1
|
González-Saiz F, Vergara-Moragues E, Trujols J, Alcaraz S, Siñol N, Pérez de Los Cobos J. Assessing predictors of adequate individual buprenorphine maintenance dosage for the treatment of opioid use disorder: Listening to the patient. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104519. [PMID: 39024687 DOI: 10.1016/j.drugpo.2024.104519] [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: 02/28/2024] [Revised: 05/27/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Dose optimization plays a key role in determining clinical outcomes in patients on opioid agonist treatment (OAT). The objective of this study was to identify the variables independently associated with buprenorphine/naloxone (B/N) dose adequacy in patients with opiate use disorder (OUD). METHOD Cross-sectional study of a convenience sample of patients with OUD treated with B/N (n = 315) in four regions in Spain. The Opiate Dosage Adequacy Scale (ODAS) was used to determine B/N dose adequacy. The ODAS evaluate the six components of the "dose adequacy" construct, as follows: continued use of heroin; narcotic blockade or crossed tolerance; objective opioid withdrawal symptoms (OWS); subjective OWS; craving for heroin; and overmedication. A binomial logistic regression analysis was performed to identify the variables associated with the condition "ODAS Adequate B/N dose". Participants completed a battery of instruments to assess sociodemographic, substance use, clinical, and treatment variables. RESULTS The B/N dose was considered adequate in 231 of the 315 participants (73.3 %). Two variables, satisfaction with B/N as a medication (OR=5.764, 95 % CI=2.211-15.030) and patient-perceived participation in B/N dose decisions (OR=1.790, 95 % CI=1221-2623), were independently, significantly, and positively associated with the "ODAS Adequate B/N dose" condition. While the severity of heroin dependence was significantly associated with buprenorphine dose adequacy in the bivariate analyses, significance was lost in the full regression model. CONCLUSION Satisfaction with B/N as a medication and patient-perceived involvement in the dose decision are associated with clinician-assessed dose adequacy. In the context of good clinical practice, it is important to take into account both of these variables to individualize the prescribed dose through a shared decision-making process.
Collapse
Affiliation(s)
- Francisco González-Saiz
- Unidad de Hospitalización de Salud Mental, UGC Salud Mental, Hospital Universitario de Jerez, Servicio Andaluz de Salud, Spain; Departamento de Neurociencias, Área de Psiquiatría, Universidad de Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | | | - Joan Trujols
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Saul Alcaraz
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Núria Siñol
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - José Pérez de Los Cobos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autonoma de Barcelona, Bellaterra, Spain
| |
Collapse
|
2
|
Brandt L, Odom GJ, Hu MC, Castro C, Balise RR. Empirically contrasting urine drug screening-based opioid use disorder treatment outcome definitions. Addiction 2024; 119:1289-1300. [PMID: 38616571 DOI: 10.1111/add.16494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 02/21/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND AIMS A lack of consensus on the optimal outcome measures to assess opioid use disorder (OUD) treatment efficacy and their precise definition and computation has hampered the pooling of research data for evidence synthesis and meta-analyses. This study aimed to empirically contrast multiple clinical trial definitions of treatment success by applying them to the same dataset. METHODS Data analysis used a suite of functions, developed as a software package for the R language, to operationalize 61 treatment outcome definitions based on urine drug screening (UDS) results. Outcome definitions were derived from clinical trials that are among the most influential in the OUD treatment field. Outcome functions were applied to a harmonized dataset from three large-scale National Drug Abuse Treatment Clinical Trials Network (CTN) studies, which tested various medication for OUD (MOUD) options (n = 2492). Hierarchical clustering was employed to empirically contrast outcome definitions. RESULTS The optimal number of clusters identified was three. Cluster 1, comprising eight definitions focused on detecting opioid-positive UDS, did not include missing UDS in outcome calculations, potentially resulting in inflated rates of treatment success. Cluster 2, with the highest variability, included 10 definitions characterized by strict criteria for treatment success, relying heavily on UDS results from either a brief period or a single study visit. The 43 definitions in Cluster 3 represented a diverse range of outcomes, conceptualized as measuring abstinence, use reduction and relapse. These definitions potentially offer more balanced measures of treatment success or failure, as they avoid the extreme methodologies characteristic of Clusters 1 and 2. CONCLUSIONS Clinical trials using urine drug screening (UDS) for objective substance use assessment in outcome definitions should consider (1) incorporating missing UDS data in outcome computation and (2) avoiding over-reliance on UDS data confined to a short time frame or the occurrence of a single positive urine test following a period of abstinence.
Collapse
Affiliation(s)
- Laura Brandt
- Department of Psychology, The City College of New York, New York, New York, USA
| | - Gabriel J Odom
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Clinton Castro
- The Information School, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Raymond R Balise
- Division of Biostatistics, Department of Public Health Sciences, The University of Miami, Miami, Florida, USA
| |
Collapse
|
3
|
Gueguen MCM, Anlló H, Bonagura D, Kong J, Hafezi S, Palminteri S, Konova AB. Recent Opioid Use Impedes Range Adaptation in Reinforcement Learning in Human Addiction. Biol Psychiatry 2024; 95:974-984. [PMID: 38101503 PMCID: PMC11065633 DOI: 10.1016/j.biopsych.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Drugs like opioids are potent reinforcers thought to co-opt value-based decisions by overshadowing other rewarding outcomes, but how this happens at a neurocomputational level remains elusive. Range adaptation is a canonical process of fine-tuning representations of value based on reward context. Here, we tested whether recent opioid exposure impacts range adaptation in opioid use disorder, potentially explaining why shifting decision making away from drug taking during this vulnerable period is so difficult. METHODS Participants who had recently (<90 days) used opioids (n = 34) or who had abstained from opioid use for ≥ 90 days (n = 20) and comparison control participants (n = 44) completed a reinforcement learning task designed to induce robust contextual modulation of value. Two models were used to assess the latent process that participants engaged while making their decisions: 1) a Range model that dynamically tracks context and 2) a standard Absolute model that assumes stationary, objective encoding of value. RESULTS Control participants and ≥90-days-abstinent participants with opioid use disorder exhibited choice patterns consistent with range-adapted valuation. In contrast, participants with recent opioid use were more prone to learn and encode value on an absolute scale. Computational modeling confirmed the behavior of most control participants and ≥90-days-abstinent participants with opioid use disorder (75%), but a minority in the recent use group (38%), was better fit by the Range model than the Absolute model. Furthermore, the degree to which participants relied on range adaptation correlated with duration of continuous abstinence and subjective craving/withdrawal. CONCLUSIONS Reduced context adaptation to available rewards could explain difficulty deciding about smaller (typically nondrug) rewards in the aftermath of drug exposure.
Collapse
Affiliation(s)
- Maëlle C M Gueguen
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey; Intercultural Cognitive Network, Tokyo, Japan
| | - Hernán Anlló
- Intercultural Cognitive Network, Tokyo, Japan; Watanabe Laboratory, School of Fundamental Science and Engineering, Waseda University, Tokyo, Japan; Laboratoire de Neurosciences Cognitives et Computationnelles, Institut National de la Santé et de la Recherche Médicale U960, École Normale Supérieure-Université de Recherche Paris Science et Lettres, Paris, France
| | - Darla Bonagura
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey; Intercultural Cognitive Network, Tokyo, Japan
| | - Julia Kong
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey
| | - Sahar Hafezi
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey
| | - Stefano Palminteri
- Intercultural Cognitive Network, Tokyo, Japan; Laboratoire de Neurosciences Cognitives et Computationnelles, Institut National de la Santé et de la Recherche Médicale U960, École Normale Supérieure-Université de Recherche Paris Science et Lettres, Paris, France
| | - Anna B Konova
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey; Intercultural Cognitive Network, Tokyo, Japan.
| |
Collapse
|
4
|
Hayes BT, Li P, Nienaltow T, Torres-Lockhart K, Khalid L, Fox AD. Low-dose buprenorphine initiation and treatment continuation among hospitalized patients with opioid dependence: A retrospective cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209261. [PMID: 38103838 PMCID: PMC10947892 DOI: 10.1016/j.josat.2023.209261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/20/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Buprenorphine is an effective treatment for both opioid use disorder (OUD) and chronic pain, but buprenorphine's pharmacology complicates treatment initiation for some patients. Low-dose buprenorphine initiation is a novel strategy that may reduce precipitated withdrawal. Few studies describe what patient populations benefit most from low-dose initiations and the clinical parameters that impact treatment continuation. This study aimed to 1) describe experiences with low-dose buprenorphine initiation, including both successes and failures among hospitalized patients in an urban underserved community; 2) identify patient- and treatment-related characteristics associated with unsuccessful initiation and treatment discontinuation; and 3) assess buprenorphine treatment continuation after discharge. METHODS This is a retrospective cohort study with opioid-dependent (meaning OUD or receiving long-term opioid therapy for chronic pain) patients who underwent low-dose buprenorphine initiation during hospital admission from October 2021 through April 2022. The primary outcome was successful completion of low-dose initiation. Bivariate analysis identified patient- and treatment-related factors associated with unsuccessful initiation. Secondary outcomes were buprenorphine treatment discontinuation at post-discharge follow-up, 30- and 90-days. RESULTS Of 28 patients who underwent low-dose buprenorphine initiation, 68 % successfully completed initiation. Unsuccessful initiation was associated with receipt of methadone during admission and higher morphine milligram equivalents (MME) of supplemental opioids. Of 22 patients with OUD, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 46 %, 36 %, and 36 %. Of 6 patients with chronic pain, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 100 %, 100 %, and 83 %. CONCLUSION Low-dose buprenorphine initiation can be successful in opioid-dependent hospitalized patients. Patients taking methadone or requiring higher MME of supplemental opioids may have more difficulty with the low-dose buprenorphine initiation approach, but these findings should be replicated in larger studies. This study suggests patient- and treatment-related factors that clinicians could consider when determining the optimal treatment strategy for patients wishing to transition to buprenorphine.
Collapse
Affiliation(s)
| | - Phoebe Li
- Montefiore Medical Center, United States of America
| | | | | | - Laila Khalid
- Montefiore Medical Center, United States of America
| | - Aaron D Fox
- Montefiore Medical Center, United States of America
| |
Collapse
|
5
|
Goddard-Eckrich D, Gatanaga OS, Thomas BV, Liu Y, Downey DL, Dsouza N, Medley B, Hunt T, Wu E, Johnson K, Black C, Brown M, Hall J, El-Bassel N, Gilbert L. Characteristics of drug-involved black women under community supervision; implications for retention in HIV clinical trials and healthcare. SOCIAL WORK IN HEALTH CARE 2024; 63:35-52. [PMID: 37965711 PMCID: PMC10842763 DOI: 10.1080/00981389.2023.2278781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023]
Abstract
This study examined retention and its relationship to mental health, substance use, and social determinants of health in a randomized clinical trial of a behavioral HIV/sexually transmitted infection prevention intervention with drug-involved Black women (N = 348) under community supervision programs in New York City. Using secondary analysis, we used logistic models to test the association between factors related to mental health, substance use, and social determinants of health and follow-up assessment completion (three, six, and 12 months). Participants who were diagnosed with schizophrenia had lower odds of retention. Participants who misused prescription opiates during their lifetime or food insecure in the past 90 days had higher odds of retention throughout the intervention.
