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Milano N, Lister JJ, Victor G. Differences in intent to refer buprenorphine among community correctional and treatment staff: A set of cross-lagged models predicting efficacy beliefs and familiarity with buprenorphine for opioid use disorder. Am J Addict 2023; 32:352-359. [PMID: 36751913 DOI: 10.1111/ajad.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/19/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite high rates of individuals with opioid use disorder, community correctional agencies underutilize medications for opioid use disorder (MOUD). Knowledge about the mechanisms which motivate correctional employees to refer buprenorphine remains underdeveloped, and differences in these patterns by employee status are unknown. This study has two objectives: (1) investigate the presence of a reciprocal relationship between familiarity with buprenorphine and efficacy beliefs among community corrections and community treatment staff and (2) identify whether this relationship differs by staff status in referral intentions. METHODS Data were used from the Criminal Justice Drug Abuse Treatment Studies 2 (CJ-DATS 2) among correctional and treatment employees (N = 873). Four models investigated whether a reciprocal relationship existed between buprenorphine familiarity and efficacy beliefs. Then, the best fitting model was used to test the influence that prior training had on future referral intention through familiarity and efficacy beliefs among the analytic sample (n = 612), by comparing two separate structural equation models (SEMs) among correctional staff and treatment staff, respectively. RESULTS The fully cross-lagged model provided a significantly better fit to the data than other models (χ diff 2 ${\chi }_{\mathrm{diff}}^{2}$ (1) = 7.189, p < .01). The results of the multigroup SEM show that training had positive, indirect effects on future referral intentions that significantly differed between treatment and community correction staff. DISCUSSION AND CONCLUSIONS Findings show that training may influence correctional staff intent to refer individuals to receive buprenorphine through familiarity. SCIENTIFIC SIGNIFICANCE Tailored training for MOUD treatment for specific staff populations may prove more beneficial than existing approaches.
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Affiliation(s)
- Nicole Milano
- School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Jamey J Lister
- School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Grant Victor
- School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
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Ellefsen R, Wüsthoff LEC, Arnevik EA. Patients' satisfaction with heroin-assisted treatment: a qualitative study. Harm Reduct J 2023; 20:73. [PMID: 37312181 DOI: 10.1186/s12954-023-00808-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Heroin-assisted treatment (HAT) involves supervised dispensing of medical heroin (diacetylmorphine) for people with opioid use disorder. Clinical evidence has demonstrated the effectiveness of HAT, but little is known about the self-reported satisfaction among the patients who receive this treatment. This study presents the first empirical findings about the patients' experiences of, and satisfaction with, HAT in the Norwegian context. METHODS Qualitative in-depth interviews with 26 patients in HAT were carried out one to two months after their enrollment. Analysis sought to identify the main benefits and challenges that the research participants experienced with this treatment. An inductive thematic analysis was conducted to identify the main areas of benefits and challenges. The benefits were weighed against the challenges in order to assess the participants' overall level of treatment satisfaction. RESULTS Analysis identified three different areas of experienced benefits and three areas of challenges of being in this treatment. It outlines how the participants' everyday lives are impacted by being in the treatment and how this, respectively, results from the treatment's medical, relational, or configurational dimensions. We found an overall high level of treatment satisfaction among the participants. The identification of experienced challenges reveals factors that reduce satisfaction and thus may hinder treatment retention and positive treatment outcomes. CONCLUSIONS The study demonstrates a novel approach to qualitatively investigate patients' treatment satisfaction across different treatment dimensions. The findings have implications for clinical practice by pointing out key factors that inhibit and facilitate patients' satisfaction with HAT. The identified importance of the socio-environmental factors and relational aspect of the treatment has further implications for the provision of opioid agonist treatment in general.
