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Crisanti AS, Page K, Saavedra JL, Kincaid T, Caswell CM, Waldorf VA. A combined intervention strategy to increase linkage to and retention in substance use treatment for individuals accessing hospital-based services: study protocol. Front Psychiatry 2024; 15:1330436. [PMID: 38855640 PMCID: PMC11160486 DOI: 10.3389/fpsyt.2024.1330436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Background In 2020, New Mexico had the highest alcohol related death and the 11th highest drug overdose rate in the U.S. Towards the long-term goal of addressing this public health problem, we are implementing and evaluating an multi-level intervention designed to identify adults at risk of substance use disorder (SUD) and encourage linkage to and retention in treatment. The first level includes equipping the ED and medical inpatient units of a safety-net hospital with a method to screen individuals at risk of a SUD. The second level includes Seeking Safety (SS), a trauma-specific treatment for PTSD and SUD; and pharmacotherapy for SUD. Motivational Interviewing (MI) is used throughout both levels. Using the SPIRIT guidelines and checklist, this study protocol describes the multi-level intervention and the methodology we are using to assess feasibility and effectiveness. Methods We are using a Type 1 hybrid implementation design with a non-randomized approach (ISRCTN registration # ISRCTN33100750). We aim to enroll 110 adults ( ≧ 18 ) who screen positive for unhealthy use of alcohol, prescription medications (used nonmedically) and/or illicit drugs. Peer support workers are responsible for screening, using MI to increase engagement in screening and treatment and delivery of SS. Pharmacotherapy is provided by addiction clinical specialists. Treatment is provided post hospital discharge via telehealth to increase access to care. Participants are identified through (1) review of electronic health records for individuals with a chief or secondary complaint or mental health condition relating to alcohol and/or other drug use, (2) referrals from clinical staff and (3) screening in the ED and medical inpatient units. Feasibility is being measured through process data. Effectiveness will be determined by changes in two primary outcomes: (i) PTSD symptom severity; and (ii) substance use. Discussion Our study will expand on research related to the implementation of treatment strategies for patients presenting at EDs and admitted to medical inpatients units wherein there is a significant window of opportunity to link patients with follow-up behavioral and clinical services for alcohol and/or drug misuse. The challenges associated with implementation and strategies that have been helpful to address these challenges will further inform the field.
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Affiliation(s)
- A. S. Crisanti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - K. Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - J. L. Saavedra
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - T. Kincaid
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - C. M. Caswell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - V. A. Waldorf
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Baucum M, Khojandi A, Myers CR, Kessler LM. Optimizing Substance Use Treatment Selection Using Reinforcement Learning. ACM TRANSACTIONS ON MANAGEMENT INFORMATION SYSTEMS 2022. [DOI: 10.1145/3563778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Substance use disorder (SUD) exacts a substantial economic and social cost in the United States, and it is crucial for SUD treatment providers to match patients with feasible, effective, and affordable treatment plans. The availability of large SUD patient datasets allows for machine learning techniques to predict patient-level SUD outcomes, yet there has been almost no research on whether machine learning can be used to
optimize
or
personalize
which treatment plans SUD patients receive. We use contextual bandits (a reinforcement learning technique) to optimally map patients to SUD treatment plans, based on dozens of patient-level and geographic covariates. We also use near-optimal policies to incorporate treatments’ time-intensiveness and cost into our recommendations, to aid treatment providers and policymakers in allocating treatment resources. Our personalized treatment recommendation policies are estimated to yield higher remission rates than observed in our original dataset, and they suggest clinical insights to inform future research on data-driven SUD treatment matching.
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Zeledon I, Telles V, Dickerson D, Johnson C, Schweigman K, West A, Soto C. Exploring Culturally Based Treatment Options for Opioid Use Disorders Among American Indian and Alaska Native Adults in California. J Stud Alcohol Drugs 2022; 83:613-620. [PMID: 35838440 PMCID: PMC9318704 DOI: 10.15288/jsad.2022.83.613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/26/2022] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVE American Indian and Alaska Native (AIAN) communities have been severely affected by the opioid epidemic, resulting in high opioid overdose death rates and disrupted community life. An added complexity is the diversity of AIAN communities throughout California, with regional differences, resources, infrastructure, and economic opportunities. This study examined the perspective of 163 AIANs in California to assess culturally based or traditional healing treatment modalities to treat opioid/substance use disorder. METHOD A total of 21 adult focus groups were conducted throughout 10 counties in California reaching 20 urban and tribal communities. Eight of these focus groups were conducted in recovery centers and 13 focus groups were conducted in tribal and urban organizations. Interviews were transcribed and coded using NVivo software utilizing an iterative coding approach with a priori domains. RESULTS Participants emphasized building a sense of belonging, connecting with their culture, and having awareness of substance use disorder and treatment as protective factors. CONCLUSIONS Findings indicate that medications for opioid use disorder programs serving AIAN communities should include cultural components that resonate with urban and tribal communities.