Collapse
Affiliation(s)
| | | | | | - Yang Liu
- The Social Intervention Group, Columbia University, New York, New York
| | - Dget Lynn Downey
- The Social Intervention Group, Columbia University, New York, New York
| | - Nishita Dsouza
- The Social Intervention Group, Columbia University, New York, New York
| | - Bethany Medley
- The Social Intervention Group, Columbia University, New York, New York
| | - Timothy Hunt
- The Social Intervention Group, Columbia University, New York, New York
| | - Elwin Wu
- The Social Intervention Group, Columbia University, New York, New York
| | - Karen Johnson
- University of Alabama School of Social Work, Tuscaloosa, AL
| | - Chermaine Black
- The Social Intervention Group, Columbia University, New York, New York
| | - Mary Brown
- The Social Intervention Group, Columbia University, New York, New York
| | - Jennifer Hall
- The Social Intervention Group, Columbia University, New York, New York
| | - Nabila El-Bassel
- The Social Intervention Group, Columbia University, New York, New York
| | - Louisa Gilbert
- The Social Intervention Group, Columbia University, New York, New York
| |
Collapse
|
6
|
Adams JW, Duprey M, Khan S, Cance J, Rice DP, Bobashev G. Examining buprenorphine diversion through a harm reduction lens: an agent-based modeling study. Harm Reduct J 2023; 20:150. [PMID: 37848945 PMCID: PMC10580611 DOI: 10.1186/s12954-023-00888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Recent policies have lessened restrictions around prescribing buprenorphine-naloxone (buprenorphine) for the treatment of opioid use disorder (OUD). The primary concern expressed by critics of these policies is the potential for buprenorphine diversion. However, the population-level effects of increased buprenorphine diversion are unclear. If replacing the use of heroin or fentanyl, use of diverted buprenorphine could be protective. METHODS Our study aim was to estimate the impact of buprenorphine diversion on opioid overdose using an agent-based model calibrated to North Carolina. We simulated the progression of opioid misuse and opioid-related outcomes over a 5-year period. Our status quo scenario assumed that 50% of those prescribed buprenorphine diverted at least one dose per week to other individuals with OUD and 10% of individuals with OUD used diverted buprenorphine at least once per week. A controlled prescription only scenario assumed that no buprenorphine would be diverted, while an increased diversion scenario assumed that 95% of those prescribed buprenorphine diverted and 50% of individuals with OUD used diverted buprenorphine. We assumed that use of diverted buprenorphine replaced the use of other opioids for that day. Sensitivity analyses increased the risk of overdose when using diverted buprenorphine, increased the frequency of diverted buprenorphine use, and simulated use of diverted buprenorphine by opioid-naïve individuals. Scenarios were compared on opioid overdose-related outcomes over the 5-year period. RESULTS Our status quo scenario predicted 10,658 (credible interval [CI]: 9699-11,679) fatal opioid overdoses. A scenario simulating controlled prescription only of buprenorphine (i.e., no diversion) resulted in 10,741 (9895-11,650) fatal opioid overdoses versus 10,301 (9439-11,244) within a scenario simulating increased diversion. Compared to the status quo, the controlled prescription only scenario resulted in a similar number of fatal overdoses, while the scenario with increased diversion of buprenorphine resulted in 357 (3.35%) fewer fatal overdoses. Even when increasing overdose risk while using diverted buprenorphine and incorporating use by opioid naïve individuals, increased diversion did not increase overdoses compared to a scenario with no buprenorphine diversion. CONCLUSIONS A similar number of opioid overdoses occurred under modeling conditions with increased rates of buprenorphine diversion among persons with OUD, with non-statistical trends toward lower opioid overdoses. These results support existing calls for low- to no-barrier access to buprenorphine for persons with OUD.
Collapse
Affiliation(s)
| | | | - Sazid Khan
- RTI International, Research Triangle, NC, USA
| | | | - Donald P Rice
- Division of Infectious Disease, Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | | |
Collapse
|
7
|
Singh VV, Dhawan A, Sarkar S, Mishra AK, Chadda RK. Relapse during opioid use disorder treatment: A pilot study to understand the reasons for opioid use during treatment. Ind Psychiatry J 2023; 32:361-368. [PMID: 38161454 PMCID: PMC10756605 DOI: 10.4103/ipj.ipj_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/17/2023] [Accepted: 03/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Opioid use is a cause of concern in many parts of the world. About 2.1% Indians use opioids. Opioids are also the most common drugs used by injection drug users in India. Despite various treatment strategies used to manage opioid use disorders (OUDs), relapse is common. A good treatment program would make efforts to address lapses and prevent relapse. Hence, there is a need to understand the factors associated with relapse in OUD. Method One hundred and twenty patients completed a baseline assessment that included socio-demographic details and the Maudsley Addiction Profile (MAP). They were followed up for three months and assessed using telephonic interview for opioid use. All those who relapsed were assessed using the Reasons for Relapse Questionnaire (RRQ). The patients who relapsed were compared with the patients who were abstinent. Relapse was defined as any use of opioid during follow-up. Results Forty participants relapsed during the 90 days of the study period. Relapsed patients had a greater number of conflict days with family members, used a higher amount of heroin and cannabis at baseline, were less likely to be discharged on buprenorphine, and were more likely to drop out. Participants cited mood and social reasons more often than cue/craving and unwell domains of RRQ. Conclusion Baseline treatment and prospective factors are associated with relapse in OUD. Addressing these factors can help in reducing relapse in OUD patients.
Collapse
Affiliation(s)
- Virendra V. Singh
- Department of Psychiatry, Army College of Medical Sciences and Base Hospital, Delhi Cantt, Delhi, India
| | - Anju Dhawan
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Siddhartha Sarkar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwani K. Mishra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh K. Chadda
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
8
|
Degenhardt L, Clark B, Macpherson G, Leppan O, Nielsen S, Zahra E, Larance B, Kimber J, Martino-Burke D, Hickman M, Farrell M. Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies. Lancet Psychiatry 2023; 10:386-402. [PMID: 37167985 DOI: 10.1016/s2215-0366(23)00095-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Opioid dependence is associated with substantial health and social burdens, and opioid agonist treatment (OAT) is highly effective in improving multiple outcomes for people who receive this treatment. Methadone and buprenorphine are common medications provided as OAT. We aimed to examine buprenorphine compared with methadone in the treatment of opioid dependence across a wide range of primary and secondary outcomes. METHODS We did a systematic review and meta-analysis in accordance with GATHER and PRISMA guidelines. We searched Embase, MEDLINE, CENTRAL, and PsycINFO from database inception to Aug 1, 2022; clinical trial registries and previous relevant Cochrane reviews were also reviewed. We included all RCTs and observational studies of adults (aged ≥18 years) with opioid dependence comparing treatment with buprenorphine or methadone. Primary outcomes were retention in treatment at 1, 3, 6, 12, and 24 months, treatment adherence (measured through doses taken as prescribed, dosing visits attended, and biological measures), or extra-medical opioid use (measured by urinalysis and self-report). Secondary outcomes were use of benzodiazepines, cannabis, cocaine, amphetamines, and alcohol; withdrawal; craving; criminal activity and engagement with the criminal justice system; overdose; mental and physical health; sleep; pain; global functioning; suicidality and self-harm; and adverse events. Single-arm cohort studies and RCTs that collected data on buprenorphine retention alone were also reviewed. Data on study, participant, and treatment characteristics were extracted. Study authors were contacted to obtain additional data when required. Comparative estimates were pooled with use of random-effects meta-analyses. The proportion of individuals retained in treatment across multiple timepoints was pooled for each drug. This study is registered with PROSPERO (CRD42020205109). FINDINGS We identified 32 eligible RCTs (N=5808 participants) and 69 observational studies (N=323 340) comparing buprenorphine and methadone, in addition to 51 RCTs (N=11 644) and 124 observational studies (N=700 035) that reported on treatment retention with buprenorphine. Overall, 61 studies were done in western Europe, 162 in North America, 14 in north Africa and the Middle East, 20 in Australasia, five in southeast Asia, seven in south Asia, two in eastern Europe, three in central Europe, one in east Asia, and one in central Asia. 1 040 827 participants were included in these primary studies; however, gender was only reported for 572 111 participants, of whom 377 991 (66·1%) were male and 194 120 (33·9%) were female. Mean age was 37·1 years (SD 6·0). At timepoints beyond 1 month, retention was better for methadone than for buprenorphine: for example, at 6 months, the pooled effect favoured methadone in RCTs (risk ratio 0·76 [95% CI 0·67-0·85]; I·=74·2%; 16 studies, N=3151) and in observational studies (0·77 [0·68-0·86]; I·=98·5%; 21 studies, N=155 111). Retention was generally higher in RCTs than observational studies. There was no evidence suggesting that adherence to treatment differed with buprenorphine compared with methadone. There was some evidence that extra-medical opioid use was lower in those receiving buprenorphine in RCTs that measured this outcome by urinalysis and reported proportion of positive urine samples (over various time frames; standardised mean difference -0·20 [-0·29 to -0·11]; I·=0·0%; three studies, N=841), but no differences were found when using other measures. Some statistically significant differences were found between buprenorphine and methadone among secondary outcomes. There was evidence of reduced cocaine use, cravings, anxiety, and cardiac dysfunction, as well as increased treatment satisfaction among people receiving buprenorphine compared with methadone; and evidence of reduced hospitalisation and alcohol use in people receiving methadone. These differences in secondary outcomes were based on small numbers of studies (maximum five), and were often not consistent across study types or different measures of the same constructs (eg, cocaine use). INTERPRETATION Evidence from trials and observational studies suggest that treatment retention is better for methadone than for sublingual buprenorphine. Comparative evidence on other outcomes examined showed few statistically significant differences and was generally based on small numbers of studies. These findings highlight the imperative for interventions to improve retention, consideration of client-centred factors (such as client preference) when selecting between methadone and buprenorphine, and harmonisation of data collection and reporting to strengthen future syntheses. FUNDING Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Brodie Clark
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Georgina Macpherson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Oscar Leppan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Emma Zahra
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Briony Larance
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jo Kimber
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Daniel Martino-Burke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
9
|
Chen Z, Tang X, Xu C, Wang C, Ling L. Exploring factors jointly associated with recurrent relapse and dropout of methadone maintenance treatment clients in Guangdong, China: A retrospective cohort study. Drug Alcohol Depend 2023; 243:109739. [PMID: 36535097 DOI: 10.1016/j.drugalcdep.2022.109739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Clients receiving methadone maintenance treatment (MMT) may experience multiple relapses, which may lead to dropout. However, previous studies mostly only explored the influencing factors of relapse or dropout separately. In this study, we investigated the influencing factors jointly associated with both recurrent relapse and dropout. METHODS This study was conducted in 16 MMT clinics in Guangdong, China. Data on the clients' demographic characteristics; drug-related behavior; HIV, HCV, and urine morphine test results; and daily methadone doses were collected. The outcomes were time to recurrent relapse and time to dropout. A joint frailty model was used to explore factors jointly associated with recurrent relapse and dropout. The hazard ratios (HRs) of the covariates in the multivariable model were adjusted, with HR > 1 indicating a faster time to recurrent relapse and dropout. RESULTS Among 1539 clients, 39.5% had ≥ 2 relapse events, and 90.8% of the clients dropped out. A high attendance rate was protective for recurrent relapse (HR50-80%=0.63, 95% CI: 0.51, 0.79; HR>80%=0.35, 95% CI: 0.28, 0.44) and dropout (HR50-80%=0.56, 95% CI: 0.47, 0.68; HR>80%=0.27, 95% CI: 0.23, 0.33). Being married (HR=0.80, 95% CI: 0.67, 0.96), having a fair relationship with family (HR=0.79, 95% CI: 0.67, 0.93) and drug injection (HR=0.80, 95% CI: 0.67, 0.96) were also protective for recurrent relapse. Female (HR=0.64, 95% CI: 0.50, 0.82) and a high methadone dose (≥60 ml/day; HR=0.79, 95% CI: 0.65, 0.96) were protective for dropout, and a longer traveling time to the clinic (>60 min; HR=1.59, 95% CI: 1.20, 2.10) was associated with an increased risk of dropout. CONCLUSIONS It is common for clients to experience recurrent relapse and dropout. The findings suggest that MMT clinics should provide holistic interventions and appropriate methadone doses for clients to improve treatment compliance.
Collapse
Affiliation(s)
- Zouxiang Chen
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Xijia Tang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Chaofan Xu
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Chijie Wang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Li Ling
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China; Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
| |
Collapse
|
10
|
Tang X, Fan C, Wang C, Wang W, Chen Z, Xu C, Ling L. The risk assessment of relapse among newly enrolled participants in methadone maintenance treatment: A group-LASSO based Bayesian network study. Front Public Health 2023; 10:1032217. [PMID: 36733286 PMCID: PMC9886899 DOI: 10.3389/fpubh.2022.1032217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
Background Relapse is a great barrier to improving the effectiveness of methadone maintenance treatment (MMT). Participants with different treatment durations could vary in their compliance with MMT, which may lead to different levels of relapse risk. This study aims to identify the risk factors for relapse and assess the relapse risk of MMT participants of different treatment durations. Method This retrospective study used data collected from seven MMT clinics in Guangdong Province, China, from January 2010 to April 2017. Newly enrolled participants who received 6 (n = 903) and 12 (n = 710) months of consecutive treatment with complete data were included. We selected significant risk factors for relapse through the group lasso regression and then incorporated them into Bayesian networks to reveal relationships between factors and predict the relapse risk. Results The results showed that participants who received 6-month treatment had a lower relapse rate (32.0%) than those of 12-month treatment (39.0%, P < 0.05). Factors including personal living status and daily methadone dose were only influential to those who received the 6-month treatment. However, age, age at the initial drug use, HIV infection status, sexual behaviors, and continuous treatment days were common factors of both durations. The highest relapse risk for those after the 6-month treatment was inferred as 66.7% while that of the 12-month treatment was 83.3%. Farmers and those who have high accessibility to MMT services may require additional attention. Conclusion It is necessary to implement targeted interventions and education based on the treatment durations of participants to decrease the relapse rate. Meanwhile, those about HIV/sexually transmitted infection prevention and anti-narcotics should be held in the whole process.