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Affiliation(s)
- Rune Ellefsen
- Section for Clinical Addiction Research, Oslo University Hospital, PO Box 4959 Nydalen, 0424, Oslo, Norway.
| | - Linda Elise Couëssurel Wüsthoff
- Section for Clinical Addiction Research, Oslo University Hospital, PO Box 4959 Nydalen, 0424, Oslo, Norway
- The Norwegian Centre for Addiction Research, University of Oslo, PO Box 1039 Blindern, 0315, Oslo, Norway
| | - Espen Ajo Arnevik
- Section for Clinical Addiction Research, Oslo University Hospital, PO Box 4959 Nydalen, 0424, Oslo, Norway
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Weiss M, Geißelsöder K, Breuer M, Dechant M, Endres J, Stemmler M, Wodarz N. [Treatment of Opioid-dependent Inmates - Attitudes and Treatment Practice of medical Staff in Bavarian Prisons]. DAS GESUNDHEITSWESEN 2022; 84:1107-1112. [PMID: 33782924 DOI: 10.1055/a-1399-9286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The present study examines the treatment practice and attitudes of medical staff towards opioid-dependent inmates in Bavarian prisons. METHOD We interviewed medical staff (n=20) from 18 Bavarian prisons about substitution practice and attitudes by semi-structured interviews. RESULTS With regard to the treatment routines and the attitudes of the medical staff, we found mixed results. From the perspective of the medical staff, the treatment decision depends on the patients' wishes, the severity and duration of the dependence, the length of sentence and organizational factors. Problems were discussed in particular with regard to the care situation inside and outside the prisons and difficulties in transition management. CONCLUSIONS Substitution therapy is considered a standard treatment method in prisons today. However, our respondents highlighted some disadvantages (e. g. passing on the substitution drug). Although the treatment goal of complete abstinence was generally viewed positively by a part of the medical staff, it was not considered very realistic. From the point of view of the respondents, special attention should be paid to the continuity of the chosen treatment strategy in the context of discharge management.
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Affiliation(s)
- Maren Weiss
- Lehrstuhl für Psychologische Diagnostik, Methodenlehre und Rechtspsychologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Kerstin Geißelsöder
- Lehrstuhl für Psychologische Diagnostik, Methodenlehre und Rechtspsychologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Maike Breuer
- Kriminologischer Dienst, Bayerischer Justizvollzug, Erlangen, Deutschland
| | - Michael Dechant
- Lehrstuhl für Psychologische Diagnostik, Methodenlehre und Rechtspsychologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Johann Endres
- Kriminologischer Dienst, Bayerischer Justizvollzug, Erlangen, Deutschland
| | - Mark Stemmler
- Lehrstuhl für Psychologische Diagnostik, Methodenlehre und Rechtspsychologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Norbert Wodarz
- Zentrum für Suchtmedizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg, Regensburg, Deutschland
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Brown PCM, Button DA, Bethune D, Kelly E, Tierney HR, Nerurkar RM, Nicolaidis C, Harrison RA, Levander XA. Assessing Student Readiness to Work with People Who Use Drugs: Development of a Multi-disciplinary Addiction Educational Survey. J Gen Intern Med 2022; 37:3900-3906. [PMID: 35419741 PMCID: PMC9640533 DOI: 10.1007/s11606-022-07494-5] [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: 09/14/2021] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND As health profession schools implement addiction curricula, they need survey instruments to evaluate the impact of the educational interventions. However, existing measures do not use current non-stigmatizing language and fail to capture core concepts. OBJECTIVE To develop a brief measure of health profession student readiness to work with people who use drugs (PWUDs) and establish its content validity. METHODS We conducted a literature review of existing instruments and desired clinical competencies related to providing care to PWUD and used results and expert feedback to create and revise a pool of 72 items. We conducted cognitive interviews with ten pre-clinical health profession students from various US schools of nursing, pharmacy, and medicine to ensure the items were easy to understand. Finally, we used a modified Delphi process with twenty-four health professions educators and addiction experts (eight each from nursing, pharmacy, and medicine) to select items for inclusion in the final scale. We analyzed expert ratings of individual items and interdisciplinary agreement on ratings to decide how to prioritize items. We ultimately selected 12 attitudes and 12 confidence items to include in the REadiness to Discuss Use, Common Effects, and HArm Reduction Measure (REDUCE-HARM). Experts rated their overall assessment of the final scale. RESULTS Twenty-two of twenty-four experts agreed or strongly agreed that the attitudes scale measures student attitudes that impact readiness to work with PWUDs. Twenty-three of twenty-four experts agreed or strongly agreed that the confidence scale measures student self-efficacy in competencies that impact readiness to work with PWUDs. Seven of 72 initial items and none of the 24 selected items had statistically significant differences between disciplines. CONCLUSIONS The REDUCE-HARM instrument has strong content validity and may serve as a useful tool in evaluating addiction education. Additional research is needed to establish its reliability, construct validity, and responsiveness to change.
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Affiliation(s)
- Patrick C M Brown
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Dana A Button
- School of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Danika Bethune
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Emily Kelly
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Hannah R Tierney
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, OR, USA
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Rebecca A Harrison
- Division of Hospital Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ximena A Levander
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, School of Medicine, Oregon Health & Science University, Portland, OR, USA
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Moore KE, Siebert SL, Kromash R, Owens MD, Allen DC. Negative attitudes about medications for opioid use disorder among criminal legal staff. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100056. [PMID: 36845981 PMCID: PMC9948914 DOI: 10.1016/j.dadr.2022.100056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Stigma is a barrier to the treatment of opioid use disorder (OUD) in the criminal legal system. Staff sometimes have negative attitudes about medications for OUD (i.e., MOUD), but there is little research on what drives these attitudes. How staff think about criminal involvement and addiction may explain their attitudes toward MOUD. METHODS A convenience sample of U.S. criminal legal staff (e.g., correctional/probation officers, nurses, psychologists, court personnel) were recruited via online methods (N = 152). Participants completed an online survey of their attitudes about justice-involved people and addiction, and these were entered as predictors of an adapted version of the Opinions about Medication Assisted Treatment survey (OAMAT) in a linear regression, controlling for sociodemographics (cross-sectional design). RESULTS At the bivariate level, measures capturing more stigmatizing attitudes toward justice-involved people, believing addiction represents a moral weakness, and believing people with addiction are responsible for their actions and their recovery were related to more negative attitudes about MOUD, whereas higher educational attainment and believing addiction has a genetic basis were related to more positive attitudes about MOUD. In a linear regression, only stigma toward justice-involved people significantly predicted negative attitudes about MOUD (B = -.27, p = .010). CONCLUSION Criminal legal staff's stigmatizing attitudes about justice-involved people, such as believing they are untrustworthy and cannot be rehabilitated, contributed significantly to negative attitudes about MOUD, above their beliefs about addiction. The stigma tied to criminal involvement needs to be addressed in attempts to increase MOUD adoption in the criminal legal system.
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Affiliation(s)
- Kelly E Moore
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Shania L Siebert
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Rachelle Kromash
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
| | - Mandy D Owens
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, USA
| | - Diamond C Allen
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall P.O. Box 70649, Johnson City, TN 37614, USA
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Cioe K, Biondi BE, Easly R, Simard A, Zheng X, Springer SA. A systematic review of patients' and providers' perspectives of medications for treatment of opioid use disorder. J Subst Abuse Treat 2020; 119:108146. [PMID: 33138929 PMCID: PMC7609980 DOI: 10.1016/j.jsat.2020.108146] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/02/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The opioid epidemic is a public health crisis. Medications for opioid use disorder (MOUD) include: 1) buprenorphine, 2) methadone, and 3) extended-release naltrexone (XR-NTX). Research should investigate patients' and providers' perspectives of MOUD since they can influence prescription, retention, and recovery. METHODS This systematic review focused on patients' and providers' perceptions of MOUD. The review eligibility criteria included inclusion of the outcome of interest, in English, and involving persons ≥18 years. A PubMed database search yielded 1692 results; we included 152 articles in the final review. RESULTS There were 63 articles about buprenorphine, 115 articles about methadone, and 16 about naltrexone. Misinformation and stigma associated with MOUD were common patient themes. Providers reported lack of training and resources as barriers to MOUD. CONCLUSION This review suggests that patients have significant misinformation regarding MOUD. Due to the severity of the opioid epidemic, research must consider the effects of patients' and providers' perspectives on treatment for OUD, including the effects on the type of MOUD prescribed, patient retention and adherence, and ultimately the number of patients treated for OUD, which will aid in curbing the opioid epidemic.
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Affiliation(s)
- Katharine Cioe
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Breanne E Biondi
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, United States of America
| | - Rebecca Easly
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Amanda Simard
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Xiao Zheng
- Yale University, New Haven, CT 06520, United States of America
| | - Sandra A Springer
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, United States of America; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, United States of America.
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Khalaf D, Hayek M, Bakhos JJ, Abou-Mrad F. Comparative study between prison- and community-based treatment satisfaction for opioid use disorder in Lebanon. Int J Prison Health 2019; 15:138-152. [PMID: 31172852 DOI: 10.1108/ijph-12-2017-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Opioid substitution treatment (OST), such as Buprenorphine, has become a well-established evidence-based approach for the treatment of inmates with opioid use disorder (OUD) in most of the developed world. However, its application in Lebanon remains mainly as a community-based intervention. The purpose of this paper is to highlight the need of its implementation within the Lebanese correctional system. DESIGN/METHODOLOGY/APPROACH The work is a pilot cross-sectional study that compares two groups: 30 male adult prisoners with OUD convictions receiving symptomatic treatment and 30 male adult community patients with OUD receiving Buprenorphine. The objective was to measure the difference in the patients' general perception and satisfaction of the treatments available. OUD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria and the level of satisfaction was measured by "Treatment Perceptions Questionnaire (TPQ)." FINDINGS The prison group reported significantly lower satisfaction when compared to the community group (total TPQ mean scores: M=34.73, SD =4.12 and M=16.67, SD =4.78, respectively, with t (56.76) =15.68, p=0.000). Furthermore, age, marital status, education level and elapsed time in treatment had no significant interactions with the total TPQ score. ORIGINALITY/VALUE The major principles of the ethics of care and evidence-based safe practices will be proposed for the introduction of Buprenorphine to Lebanese prisons. This work provides an opportunity for the expansion of the Lebanese OST program and consequently other countries in the region could benefit from this experience.
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Affiliation(s)
- Dany Khalaf
- Department of Neurosciences, Saint-Charles University Hospital , Baabda, Lebanon.,Division of Medical Ethics, Faculty of Medical Sciences, Lebanese University (LU) , Hadath, Lebanon
| | - Maryse Hayek
- Department of Neurosciences, Saint-Charles University Hospital , Baabda, Lebanon.,Division of Medical Ethics, Faculty of Medical Sciences, Lebanese University (LU) , Hadath, Lebanon
| | - Jules-Joel Bakhos
- Division of Medical Ethics, Faculty of Medical Sciences, Lebanese University (LU) , Hadath, Lebanon.,Department of Medical Students, Faculty of Medicine, Saint-Joseph University (USJ) , Beirut, Lebanon
| | - Fadi Abou-Mrad
- Department of Neurosciences, Saint-Charles University Hospital , Baabda, Lebanon.,Division of Medical Ethics, Faculty of Medical Sciences, Lebanese University (LU) , Hadath, Lebanon
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Larjow E, Papavasiliou E, Payne S, Scholten W, Radbruch L. A Systematic Content Analysis of Policy Barriers Impeding Access to Opioid Medication in Central and Eastern Europe: Results of ATOME. J Pain Symptom Manage 2016; 51:99-107. [PMID: 26386186 DOI: 10.1016/j.jpainsymman.2015.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/08/2015] [Accepted: 08/20/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT Reliable access to opioid medication is critical to delivering effective pain management, adequate treatment of opioid dependence, and quality palliative care. However, more than 80% of the world population is estimated to be inadequately treated for pain because of difficulties in accessing opioids. Although barriers to opioid access are primarily associated with restrictive laws, regulations, and licensing requirements, a key problem that significantly limits opioid access relates to policy constraints. OBJECTIVES To identify and explore policy barriers to opioid access in 12 Eastern and Central European countries involved in the Access to Opioid Medication in Europe project, funded by the European Community's Seventh Framework (FP7/2007-2013, no. 222994) Programme. METHODS A systematic content analysis of texts retrieved from documents (e.g., protocols of national problem analyses, strategic planning worksheets, and executive summaries) compiled, reviewed, approved, and submitted by either the Access to Opioid Medication in Europe consortium or the national country teams (comprising experts in pain management, harm reduction, and palliative care) between September 2011 and April 2014 was performed. RESULTS Twenty-five policy barriers were identified (e.g., economic crisis, bureaucratic issues, lack of training initiatives, stigma, and discrimination), classified under four predetermined categories (financial/economic aspects and governmental support, formularies, education and training, and societal attitudes). Key barriers related to issues of funding allocation, affordability, knowledge, and fears associated with opioids. CONCLUSION Reducing barriers and improving access to opioids require policy reform at the governmental level with a set of action plans being formulated and concurrently implemented and aimed at different levels of social, education, and economic policy change.
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Affiliation(s)
- Eugenia Larjow
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Evangelia Papavasiliou
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
| | | | - Lukas Radbruch
- Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
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Within-prison drug injection among HIV-infected male prisoners in Indonesia: a highly constrained choice. Drug Alcohol Depend 2015; 149:71-9. [PMID: 25659895 PMCID: PMC5108518 DOI: 10.1016/j.drugalcdep.2015.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/16/2015] [Accepted: 01/17/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND In Indonesia, incarceration of people who inject drugs (PWID) and access to drugs in prison potentiate within-prison drug injection (WP-DI), a preventable and extremely high-risk behavior that may contribute substantially to HIV transmission in prison and communities to which prisoners are released. AIMS This mixed method study examined the prevalence, correlates, and social context of WP-DI among HIV-infected male prisoners in Indonesia. METHODS 102 randomly selected HIV-infected male prisoners completed semi-structured voice-recorded interviews about drug use changes after arrest, drug use cues within prison, and impact of WP-DI on HIV and addiction treatment. Logistic regression identified multivariate correlates of WP-DI and thematic analysis of interview transcripts used grounded-theory. RESULTS Over half (56%) of participants reported previous WP-DI. Of those, 93% shared injection equipment in prison, and 78.6% estimated sharing needles with ≥ 10 other prisoners. Multivariate analyses independently correlated WP-DI with being incarcerated for drug offenses (AOR = 3.29, 95%CI = 1.30-8.31, p = 0.011) and daily drug injection before arrest (AOR = 5.23, 95%CI = 1.42-19.25, p = 0.013). Drug availability and proximity to drug users while incarcerated were associated with frequent drug craving and escalating drug use risk behaviors after arrest. Energetic heroin marketing and stigmatizing attitudes toward methadone contribute to WP-DI and impede addiction and HIV treatment. CONCLUSIONS Frequent WP-DI and needle sharing among these HIV-infected Indonesian prison inmates indicate the need for structural interventions that reduce overcrowding, drug supply, and needle sharing, and improve detection and treatment of substance use disorders upon incarceration to minimize WP-DI and associated harm.
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Clark CB, Hendricks PS, Lane PS, Trent L, