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Plesons M, Malecki E, Ciraldo K, Ashbes E, Suarez E, Tookes HE, Bartholomew TS. Accessibility of methadone treatment via public transit for syringe services program participants in Miami-Dade County, Florida. RESEARCH SQUARE 2024:rs.3.rs-4791074. [PMID: 39257978 PMCID: PMC11384030 DOI: 10.21203/rs.3.rs-4791074/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
Methadone is an opioid receptor agonist medication used in the treatment of opioid use disorder (OUD). Geographic distance to opioid treatment programs (OTPs) is a major barrier to treatment, given requirements for direct observation of dosing and periodic drug screens, and 'methadone treatment deserts' are defined as a public transit threshold of 30 minutes. The purpose of this study was to examine public transit access to methadone treatment for participants of a syringe services program (SSP) in Miami-Dade County, Florida. Public transit times were calculated using the R library r5r, which facilitates multi-modal transportation network routing. General Transit Feed Specification data was combined with street network data from OpenStreetMap for Miami-Dade County. Transit times were estimated from the population-weighted centroid of each zip code (n=79) with participants of Miami's only SSP (n=1597) to the nearest OTP (n=4) using 10 departure windows aligned with OTP service hours. The mean one-way transit time from zip codes with SSP participants in Miami-Dade County to the nearest OTP was 80 minutes. 75 of the 79 (95%) zip codes with SSP participants in Miami-Dade County have a mean transit time to the closest OTP greater than 30 minutes. Transit times differ substantially between zip codes with different numbers of SSP participants, but not between departure windows. Nearly all zip codes with SSP participants in Miami-Dade County can be classified as 'methadone treatment deserts'. Geographic isolation of methadone treatment from public transit routes represents a significant barrier to equitable OUD treatment.
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Affiliation(s)
- Marina Plesons
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Eileen Malecki
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Katrina Ciraldo
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Emilie Ashbes
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Edward Suarez
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Hansel E Tookes
- University of Miami Miller School of Medicine: University of Miami School of Medicine
| | - Tyler S Bartholomew
- University of Miami Miller School of Medicine: University of Miami School of Medicine
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Roth KB, Goplerud DK, Babjak JS, Nguyen JL, Gilbert LR. Examining the association of rurality with opioid-related morbidity and mortality in Georgia: A geospatial analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209336. [PMID: 38494047 DOI: 10.1016/j.josat.2024.209336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The US opioid epidemic continues to escalate, with overdose deaths being the most-used metric to quantify its burden. There is significant geographic variation in opioid-related outcomes. Rural areas experience unique challenges, yet many studies oversimplify rurality characterizations. Contextual factors, such as area deprivation, are also important to consider when understanding a community's need for treatment services and prevention programming. This study aims to provide a geospatial snapshot of the opioid epidemic in Georgia using several metrics of opioid-related morbidity and mortality and explore differences by rurality across counties. METHODS This was a spatial ecologic study. Negative binominal regression was used to model the relationship of county rurality with four opioid-related outcomes - overdose mortality, emergency department visits, inpatient hospitalizations, and overdose reversals - adjusting for county-level sex, racial/ethnic, and age distributions. Area Deprivation Index was also included. RESULTS There was significant geographic variation across the state for all four opioid-related outcomes. Counts remained highest among the metro areas. For rates, counties in the top quartile of rates varied by outcome and were often rural areas. In the final models, rurality designation was largely unrelated to opioid outcomes, with the exception of medium metro areas (inversely related to hospitalizations and overdose reversals) and non-core areas (inversely related to hospitalizations), as compared to large central metro areas. Higher deprivation was significantly related to increased ED visits and hospitalizations, but not overdose mortality and reversals. CONCLUSIONS When quantifying the burden of the opioid epidemic in a community, it is essential to consider multiple outcomes of morbidity and mortality. Understanding what outcomes are problematic for specific communities, in combination with their demographic and socioeconomic context, can provide insight into gaps in the treatment continuum and potential areas for intervention. Additionally, compared to demographic and socioeconomic factors, rurality may no longer be a salient predictor of the severity of the opioid epidemic in an area.
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Affiliation(s)
- Kimberly B Roth
- Mercer University School of Medicine, Department of Community Medicine, 1250 E 66(th) Street, Savannah, GA 31404, USA.
| | - Dana K Goplerud
- Johns Hopkins School of Medicine, Departments of Medicine and Pediatrics, Baltimore, MD 21205, USA
| | - Jennifer S Babjak
- Mercer University School of Medicine, Department of Community Medicine, 1250 E 66(th) Street, Savannah, GA 31404, USA
| | - Jennifer L Nguyen
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - Lauren R Gilbert
- Tilman J. Fertitta Family College of Medicine, University of Houston, 5055 Medical Circle, Houston, TX 77004, USA; Humana Integrated Health System Sciences Institute at the University of Houston, 5055 Medical Circle, Houston, TX 77004, USA
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Shakya P, Jangra J, Rao R, Mishra AK, Bhad R. Assessment of treatment retention rates and predictors of retention on opioid agonist treatment among adolescents. Drug Alcohol Rev 2024. [PMID: 38884374 DOI: 10.1111/dar.13890] [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: 06/20/2023] [Revised: 05/09/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Opioid agonist treatment (OAT) is an effective treatment for opioid dependence syndrome in adults. However, studies on effectiveness of OAT in adolescents are limited; existing studies show varying retention rates. The present study aimed to assess OAT retention rates in adolescent patients with opioid dependence syndrome registered in a community drug treatment clinic in Delhi, India, and to analyse factors associated with retention at 1 year. METHODS Retrospective cohort study. All adolescents (n = 130) aged 10-19 years, started on OAT from January 2020 to July 2022 were included. Baseline and follow-up data was extracted from online record system maintained at the clinic. OAT retention rates at different timepoints were assessed. Multivariable logistic regression was used to discern factors associated with one-year retention. RESULTS The participants' mean age was 16.9 (SD 1.4) years. Mean age of starting opioids was 14.9 (SD 2.2) years; 29.5% (n = 38) injected opioids. The 6-, 12-, 18- and 24-month retention rate on OAT was 64.4%, 45.6%, 38.7% and 29% respectively. The retention rates with buprenorphine and methadone were comparable. Multivariate logistic regression showed retention for less than 12 months to be significantly associated with younger age of starting heroin, involvement in illegal activities, absenteeism from school and substance use in family. DISCUSSION AND CONCLUSIONS The 12-month retention rates on OAT in adolescents is comparable to retention rates in adults. Various factors associated with early age of onset of opioid use are also associated with lower retention rates on OAT.
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Affiliation(s)
- Pooja Shakya
- Department of Psychiatry, Institute of Human Behaviour and Allied Science, New Delhi, India
| | - Jaswant Jangra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Rao
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwani Kumar Mishra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Roshan Bhad
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Bakouni H, Haquet L, Socias ME, Le Foll B, Lim R, Ahamad K, Jutras-Aswad D. Associations of Methadone and BUP/NX Dose Titration Patterns With Retention in Treatment and Opioid Use in Individuals With Prescription-Type Opioid Use Disorder: Secondary Analysis of the OPTIMA Study. J Addict Med 2024; 18:167-173. [PMID: 38258865 DOI: 10.1097/adm.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Methadone and buprenorphine/naloxone (BUP/NX) titration parameters (eg, range, duration, and rate) can vary during opioid use disorder (OUD) treatment. We describe methadone and BUP/NX titration patterns and their associations with treatment outcomes among individuals with a prescription-type OUD. METHODS We used data from a 24-week open-label, multicenter randomized controlled trial, including N = 167 participants aged 18-64 years old with prescription-type OUD who received at least a first dose of treatment. Descriptive analyses of methadone and BUP/NX titration patterns were conducted, that is, range and duration from first to maximum dose, and rate (range/duration ratio). Outcomes included percentage of opioid-positive urine drug screens (UDS) and treatment retention. Adjusted linear and logistic regressions were used to study associations between titration patterns and percentage of opioid-positive UDS and treatment retention. RESULTS Methadone doses were increased by a mean dose range of 42.4 mg over a mean duration of 42.2 days. BUP/NX doses were increased by a mean dose range of 8.4 mg over a mean duration of 28.7 days. Only methadone dose titration range (odds ratio: 1.03; 95% CI, 1.01 to 1.05) and duration (odds ratio: 1.03; 95% CI, 1.01 to 1.05) were associated with higher retention. Only methadone dose titration rate was associated with lower percentage of opioid-positive UDS at weeks 12-24 ( B : -2.77; 95% CI, -4.72 to -0.81). CONCLUSIONS Specific parameters of methadone titration were associated with treatment outcomes and may help in personalizing treatment schedules. Sustained methadone dose titration, when indicated, may help increase retention, whereas faster dose titration for methadone may help decrease opioid use.
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Affiliation(s)
- Hamzah Bakouni
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada (HB, LH, DJ-A); Department of Psychiatry and Addictology, Université de Montréal, Montréal, Quebec, Canada (HB, DJ-A); Université de Rennes, Rennes, France (LH); British Columbia Centre on Substance Use, Vancouver, BC, Canada (MES); Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada (MES); Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (BLF); Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (BLF); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (BLF); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (BLF); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada (BLF); Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada (BLF); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (RL); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (KA); Acute Care Program, Center for Addiction and Mental Health, Toronto, Ontario, Canada (KA)
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Sevigny EL, Greathouse J, Medhin DN. Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1362. [PMID: 37915420 PMCID: PMC10616541 DOI: 10.1002/cl2.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms. Objectives This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps. Search Methods We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020. Selection Criteria The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws. Data Collection and Analysis Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2. Main Results The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality. Authors’ Conclusions More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.
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Affiliation(s)
- Eric L. Sevigny
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Jared Greathouse
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Danye N. Medhin
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
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Gibbons JB, Harris SJ, Solomon KT, Sugarman O, Hardy C, Saloner B. Increasing overdose deaths among Black Americans: a review of the literature. Lancet Psychiatry 2023; 10:719-726. [PMID: 37236218 DOI: 10.1016/s2215-0366(23)00119-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 05/28/2023]
Abstract
In 2020, opioid overdose fatalities among Black Americans surpassed those among White Americans for the first time in US history. This Review analyses the academic literature on disparities in overdose deaths to highlight potential factors that could explain these increases in overdose deaths among Black Americans. Overall, we find that differences in structural and social determinants of health; inequality in the access, use, and continuity of substance use disorder and harm reduction services; variability in fentanyl exposure and risk; and changes in social and economic circumstances since the onset of the COVID-19 pandemic are central to explaining this trend. We conclude with a discussion of opportunities for US policy reform and opportunities for future research.
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Affiliation(s)
- Jason B Gibbons
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Samantha J Harris
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Olivia Sugarman
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Hardy
- Maryland Recovery Organization Connecting Communities, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Bakouni H, McAnulty C, Tatar O, Socias ME, Le Foll B, Lim R, Ahamad K, Jutras-Aswad D. Associations of methadone and buprenorphine-naloxone doses with unregulated opioid use, treatment retention, and adverse events in prescription-type opioid use disorders: Exploratory analyses of the OPTIMA study. Am J Addict 2023; 32:469-478. [PMID: 37308805 DOI: 10.1111/ajad.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/13/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Buprenorphine/naloxone (BUP-NX) and methadone are used to treat opioid use disorder (OUD), yet there is insufficient evidence on the impact of doses on interventions' effectiveness and safety when treating OUD attributable to other opioids than heroin. METHODS We explored associations between methadone and BUP-NX doses and treatment outcomes using data from OPTIMA, a 24-week, pragmatic, open-label, multicenter, pan-Canadian, randomized controlled, two-arm parallel trial with participants (N = 272) with OUD who primarily use opioids other than heroin. Participants were randomized to receive flexible take-home BUP-NX (n = 138) or standard supervised methadone treatment (n = 134). We examined associations between highest BUP-NX and methadone doses, and (1) percentage of opioid-positive urine drug screens (UDS); (2) retention in the assigned treatment; and (3) adverse events (AEs). RESULTS The mean (SD) highest BUP-NX and methadone dose were 17.31 mg/day (8.59) and 67.70 mg/day (34.70). BUP-NX and methadone doses were not associated with opioid-positive UDS percentages or AEs. Methadone dose was associated with higher retention in treatment (odds ratio [OR]: 1.025; 95% confidence interval [CI]: 1.010; 1.041), while BUP-NX dose was not (OR: 1.055; 95% CI: 0.990; 1.124). Higher methadone doses (70-110 mg/day) offered higher odds of treatment retention. DISCUSSION AND CONCLUSION Methadone dose was associated with higher retention, which may be related to its full µ-opioid receptor agonism. Future research should notably ascertain the effect of pace of titration on a wide range of outcomes. SCIENTIFIC SIGNIFICANCE Our results extend previous findings of high doses of methadone increasing retention to be applied in our population using opioids other than heroin, including highly potent opioids.