Collapse
Affiliation(s)
- Xijia Tang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chaonan Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chijie Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenjuan Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zouxiang Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chaofan Xu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China,Clinical Research Design Division, Clinical Research Center, Sun-Yat sen Memorial Hospital, Sun Yat-sen University, Guangdong, China,*Correspondence: Li Ling ✉
| |
Collapse
|
11
|
Singh VV, Dhawan A, Chadda RK, Mishra AK, Sarkar S. A Prospective Three-Months Naturalistic Follow-Up Study of Outcomes of Patients with Opioid Dependence Discharged on Buprenorphine or Oral Naltrexone. Indian J Psychol Med 2023; 45:26-32. [PMID: 36778621 PMCID: PMC9896119 DOI: 10.1177/02537176211066739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Comparative studies of the naturalistic course of patients of opioid dependence on naltrexone and buprenorphine are likely to be helpful for clinical decision-making. The article aimed to report on the three-months naturalistic outcomes of patients discharged on naltrexone or buprenorphine from the same center. METHODS Patients with opioid dependence who were discharged on either naltrexone (n = 86) or buprenorphine (n = 30) were followed up for three months for retention in treatment. The patients were also followed up telephonically, and the Maudsley Addiction Profile was applied. RESULTS The days of retention in treatment were significantly higher in the buprenorphine group (69.5 versus 48.7 days, P = 0.009). Heroin use, pharmaceutical opioid use, injection drug use, involvement in illegal activity, and percentage of contact days in conflict with friends in the last 30 days reduced over three months in both the groups, while the physical and psychological quality of life improved in both the groups. Additionally, in the naltrexone group, smoked tobacco use, cannabis use, and percentage of contact days in conflict with family within the last 30 days reduced at three months compared to baseline. CONCLUSION With the possible limitations of choice of medication-assisted treatment for opioid dependence being determined by the patient, and prescribing related factors and sample size constraints, the study suggests that retention outcomes may vary between naltrexone and buprenorphine, though both medications may improve several patient-related parameters. However, a true head-to-head comparison of the outcomes of buprenorphine and naltrexone in a naturalistic setting may be difficult.
Collapse
Affiliation(s)
- Virendra Vikram Singh
- Dept. of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anju Dhawan
- Dept. of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh K Chadda
- Dept. of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashwani Kumar Mishra
- Dept. of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Siddharth Sarkar
- Dept. of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
12
|
Jutras-Aswad D, Le Foll B, Ahamad K, Lim R, Bruneau J, Fischer B, Rehm J, Wild TC, Wood E, Brissette S, Gagnon L, Fikowski J, Ledjiar O, Masse B, Socias ME. Flexible Buprenorphine/Naloxone Model of Care for Reducing Opioid Use in Individuals With Prescription-Type Opioid Use Disorder: An Open-Label, Pragmatic, Noninferiority Randomized Controlled Trial. Am J Psychiatry 2022; 179:726-739. [PMID: 35702828 DOI: 10.1176/appi.ajp.21090964] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Extensive exposure to prescription-type opioids has resulted in major harm worldwide, calling for better-adapted approaches to opioid agonist therapy. The authors aimed to determine whether flexible take-home buprenorphine/naloxone is as effective as supervised methadone in reducing opioid use in prescription-type opioid consumers with opioid use disorder. METHODS This seven-site, pan-Canadian, 24-week, pragmatic, open-label, noninferiority, two-arm parallel randomized controlled trial involved treatment-seeking adults with prescription-type opioid use disorder. Participants were randomized in a 1:1 ratio to treatment with sublingual buprenorphine/naloxone (target dosage, 8 mg/2 mg to 24 mg/6 mg per day; flexible take-home dosing) or oral methadone (≈60-120 mg/day; closely supervised). The primary outcome was the proportion of opioid-free urine drug screens over 24 weeks (noninferiority margin, 15%). All randomized participants were analyzed, excluding one who died shortly after randomization, for the primary analysis (modified intention-to-treat analysis). RESULTS Of 272 participants recruited (mean age, 39 years [SD=11]; 34.2% female), 138 were randomized to buprenorphine/naloxone and 134 to methadone. The mean proportion of opioid-free urine drug screens was 24.0% (SD=34.4) in the buprenorphine/naloxone group and 18.5% (SD=30.5) in the methadone group, with a 5.6% adjusted mean difference (95% CI=-0.3, +∞). Participants in the buprenorphine/naloxone group had 0.47 times the odds (95% CI=0.24, 0.90) of being retained in the assigned treatment compared with those in the methadone group. Overall, 24 drug-related adverse events were reported (12 in the buprenorphine/naloxone group [N=8/138; 5.7%] and 12 in the methadone group [N=12/134; 9.0%]) and mostly included withdrawal, hypogonadism, and overdose. CONCLUSIONS The buprenorphine/naloxone flexible model of care was safe and noninferior to methadone in reducing opioid use among people with prescription-type opioid use disorder. This flexibility could help expand access to opioid agonist therapy and reduce harms in the context of the opioid overdose crisis.
Collapse
Affiliation(s)
- Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Bernard Le Foll
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Keith Ahamad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Ron Lim
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Benedikt Fischer
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Jürgen Rehm
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - T Cameron Wild
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Evan Wood
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Suzanne Brissette
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Lea Gagnon
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Jill Fikowski
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Omar Ledjiar
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - Benoit Masse
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | - M Eugenia Socias
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| | -
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal (Jutras-Aswad, Bruneau, Gagnon, Brissette); Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal (Jutras-Aswad); Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto (Le Foll); Department of Psychiatry, University of Toronto, Toronto (Le Foll, Fischer, Rehm); Dalla Lana School of Public Health, University of Toronto, Toronto (Le Foll, Rehm); Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto (Le Foll); Acute Care Program, CAMH, Toronto (Le Foll); British Columbia Centre on Substance Use, Vancouver (Ahamad, Wood, Fikowski, Socias); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver (Ahamad); Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Alberta, Canada (Lim); Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal (Bruneau, Brissette); Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Fischer); Centre for Applied Research in Mental Health and Addiction, Faculty of Health Science, Simon Fraser University, Vancouver (Fischer); Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Fischer); Institute for Mental Health Policy Research, CAMH, Toronto (Rehm); Institute of Clinical Psychology and Psychotherapy Centre and Centre for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany (Rehm); Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow (Rehm); School of Public Health, University of Alberta, Edmonton, Canada (Wild); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver (Wood, Socias); Unité de Recherche Clinique Appliquée, Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal (Ledjiar, Masse); Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal (Masse)
| |
Collapse
|
13
|
Ellerbroek H, van den Heuvel SAS, Dahan A, Timmerman H, Kramers C, Schellekens AFA. Buprenorphine/naloxone versus methadone opioid rotation in patients with prescription opioid use disorder and chronic pain: study protocol for a randomized controlled trial. Addict Sci Clin Pract 2022; 17:47. [PMID: 36057608 PMCID: PMC9441071 DOI: 10.1186/s13722-022-00326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Opioids are effective in pain-management, but long-term opioid users can develop prescription opioid use disorder (OUD). One treatment strategy in patients with OUD is rotating from a short-acting opioid to a long-acting opioid (buprenorphine/naloxone (BuNa) or methadone). Both BuNa and methadone have been shown to be effective strategies in patients with OUD reducing opioid misuse, however data on head-to-head comparison in patients with chronic non-malignant pain and prescription OUD are limited. Methods This two-armed open-label, randomized controlled trial aims to compare effectiveness between BuNa and methadone in patients with chronic non-malignant with prescription OUD (n = 100). Participants receive inpatient rotation to either BuNa or methadone with a flexible dosing regimen. The primary outcome is opioid misuse 2 months after rotation. Secondary outcomes include treatment compliance, side effects, analgesia, opioid craving, quality of life, mood symptoms, cognitive and physical functioning over 2- and 6 months follow-up. Linear mixed model analysis will be used to evaluate change in outcome parameters over time between the treatment arms. Discussion This is one of the first studies comparing buprenorphine/naloxone and methadone for treating prescription OUD in a broad patient group with chronic non-malignant pain. Results may guide future treatment for patients with chronic pain and prescription OUD. Trial registrationhttps://www.trialregister.nl/, NL9781
Collapse
Affiliation(s)
- Hannah Ellerbroek
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Sandra A S van den Heuvel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Timmerman
- Department of Anesthesiology, Pain Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cornelis Kramers
- Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Pharmacology-Toxicology and Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Center for Medical Neuroscience, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| |
Collapse
|
14
|
Savinkina A, Madushani RWMA, Yazdi GE, Wang J, Barocas JA, Morgan JR, Assoumou SA, Walley AY, Linas BP, Murphy SM. Population-level impact of initiating pharmacotherapy and linking to care people with opioid use disorder at inpatient medically managed withdrawal programs: an effectiveness and cost-effectiveness analysis. Addiction 2022; 117:2450-2461. [PMID: 35315162 PMCID: PMC9377514 DOI: 10.1111/add.15879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Medications for opioid use disorder (MOUD) are shown to reduce opioid use and the risk of overdose. People with opioid use disorder (OUD) who exit inpatient medically managed withdrawal programs (detox) without initiating MOUD and linking to outpatient care have high rates of overdose. While detox encounters provide a theoretical opportunity for MOUD initiation, this is not ubiquitous in the United States. We used simulation modeling to estimate the population-level health effects and cost-effectiveness of a policy encouraging MOUD initiation during inpatient detox encounters. DESIGN, SETTING AND PARTICIPANTS We employed a dynamic population state-transition model to evaluate the effectiveness and cost-effectiveness of using detox programs as venues for initiating MOUD in Massachusetts, United States. We compared standard of care, where no detox patients initiate MOUD or link to outpatient MOUD providers, to strategies of offering MOUD to detox patients and linking those patients to outpatient MOUD. MEASURES Budgetary impact to the Massachusetts health-care sector, incremental cost-effectiveness ratios (ICER) and total counts and percentage differences of fatal overdoses prevented. FINDINGS Initiating MOUD in detox with perfect linkage to outpatient MOUD would reduce fatal overdoses by 4.5% [95% confidence interval (CI) = 2.3-5.9], at an ICER of $56 000 per quality-adjusted life-year (QALY) gained, compared with the standard of care. With moderate linkage, fatal overdoses would be reduced by 2.3% (95% CI= 1.2-3.1) with an ICER of $78 500 per QALY gained, compared with standard of care. Budgetary increase to Massachusetts health-care spending ranged from 0.5-1%. CONCLUSION A simulation model indicates that initiation of medications for opioid use disorder and linkage policies among detox patients in Massachusetts, USA could prevent fatal opioid overdoses in the opioid use disorder population and would be cost-effective from a health-care sector perspective.
Collapse
Affiliation(s)
- Alexandra Savinkina
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - R. W. M. A. Madushani
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Golnaz Eftekhari Yazdi
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Jianing Wang
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Joshua A. Barocas
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
- Boston University School of Medicine (BUSM), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Jake R. Morgan
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Sabrina A. Assoumou
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
- Boston University School of Medicine (BUSM), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Alexander Y. Walley
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Grayken Center for Addiction at Boston Medical Center, Boston, MA, USA, 02118
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
- Boston University School of Medicine (BUSM), 801 Massachusetts Ave, 2 Floor, Boston, MA, USA, 02118
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065
| |
Collapse
|
15
|
Patients' experiences of continued treatment with extended-release naltrexone: a Norwegian qualitative study. Addict Sci Clin Pract 2022; 17:36. [PMID: 35850782 PMCID: PMC9290197 DOI: 10.1186/s13722-022-00317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background The opioid antagonist extended-release naltrexone (XR-NTX) in the treatment of opioid use disorder (OUD) is effective in terms of safety, abstinence from opioid use and retention in treatment. However, it is unclear how patients experience and adjust to losing the possibility of achieving an opioid effect. This qualitative study is the first to explore how people with opioid dependence experience XR-NTX treatment, focusing on the process of treatment over time. Methods Using a purposive sampling strategy, semi-structured interviews were undertaken with 19 persons with opioid use disorder (15 men, four women, 22–55 years of age) participating in a clinical trial of XR-NTX in Norway. The interviewees had received at least three XR-NTX injections. Qualitative content analysis with an inductive approach was used. Findings Participants described that XR-NTX treatment had many advantages. However they still faced multiple challenges, some of which they were not prepared for. Having to find a new foothold and adapt to no longer gaining an effect from opioids due to the antagonist medication was challenging. This was especially true for those struggling emotionally and transitioning into the harmful use of non-opioid substances. Additional support was considered crucial. Even so, the treatment led to an opportunity to participate in society and reclaim identity. Participants had strong goals for the future and described that XR-NTX enabled a more meaningful life. Expectations of a better life could however turn into broken hopes. Although participants were largely optimistic about the future, thinking about the end of treatment could cause apprehension. Conclusions XR-NTX treatment offers freedom from opioids and can facilitate the recovery process for people with OUD. However, our findings also highlight several challenges associated with XR-NTX treatment, emphasizing the importance of monitoring emotional difficulties and increase of non-opioid substances during treatment. As opioid abstinence in itself does not necessarily equal recovery, our findings underscore the importance of seeing XR-NTX as part of a comprehensive, individualized treatment approach. Trial registration: Clinicaltrials.gov # NCT03647774, first Registered: Aug 28, 2018.