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Affiliation(s)
- Ingrid Zeledon
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Victoria Telles
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Daniel Dickerson
- UCLA Integrated Substance Abuse Programs, Los Angeles, California
| | - Carrie Johnson
- United American Indian Involvement, Inc., Los Angeles, California
| | | | - Amy West
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Claradina Soto
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
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Zeledon I, Telles V, Dickerson D, Johnson C, Schweigman K, West A, Soto C. Exploring Culturally Based Treatment Options for Opioid Use Disorders Among American Indian and Alaska Native Adults in California. J Stud Alcohol Drugs 2022; 83:613-620. [PMID: 35838440 PMCID: PMC9318704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/26/2022] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE American Indian and Alaska Native (AIAN) communities have been severely affected by the opioid epidemic, resulting in high opioid overdose death rates and disrupted community life. An added complexity is the diversity of AIAN communities throughout California, with regional differences, resources, infrastructure, and economic opportunities. This study examined the perspective of 163 AIANs in California to assess culturally based or traditional healing treatment modalities to treat opioid/substance use disorder. METHOD A total of 21 adult focus groups were conducted throughout 10 counties in California reaching 20 urban and tribal communities. Eight of these focus groups were conducted in recovery centers and 13 focus groups were conducted in tribal and urban organizations. Interviews were transcribed and coded using NVivo software utilizing an iterative coding approach with a priori domains. RESULTS Participants emphasized building a sense of belonging, connecting with their culture, and having awareness of substance use disorder and treatment as protective factors. CONCLUSIONS Findings indicate that medications for opioid use disorder programs serving AIAN communities should include cultural components that resonate with urban and tribal communities.
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Affiliation(s)
- Ingrid Zeledon
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Victoria Telles
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Daniel Dickerson
- UCLA Integrated Substance Abuse Programs, Los Angeles, California
| | - Carrie Johnson
- United American Indian Involvement, Inc., Los Angeles, California
| | | | - Amy West
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Claradina Soto
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
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Ward HB, Mosquera MJ, Suzuki J, Mariano TY. A Systematic Review of Noninvasive Brain Stimulation for Opioid Use Disorder. Neuromodulation 2020; 23:301-311. [DOI: 10.1111/ner.13108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/20/2019] [Accepted: 01/02/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Heather B. Ward
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Matthew J. Mosquera
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Joji Suzuki
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Timothy Y. Mariano
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
- Butler Hospital Providence RI USA
- Center for Neurorestoration and Neurotechnology Providence Veterans Affairs Medical Center Providence RI USA
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Carroll KM, Weiss RD. The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 17:183-192. [PMID: 32021588 DOI: 10.1176/appi.focus.17206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from Am J Psychiatry 2017;174:738-747).
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Affiliation(s)
- Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.; the Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Mass.; and the Department of Psychiatry, Harvard Medical School, Boston
| | - Roger D Weiss
- Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.; the Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Mass.; and the Department of Psychiatry, Harvard Medical School, Boston
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Venner KL, Donovan DM, Campbell ANC, Wendt DC, Rieckmann T, Radin SM, Momper SL, Rosa CL. Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives. Addict Behav 2018; 86:111-117. [PMID: 29914717 PMCID: PMC6129390 DOI: 10.1016/j.addbeh.2018.05.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 04/06/2018] [Accepted: 05/21/2018] [Indexed: 01/01/2023]
Abstract
The U.S. is experiencing an alarming opioid epidemic, and although American Indians and Alaska Natives (AI/ANs) are especially hard hit, there is a paucity of opioid-related treatment research with these communities. AI/ANs are second only to Whites in the U.S. for overdose mortality. Thus, the National Institute on Drug Abuse convened a meeting of key stakeholders to elicit feedback on the acceptability and uptake of medication assisted treatment (MAT) for opioid use disorders (OUDs) among AI/ANs. Five themes from this one-day meeting emerged: 1) the mismatch between Western secular and reductionistic medicine and the AI/AN holistic healing tradition; 2) the need to integrate MAT into AI/AN traditional healing; 3) the conflict between standardized MAT delivery and the traditional AI/AN desire for healing to include being medicine free; 4) systemic barriers; and 5) the need to improve research with AI/ANs using culturally relevant methods. Discussion is organized around key implementation strategies informed by these themes and necessary for the successful adoption of MAT in AI/AN communities: 1) type of medication; 2) educational interventions; 3) coordination of care; and 4) adjunctive psychosocial counseling. Using a community-based participatory research approach is consistent with a "two eyed seeing" approach that integrates Western and Indigenous worldviews. Such an approach is needed to develop impactful research in collaboration with AI/AN communities to address OUD health disparities.
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Affiliation(s)
- Kamilla L Venner
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA.
| | - Dennis M Donovan
- Alcohol & Drug Abuse Institute and Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Room 3719, Box 120, New York, NY 10032, USA
| | - Dennis C Wendt
- Alcohol & Drug Abuse Institute and Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631, USA
| | - Traci Rieckmann
- School of Public Health, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Sandra M Radin
- Alcohol & Drug Abuse Institute and Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631, USA
| | - Sandra L Momper
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Carmen L Rosa
- Center for the Clinical Trials Network, National Institute on Drug Abuse, 6001 Executive Blvd, Bethesda, MD 20892, USA
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Abstract
Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive. Discussion: Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis' potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse. Conclusion: The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
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Affiliation(s)
- Beth Wiese
- Department of Psychology, University of Missouri–St. Louis, St. Louis, Missouri
- Department of Anesthesiology, Pain Center, Washington University School of Medicine, St. Louis, Missouri
| | - Adrianne R. Wilson-Poe
- Department of Anesthesiology, Pain Center, Washington University School of Medicine, St. Louis, Missouri
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Wilson‐Poe AR, Morón JA. The dynamic interaction between pain and opioid misuse. Br J Pharmacol 2018; 175:2770-2777. [PMID: 28602044 PMCID: PMC6016619 DOI: 10.1111/bph.13873] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/21/2017] [Accepted: 05/09/2017] [Indexed: 12/22/2022] Open
Abstract
In 2014, drug overdose surpassed automobile accidents as the number one cause of accidental death for the first time in the history of the United States. The overdose epidemic is largely driven by opioids, and genuine prescription opioid analgesics play the biggest role in this phenomenon. Despite advancements in abuse deterrent formulations, prescription drug monitoring programmes and clinical assessments for the detection of abuse potential, drug overdoses continue to escalate. The Center for Disease Control has recently issued new guidelines for opioid prescription, yet even these recommendations have their shortcomings. Furthermore, undertreated pain in patients with comorbid substance use disorder poses a major clinical challenge, particularly for patients on opioid replacement therapy. Despite the seemingly obvious interaction between the presence of pain and the abuse of pain-relieving opioids, there is surprisingly little mechanistic data to further our understanding of this vitally important topic. The need for novel pain interventions that minimize abuse liability is critical. Without a fundamental characterization of pain neurobiology and the interaction between chronic pain and the brain's reward system, we are unlikely to make progress in the alleviation of the opioid epidemic. LINKED ARTICLES This article is part of a themed section on Emerging Areas of Opioid Pharmacology. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.14/issuetoc.
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Affiliation(s)
- Adrianne R Wilson‐Poe
- Pain Center, Department of AnesthesiologyWashington University School of MedicineSt. LouisMOUSA
| | - Jose A Morón
- Pain Center, Department of AnesthesiologyWashington University School of MedicineSt. LouisMOUSA
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Abstract
OBJECTIVE Although counseling is a required part of office-based buprenorphine treatment of opioid use disorders, the nature of what constitutes appropriate counseling is unclear and controversial. The authors review the literature on the role, nature, and intensity of behavioral interventions in office-based buprenorphine treatment. METHOD The authors conducted a review of randomized controlled studies testing the efficacy of adding a behavioral intervention to buprenorphine maintenance treatment. RESULTS Four key studies showed no benefit from adding a behavioral intervention to buprenorphine plus medical management, and four studies indicated some benefit for specific behavioral interventions, primarily contingency management. The authors examined the findings from the negative trials in the context of six questions: 1) Is buprenorphine that effective? 2) Is medical management that effective? 3) Are behavioral interventions that ineffective in this population? 4) How has research design affected the results of studies of buprenorphine plus behavioral treatment? 5) What do we know about subgroups of patients who do and those who do not seem to benefit from behavioral interventions? 6) What should clinicians aim for in terms of treatment outcome in buprenorphine maintenance? CONCLUSIONS High-quality medical management may suffice for some patients, but there are few data regarding the types of individuals for whom medical management is sufficient. Physicians should consider a stepped-care model in which patients may begin with relatively nonintensive treatment, with increased intensity for patients who struggle early in treatment. Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment.
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Affiliation(s)
- Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, MIRECC 151D, West Haven, CT 06516, 203-932-5711 x 7403,
| | - Roger D. Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill St. Belmont, MA 02478, 617-855-2242, , Department of Psychiatry, Harvard Medical School, Boston, MA 02215
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Glasner-Edwards S, Patrick K, Ybarra ML, Reback CJ, Rawson RA, Chokron Garneau H, Chavez K, Venegas A. A Cognitive Behavioral Therapy-Based Text Messaging Intervention Versus Medical Management for HIV-Infected Substance Users: Study Protocol for a Pilot Randomized Trial. JMIR Res Protoc 2016; 5:e131. [PMID: 27341852 PMCID: PMC4938885 DOI: 10.2196/resprot.5407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/15/2016] [Accepted: 02/20/2016] [Indexed: 02/02/2023] Open
Abstract
Background Evidence-based psychosocial interventions for addictions and related conditions such as cognitive behavioral therapy (CBT) are underutilized. Obstacles to implementation of CBT in clinical settings include limited availability of quality training, supervision, and certification in CBT for clinicians; high rates of clinician turnover and high caseloads; and limited qualifications of the workforce to facilitate CBT expertise. Objective Mobile phone–based delivery of CBT, if demonstrated to be feasible and effective, could be transformative in broadening its application and improving the quality of addiction treatment. No experimental interventions that deliver CBT targeting both drug use and medication adherence using text messaging have been previously reported; as such, the objective of this study is to develop and test an SMS-based treatment program for HIV-positive adults with comorbid substance use disorders. Methods With user input, we developed a 12-week CBT-based text messaging intervention (TXT-CBT) targeting antiretroviral (ART) adherence, risk behaviors, and drug use in a population of HIV-infected substance users. Results The intervention has been developed and is presently being tested in a pilot randomized clinical trial. Results will be reported later this year. Conclusions This investigation will yield valuable knowledge about the utility of a cost-effective, readily deployable text messaging behavioral intervention for HIV-infected drug users.
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Affiliation(s)
- Suzette Glasner-Edwards
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States.
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El-Khoury J, Abbas Z, Nakhle PE, Matar MT. Implementing opioid substitution in Lebanon: Inception and challenges. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 31:178-83. [DOI: 10.1016/j.drugpo.2016.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/28/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
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Design and methods of a double blind randomized placebo-controlled trial of extended-release naltrexone for HIV-infected, opioid dependent prisoners and jail detainees who are transitioning to the community. Contemp Clin Trials 2014; 39:256-68. [PMID: 25240704 DOI: 10.1016/j.cct.2014.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND People with opioid dependence and HIV are concentrated within criminal justice settings (CJS). Upon release, however, drug relapse is common and contributes to poor HIV treatment outcomes, increased HIV transmission risk, reincarceration and mortality. Extended-release naltrexone (XR-NTX) is an evidence-based treatment for opioid dependence, yet is not routinely available for CJS populations. METHODS A randomized, double-blind, placebo-controlled trial of XR-NTX for HIV-infected inmates transitioning from correctional to community settings is underway to assess its impact on HIV and opioid-relapse outcomes. RESULTS We describe the methods and early acceptability of this trial. In addition we provide protocol details to safely administer XR-NTX near community release and describe logistical implementation issues identified. Study acceptability was modest, with 132 (66%) persons who consented to participate from 199 total referrals. Overall, 79% of the participants had previously received opioid agonist treatment before this incarceration. Thus far, 65 (49%) of those agreeing to participate in the trial have initiated XR-NTX or placebo. Of the 134 referred patients who ultimately did not receive a first injection, the main reasons included a preference for an alternative opioid agonist treatment (37%), being ineligible (32%), not yet released (10%), and lost upon release before receiving their injection (14%). CONCLUSIONS Study findings should provide high internal validity about HIV and opioid treatment outcomes for HIV-infected prisoners transitioning to the community. The large number of patients who ultimately did not receive the study medication may raise external validity concerns due to XR-NTX acceptability and interest in opioid agonist treatments. CLINICAL TRIAL NUMBER NCT01246401.
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Gibson BA, Ghosh D, Morano JP, Altice FL. Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations. Health Place 2014; 28:153-66. [PMID: 24853039 DOI: 10.1016/j.healthplace.2014.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/23/2014] [Accepted: 04/26/2014] [Indexed: 01/08/2023]
Abstract
We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11-20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist.
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Affiliation(s)
- Britton A Gibson
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | - Debarchana Ghosh
- University of Connecticut, Department of Geography, Storrs, CT, USA.
| | - Jamie P Morano
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; University of Malaya, Centre of Excellence on Research in AIDS (CERiA), Kuala Lumpur, Malaysia
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Haddad MS, Zelenev A, Altice FL. Integrating buprenorphine maintenance therapy into federally qualified health centers: real-world substance abuse treatment outcomes. Drug Alcohol Depend 2013; 131:127-35. [PMID: 23332439 PMCID: PMC3674170 DOI: 10.1016/j.drugalcdep.2012.12.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 12/09/2012] [Accepted: 12/10/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have examined real-world effectiveness of integrated buprenorphine maintenance treatment (BMT) programs in federally qualified health centers (FQHCs). METHODS Opioid dependent patients (N=266) inducted on buprenorphine between July 2007 and December 2008 were retrospectively assessed at Connecticut's largest FQHC network. Six-month BMT retention and opioid-free time were collected longitudinally from electronic health records; 136 (51.1%) of patients were followed for at least 12 months. RESULTS Participants had a mean age of 40.1 years, were primarily male (69.2%) and treated by family practitioners (70.3%). Co-morbidity included HCV infection (59.8%), mood disorders (71.8%) and concomitant cocaine use (59%). Retention on BMT was 56.8% at 6 months and 61.6% at 12 months for the subset observed over 1 year. Not being retained on BMT at 12 months was associated with cocaine use (AOR=2.18; 95% CI=1.35-3.50) while prescription of psychiatric medication (AOR=0.36; 95% CI 0.20-0.62) and receiving on-site substance abuse counseling (AOR=0.34; 95% CI 0.19, 0.59) improved retention. Two thirds of the participants experienced at least one BMT gap of 2 or more weeks with a mean gap length of 116.4 days. CONCLUSIONS Integrating BMT in this large FQHC network resulted in retention rates similarly reported in clinical trials and emphasizes the need for providing substance abuse counseling and screening for and treating psychiatric comorbidity.
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Affiliation(s)
| | | | - Frederick L. Altice
- Yale University School of Medicine, New Haven, CT, USA,Yale University School of Public Health, New Haven, CT, USA
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Yang A, Arfken CL, Johanson CE. Steps Physicians Report Taking to Reduce Diversion of Buprenorphine. Am J Addict 2013; 22:184-7. [DOI: 10.1111/j.1521-0391.2012.00335.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/17/2011] [Accepted: 09/06/2011] [Indexed: 11/29/2022] Open
Affiliation(s)
- Amy Yang
- Department of Psychiatry and Behavioral Neurosciences; University of Chicago; Chicago, Illinois
| | - Cynthia L. Arfken
- Department of Psychiatry and Behavioral Neurosciences; Wayne State University; Detroit, Michigan
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Schwarz R, Zelenev A, Bruce RD, Altice FL. Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence. J Subst Abuse Treat 2012; 43:451-7. [PMID: 22534003 PMCID: PMC3419304 DOI: 10.1016/j.jsat.2012.03.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 03/15/2012] [Accepted: 03/19/2012] [Indexed: 11/22/2022]
Abstract
Drug users are marginalized from typical primary care, often resulting in emergency department (ED) usage and hospitalization due to late-stage disease. Though data suggest methadone decreases such fragmented healthcare utilization (HCU), the impact of buprenorphine maintenance treatment (BMT) on HCU is unknown. Chart review was conducted on opioid dependent patients seeking BMT, comparing individuals (n=59) who left BMT≤7days with those retained on BMT (n=150), for ED use and hospitalization. Using negative binomial regressions, including comparison of time before BMT induction, ED utilization and hospitalization were assessed. Overall, ED utilization was 0.93 events per person year and was significantly reduced by BMT, with increasing time (retention) on BMT. BMT had no significant effect on hospitalizations or average length of stay.
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Affiliation(s)
- Ryan Schwarz
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Abstract
The interrelationships of HIV/AIDS and drug use and misuse result in complex problems that have been addressed by a variety of sociolegal approaches that often are in contrast to evidence-based medical practices proven effective in reducing associated harms. Like other countries struggling to reduce the incidence and consequences of addiction and HIV/AIDS, China is working to improve systems of care and to revise policies toward drug use and misuse and HIV/AIDS. Greater interaction with researchers and clinicians from around the world can foster increased awareness of effective practices and help implement effective strategies to deal with the problems of HIV/AIDS, and addiction.
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Affiliation(s)
- Min Zhao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Walter Ling
- UCLA Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Springer SA, Qiu J, Saber-Tehrani AS, Altice FL. Retention on buprenorphine is associated with high levels of maximal viral suppression among HIV-infected opioid dependent released prisoners. PLoS One 2012; 7:e38335. [PMID: 22719814 PMCID: PMC3365007 DOI: 10.1371/journal.pone.0038335] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/07/2012] [Indexed: 01/03/2023] Open
Abstract
Introduction HIV-infected prisoners lose viral suppression within the 12 weeks after release to the community. This prospective study evaluates the use of buprenorphine/naloxone (BPN/NLX) as a method to reduce relapse to opioid use and sustain viral suppression among released HIV-infected prisoners meeting criteria for opioid dependence (OD). Methods From 2005–2010, 94 subjects meeting DSM-IV criteria for OD were recruited from a 24-week prospective trial of directly administered antiretroviral therapy (DAART) for released HIV-infected prisoners; 50 (53%) selected BPN/NLX and were eligible to receive it for 6 months; the remaining 44 (47%) selected no BPN/NLX therapy. Maximum viral suppression (MVS), defined as HIV-1 RNA<50 copies/mL, was compared for the BPN/NLX and non-BPN/NLX (N = 44) groups. Results The two groups were similar, except the BPN/NLX group was significantly more likely to be Hispanic (56.0% v 20.4%), from Hartford (74.4% v 47.7%) and have higher mean global health quality of life indicator scores (54.18 v 51.40). MVS after 24 weeks of being released was statistically correlated with 24-week retention on BPN/NLX [AOR = 5.37 (1.15, 25.1)], having MVS at the time of prison-release [AOR = 10.5 (3.21, 34.1)] and negatively with being Black [AOR = 0.13 (0.03, 0.68)]. Receiving DAART or methadone did not correlate with MVS. Conclusions In recognition that OD is a chronic relapsing disease, strategies that initiate and retain HIV-infected prisoners with OD on BPN/NLX is an important strategy for improving HIV treatment outcomes as a community transition strategy.
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Affiliation(s)
- Sandra A Springer
- Section of Infectious Disease, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, United States of America.
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Saber-Tehrani AS, Springer SA, Qiu J, Herme M, Wickersham J, Altice FL. Rationale, study design and sample characteristics of a randomized controlled trial of directly administered antiretroviral therapy for HIV-infected prisoners transitioning to the community - a potential conduit to improved HIV treatment outcomes. Contemp Clin Trials 2012; 33:436-44. [PMID: 22101218 PMCID: PMC3268833 DOI: 10.1016/j.cct.2011.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/02/2011] [Accepted: 11/05/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND HIV-infected prisoners experience poor HIV treatment outcomes post-release. Directly administered antiretroviral therapy (DAART) is a CDC-designated, evidence-based adherence intervention for drug users, yet untested among released prisoners. METHODS Sentenced HIV-infected prisoners on antiretroviral therapy (ART) and returning to New Haven or Hartford, Connecticut were recruited and randomized 2:1 to a prospective controlled trial (RCT) of 6 months of DAART versus self-administered therapy (SAT); all subjects received case management services. Subjects meeting DSM-IV criteria for opioid dependence were offered immediate medication-assisted treatment. Trained outreach workers provided DAART once-daily, seven days per week, including behavioral skills training during the last intervention month. Both study groups were assessed for 6 months after the intervention period. Assessments occurred within 90 days pre-release (baseline), day of release, and then monthly for 12 months. Viral load (VL) and CD4 testing was conducted baseline and quarterly; genotypic resistance testing was conducted at baseline, 6 and 12 months. The primary outcome was pre-defined as viral suppression (VL<400 copies/mL) at 6 months. RESULTS Between 2004 and 2009, 279 participants were screened, of which 202 met eligibility criteria and 154 were ultimately enrolled in the study; 103 subjects were randomized to DAART and 51 to SAT. Subjects were mostly male (81.2%), people of color (87.0%), had an alcohol use disorder (39.7%), had underlying depression (54.2%), were virally suppressed (78.8%) and had a mean CD4=390.7 cells/mL. CONCLUSIONS Outcomes from this RCT will contribute greatly to HIV treatment outcomes after release from prison, a period associated with adverse HIV and other medical consequences.
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Affiliation(s)
- Ali Shabahang Saber-Tehrani
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, United States
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Hillhouse M, Canamar CP, Doraimani G, Thomas C, Hasson A, Ling W. Participant characteristics and buprenorphine dose. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:453-9. [PMID: 21854290 DOI: 10.3109/00952990.2011.596974] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clinical parameters for determining buprenorphine dose have not been adequately examined in treatment outcome research. OBJECTIVES This study is a secondary analysis of data collected in a recently completed comparison of buprenorphine taper schedules conducted as part of the National Institute on Drug Abuse's Clinical Trials Network to assess whether participant baseline characteristics are associated with buprenorphine dose. METHODS After 3 weeks of flexible dosing, 516 participants were categorized by dose provided in the final dosing week (9.3% received a final week dose of 8 mg buprenorphine, 27.3% received 16 mg, and 63.4% received 24 mg). RESULTS Findings show that final week dose groups differed in baseline demographic and drug use characteristics including education, heroin use, route of drug administration, withdrawal symptoms, and craving. These groups also differed in opioid use during the four dosing weeks, with the lowest use in the 8 mg group and highest use in the 24 mg group (p < .0001). Additional analyses address withdrawal symptoms and craving. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Final week dose groups differed in demographic and drug use characteristics, and the group receiving the largest final week dose had the highest rate of continued opioid use. These findings may contribute to the development of clinical guidelines regarding buprenorphine dose in the treatment of opioid dependence; however, further investigations that include random assignment to dose by baseline characteristics are needed.
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Affiliation(s)
- Maureen Hillhouse
- UCLA Integrated Substance Abuse Programs, Los Angeles, CA 90025, USA.
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22
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Ling W, Mooney L, Zhao M, Nielsen S, Torrington M, Miotto K. Selective review and commentary on emerging pharmacotherapies for opioid addiction. Subst Abuse Rehabil 2011; 2:181-8. [PMID: 24474855 PMCID: PMC3846315 DOI: 10.2147/sar.s22782] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pharmacotherapies for opioid addiction under active development in the US include lofexidine (primarily for managing withdrawal symptoms) and Probuphine®, a distinctive mode of delivering buprenorphine for six months, thus relieving patients, clinicians, and regulatory personnel from most concerns about diversion, misuse, and unintended exposure in children. In addition, two recently approved formulations of previously proven medications are in early phases of implementation. The sublingual film form of buprenorphine + naloxone (Suboxone®) provides a less divertible, more quickly administered, more child-proof version than the buprenorphine + naloxone sublingual tablet. The injectable depot form of naltrexone (Vivitrol®) ensures consistent opioid receptor blockade for one month between administrations, removing concerns about medication compliance. The clinical implications of these developments have attracted increasing attention from clinicians and policymakers in the US and around the world, especially given that human immunodeficiency virus/acquired immunodeficiency syndrome and other infectious diseases are recognized as companions to opioid addiction, commanding more efforts to reduce opioid addiction. While research and practice improvement efforts continue, reluctance to adopt new medications and procedures can be expected, especially considerations in the regulatory process and in the course of implementation. Best practices and improved outcomes will ultimately emerge from continued development efforts that reflect input from many quarters.
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Affiliation(s)
- Walter Ling
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Larissa Mooney
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suzanne Nielsen
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Matthew Torrington
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Karen Miotto
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
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Hillhouse M, Domier CP, Chim D, Ling W. Provision of ancillary medications during buprenorphine detoxification does not improve treatment outcomes. J Addict Dis 2010; 29:23-9. [PMID: 20390696 DOI: 10.1080/10550880903438925] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
For individuals dependent on opioids, recovery efforts begin with a period of withdrawal that typically includes discomfort from symptoms, possibly precipitating a return to drug use. The study described here investigated whether the provision of ancillary medications for opioid withdrawal symptoms affected treatment outcomes in 139 participants receiving buprenorphine in a 13-day detoxification trial. Outcome measures include the number of opioid-free urine samples collected and retention in treatment. Ancillary medications were provided to 70% of participants: 59% received medication for insomnia, 45% for anxiety, 40% for bone pain, 35% for nausea, and 28% for diarrhea. Findings indicate no difference in the number of opioid-free urine samples between the group receiving ancillary medication and the group who did not, although tests of specific ancillary medications indicate that those who received diarrhea medication had fewer opioid-free urines than those who did not (P = .004). Results also indicate that participants attended fewer days of treatment if they received anxiety, nausea, or diarrhea medication compared to no medication (all P values < .05).
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Affiliation(s)
- Maureen Hillhouse
- University of California, Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA 90025, USA.
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Springer SA, Chen S, Altice FL. Improved HIV and substance abuse treatment outcomes for released HIV-infected prisoners: the impact of buprenorphine treatment. J Urban Health 2010; 87:592-602. [PMID: 20177974 PMCID: PMC2900572 DOI: 10.1007/s11524-010-9438-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV-infected prisoners fare poorly after release. Though rarely available, opioid agonist therapy (OAT) may be one way to improve HIV and substance abuse treatment outcomes after release. Of the 69 HIV-infected prisoners enrolled in a randomized controlled trial of directly administered antiretroviral therapy, 48 (70%) met DSM-IV criteria for opioid dependence. Of these, 30 (62.5%) selected OAT, either as methadone (N = 7, 14.5%) or buprenorphine/naloxone (BPN/NLX; N = 23, 48.0%). Twelve-week HIV and substance abuse treatment outcomes are reported as a sub-study for those selecting BPN/NLX. Retention was high: 21 (91%) completed BPN/NLX induction and 17 (74%) remained on BPN/NLX after 12 weeks. Compared with baseline, the proportion with a non-detectable viral load (61% vs 63% log(10) copies/mL) and mean CD4 count (367 vs 344 cells/mL) was unchanged at 12 weeks. Opiate-negative urine testing remained 83% for the 21 who completed induction. Using means from 10-point Likert scales, opioid craving was reduced from 6.0 to 1.8 within 3 days of BPN/NLX induction and satisfaction remained high at 9.5 throughout the 12 weeks. Adverse events were few and mild. BPN/NLX therapy was acceptable, safe and effective for both HIV and opioid treatment outcomes among released HIV-infected prisoners. Future randomized controlled trials are needed to affirm its benefit in this highly vulnerable population.