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Affiliation(s)
- Hamzah Bakouni
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec, Montréal, Canada
| | - Christina McAnulty
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec, Montréal, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Québec, Montréal, Canada
| | - Ovidiu Tatar
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec, Montréal, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Québec, Montréal, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Ontario, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Ontario, Toronto, Canada
- Department of Psychiatry, University of Toronto, Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Toronto, Canada
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Ontario, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Ontario, Penetanguishene, Canada
| | - Ron Lim
- Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith Ahamad
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec, Montréal, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Québec, Montréal, Canada
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Alexander K, Reed MK, Sterling RC. The interaction of race and age in methadone treatment retention outcomes: A single-center analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209020. [PMID: 36933661 DOI: 10.1016/j.josat.2023.209020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/28/2022] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES Early treatment drop-out is due to the unique interplay of the individual and their context, and is associated with overdose death. The objective of this project was to determine if age or race is associated with 6-month treatment retention outcome differences at a single-center opioid treatment program. METHODS The study team performed a retrospective administrative database study from January 2014 to January 2017 using admission data with age and race as predictors of 6-month treatment retention outcomes. RESULTS Of the 457 admissions, 114 were under the age of 30; however, only 4 % of these young adults were Black, Indigenous, and/or People of Color (BIPOC). While retention for BIPOC patients (62 %) was slightly higher than for White patients (57 %), this difference did not reach traditional levels of significance. CONCLUSIONS Once BIPOC enter treatment, their treatment retention is similar to their White counterparts. Young adult BIPOC were less represented in the admission data, but treatment retention across racial groups was similar. An urgent need exists to determine the barriers and facilitators to treatment access among BIPOC young adults.
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Affiliation(s)
| | - Megan K Reed
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, United States of America; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA 19107, United States of America
| | - Robert C Sterling
- Division of Community Substance Abuse Programs, Thomas Jefferson University, United States of America
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Media literacy’s role in the mitigation of disinformation effects on substance misuse. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2183150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Gray E, Wilson M, Landis TT, Little-Gott A. "It's Like Your Whole Body Hates You": Experiences of Withdrawal, Distress, and Barriers to Relief Among Adults Receiving Methadone for Opioid Use Disorder. J Addict Nurs 2022; 33:309-316. [PMID: 37140418 DOI: 10.1097/jan.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT A qualitative descriptive study was conducted concurrent with a larger study investigating the effects of hyperbaric oxygen treatment on withdrawal symptoms for adults receiving daily methadone for opioid use disorder. The aims of this study were to (a) evaluate the perceptions of withdrawal symptoms and sleep characteristics of study participants and (b) explore the experiences of participation in the parent trial of hyperbaric oxygen treatment.Adults with opioid use disorder can experience distressing symptoms related to withdrawal as well as co-occurring symptoms; sleep impairment is frequently reported. Few studies have examined how adults who receive medication for opioid use disorder experience sleep. A preliminary study of adults receiving daily methadone found that withdrawal symptoms were improved after hyperbaric oxygen treatment. This study explores the narrative of opioid users who report their overall experiences with withdrawal and sleep as well as their experiences of hyperbaric therapy.A convenience sample of six participants was recruited, who represented a small subgroup of participants who completed the larger hyperbaric treatment study. Data were collected via semistructured interviews. Data were analyzed using the qualitative content analysis guidelines proposed by Schreier (2012). All participants described poor overall sleep hygiene and disturbed sleep. More than half of the respondents reported improved or eliminated withdrawal symptoms, and all reported improvement in sleep quality after participation in the sleep study.This companion study confirms that subjective sleep disturbance may be prevalent for adults with opioid use disorder. Participants felt the experience of hyperbaric oxygen treatment produced a positive effect on sleep.
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Amiri S, Pham CD, Castonguay S, Denney JT, Buchwald DS. Deaths associated with opioids, race and ethnicity, and years of potential life lost in Washington State. J Subst Abuse Treat 2022; 139:108789. [DOI: 10.1016/j.jsat.2022.108789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/09/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
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Tahsin F, Morin KA, Vojtesek F, Marsh DC. Measuring treatment attrition at various stages of engagement in Opioid Agonist Treatment in Ontario Canada using a cascade of care framework. BMC Health Serv Res 2022; 22:490. [PMID: 35413980 PMCID: PMC9004214 DOI: 10.1186/s12913-022-07877-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for patients who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients’ location of the residence on retention in OAT. Design A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014 to 2020. Study participants included all patients who received OAT from the network of clinics during the study period. Measurements In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to 2 years, and more than 2 years. Correlates associated with OAT retention for 90 days, 90 to 365 days, 1 to 2 years, and more than 2 years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 patients were included in the study. Compared to patients who were retained in OAT for 90 days, patients who were retained for 90 to 365 days, 1 to 2 years, or more than 2 years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of retention have the potential to improve outcomes of OAT.