Collapse
|
16
|
Lim J, Farhat I, Douros A, Panagiotoglou D. Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0266142. [PMID: 35358261 PMCID: PMC8970369 DOI: 10.1371/journal.pone.0266142] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Several pharmacotherapeutic interventions are available for maintenance treatment for opioid-related disorders. However, previous meta-analyses have been limited to pairwise comparisons of these interventions, and their efficacy relative to all others remains unclear. Our objective was to unify findings from different healthcare practices and generate evidence to strengthen clinical treatment protocols for the most widely prescribed medications for opioid-use disorders. METHODS We searched Medline, EMBASE, PsycINFO, CENTRAL, and ClinicalTrials.gov for all relevant randomized controlled trials (RCT) from database inception to February 12, 2022. Primary outcome was treatment retention, and secondary outcome was opioid use measured by urinalysis. We calculated risk ratios (RR) and 95% credible interval (CrI) using Bayesian network meta-analysis (NMA) for available evidence. We assessed the credibility of the NMA using the Confidence in Network Meta-Analysis tool. RESULTS Seventy-nine RCTs met the inclusion criteria. Due to heterogeneity in measuring opioid use and reporting format between studies, we conducted NMA only for treatment retention. Methadone was the highest ranked intervention (Surface Under the Cumulative Ranking [SUCRA] = 0.901) in the network with control being the lowest (SUCRA = 0.000). Methadone was superior to buprenorphine for treatment retention (RR = 1.22; 95% CrI = 1.06-1.40) and buprenorphine superior to naltrexone (RR = 1.39; 95% CrI = 1.10-1.80). However, due to a limited number of high-quality trials, confidence in the network estimates of other treatment pairs involving naltrexone and slow-release oral morphine (SROM) remains low. CONCLUSION All treatments had higher retention than the non-pharmacotherapeutic control group. However, additional high-quality RCTs are needed to estimate more accurately the extent of efficacy of naltrexone and SROM relative to other medications. For pharmacotherapies with established efficacy profiles, assessment of their long-term comparative effectiveness may be warranted. TRIAL REGISTRATION This systematic review has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero) (identifier CRD42021256212).
Collapse
Affiliation(s)
- Jihoon Lim
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Imen Farhat
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Antonios Douros
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Institute of Clinical Pharmacology and Toxicology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- * E-mail:
| |
Collapse
|
17
|
Song MJ, Westenberg JN, Kianpoor K, Nikoo M, Kazemi A, Schuetz C, Jang K, Gholami A, Akhondzadeh S, Krausz M. Substance of choice, impact of heroin or opium on treatment retention in a multicentre randomised controlled trial in Iran. Drug Alcohol Rev 2022; 41:895-901. [PMID: 35170124 DOI: 10.1111/dar.13445] [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: 06/14/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In the Middle East and Asia, illicit opioid use exists across a spectrum between heroin and opium. The impact of primary opioid of choice on opioid agonist treatment retention has not been well evaluated previously, especially for opium tincture, an increasingly popular form of opioid agonist treatment in Iran. This study investigates the relationship between primary opioid of choice, namely heroin or opium, and retention in opium tincture and methadone treatment. METHODS Participants with opioid use disorder (n = 204) were randomised to receive opium tincture or methadone. All participants were categorised as mainly using opium or heroin. Bivariate analyses between treatment retention and primary opioid of choice (P < 0.05) and logistic regression were conducted. RESULTS Among the 191 participants included in this analysis, heroin was the primary substance of choice for 135 participants (70.7%) and opium for 56 (29.3%). Bivariate analysis showed that the opium group was more likely to be satisfied with family situation, employed and retained in treatment than the heroin group while less likely to experience incarceration and use multiple substances. When adjusting for covariates, primary opioid of choice was not significantly associated with retention in either methadone or opium tincture treatment arm. DISCUSSION AND CONCLUSIONS Positive factors, such as employment, housing and family support, seem to collectively explain the higher retention in treatment among those who primarily use opium compared to those who use heroin. To optimise retention in opioid agonist treatment, biopsychosocial care models should be further evaluated to improve psychosocial functioning.
Collapse
Affiliation(s)
- Michael Jae Song
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Kiana Kianpoor
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alireza Kazemi
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Christian Schuetz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kerry Jang
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Private Practice and Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| |
Collapse
|
18
|
Mannelli P, Douaihy AB, Zavod A, Legedza A, Akerman SC, Sullivan MA. Patterns of withdrawal in patients with opioid use disorder (OUD) transitioning from untreated OUD or buprenorphine treatment to extended-release naltrexone. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:753-759. [PMID: 34752714 DOI: 10.1080/00952990.2021.1969659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pharmacologic treatment is recommended for many individuals with opioid use disorder (OUD). For patients who select opioid antagonist treatment, effective management of opioid withdrawal symptoms during transition to antagonist treatment requires consideration of the patient experience. OBJECTIVES To compare patterns of opioid withdrawal between those withdrawing from untreated opioid use and those withdrawing from buprenorphine. METHODS We performed a post hoc, cross-study comparison of the temporal pattern of opioid withdrawal during 1-week induction onto extended-release naltrexone by similar protocols enrolling two participant populations: participants with OUD entering a study with untreated opioid use (N = 378, NCT02537574) or on stable buprenorphine (BUP) treatment (N = 101, NCT02696434). RESULTS The temporal pattern of withdrawal from induction day 1 through day 7 differed between the two participant populations for Clinical Opiate Withdrawal Score (COWS) and Subjective Opiate Withdrawal Score (SOWS): participants with untreated OUD prior to study entry were more likely to experience an earlier relative peak in opioid withdrawal followed by a gradual decline, whereas participants on stable BUP treatment prior to study entry were more likely to experience a relatively later, though still mild, peak opioid withdrawal. The peak COWS was reached at a mean (standard deviation) of 1.9 (1.5) days for participants with untreated OUD and 5.0 (1.5) days for participants on stable BUP. Daily peak cravings were generally higher for participants with untreated OUD than participants on stable BUP. CONCLUSION Awareness of population-specific variations in the patient experience of opioid withdrawal may help clinicians anticipate the expected course of withdrawal.
Collapse
Affiliation(s)
- Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Antoine B Douaihy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | | | - Maria A Sullivan
- Medical Affairs, Alkermes, Inc, Waltham, MA, USA.,Department of Psychiatry, Columbia University, New York, NY, USA
| |
Collapse
|
19
|
Teeters JB, Jones JL, Jarnecke AM, Back SE. Sleep moderates the relationship between stress and craving in individuals with opioid use disorder. Exp Clin Psychopharmacol 2021; 29:418-426. [PMID: 32297784 PMCID: PMC8375668 DOI: 10.1037/pha0000372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Opioid use disorder (OUD) is a national public health concern. Craving, stress, and exposure to conditioned drug cues are implicated in risk of relapse to opioids. Although impaired sleep has been implicated in risk of relapse to other substances of misuse, little research to date has examined the relationship between sleep and craving in individuals with OUD. The present study examined sleep as a moderator of the relationship between craving and stress in a randomized controlled human laboratory study. Individuals with current OUD (N = 39) completed a 1-night hospital stay to control for factors that may affect craving, stress, and sleep. Sleep was monitored via an actigraphy watch and the Pittsburgh Sleep Quality Index. The next morning, participants were randomized to a 15-min laboratory stress task or a no-stress condition. All participants were then exposed to a 15-min opioid cue paradigm, and craving was measured via self-report. Moderation models were conducted to evaluate whether the sleep indices moderated the relationship between stress condition (independent variable) and craving (dependent variable). Average self-reported nightly sleep duration moderated the relationship between stress condition and craving for participants in the no-stress condition (b = 0.95, p < .05). Specifically, participants in the no-stress condition with lower average nightly sleep duration exhibited significantly greater craving following the opioid cue paradigm. Although preliminary, the findings add to the literature on craving, stress, and sleep among individuals with OUD. Sleep impairment may be an important target of a comprehensive, long-term treatment plan for some patients with OUD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Jenni B. Teeters
- Psychological Sciences Department, Western Kentucky University, Bowling Green, KY
| | - Jennifer L. Jones
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Amber M. Jarnecke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| |
Collapse
|
20
|
Mun CJ, Finan PH, Epstein DH, Kowalczyk WJ, Agage D, Letzen JE, Phillips KA, Preston KL. Craving mediates the association between momentary pain and illicit opioid use during treatment for opioid-use disorder: an ecological momentary assessment study. Addiction 2021; 116:1794-1804. [PMID: 33220102 PMCID: PMC8137724 DOI: 10.1111/add.15344] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 02/02/2023]
Abstract
AIM To assess the role of momentary pain on opioid craving and illicit opioid use among individuals receiving opioid agonist treatment. DESIGN Observational study using ecological momentary assessment. SETTING The National Institute of Drug Abuse Intramural Research Program in the United States. PARTICIPANTS Fifty-six adults who qualified for opioid agonist treatment. MEASUREMENTS Participants completed randomly prompted assessments of pain severity, stress, negative mood, opioid craving and illicit opioid use for a mean of 66 days [standard deviation (SD) = 27]. Urine samples were collected two to three times/week throughout. FINDINGS Almost 70% of participants reported moderate average pain severity in the past 24 hours at intake and 35% of participants reported chronic pain. There were no significant differences in percent of opioid-positive urine samples (P = 0.73) and average level of opioid craving during the study period (P = 0.91) among opioid agonist treatment only patients versus opioid agonist treatment patients with chronic pain. However, momentary pain severity significantly predicted concurrent opioid craving [B = 0.02, 95% confidence interval (CI) = 0.01, 0.04], over and above stress and negative mood. Momentary opioid craving, in turn, significantly predicted illicit opioid use that was assessed in the next moment [odds ratio (OR) = 1.72, 95% CI = 1.12, 2.64), while controlling for autocorrelation and the effects of pain, negative mood and stress. Momentary opioid craving significantly mediated the prospective association between momentary pain and illicit opioid use (95% CI = 0.003, 0.032). Exploratory analysis revealed that momentary pain severity also significantly moderated the momentary association between stress and opioid craving (B = 0.02, 95% CI = 0.00, 0.04), such that when momentary pain severity increased, the association between the two intensified. CONCLUSIONS Among people receiving opioid agonist treatment, momentary pain appears to be indirectly associated with illicit opioid use via momentary opioid craving.
Collapse
Affiliation(s)
- Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, United States,Address Correspondence to: Chung Jung Mun, Ph.D., 5510 Nathan Shock Drive, Suite 100, Baltimore MD, 21224, and, Kenzie L. Preston, Ph.D., National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224,
| | - Patrick H. Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, United States
| | - David H. Epstein
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, United States
| | - William J. Kowalczyk
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, United States
| | - Daniel Agage
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, United States
| | - Janelle E. Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, United States
| | - Karran A. Phillips
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, United States
| | - Kenzie L. Preston
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, United States,Address Correspondence to: Chung Jung Mun, Ph.D., 5510 Nathan Shock Drive, Suite 100, Baltimore MD, 21224, and, Kenzie L. Preston, Ph.D., National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224,
| |
Collapse
|
21
|
Adams KK, Machnicz M, Sobieraj DM. Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review. Addict Sci Clin Pract 2021; 16:36. [PMID: 34103087 PMCID: PMC8186092 DOI: 10.1186/s13722-021-00244-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Opioid withdrawal symptoms prior to buprenorphine initiation may be intolerable and as a result, alternative strategies have emerged. We aim to systematically review the efficacy and safety of buprenorphine initiation that aims to omit prerequisite withdrawal. METHODS We conducted a systematic literature search of MEDLINE and CENTRAL from 1996 through April 10, 2020, augmented with searches in Google Scholar and www.clinicaltrials.gov . A study was included if it was in patients with substance use disorder or chronic pain that were taking a full mu opioid agonist and transitioning to buprenorphine without preceding withdrawal, and reported withdrawal during initiation as an outcome. Two investigators independently screened citations and articles for inclusion, collected data using a standardized data collection tool, and assessed study risk of bias. RESULTS We included 15 case reports/series, reporting 24 unique cases, in our qualitative synthesis. No controlled studies were identified. Microdosing and bridging with a buprenorphine patch were the most common strategies reported. Transition to buprenorphine with complete cessation of opioid agonists was achieved in 87.5% (n = 21) of cases. Withdrawal during initiation occurred in 58.3% (n = 14) of cases, two of which were at least moderate in severity. CONCLUSION Buprenorphine initiation strategies that omit prerequisite withdrawal have emerged. Low quality evidence from case reports suggests withdrawal during initiation is common but most often mild in severity. There is an unmet need for controlled studies to inform their efficacy and safety compared with traditional strategies, including outcomes during initiation and in the long-term.