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25
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Schwarz RK, Bruce RD, Ball SA, Herme M, Altice FL. Comparison of tuberculin skin testing reactivity in opioid-dependent patients seeking treatment with methadone versus buprenorphine: policy implications for tuberculosis screening. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 35:439-44. [PMID: 20014914 DOI: 10.3109/00952990903447741] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Buprenorphine's availability in primary care settings offers increased access to treatment and linkage to primary care for opioid-dependent patients. Currently, tuberculin skin testing (TST) is recommended for patients enrolling in methadone maintenance treatment (MMT), but not for those enrolling in buprenorphine maintenance treatment (BMT). OBJECTIVES To compare TST screening results in enrollees in BMT and MMT programs and assess the correlates of TST positivity among these subjects. METHODS A cross-sectional analysis of a retrospective cohort study was conducted to compare concurrent TST results among contemporaneously matched groups of MMT and BMT patients in the same community. RESULTS TST positivity was approximately 9% in both MMT and BMT settings (p = .27). Increased TST positivity was associated with being Black (AOR = 3.53, CI = 1.28-9.77), Hispanic (AOR = 3.11, CI = 1.12-8.60), and having higher education (AOR = 3.01, CI = 1.20-7.53). CONCLUSIONS These results confirm a similar high prevalence of TST positivity in opioid-dependent patients enrolling in MMT and BMT programs. Racial and ethnic health disparities remain associated with TST positivity, yet a relationship between higher education and tuberculosis requires further investigation. SCIENTIFIC SIGNIFICANCE These data suggest the importance of incorporating TST screening in emerging BMT programs as a mechanism to provide increased detection and treatment of tuberculosis infection in opioid-dependent patient populations.
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Affiliation(s)
- Ryan K Schwarz
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA
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Tiburcio NJ, Twiggs R, Dunlap EE. HURRICANE CHANGES: EXAMINING ENHANCED MOTIVATION TO CHANGE DRUG USING BEHAVIORS AMONG KATRINA EVACUEES. ANUARIO DE INVESTIGACION EN ADICCIONES 2009; 10:79-95. [PMID: 21852981 PMCID: PMC3156670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Substance use disorders are credited with greater amounts of death and illness than all other preventable health problems. Billions of dollars are spent on efforts to control drug supplies and fund various treatment approaches, but relatively little resources have been directed towards investigating how environmental conditions can contribute to or detract from substance user's individual motivation to change behavior. Hurricane Katrina caused untold property damage and upheaval, in addition to the vast numbers of people whose lives it drastically affected. This article examines how surviving this ordeal, subsequent evacuation, and eventual resettlement in New Orleans or re-location to a different city (in this case, Houston) impacted individuals' motivation to change their substance use patterns and behaviors. This article's approach is grounded in the values of the social work profession and examines: 1) the role of life events in motivating change of substance using behaviors in the absence of formal treatment interventions; and 2) participant resilience in overcoming the adversities inherent to this disaster.
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Affiliation(s)
- Nelson Jose Tiburcio
- Institute for Special Populations Research. National Development and Research Institutes, Inc., New York, New York
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Norton WE, Amico KR, Fisher WA, Copenhaver MM, Kozal MJ, Cornman DH, Friedland G, Fisher JD. Attitudes toward needle-sharing and HIV transmission risk behavior among HIV+ injection drug users in clinical care. AIDS Care 2008; 20:462-9. [PMID: 18449824 DOI: 10.1080/09540120701867081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Risky behavior related to injection drug use accounts for a considerable proportion of incident HIV infection in the United States. Large numbers of injection drug users (IDUs) currently receive antiretroviral therapy in clinical settings and are accessible for risk-reduction interventions to reduce transmission of drug-resistant HIV and spread of HIV to uninfected others. The current study examined attitudes toward needle- or equipment-sharing among 123 HIV-positive IDUs in clinical care in an effort to understand the dynamics of such behavior and to create a basis for clinic-based risk-reduction interventions. Results indicate that at baseline, participants who reported extremely negative attitudes toward needle-sharing were less likely to have shared during the past month than those with less-extreme negative attitudes. Demographic, behavioral, and attitudinal variables were entered into a logistic regression model to examine needle-sharing group membership among HIV-positive IDUs. Being female and having less-extreme negative attitudes toward sharing were independent and significant correlates of sharing behavior. Interventions targeting needle-sharing attitudes deployed within the clinical care setting may be well-positioned to reduce HIV transmission among HIV-positive IDUs.
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Affiliation(s)
- Wynne E Norton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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