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Affiliation(s)
| | - Kristen A Morin
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada.,ICES North, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Canada
| | - Frank Vojtesek
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada. .,ICES North, Sudbury, Canada. .,Health Sciences North Research Institute, Sudbury, Canada. .,Canadian Addiction Treatment Centres, Markham, Canada.
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Frontal Lobe Functions, Demoralization, Depression and Craving as Prognostic Factors and Positive Outcomes of Patients with Heroin Use Disorder Receiving 6 Months of Methadone Maintenance Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063703. [PMID: 35329387 PMCID: PMC8954515 DOI: 10.3390/ijerph19063703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 12/04/2022]
Abstract
Methadone maintenance therapy (MMT) is a well-established and effective treatment for heroin use disorders. Whether frontal lobe function and demoralization serve as suitable prognostic and outcome assessment factors remains unknown. A quasi-experimental study was conducted with a single-group repeated-measures design at a medical center and mental hospital in Taiwan. We enrolled 70 participants (39 completed treatments and 31 dropped out). Frontal lobe function, demoralization, depression, and craving at three time points were analyzed. There were differences between patients who completed the treatment (n = 39) and those who did not (n = 31). Thirty-nine patients completed the treatment (average age, 45.5 years; 89.7% men; average duration of heroin use, 27.21 years; MMT, 38.18 mg/day). Post-MMT (6 months), frontal lobe function, demoralization, depression, and craving significantly improved. Dropouts had higher frontal lobe function, lower demoralization, higher craving, younger age, and earlier onset age than patients who completed the pretest treatment. Clinicians should be aware of the severity of demoralization. Clinicians may select suitable patients for MMT by assessing frontal lobe function, demoralization, craving, age, and onset age. A 6-month course of MMT improved demoralization, frontal lobe function, depression, and addiction. Six months of treatment was more effective than 3 months. Suitable patient identification and continuous treatment are important in MMT.
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Hochheimer M, Unick GJ. Systematic review and meta-analysis of retention in treatment using medications for opioid use disorder by medication, race/ethnicity, and gender in the United States. Addict Behav 2022; 124:107113. [PMID: 34543869 DOI: 10.1016/j.addbeh.2021.107113] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS There is mounting evidence that opioid use disorder is experienced differently by people of different genders and race/ethnicity groups. Similarly, in the US access to specific medications for opioid use is limited by gender and race/ethnicity. This study aims to evaluate if gender or race/ethnicity is associated with different rates of treatment retention in the US, for each of three medications used to treat opioid use disorder. METHODS A systematic search was conducted using PubMed, CINHAL, and PsychINFO, databases. All studies that provided a ratio of those retained in treatment at a specified time in terms of gender and/or race/ethnicity and medication were included. Variables were created to assess the effects of time in treatment, recruited sample, required attendance at concurrent psychosocial treatment, and adherence to strict rules of conduct for continuation in treatment on retention. Meta-analytical and meta-regression methods were used to compare studies on the ratio of those who completed a specific time in treatment by race/ethnicity group and by gender. RESULTS Nineteen articles that provided the outcome variable of interest were found (11 buprenorphine, six methadone, and two naltrexone). Meta-analyses found that treatment retention was similar for all gender and racial/ethnic groups for all three medications. Meta-regression found that those of the African American group who were recruited into buprenorphine treatment were retained significantly longer than African Americans in buprenorphine treatment who were studied retrospectively. Also, both genders had significantly lower retention in methadone treatment when there was the additional requirement of psychosocial therapy.