Collapse
Affiliation(s)
- K K Adams
- University of Connecticut School of Pharmacy, 69 N Eagleville Rd Unit 3092, Storrs, CT, 06269, USA.
| | - M Machnicz
- University of Connecticut School of Pharmacy, 69 N Eagleville Rd Unit 3092, Storrs, CT, 06269, USA
| | - D M Sobieraj
- University of Connecticut School of Pharmacy, 69 N Eagleville Rd Unit 3092, Storrs, CT, 06269, USA.,Hartford Hospital, Hartford, USA
| |
Collapse
|
22
|
Linas BP, Savinkina A, Madushani RWMA, Wang J, Eftekhari Yazdi G, Chatterjee A, Walley AY, Morgan JR, Epstein RL, Assoumou SA, Murphy SM, Schackman BR, Chrysanthopoulou SA, White LF, Barocas JA. Projected Estimates of Opioid Mortality After Community-Level Interventions. JAMA Netw Open 2021; 4:e2037259. [PMID: 33587136 PMCID: PMC7885041 DOI: 10.1001/jamanetworkopen.2020.37259] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/13/2020] [Indexed: 11/14/2022] Open
Abstract
Importance The United States is experiencing a crisis of opioid overdose. In response, the US Department of Health and Human Services has defined a goal to reduce overdose mortality by 40% by 2022. Objective To identify specific combinations of 3 interventions (initiating more people to medications for opioid use disorder [MOUD], increasing 6-month retention with MOUD, and increasing naloxone distribution) associated with at least a 40% reduction in opioid overdose in simulated populations. Design, Setting, and Participants This decision analytical model used a dynamic population-level state-transition model to project outcomes over a 2-year horizon. Each intervention scenario was compared with the counterfactual of no intervention in simulated urban and rural communities in Massachusetts. Simulation modeling was used to determine the associations of community-level interventions with opioid overdose rates. The 3 examined interventions were initiation of more people to MOUD, increasing individuals' retention with MOUD, and increasing distribution of naloxone. Data were analyzed from July to November 2020. Main Outcomes and Measures Reduction in overdose mortality, medication treatment capacity needs, and naloxone needs. Results No single intervention was associated with a 40% reduction in overdose mortality in the simulated communities. Reaching this goal required use of MOUD and naloxone. Achieving a 40% reduction required that 10% to 15% of the estimated OUD population not already receiving MOUD initiate MOUD every month, with 45% to 60%% retention for at least 6 months, and increased naloxone distribution. In all feasible settings and scenarios, attaining a 40% reduction in overdose mortality required that in every month, at least 10% of the population with OUD who were not currently receiving treatment initiate an MOUD. Conclusions and Relevance In this modeling study, only communities with increased capacity for treating with MOUD and increased MOUD retention experienced a 40% decrease in overdose mortality. These findings could provide a framework for developing community-level interventions to reduce opioid overdose death.
Collapse
Affiliation(s)
- Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Alexandra Savinkina
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | | | - Jianing Wang
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | | | - Avik Chatterjee
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Grayken Center for Addiction at Boston Medical Center, Boston, Massachusetts
| | - Alexander Y. Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Grayken Center for Addiction at Boston Medical Center, Boston, Massachusetts
| | - Jake R. Morgan
- Boston University School of Public Health, Boston, Massachusetts
| | - Rachel L. Epstein
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Sabrina A. Assoumou
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Sean M. Murphy
- Boston University School of Public Health, Boston, Massachusetts
- Department of Healthcare Quality and Research, Weill Cornell Medical College, New York, New York
| | - Bruce R. Schackman
- Boston University School of Public Health, Boston, Massachusetts
- Department of Healthcare Quality and Research, Weill Cornell Medical College, New York, New York
| | | | - Laura F. White
- Boston University School of Public Health, Boston, Massachusetts
| | - Joshua A. Barocas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
23
|
Biondi BE, Mohanty S, Wyk BV, Montgomery RR, Shaw AC, Springer SA. Design and implementation of a prospective cohort study of persons living with and without HIV infection who are initiating medication treatment for opioid use disorder. Contemp Clin Trials Commun 2021; 21:100704. [PMID: 33490708 PMCID: PMC7807244 DOI: 10.1016/j.conctc.2021.100704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/15/2020] [Accepted: 01/01/2021] [Indexed: 02/02/2023] Open
Abstract
Background Opioid use disorder (OUD) negatively impacts the HIV continuum of care for persons living with HIV. Medication treatment for OUD (MOUD) may have differential biological effects in individuals with HIV and OUD. To address the question of modulation of immune responses by MOUDs, we describe state of the art systems biology approaches to carry out the first prospective, longitudinal study of persons with and without HIV infection with OUD initiating MOUD. Methods A prospective cohort study of persons with DSM-5 diagnosed OUD who are living with and without HIV infection and initiating treatment with methadone or buprenorphine is underway to assess biological effects of these medications on immunobiological outcomes. Results We describe the recruitment, laboratory, and statistical methods of this study as well as the protocol details. Of those screened for enrollment into the study, 468 (36%) were eligible and 135 were enrolled thus far. Retention through month 6 has been high at 80%. Conclusions This study will use state of the art systems biology approaches to carry out the first prospective, longitudinal studies of persons living with and without HIV with DSM-5 OUD initiating treatment with MOUD.
Collapse
Affiliation(s)
- Breanne E Biondi
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Subhasis Mohanty
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Brent Vander Wyk
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Ruth R Montgomery
- Department of Internal Medicine, Section of Rheumatology, Yale School of Medicine, New Haven, CT, USA
| | - Albert C Shaw
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA.,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| |
Collapse
|
24
|
Gainer DM, Nahhas RW, Vanderhoof T, Silverstein SM, Wright MD, Vanderhoof SO, Miller SC. Exploring the Interactions between Non-Medical Methamphetamine Use and Prescribed Buprenorphine or Naltrexone in Opioid Use Disorder Treatment Retention. Subst Use Misuse 2021; 56:2160-2170. [PMID: 34538204 DOI: 10.1080/10826084.2021.1975747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our objectives were to examine the impact of methamphetamine use on opioid use disorder (OUD) treatment retention in patients prescribed either buprenorphine/buprenorphine-naloxone (BUP-NX) or naltrexone/extended-release naltrexone (XR-NTX), while also exploring the role of other risk factors that may modify the impact of methamphetamine use. METHODS We conducted an exploratory retrospective study examining OUD treatment retention in 127 patients in Ohio (USA). Patients were prescribed either BUP-NX or naltrexone/XR-NTX. Cox proportional hazard regression was used to compare time to dropout of treatment between patients positive and negative on screening for methamphetamines at intake, estimate the association between other risk factors and time to dropout, and test interactions between risk factors and methamphetamine status. RESULTS Among patients prescribed naltrexone/XR-NTX, those positive for methamphetamines had almost three times the risk of treatment dropout (AHR = 2.89, 95% CI =1.11, 7.07), significantly greater (interaction p = .039) than the methamphetamine effect among those prescribed BUP-NX (AHR = 0.94, 95% CI = 0.51, 1.65). Early in treatment, being prescribed BUP-NX was strongly associated with a greater risk of treatment dropout (at baseline: AHR = 2.90, 95% CI = 1.33, 7.15), regardless of baseline methamphetamine use status. However, this effect decreased with time and shifted to greater risk of dropout among those prescribed naltrexone/XR-NTX (non-proportional hazard; interaction with time AHR = 0.66, 95% CI = 0.49, 0.86), with the shift occurring sooner among those positive for methamphetamine at baseline. CONCLUSIONS Additional support should be provided to patients who use methamphetamines prior to starting OUD treatment.
Collapse
Affiliation(s)
- Danielle M Gainer
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA.,Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Ramzi W Nahhas
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA.,Department of Population & Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Tyler Vanderhoof
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sydney M Silverstein
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA.,Department of Population & Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Mark D Wright
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | | | - Shannon C Miller
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA.,Department of Population & Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA.,Mental Health Care Line, Dayton VA Medical Center/Middletown CBOC, Middletown, Ohio, USA
| |
Collapse
|
25
|
Dong H, Hayashi K, Fairbairn N, Milloy MJ, DeBeck K, Wood E, Kerr T. Long term pre-treatment opioid use trajectories in relation to opioid agonist therapy outcomes among people who use drugs in a Canadian setting. Addict Behav 2021; 112:106655. [PMID: 32977270 DOI: 10.1016/j.addbeh.2020.106655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Opioid agonist therapy (OAT) models are generally provided without consideration of how pre-treatment characteristics may be associated with outcome. Therefore, we aimed to first characterize longitudinal trajectories of opioid use before initiating OAT. Then we explored the impact of OAT on opioid use across these pre-treatment trajectories. METHODS Data were derived from three prospective cohort studies involving people who use drugs in Vancouver, Canada. Latent class growth analysis was applied to identify opioid use trajectories based on individual-level observations three years before starting OAT. Multivariable generalized linear mixed model was used to examine whether engaging in OAT was associated with lower risk of illicit opioid use among participants with different pre-treatment opioid use trajectories. RESULTS 464 participants were included in the study between September 2005 and November 2018. Two pre-treatment opioid use trajectories were identified: high frequency users (246, 53.0%) and gradually increasing frequency users (218, 47.0%). We observed different strengths of association between OAT engagement and illicit opioid use among high frequency users (adjusted odds ratio [AOR] = 0.36, 95% Confidence Interval [CI]: 0.20 - 0.63) and gradually increasing frequency users (AOR = 0.91, 95% CI: 0.53 - 1.56). Unstable housing, any stimulant use, experiencing violence, drug dealing, sex work involvement, and incarceration were independently and positively associated with ongoing illicit opioid use. CONCLUSIONS Distinct pre-treatment opioid use trajectories are likely to influence treatment outcomes. Research is required to determine if tailored strategies specific to people with different pre-treatment opioid use patterns have potential to improve outcomes of OAT.
Collapse
Affiliation(s)
- Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6 Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6 Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada.
| |
Collapse
|
26
|
Kumar N, Mancino MJ, Thostenson JD, McGaugh J, Oliveto AH. Feasibility and Preliminary Efficacy of Isradipine During Outpatient Buprenorphine Stabilization and Detoxification: A Pilot Randomized, Placebo-Controlled Trial. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820970926. [PMID: 33281447 PMCID: PMC7686602 DOI: 10.1177/1178221820970926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022]
Abstract
Background: Given the immense burden of the widespread use of opioids around the world,
exploring treatments that improve drug use outcomes, and craving and
withdrawal measures in individuals with opioid use disorder is crucial. This
pilot study examined the feasibility and preliminary efficacy of the L-type
calcium-channel blocker isradipine (ISR) to improve drug use outcomes, and
craving and withdrawal measures during buprenorphine (BUP)/ISR stabilization
and subsequent taper in opioid-dependent individuals. Methods: Participants were stabilized on BUP sublingual tablets within the first 2
days of week 1, were then randomized and inducted on either ISR or placebo,
gradually increasing the dose over the next 2 weeks, followed by a 10-day
BUP taper during weeks 5-6, and ISR/placebo taper during weeks 7 to 8.
