quality Assurance, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (Ms Niles); and Johns Hopkins University School of Medicine, Johns Hopkins Medicine, Baltimore, Maryland (Dr Stoller)
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Mackay L, Bach P, Milloy MJ, Cui Z, Kerr T, Hayashi K. The relationship between crystal methamphetamine use and methadone retention in a prospective cohort of people who use drugs. Drug Alcohol Depend 2021; 225:108844. [PMID: 34182377 PMCID: PMC8812812 DOI: 10.1016/j.drugalcdep.2021.108844] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The efficacy of methadone in reducing morbidity and mortality associated with opioid use disorder is supported by a wealth of evidence, yet methadone retention is often poor. While crystal methamphetamine (methamphetamine) use has been recently increasing in many countries, the effect of frequency of methamphetamine use on methadone discontinuation has not been investigated. We aimed to examine whether frequency of methamphetamine use is associated with increased rates of methadone discontinuation among individuals on methadone. DESIGN Two harmonized ongoing open prospective cohort studies of community-recruited people who use illicit drugs with semi-annual follow-ups between 2014 and 2018. SETTING Vancouver, Canada. PARTICIPANTS A community recruited sample of people who use drugs. INTERVENTION A time-varying variable of self-reported methamphetamine use frequency within the past six months. MEASUREMENTS The primary outcome was time to discontinuation of methadone, defined as reporting not being on methadone at the time of a follow-up interview during the study period. We employed multivariable extended Cox regression analysis to examine the relationship between frequency of methamphetamine use and time to methadone discontinuation after adjusting for potential confounders. FINDINGS Of 875 eligible participants who contributed 2319 person-years of follow-up, 284 (32.5 %) discontinued methadone at least once during follow-up and 135 (15.4 %) reported more than weekly methamphetamine use at study baseline. In a multivariate analysis, in comparison to no use, ≥weekly use of methamphetamine remained independently associated with methadone discontinuation (adjusted hazard ratio [aHR] = 1.38, 95 % CI = 1.03-1.85). CONCLUSIONS A significant proportion of participants on methadone in this study reported more than weekly crystal methamphetamine use, which was associated with an increased risk of methadone discontinuation. Closer follow up, education, and treatment of methamphetamine use may be needed for this group to improve methadone retention.
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Affiliation(s)
- Lindsay Mackay
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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10
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Lake S, St Pierre M. The relationship between cannabis use and patient outcomes in medication-based treatment of opioid use disorder: A systematic review. Clin Psychol Rev 2020; 82:101939. [PMID: 33130527 DOI: 10.1016/j.cpr.2020.101939] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Despite high rates of cannabis use during medication-based treatment of opioid use disorder (MOUD), uncertainty remains around how cannabis influences treatment outcomes. We sought to investigate the relationship between cannabis use during MOUD and a number of patient outcomes. We searched seven databases for original peer-reviewed studies documenting the relationship between cannabis use and at least one primary outcome (opioid use, treatment adherence, or treatment retention) among patients enrolled in methadone-, buprenorphine-, or naltrexone-based therapy for OUD. In total, 41 articles (including 23 methadone, 7 buprenorphine, 6 naltrexone, and 5 mixed modalities) were included in this review. For each primary outcome area, there was a small number of studies that produced findings suggestive of a supportive or detrimental role of concurrent cannabis use, but the majority of studies reported that cannabis use was not statistically significantly associated with the outcome. No studies of naltrexone treatment demonstrated significantly worse outcomes for cannabis users. We identified methodological shortcomings and future research priorities, including exploring the potential role of adjunct cannabis use for improving opioid craving and withdrawal during MOUD. While monitoring for cannabis use may help guide clinicians towards an improved treatment plan, cannabis use is unlikely to independently threaten treatment outcomes.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Michelle St Pierre
- Department of Psychology, University of British Columbia, 3187 University Way, Kelowna, BC V1V 1V7, Canada
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Abstract
BACKGROUND Although homelessness and opioid use disorder (OUD) are important public health issues, few studies have examined their cooccurrence. OBJECTIVES The aim of this study was to evaluate the correlates of homelessness among patients enrolled in low-barrier-to-treatment-access methadone maintenance treatment (MMT) programs for OUD. METHODS Demographic, diagnosis-related, and treatment-related correlates were assessed by self-report for 164 patients in MMT. Correlates of past-month homelessness were investigated with logistic regression. RESULTS Twenty-four percent of patients reported homelessness in the past month. Bivariate analyses initially identified 7 statistically significant (P<0.05) correlates of homelessness: gender; Latinx ethnicity; symptoms of depression, anxiety, and somatization; self-criticism; and duration of MMT. In the final logistic regression model, which included significant independent variables from the bivariate logistic regressions, patients in MMT who were homeless (vs. domiciled) were more likely to be male (odds ratio 2.54; confidence interval, 1.01-6.36) and report higher symptoms of depression (odds ratio 1.07; confidence interval, 1.01-1.15). CONCLUSIONS Low-barrier-to-treatment-access programs can attract people who are homeless with OUD into MMT. These programs also have an important public health role in addressing both depression and OUD among people who are homeless.
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12
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Morgan N, Daniels W, Subramaney U. An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification. Subst Abuse Rehabil 2020; 11:1-8. [PMID: 32021548 PMCID: PMC6955608 DOI: 10.2147/sar.s228224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022] Open
Abstract
Background Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use. Methods 300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints. Results Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased. Conclusion After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.
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Affiliation(s)
- Nirvana Morgan
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - William Daniels
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ugasvaree Subramaney
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Fortier E, Sylvestre MP, Artenie AA, Minoyan N, Jutras-Aswad D, Roy É, Grebely J, Bruneau J. Associations between housing stability and injecting frequency fluctuations: findings from a cohort of people who inject drugs in Montréal, Canada. Drug Alcohol Depend 2020; 206:107744. [PMID: 31785537 DOI: 10.1016/j.drugalcdep.2019.107744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between housing stability and drug injecting is complex, as both outcomes fluctuate over time. The objectives were to identify short-term trajectories of housing stability and injecting frequency among people who inject drugs (PWID) and examine how patterns of injecting frequency relate to those of housing stability. METHODS At three-month intervals, PWID enrolled between 2011 and 2016 in the Hepatitis Cohort completed an interviewer-administered questionnaire and were tested for hepatitis C and HIV infections. At each visit, participants reported, for each of the past three months, the accommodation they lived in the longest (stable/unstable) and the number of injecting days (0-30). Group-based dual trajectory modeling was conducted to identify housing stability and injecting frequency trajectories evolving concomitantly over 12 months and estimate the probabilities of following injecting trajectories conditional upon housing trajectories. RESULTS 386 participants were included (mean age 40.0, 82 % male). Three housing stability trajectories were identified: sustained (53 %), declining (20 %), and improving (27 %). Five injecting frequency trajectories were identified: sporadic (26 %), infrequent (34 %), increasing (15 %), decreasing (11 %), and frequent (13 %). PWID with improving housing were less likely to increase injecting (8 %) compared to those with sustained (17 %) or declining housing (17 %). CONCLUSIONS Improving housing was associated with a lower probability of increasing injecting compared to declining housing, while sustained housing stability was associated with a higher probability of increasing injecting compared to improving housing. Therefore, policies to improve PWID's access to stable housing are warranted and may reduce, to some extent, drug injecting and related harms.
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Affiliation(s)
- Emmanuel Fortier
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Sylvestre
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Andreea Adelina Artenie
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Nanor Minoyan
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Didier Jutras-Aswad
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Élise Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada; Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Julie Bruneau
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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