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Bharat C, Larney S, Barbieri S, Dobbins T, Jones NR, Hickman M, Gisev N, Ali R, Degenhardt L. The effect of person, treatment and prescriber characteristics on retention in opioid agonist treatment: a 15-year retrospective cohort study. Addiction 2021; 116:3139-3152. [PMID: 33979008 DOI: 10.1111/add.15514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/30/2020] [Accepted: 03/24/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment and prescriber characteristics. DESIGN Retrospective longitudinal study. SETTING New South Wales, Australia. PARTICIPANTS People entering the opioid agonist treatment programme for the first time between August 2001 and December 2015. MEASUREMENTS Time in opioid agonist treatment (primary outcome) was modelled using a generalized estimating equation model to estimate associations with person, treatment and prescriber characteristics. FINDINGS The impact of medication type on opioid agonist treatment retention reduced over time; the risk of leaving treatment when on buprenorphine compared with methadone was higher among those who entered treatment earlier [e.g. 2001-03: odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.45-1.75] and lowest among those who entered most recently (2013-15: OR = 1.23, 95% CI = 1.11-1.36). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR = 0.94, 95% CI = 0.93-0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past-year psychosis disorder and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment. CONCLUSION In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in opioid agonist treatment.
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Affiliation(s)
- Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- Université de Montréal and Centre de Recherche du CHUM, Montreal, Canada
| | | | - Timothy Dobbins
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Nicola R Jones
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Robert Ali
- Department of Pharmacology, University of Adelaide, Adelaide, SA, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
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Andraka-Christou B. Addressing Racial And Ethnic Disparities In The Use Of Medications For Opioid Use Disorder. Health Aff (Millwood) 2021; 40:920-927. [PMID: 34097509 DOI: 10.1377/hlthaff.2020.02261] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Social discourse about the opioid crisis in the US has focused on White populations, even though opioid-related deaths have grown at a higher rate among people of color than among non-Hispanic White people in recent years. Medications for opioid use disorder (OUD) are the gold standard for treating OUD and preventing overdose but are underused among people with OUD, with disproportionately low treatment initiation and retention among people of color. Methadone, which is highly stigmatized and has a more burdensome treatment regimen, is the predominant medication for OUD available to people of color. To address disparities in the initiation and retention of treatment using medication for OUD, policy makers should consider strategies such as Medicaid expansion, increased grant funding for federally qualified health centers to provide buprenorphine treatment, retention of temporary telehealth policies that allow remote buprenorphine induction, and regulatory changes to allow methadone treatment in office-based practices.
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Affiliation(s)
- Barbara Andraka-Christou
- Barbara Andraka-Christou is an assistant professor in the Department of Health Management and Informatics, University of Central Florida, in Orlando, Florida, with a secondary joint appointment in the Department of Internal Medicine. She is also a licensed attorney in the state of Florida
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Daigre C, Rodríguez L, Roncero C, Palma-Álvarez RF, Perea-Ortueta M, Sorribes-Puertas M, Martínez-Luna N, Ros-Cucurull E, Ramos-Quiroga JA, Grau-López L. Treatment retention and abstinence of patients with substance use disorders according to addiction severity and psychiatry comorbidity: A six-month follow-up study in an outpatient unit. Addict Behav 2021; 117:106832. [PMID: 33529849 DOI: 10.1016/j.addbeh.2021.106832] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/10/2020] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The impact of psychiatric comorbidity and addiction features throughout the course of addiction has been widely studied. This is a naturalistic study conducted in an outpatient unit, where treatment follow-up studies are scarce compared to studies including inpatients or those under experimental conditions. Therefore, this follow-up study aims to analyze the treatment adherence and abstinence of outpatients with SUD (Substance Use Disorders) according to addiction severity and psychiatric comorbidity. METHODS The current six-month follow-up study examined 404 SUD outpatients. Psychiatric comorbidity, addiction severity, substance consumption and treatment adherence were systematically evaluated using semistructured interviews. Survival analyses were conducted to compare the time of treatment adherence and abstinence in a bivariate and multivariate level. RESULTS A progressive dropout was observed, reaching 32.2% of dropouts at the six-month follow-up. More than 50% achieved abstinence during the first month and similar percentages were found until the six-month follow-up. At the multivariate level, treatment adherence, cannabis use disorder and polyconsumption were independently associated with earlier dropout. ADHD was the only mental disorder significantly related with dropout. Regarding substance consumption, the time of abstinence was independently associated with months of treatment adherence and the achievement of abstinence before starting treatment. In general, dual diagnosis was associated with less time of abstinence, but only depressive disorder across the lifespan was related to less time of abstinence in the multivariate model. CONCLUSION These findings highlight the importance of an accurate diagnosis at the beginning of treatment, especially in an outpatient setting, addressing the treatment needs and promoting strategies that improve treatment adherence and reduce the risk of relapses.