Assessments included thrice-weekly measures of craving and withdrawal, as
well as vital signs and urine drug screens. Medication compliance was
assessed by monitoring number of missed clinic visit days. Results: Baseline characteristics of participants (n = 25; 60% male, 96% Caucasian,
48% employed, mean age 32.8 years) did not differ significantly between
treatment groups (isradipine, n = 11; placebo, n = 14). During the
stabilization phase (n = 19), ISR participants had significantly lower rates
of illicit opioid-positive urines (treatment × visit:
t = -2.16, P = 0.03), as well as reduction
in craving intensity (t = –2.50,
P = 0.01), frequency (t = –3.43,
P < 0.01) and duration (t = –2.51,
P = 0.01). ISR was well tolerated with mild adverse
effects. Conclusions: This study was likely underpowered due to being a pilot trial. Although
preliminary results suggest ISR may improve BUP-assisted treatment outcomes,
concerns about high number of exclusions (n = 11 during taper phase) based
on cardiovascular measures as well as ISR-induced changes in vital signs
with the immediate release formulation may limit the feasibility of this
approach. Trial Registration: Clinicaltrials.gov identifier NCT01895270. Registered 10 July 2013, https://clinicaltrials.gov/ct2/show/NCT01895270?id=NCT01895270&draw=2&rank=1
Collapse
Affiliation(s)
- Nihit Kumar
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael J Mancino
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeff D Thostenson
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Janette McGaugh
- Ouachita Behavioral Health and Wellness, Hot Springs, AR, USA
| | - Alison H Oliveto
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
27
|
Piske M, Thomson T, Krebs E, Hongdilokkul N, Bruneau J, Greenland S, Gustafson P, Karim ME, McCandless LC, Maclure M, Platt RW, Siebert U, Socías ME, Tsui JI, Wood E, Nosyk B. Comparative effectiveness of buprenorphine-naloxone versus methadone for treatment of opioid use disorder: a population-based observational study protocol in British Columbia, Canada. BMJ Open 2020; 10:e036102. [PMID: 32912944 PMCID: PMC7482450 DOI: 10.1136/bmjopen-2019-036102] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/26/2020] [Accepted: 07/24/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Despite a recent meta-analysis including 31 randomised controlled trials comparing methadone and buprenorphine for the treatment of opioid use disorder, important knowledge gaps remain regarding the long-term effectiveness of different treatment modalities across individuals, including rigorously collected data on retention rates and other treatment outcomes. Evidence from real-world data represents a valuable opportunity to improve personalised treatment and patient-centred guidelines for vulnerable populations and inform strategies to reduce opioid-related mortality. Our objective is to determine the comparative effectiveness of methadone versus buprenorphine/naloxone, both overall and within key populations, in a setting where both medications are simultaneously available in office-based practices and specialised clinics. METHODS AND ANALYSIS We propose a retrospective cohort study of all adults living in British Columbia receiving opioid agonist treatment (OAT) with methadone or buprenorphine/naloxone between 1 January 2008 and 30 September 2018. The study will draw on seven linked population-level administrative databases. The primary outcomes include retention in OAT and all-cause mortality. We will determine the effectiveness of buprenorphine/naloxone vs methadone using intention-to-treat and per-protocol analyses-the former emulating flexible-dose trials and the latter focusing on the comparison of the two medication regimens offered at the optimal dose. Sensitivity analyses will be used to assess the robustness of results to heterogeneity in the patient population and threats to internal validity. ETHICS AND DISSEMINATION The protocol, cohort creation and analysis plan have been approved and classified as a quality improvement initiative exempt from ethical review (Providence Health Care Research Institute and the Simon Fraser University Office of Research Ethics). Dissemination is planned via conferences and publications, and through direct engagement and collaboration with entities that issue clinical guidelines, such as professional medical societies and public health organisations.
Collapse
Affiliation(s)
- Micah Piske
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Trevor Thomson
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Emanuel Krebs
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Natt Hongdilokkul
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Julie Bruneau
- Centre hospitalier de l'Université de Montréal, CRCHUM, Montreal, Quebec, Canada
- Département de médecine de famille et de médecine d'urgence, Universite de Montreal, Montreal, Quebec, Canada
| | - Sander Greenland
- Department of Epidemiology and Department of Statistics, UCLA, Los Angeles, California, USA
| | - Paul Gustafson
- Department of Statistics, UBC, Vancouver, British Columbia, Canada
| | - M Ehsan Karim
- School of Population and Public Health, UBC, Vancouver, British Columbia, Canada
- Providence Health Care Research Institute, Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Lawrence C McCandless
- Department of Statstics and Actuarial Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics, UBC, Vancouver, British Columbia, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Uwe Siebert
- Department of Health Policy and Management, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Tirol, Austria
- Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - M Eugenia Socías
- BC Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, UBC, Vancouver, Briitish Columbia, Canada
| | - Judith I Tsui
- Department of Medicine, Section of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Evan Wood
- BC Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, UBC, Vancouver, Briitish Columbia, Canada
| | - Bohdan Nosyk
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
28
|
Herrera L, Markle SL, Fukuda M, Aroca P, Villar A, Wang Y, Dominique G, Umoren O, Alegría M. Predictors of Research Assessment Completion in a Latino Sample with Dual Disorders. J Immigr Minor Health 2020; 22:1094-1100. [PMID: 32347414 DOI: 10.1007/s10903-020-01010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Latinos are underrepresented in clinical trials, where they encounter challenges in participation and a lack of effective recruitment and retention strategies. For Latino migrants with mental health and substance use problems, these challenges are even greater. Analyzing results from a multicenter randomized clinical trial for Latino migrants with mental health and substance use problems in Boston, Massachusetts, USA as well as Madrid and Barcelona, Spain, we describe six retention strategies used to facilitate participant engagement in follow-up assessments, and report the sociodemographic, clinical, and educational factors associated with research assessment completion. Among 341 randomized participants, 77% completed the 12-month follow-up and 75% completed at least 3 of the 4 follow-up assessments. Having a high school diploma, being recruited at community centers versus other sites, and having a less severe mental health condition were significantly associated with completing more follow-up interviews. Rigorous and customized methods reflecting participant's individual context can bolster research assessment completion for diverse Latino populations with behavioral health concerns.
Collapse
Affiliation(s)
- Lizbeth Herrera
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Paloma Aroca
- Department of Psychiatry, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Villar
- Department of Psychiatry, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Georgina Dominique
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Olivia Umoren
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA. .,Departments of Medicine and Psychiatry, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
29
|
Konova AB, Lopez-Guzman S, Urmanche A, Ross S, Louie K, Rotrosen J, Glimcher PW. Computational Markers of Risky Decision-making for Identification of Temporal Windows of Vulnerability to Opioid Use in a Real-world Clinical Setting. JAMA Psychiatry 2020; 77:368-377. [PMID: 31812982 PMCID: PMC6902203 DOI: 10.1001/jamapsychiatry.2019.4013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Opioid addiction is a major public health problem. Despite availability of evidence-based treatments, relapse and dropout are common outcomes. Efforts aimed at identifying reuse risk and gaining more precise understanding of the mechanisms conferring reuse vulnerability are needed. OBJECTIVE To use tools from computational psychiatry and decision neuroscience to identify changes in decision-making processes preceding opioid reuse. DESIGN, SETTING, AND PARTICIPANTS A cohort of individuals with opioid use disorder were studied longitudinally at a community-based treatment setting for up to 7 months (1-15 sessions per person). At each session, patients completed a risky decision-making task amenable to computational modeling and standard clinical assessments. Time-lagged mixed-effects logistic regression analyses were used to assess the likelihood of opioid use between sessions (t to t + 1; within the subsequent 1-4 weeks) from data acquired at the current session (t). A cohort of control participants completed similar procedures (1-5 sessions per person), serving both as a baseline comparison group and an independent sample in which to assess measurement test-retest reliability. Data were analyzed between January 1, 2018, and September 5, 2019. MAIN OUTCOMES AND MEASURES Two individual model-based behavioral markers were derived from the task completed at each session, capturing a participant's current tolerance of known risks and ambiguity (partially unknown risks). Current anxiety, craving, withdrawal, and nonadherence were assessed via interview and clinic records. Opioid use was ascertained from random urine toxicology tests and self-reports. RESULTS Seventy patients (mean [SE] age, 44.7 [1.3] years; 12 women and 58 men [82.9% male]) and 55 control participants (mean [SE] age, 42.4 [1.5] years; 13 women and 42 men [76.4% male]) were included. Of the 552 sessions completed with patients (mean [SE], 7.89 [0.59] sessions per person), 252 (45.7%) directly preceded opioid use events (mean [SE], 3.60 [0.44] sessions per person). From the task parameters, only ambiguity tolerance was significantly associated with increased odds of prospective opioid use (adjusted odds ratio, 1.37 [95% CI, 1.07-1.76]), indicating patients were more tolerant specifically of ambiguous risks prior to these use events. The association of ambiguity tolerance with prospective use was independent of established clinical factors (adjusted odds ratio, 1.29 [95% CI, 1.01-1.65]; P = .04), such that a model combining these factors explained more variance in reuse risk. No significant differences in ambiguity tolerance were observed between patients and control participants, who completed 197 sessions (mean [SE], 3.58 [0.21] sessions per person); however, patients were more tolerant of known risks (B = 0.56 [95% CI, 0.05-1.07]). CONCLUSIONS AND RELEVANCE Computational approaches can provide mechanistic insights about the cognitive factors underlying opioid reuse vulnerability and may hold promise for clinical use.
Collapse
Affiliation(s)
- Anna B. Konova
- Brain Health Institute, Department of Psychiatry, University Behavioral Health Care, Rutgers University–New Brunswick, Piscataway, New Jersey,Neuroscience Institute, New York University School of Medicine, New York
| | - Silvia Lopez-Guzman
- Neuroscience Institute, New York University School of Medicine, New York,,Grupo de Investigación en Neurociencias, Neuros Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Adelya Urmanche
- Department of Psychiatry, New York University School of Medicine, New York
| | - Stephen Ross
- Department of Psychiatry, New York University School of Medicine, New York
| | - Kenway Louie
- Neuroscience Institute, New York University School of Medicine, New York,,Center for Neural Science, New York University, New York
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine, New York
| | - Paul W. Glimcher
- Neuroscience Institute, New York University School of Medicine, New York,,Department of Psychiatry, New York University School of Medicine, New York
| |
Collapse
|
30
|
Socias ME, Wood E, Dong H, Brar R, Bach P, Murphy SM, Fairbairn N. Slow release oral morphine versus methadone for opioid use disorder in the fentanyl era (pRESTO): Protocol for a non-inferiority randomized clinical trial. Contemp Clin Trials 2020; 91:105993. [PMID: 32194251 PMCID: PMC7919741 DOI: 10.1016/j.cct.2020.105993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND North America is facing an unprecedented public health crisis of opioid-related morbidity and mortality, increasingly as a result of the introduction of illicitly manufactured fentanyl into the street drug market. Although the treatment of opioid use disorder (OUD) is a key element in the response to the opioid overdose epidemic, currently available pharmacotherapies (e.g., methadone, buprenorphine) may not be acceptable to or effective in all patients. Available evidence suggests that slow-release oral morphine (SROM) has similar efficacy rates as methadone with respect to promoting abstinence, and with improvements in a number of patient-reported outcomes among persons using heroin. However, little is known about the relative effectiveness and acceptability of SROM compared to methadone in the context of fentanyl use. This study aims to address this research gap. METHODS pRESTO is a 24-week, open-label, two arm, non-inferiority, randomized controlled trial comparing SROM versus methadone for the treatment of OUD. Participants will be 298 clinically stable, non-pregnant adults with OUD, recruited from outpatient clinics in Vancouver, Canada, where the majority of the illicit opioids are contaminated with fentanyl. The primary outcome is suppression of illicit opioid use, measured by bi-weekly urine drug screens. Secondary outcomes include: treatment retention, medication safety, overdose events, treatment satisfaction, psychological functioning, changes in drug-related problems, changes in quality of life, opioid cravings, other substance use, and cost-effectiveness. DISCUSSION pRESTO will be among the first studies to evaluate treatment options for individuals primarily using synthetic street opioids, providing important evidence to guide treatment strategies for this population.
Collapse
Affiliation(s)
- M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Rupinder Brar
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sean M Murphy
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
31
|
Polles AG, Williams MK, Phalin BR, Teitelbaum S, Merlo LJ. Neuropsychological impairment associated with substance use by physicians. J Neurol Sci 2020; 411:116714. [DOI: 10.1016/j.jns.2020.116714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/05/2019] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
|
32
|
Effects of lorcaserin on oxycodone self-administration and subjective responses in participants with opioid use disorder. Drug Alcohol Depend 2020; 208:107859. [PMID: 31980285 PMCID: PMC7063580 DOI: 10.1016/j.drugalcdep.2020.107859] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/18/2019] [Accepted: 01/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lorcaserin, a high-affinity 5-HT2C receptor agonist approved for treating obesity, decreased self-administration of oxycodone and cue-induced reinstatement of drug-seeking behavior in preclinical studies. The current investigation is the first clinical trial to evaluate the ability of lorcaserin to alter the reinforcing and subjective effects of oxycodone. METHODS In this 7-week inpatient trial, 12 non-treatment-seeking volunteers (11 males) with moderate-to-severe opioid use disorder were detoxified from opioids. In a randomized cross-over fashion, participants were first stabilized on lorcaserin (10 mg BID) or placebo (0 mg BID). Participants underwent a two-week testing period during which the reinforcing and subjective effects of intranasal oxycodone were examined in verbal choice, cue-exposure, and progressive-ratio choice sessions. The two testing weeks were identical with the exception that during the first week, active oxycodone (10 mg) was available during verbal choice (self-administration) sessions, and during the second week placebo oxycodone was available. Subsequently, participants were stabilized on the other medication condition (placebo or lorcaserin) and underwent the same testing procedures again. RESULTS Lorcaserin did not alter oxycodone self-administration. However, lorcaserin had a trend to increase "wanting heroin" when oxycodone was available, and to accentuate oxycodone-induced miosis. CONCLUSION Under the current experimental conditions, lorcaserin at a dose of 10 mg BID did not reliably decrease the abuse liability of oxycodone, even though the study was sufficiently powered (≥80 %) to detect clinically meaningful differences in the main outcome variables between the placebo and active lorcaserin condition. Future research could explore a wider dose range of lorcaserin and oxycodone.
Collapse
|
33
|
Carlsen SEL, Lunde LH, Torsheim T. Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment. Subst Abuse Rehabil 2020; 11:9-18. [PMID: 32099510 PMCID: PMC6996215 DOI: 10.2147/sar.s221618] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Opioid maintenance treatment reduces a person’s use of heroin. However, frequent substance use in treatment is a problem. Aim To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment. Patients and Methods Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants’ social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life. Results There was a significant negative association between time in treatment and use of opioids, b =−0.89, SE = 0.19, p = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, b =−0.40, SE =0.19, p = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, b = −0.62, SE = 0.23, p = < 0.01. Social dimensions, participants’ adverse experiences, and social resources were not associated with polydrug or opioid use. Conclusion Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients’ opioid use.
Collapse
Affiliation(s)
| | - Linn-Heidi Lunde
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Torbjørn Torsheim
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| |
Collapse
|
34
|
Hjelmström P, Banke Nordbeck E, Tiberg F. Optimal dose of buprenorphine in opioid use disorder treatment: a review of pharmacodynamic and efficacy data. Drug Dev Ind Pharm 2020; 46:1-7. [DOI: 10.1080/03639045.2019.1706552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
35
|
Dennis BB, Sanger N, Bawor M, Naji L, Plater C, Worster A, Woo J, Bhalerao A, Baptist-Mohseni N, Hillmer A, Rice D, Corace K, Hutton B, Tugwell P, Thabane L, Samaan Z. A call for consensus in defining efficacy in clinical trials for opioid addiction: combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder. Trials 2020; 21:30. [PMID: 31907000 PMCID: PMC6945391 DOI: 10.1186/s13063-019-3995-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g., EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient-reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g., abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n = 28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, although they also stressed goals under-reported in clinical trials. Conclusions There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. Trial registration PROSPERO, CRD42013006507.
Collapse
Affiliation(s)
- Brittany B Dennis
- McMaster University Internal Medicine Residency Program, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Nitika Sanger
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Monica Bawor
- McMaster University Internal Medicine Residency Program, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Leen Naji
- Department of Family Medicine Residency Program, Michael G. Degroote School of Medicine, McMaster University, Hamilton, Canada
| | - Carolyn Plater
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, Hamilton General Hospital, Hamilton, Canada
| | - Julia Woo
- University of Toronto Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anuja Bhalerao
- University of Toronto Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Natasha Baptist-Mohseni
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Alannah Hillmer
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Danielle Rice
- Faculty of Science, Department of Psychology, McGill University, Montreal, Canada.,Center for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kim Corace
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Evaluation of Medicine, Hamilton, Canada.,System Linked Research Unit, Hamilton, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, Canada.
| |
Collapse
|
36
|
De Nadai AS, Little T, McCabe SE, Schepis TS. Diverse diagnostic profiles associated with prescription opioid use disorder in a nationwide sample: One crisis, multiple needs. J Consult Clin Psychol 2019; 87:849-858. [PMID: 31556662 PMCID: PMC6764519 DOI: 10.1037/ccp0000429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The opioid crisis has had devastating effects on individuals and communities, and it has rapidly increased in severity. However, we still lack nationally representative information on the diversity of comorbidity patterns among prescription opioid use disorder (P-OUD), other substance use disorders (SUDs), and psychopathology using the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This impedes planning for multiple aspects of intervention, including society-wide allocation of treatment resources, program design at individual treatment centers, and personalized care to individual patients. METHOD To address this critical gap in information, we evaluated clinical profiles of American adults via latent class analysis in a large, recently collected epidemiological dataset that uses structured diagnostic assessment for DSM-5 psychopathology (National Epidemiologic Survey on Alcohol and Related Conditions-III; N = 36,309). Variables considered for profiles included lifetime diagnosis for multiple SUDs, various externalizing and internalizing conditions, and demographic variables. We then associated clinical profiles with demographic variables and functional impairment. RESULTS Comorbid psychopathology and other SUDs were common in latent classes with elevated and very high rates of P-OUD. To illustrate, alcohol use disorder rates were greater than 45%, and posttraumatic stress disorder rates were greater than 28% in classes with higher P-OUD rates. Higher P-OUD rates were associated with White/non-Hispanic and American Indian/Alaska Native populations. Relationships between P-OUD rates and functional impairment were inconsistent. CONCLUSION Many current treatment delivery systems are not designed to accommodate the heterogeneous profiles associated with high P-OUD rates. We provide specific suggestions for improvements to the mental health service system, individual clinical care programs, and future research approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Tara Little
- Department of Psychology, Texas State University
| | - Sean E. McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health,
School of Nursing, University of Michigan
- Institute for Research on Women and Gender, University of
Michigan
| | | |
Collapse
|
37
|
Koller G, Schwarzer A, Halfter K, Soyka M. Pain management in opioid maintenance treatment. Expert Opin Pharmacother 2019; 20:1993-2005. [DOI: 10.1080/14656566.2019.1652270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Gabi Koller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Schwarzer
- Department of Pain Medicine, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Kathrin Halfter
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University München, Munich, Germany
| | - Michael Soyka
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Medical Park Chiemseeblick, Bernau, Germany
| |
Collapse
|
38
|
Reichert J, Gleicher L. Probation clients' barriers to access and use of opioid use disorder medications. HEALTH & JUSTICE 2019; 7:10. [PMID: 31139961 PMCID: PMC6717960 DOI: 10.1186/s40352-019-0089-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/30/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND There is a gap between evidence-based treatment with medications for opioid use disorders (OUDs) and current practices of probation departments who supervise individuals with OUDs. Many probationers with OUDs cannot access FDA-approved medications to treat their disorders despite the strong evidence of their effectiveness. The barriers to medications for those under probation supervision include practitioners' negative attitudes toward medications, costs, stigma, and diversion risk. Probation officers have an ethical obligation to help their clients reduce barriers to access the care they need which in turn can improve their outcomes and increase public safety. RESULTS The current study explores how probation departments respond to probationers with OUDs, focusing on the barriers to accessing OUD medications based on a survey of probation department directors/administrators (hereafter referred to as probation department leaders) in Illinois (N = 26). A majority of probation department leaders reported perceived staff barriers to their clients accessing medications. Reasons included lack of medical personnel experience, cost, need for guidance on medications, and regulations set by their organization or jurisdiction that prohibit client use of medications. Probation department leaders reported knowing less about the use of methadone and how it is administered, compared to buprenorphine and naltrexone. In addition, probation department leaders were generally more open to referring clients for treatment that include buprenorphine or naltrexone compared to methadone. Despite slightly less training or familiarity with methadone than the other medications, the number of probation department leaders who knew where to refer someone for each of the three FDA-approved medications was similar. CONCLUSIONS The current study found probation department leaders perceive some barriers to their staff linking or referring their clients to OUD medications. Study findings indicate a need for administration- and staff-level training, interagency collaboration, and policy changes to increase access to, education on, and use of, medications for probation clients. Such efforts will ultimately help probation clients with OUDs stabilize and adhere to other probation requirements and engage in behavioral therapy, which may result in positive outcomes such as reduced recidivism, increased quality of life, and reduced mortality.
Collapse
Affiliation(s)
- Jessica Reichert
- Illinois Criminal Justice Information Authority, Center for Justice Research and Evaluation, 300 W. Adams St., Suite 200, Chicago, IL 60606 USA
| | - Lily Gleicher
- Illinois Criminal Justice Information Authority, Center for Justice Research and Evaluation, 300 W. Adams St., Suite 200, Chicago, IL 60606 USA
| |
Collapse
|
39
|
Ling S, Mangaoil R, Cleverley K, Sproule B, Puts M. A systematic review of sex differences in treatment outcomes among people with opioid use disorder receiving buprenorphine maintenance versus other treatment conditions. Drug Alcohol Depend 2019; 197:168-182. [PMID: 30831429 DOI: 10.1016/j.drugalcdep.2019.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/19/2019] [Accepted: 02/07/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Opioid use disorder is a major health concern in North America. Currently, buprenorphine is one of the most common pharmacological interventions used to treat opioid use disorder. Despite increasing prevalence of opioid use disorder among females, little is known about sex considerations in relation to treatment with buprenorphine. METHODS CINAHL, PsycINFO, EMBASE, PubMed/MEDLINE and Cochrane Central were searched for randomized controlled trials examining buprenorphine maintenance versus other medication-assisted treatment, placebo, or withdrawal management to determine if there were any sex differences in treatment outcomes reported. RESULTS This review included 25 studies and found that only 52% included information related to sex differences in treatment outcomes or discussed any sex considerations in their studies. Of the 6,466 patients represented by these studies, only 26% were female. Of the studies conducting sex-specific analyses, seven studies examined treatment retention, five examined opioid use, two examined other substance use and one examined sexual risk behaviours. However, due to mixed findings, small sample sizes, and inability to conduct meta-analyses, no conclusive statements can be made about sex differences in these outcomes. None of the studies described sex differences in quality of life, legal involvement or mental and physical health. CONCLUSIONS Low numbers of females have been included in randomized controlled trials examining buprenorphine compared to males. While sex differences in treatment outcomes were identified in this review, further research is needed in order to add to these findings. Future studies should include greater numbers of female participants and conduct sex-specific analyses.
Collapse
Affiliation(s)
- Sara Ling
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 1P8; Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada, M6J 1H4.
| | - Remar Mangaoil
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 1P8; Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada, M6J 1H4.
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 1P8; Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada, M6J 1H4.
| | - Beth Sproule
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada, M6J 1H4; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada, M5S 3M2.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 1P8.
| |
Collapse
|
40
|
Li L, Wu Z, Liang LJ, Lin C, Luo S, Cao X, Hsieh J, Rou K. An intervention trial targeting methadone maintenance treatment providers to improve clients' treatment retention in China. Drug Alcohol Depend 2019; 194:143-150. [PMID: 30445272 PMCID: PMC6413495 DOI: 10.1016/j.drugalcdep.2018.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Service providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention. METHODS This study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period. RESULTS Significantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90). CONCLUSIONS The MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs.
Collapse
Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sitong Luo
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| | - Julie Hsieh
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
| |
Collapse
|
41
|
Substance Use Issues Among the Underserved. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
42
|
Zhu Y, Evans EA, Mooney LJ, Saxon AJ, Kelleghan A, Yoo C, Hser YI. Correlates of Long-Term Opioid Abstinence After Randomization to Methadone Versus Buprenorphine/Naloxone in a Multi-Site Trial. J Neuroimmune Pharmacol 2018; 13:488-497. [PMID: 30094695 PMCID: PMC6224303 DOI: 10.1007/s11481-018-9801-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022]
Abstract
Opioid use disorder (OUD) is a chronic, relapsing condition with severe negative health consequences. Previous studies have reported that 5-year opioid abstinence is a good predictor of reduced likelihoods of relapse, but factors that shape long-term opioid abstinence are poorly understood. The present study is based on data from a prospective study of 699 adults with OUD who had been randomized to either methadone or buprenorphine/naloxone and who were followed for at least 5 years. During the 5 years prior to the participants' last follow-up interview, 232 (33.2%) had achieved 5-year abstinence from heroin. Of those 232, 145 (20.7% of the total) had remained abstinent from both heroin and other opioids (e.g., hydrocodone, oxycodone, other opioid analgesics, excluding methadone or buprenorphine). Compared to non-abstinent individuals, those in both categories of opioid abstinence had lower problem severity in health and social functioning at the final follow-up. Logistic regression results indicated that cocaine users and injection drug users were less likely to achieve 5-year heroin abstinence, whereas Hispanics (vs. whites) and those treated in clinics on the West Coast (vs. East) were less likely to achieve 5-year abstinence from heroin and other opioids. For both abstinence category groups, abstinence was positively associated with older age at first opioid use, lower impulsivity, longer duration of treatment for OUD, and greater social support. Reducing cocaine use and injection drug use and increasing social support and retention in treatment may help maintain long-term abstinence from opioids among individuals treated with agonist pharmacotherapy.