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Affiliation(s)
- Constanza Daigre
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Spain.
| | - Laia Rodríguez
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Roncero
- Psychiatry Service, Salamanca University Health Care Complex, Institute of Biomedicine, University of Salamanca, Salamanca, Spain; Psychiatry Unit. School of Medicine. University of Salamanca, Spain
| | - Raul Felipe Palma-Álvarez
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Spain
| | - Marta Perea-Ortueta
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marta Sorribes-Puertas
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Nieves Martínez-Luna
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Elena Ros-Cucurull
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Spain
| | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Spain
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Busch M, Klein C, Uhl A, Haltmayer H, Cabanis M, Westenberg JN, Vogel M, Krausz RM. Retention in the Austrian opioid agonist treatment system: a national prospective cohort study. Harm Reduct J 2021; 18:25. [PMID: 33627159 PMCID: PMC7903033 DOI: 10.1186/s12954-021-00473-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/11/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Retention in care is a prerequisite for successful recovery, especially for a chronic condition like opioid dependence. Though retention varies greatly depending on the different substitution medication and treatment model, treatment retention is used as an indicator of treatment quality and effectiveness of care on a system and individual level. To monitor the overall quality of the Austrian opioid agonist treatment (OAT) system and to monitor patient satisfaction within the system, a new online-based registry called "eSuchmittel" was introduced in Austria at the beginning of 2011. The objective of this study is to analyze retention rates within the Austrian treatment system and to identify patient characteristics associated with retention, using data collected by the substitution registry. METHODS The complete Austrian sample of 4778 registered patients starting treatment between 1.1.2011 to 31.12.2012 were included in the prospective cohort study using data from the Austrian substitution registry. For the statistical analysis, multivariate Cox Regression and Kaplan-Meier survival analysis were used to evaluate retention in treatment. RESULTS The retention rate of the total cohort after two years was around 61%. Retention rates were significantly lower for men (exp(B) = .806, 95% CI 0.714-0.908) and significantly higher for patients aged 30 and older (exp(B) = 1.155, 95% CI 1.044-1.279), among patients located in Vienna (exp(B) = 1.439, 95% CI 1.273-1.626) and among patients prescribed oral slow-release morphine (SROM) (exp(B) = 2.141, 95% CI 1.885-2.430). CONCLUSIONS Average retention in the Austrian system is high in comparison to international retention rates. Nationally, SROM demonstrates higher treatment retention when compared to other available substitution medications. Sociodemographic and regional indicators also contribute to higher retention in care. A systematic monitoring of retention rates within a national registry is an important tool helping to evaluate the quality of care. In this study, the Austrian OAT system proves very high retention in care, an important success criterion.
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Affiliation(s)
- Martin Busch
- Gesundheit Österreich GmbH (GÖG), Vienna, Austria
| | | | - Alfred Uhl
- Gesundheit Österreich GmbH (GÖG), Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| | | | - Maurice Cabanis
- Zentrum Für Seelische Gesundheit, Klinikum Stuttgart, Stuttgart, Germany
| | - Jean Nicolas Westenberg
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, University of British Columbia, David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Marc Vogel
- Psychiatrische Klinik Münsterlingen, Münsterlingen, Switzerland
| | - R. Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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O’Connor AM, Cousins G, Durand L, Barry J, Boland F. Retention of patients in opioid substitution treatment: A systematic review. PLoS One 2020; 15:e0232086. [PMID: 32407321 PMCID: PMC7224511 DOI: 10.1371/journal.pone.0232086] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 04/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout. Methods A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided. Results 67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST. Conclusions Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.
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Affiliation(s)
- Aisling Máire O’Connor
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gráinne Cousins
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- * E-mail:
| | - Louise Durand
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joe Barry
- Population Health Medicine, Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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Individual Factors Associated with Opioid Agonist Therapy Retention in Northern Ontario. CANADIAN JOURNAL OF ADDICTION 2020. [DOI: 10.1097/cxa.0000000000000076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Kapitány-Fövény M, Kiss A, Farkas J, Kuczora KE, Pataki P, Horváth J, Demetrovics Z. Childhood Trauma, Cognitive Emotion Regulation and Motivation for Behavior Change Among Clients of Opioid Substitution Treatment With and Without Past Year Synthetic Cathinone Use During Therapy. Front Neurosci 2020; 14:37. [PMID: 32082111 PMCID: PMC7004963 DOI: 10.3389/fnins.2020.00037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background With a decrease in heroin's purity and availability in the European drug market, Hungarian opioid dependent patients started to substitute heroin with novel psychoactive substances (NPS) and especially with synthetic cathinones. Goal This study aims to assess whether clients of opioid substitution treatment (OST) with and without a history of synthetic cathinone use during therapy differ in (1) the rate and type of experienced childhood trauma, (2) the way they cope with negative life events, (3) their motivation to change substance use behavior, (4) the rate of treatment retention. Methods A total of 198 clients of an outpatient centers (Nyírõ Gyula National Institute of Psychiatry and Addictions, Budapest) OST were asked to provide information about their general substance use experiences, including the consumption of NPS during treatment, their childhood traumatic experiences (Childhood Trauma Questionnaire), cognitive emotion regulation strategies (Cognitive Emotion Regulation Questionnaire), their motivation to change substance use behavior (University of Rhode Island Change Assessment Scale) and current psychiatric symptoms (Brief Symptom Inventory). Baseline data was collected in the summer of 2015, while 4 years follow-up data on treatment retention was obtained in the summer of 2019. Results The majority of the clients were male (N = 141, 71.2%), receiving methadone as a substitute for opioids (N = 178, 89.9%), while mean age of the full sample was 39.7 (SD = 6.8). Based on a logistic regression model, the odds for past year synthetic cathinone use was higher among clients with more severe psychiatric symptoms (B = 0.8, OR = 2.2, p < 0.01) and among clients who were in treatment for a shorter period of time (B = 0.1, OR = 0.9, p < 0.05). Synthetic cathinone use during treatment was further associated with less adaptive strategies to cope with negative life events. Synthetic cathinone use was also a risk factor for reduced treatment retention (B = -0.8, OR = 0.4, p < 0.05) and was associated with lower odds of being member of a latent class with less severe psychopathological profile (B = -0.9, OR = 0.4, p < 0.05). Conclusion Synthetic cathinone use during treatment is associated with poorer treatment outcomes and might be characterized by more severe psychiatric symptoms and amotivation to change substance use among opioid dependent clients.
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Affiliation(s)
- Máté Kapitány-Fövény
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.,Nyírõ Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Anna Kiss
- Nyírõ Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Judit Farkas
- Nyírõ Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Kinga Edit Kuczora
- Nyírõ Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Patrícia Pataki
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Janka Horváth
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Amiri S, Lutz RB, McDonell MG, Roll JM, Amram O. Spatial access to opioid treatment program and alcohol and cannabis outlets: analysis of missed doses of methadone during the first, second, and third 90 days of treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 46:78-87. [PMID: 31237791 DOI: 10.1080/00952990.2019.1620261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The burden of access to opioid treatment programs (OTPs) may change as clients become eligible for take-home privileges. Our previous study showed clients who lived more than 10-miles away from an OTP were more likely to miss methadone doses during the first 30 days of treatment. Proximity to alcohol and cannabis outlets may also negatively influence treatment adherence.Objective: To examine the association between access to this OTP, alcohol and cannabis outlets, and the number of missed methadone doses during the first, second, and third 90 days of treatment.Methods: The number of missed methadone doses was calculated for 752, 689, and 584 clients who remained in treatment, respectively, for at least 3, 6, and 9 months (50% female). Distance between client's home and the OTP, alcohol, and cannabis outlets was measured. Generalized linear models were employed.Results: Shorter distance from a client's residence to the OTP was associated with a decreased number of missed methadone doses during the first 90 days of treatment. Shorter distance to the closest cannabis retail outlet was associated with an increased number of missed methadone doses during the first and second 90 days of treatment. Shorter distance to the closest off-premise alcohol outlet was associated with an increased number of missed methadone doses during the third 90 days of treatment.Conclusions: Improving spatial accessibility of OTPs are essential to ensure treatment opportunities are available for individuals so affected. Exploring to what extent residing in areas that facilitate alcohol and cannabis availability can influence treatment adherence is warranted.
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Affiliation(s)
- Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Robert B Lutz
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.,Spokane Regional Health District, Spokane, WA, USA
| | - Michael G McDonell
- Program of Excellence in Addiction Research, Washington State University, Spokane, WA, USA.,Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - John M Roll
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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