Collapse
Affiliation(s)
- Yuhui Zhu
- UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA
| | - Elizabeth A Evans
- University of Massachusetts Amherst, 311 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Larissa J Mooney
- UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA
- Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Room 116 ATC, Seattle, WA, 98108, USA
| | - Annamarie Kelleghan
- University of Southern California, SGM 501, 3620 South McClintock Ave., Los Angeles, CA, 90089-1061, USA
| | - Caroline Yoo
- UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA
| | - Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA.
| |
Collapse
|
43
|
Abstract
Opioid maintenance treatment is the first-line approach in opioid dependence. Both the full opioid agonist methadone (MET) and the partial agonist buprenorphine (BUP) are licensed for the treatment of opioid dependence. BUP differs significantly from MET in its pharmacology, side effects, and safety issues. For example, the risk of respiratory depression is lower than with MET. The risk of diversion and injection of BUP have been reduced by also making it available as a tablet containing the opioid antagonist naloxone. This review summarizes the clinical effects of BUP and examines possible factors that can support decisions regarding the use of BUP or MET in opioid-dependent people.
Collapse
Affiliation(s)
- Michael Soyka
- Medical Park Chiemseeblick, Bernau, Germany; Psychiatric Hospital, University of Munich, Munich, Germany
| |
Collapse
|
44
|
Li DJ, Chung KS, Wu HC, Hsu CY, Yen CF. Factors affecting the dose of methadone among patients receiving methadone maintenance therapy in Taiwan. Am J Addict 2018; 27:225-230. [DOI: 10.1111/ajad.12712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dian-Jeng Li
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
- Graduate Institute of Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Kuan-Shang Chung
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Hung-Chi Wu
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Chih-Yao Hsu
- Department of Addiction Science; Kaohsiung Municipal Kai-Syuan Psychiatric; Hospital; Kaohsiung Taiwan
| | - Cheng-Fang Yen
- Graduate Institute of Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Psychiatry; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| |
Collapse
|
45
|
Maglione MA, Raaen L, Chen C, Azhar G, Shahidinia N, Shen M, Maksabedian E, Shanman RM, Newberry S, Hempel S. Effects of medication assisted treatment (MAT) for opioid use disorder on functional outcomes: A systematic review. J Subst Abuse Treat 2018; 89:28-51. [PMID: 29706172 DOI: 10.1016/j.jsat.2018.03.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 12/23/2022]
Abstract
This systematic review synthesizes evidence on the effects of Medication-Assisted Treatment (MAT) for opioid use disorder (OUD) on functional outcomes, including cognitive (e.g., memory), physical (e.g., fatigue), occupational (e.g., return to work), social/behavioral (e.g., criminal activity), and neurological (e.g., balance) function. Five databases were searched from inception to July 2017 to identify English-language controlled trials, case control studies, and cohort comparisons of one or more groups; cross-sectional studies were excluded. Two independent reviewers screened identified literature, abstracted study-level information, and assessed the quality of included studies. Meta-analyses used the Hartung-Knapp method for random-effects models. The quality of evidence was assessed using the GRADE approach. A comprehensive search followed by 1411 full text publication screenings yielded 30 randomized controlled trials (RCTs) and 10 observational studies meeting inclusion criteria. The studies reported highly diverse functional outcome measures. Only one RCT was rated as high quality, but several methodologically sound observational studies were identified. The statistical power to detect differences in functional outcomes was unclear in most studies. When compared with matched "healthy" controls with no history of substance use disorder (SUD), in two studies MAT patients had significantly poorer working memory and cognitive speed. One study found MAT patients scored worse in aggressive responding than did "healthy" controls. A large observational study found that MAT users had twice the odds of involvement in an injurious traffic accident as non-users. When compared with persons with OUD not on MAT, one cohort study found lower fatigue rates among buprenorphine-treated OUD patients. No differences were reported for occupational outcomes and results for criminal activity and other social/behavioral areas were mixed. There were few differences among MAT drug types. A pooled analysis of three RCTs found a significantly lower prevalence of fatigue with buprenorphine compared to methadone, while a meta-analysis of the same RCTs found no statistical difference in insomnia prevalence. Three RCTs that focused on cognitive function compared the effects of buprenorphine to methadone; no statistically significant differences in memory, cognitive speed and flexibility, attention, or vision were reported. The quality of evidence for most functional outcomes was rated low or very low. In sum, weaknesses in the body of evidence prevent strong conclusions about the effects of MAT for opioid use disorder on functional outcomes. Rigorous studies of functional effects would strengthen the body of literature.
Collapse
Affiliation(s)
| | - Laura Raaen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Christine Chen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Gulrez Azhar
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Nima Shahidinia
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Mimi Shen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Ervant Maksabedian
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Roberta M Shanman
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Sydne Newberry
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Susanne Hempel
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| |
Collapse
|
46
|
Heidebrecht F, MacLeod MB, Dawkins L. Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack. Addict Behav 2018; 77:210-216. [PMID: 29065377 DOI: 10.1016/j.addbeh.2017.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
AIMS To analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors in a clinical non-experimental setting. DESIGN Retrospective study. SETTING A community drug service in London, UK. PARTICIPANTS 325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine). MEASUREMENTS Logistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start (or at the date of transfer to another service). FINDINGS For the general model participants choosing methadone were more likely to use heroin at follow up (OR=2.36, 95% CI: 1.40-3.17) as were daily crack users on methadone (OR=2.62, 95% CI: 0.96-7.16). For the methadone model only daily crack use predicted heroin use at follow up (OR=2.62, 95% CI: 0.96-7.16). For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR=0.85, 95% CI: 0.75-0.95; OR=1.31, 95% CI: 1.06-1.60 and OR=6.04, 95% CI: 1.26-28.92). Both use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR=6.68, 95% CI: 0.37-119.59; OR=106.31, 95% CI: 3.41-3313.30) and daily (OR=57.49 (95% CI: 2.37-1396.46; OR=170.99 (95% CI: 4.61-6339.47) users. CONCLUSIONS Most of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. Crack use was a significant predictor of heroin abstinence at follow up in all models, however for buprenorphine only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.
Collapse
Affiliation(s)
| | | | - L Dawkins
- London South Bank University, London, UK
| |
Collapse
|
47
|
Diversity in the Needs and Outcomes of Low-Threshold/High-Tolerance Methadone Maintenance Therapy Clients. CANADIAN JOURNAL OF ADDICTION 2017. [DOI: 10.1097/cxa.0000000000000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
48
|
Parran TV, Mace AG, Dahan YJ, Adelman CA, Kolganov M. Buprenorphine/Naloxone Maintenance Therapy: an Observational Retrospective Report on the Effect of Dose on 18 months Retention in an Office-Based Treatment Program. Subst Abuse 2017; 11:1178221817731320. [PMID: 29051703 PMCID: PMC5638148 DOI: 10.1177/1178221817731320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/20/2017] [Indexed: 11/17/2022]
Abstract
CONTEXT AND OBJECTIVE Buprenorphine has been available with few reports of the dose range necessary to adequately maintain patients. We report on the effect of 8 mg/d versus 16 mg/d of buprenorphine on long-term patient retention in office-based opioid maintenance (OBOMT). DESIGN SETTING AND PARTICIPANTS Case series, at an urban hospital-based primary care clinic providing OBOMT to 157 opiate-dependent, low socioeconomic status, uninsured, nonhomeless patients. INTERVENTION The OBOMT program operated by a comprehensive sobriety treatment program experienced State funding cuts. Thus, after 2 years, the program was required by the State funder to decrease the buprenorphine maintenance dose from 16 to 8 mg/d for all new admissions. We report on patient retention before and after dose reduction. MAIN OUTCOME MEASURES The primary outcomes of this study were to measure and compare patient retention in the 2 cohorts at each point of treatment transition over the 18 months following OBOMT initiation. RESULTS No significant differences in patient retention were observed between the 16 and 8 mg/d patient cohorts. Lower dose buprenorphine maintenance (8 mg/d) in uninsured patients enrolled in publicly funded long-term OBOMT combined with comprehensive sobriety counseling was as effective as higher dose therapy (16 mg/d) in promoting patient retention throughout the study period. This lower dose resulted in a substantial saving to the public funding agency. CONCLUSIONS In an observational retrospective report, retention in treatment of opiate-addicted patients was the same at 8 and 16 mg/d buprenorphine doses after 18 months. These data have implications for public and managed care funding of OBOMT, for the general prescribing of buprenorphine in outpatient care, and may be instructive in the ongoing debate about the relationship between buprenorphine dose.
Collapse
Affiliation(s)
- Theodore V Parran
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Internal Medicine, Division of Addiction Medicine, Cleveland, OH, USA
| | - AG Mace
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Yael J Dahan
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Anesthesiology, Strong Memorial Hospital, Rochester, NY, USA
| | - Christopher A Adelman
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Internal Medicine, Division of Addiction Medicine, Cleveland, OH, USA
| | - Mykola Kolganov
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Internal Medicine, Division of Addiction Medicine, Cleveland, OH, USA
| |
Collapse
|
49
|
Michel L, Des Jarlais DC, Thi HD, Hai OKT, Minh KP, Peries M, Vallo R, Tuyet TNT, Thi GH, Le Sao M, Feelemyer J, Hai VV, Moles JP, Laureillard D, Nagot N. Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions. Drug Alcohol Depend 2017; 179:198-204. [PMID: 28800503 PMCID: PMC5911921 DOI: 10.1016/j.drugalcdep.2017.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. METHODS A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. RESULTS Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. CONCLUSION Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term.
Collapse
Affiliation(s)
- Laurent Michel
- CESP/Inserm1018, Pierre Nicole Centre, French Red Cross, 27 Pierre Nicole Street, 75005, Paris, France.
| | - Don C. Des Jarlais
- Mount Sinai Beth Israel, 39 Broadway 5th Floor Suite 530 New York, NY 10006, USA
| | - Huong Duong Thi
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Oanh Khuat Thi Hai
- Supporting Community Development Initiatives, 240 Mai Anh Tuan Street, Ba Dinh District, Hanoi, Viet Nam
| | - Khuê Pham Minh
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Marianne Peries
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Roselyne Vallo
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Thanh Nham Thi Tuyet
- Supporting Community Development Initiatives, 240 Mai Anh Tuan Street, Ba Dinh District, Hanoi, Viet Nam
| | - Giang Hoang Thi
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Mai Le Sao
- Departement of mental health, Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Jonathan Feelemyer
- Mount Sinai Beth Israel, 39 Broadway 5th Floor Suite 530 New York, NY 10006, USA
| | - Vinh Vu Hai
- Infectious Diseases Department, Viet Tiep Hospital, So 1, duong Nha Thuong, Le Chan, Hai Phong, Viet Nam
| | - Jean-Pierre Moles
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Didier Laureillard
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France,Infectious Diseases Department, Caremeau University Hospital, Prefessor Robert Debré Place, 30900 Nîmes, France
| | - Nicolas Nagot
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France,Department of Medical Information, University Hospital of Montpellier, 34090, Montpellier, France
| | | |
Collapse
|
50
|
Ainscough TS, McNeill A, Strang J, Calder R, Brose LS. Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis. Drug Alcohol Depend 2017; 178:318-339. [PMID: 28688295 PMCID: PMC5558146 DOI: 10.1016/j.drugalcdep.2017.05.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/24/2017] [Accepted: 05/17/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Use of non-prescribed drugs during treatment for opiate addiction reduces treatment success, creating a need for effective interventions. This review aimed to assess the efficacy of contingency management, a behavioural treatment that uses rewards to encourage desired behaviours, for treating non-prescribed drug use during opiate addiction treatment. METHODS A systematic search of the databases Embase, PsychInfo, PsychArticles and Medline from inception to March 2015 was performed. Random effects meta-analysis tested the use of contingency management to treat the use of drugs during opiate addiction treatment, using either longest duration of abstinence (LDA) or percentage of negative samples (PNS). Random effects moderator analyses were performed for six potential moderators: drug targeted for intervention, decade in which the study was carried out, study quality, intervention duration, type of reinforcer, and form of opiate treatment. RESULTS The search returned 3860 papers; 22 studies met inclusion criteria and were meta-analysed. Follow-up data was only available for three studies, so all analyses used end of treatment data. Contingency management performed significantly better than control in reducing drug use measured using LDA (d=0.57, 95% CI: 0.42-0.72) or PNS (d=0.41) (95% CI: 0.28-0.54). This was true for all drugs other than opiates. The only significant moderator was drug targeted (LDA: Q=10.75, p=0.03). CONCLUSION Contingency management appears to be efficacious for treating most drug use during treatment for opiate addiction. Further research is required to ascertain the full effects of moderating variables, and longer term effects.
Collapse
Affiliation(s)
- Tom S Ainscough
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; UK Centre for Tobacco and Alcohol Studies, UK.
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; UK Centre for Tobacco and Alcohol Studies, UK
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Calder
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Leonie S Brose
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; UK Centre for Tobacco and Alcohol Studies, UK
| |
Collapse
|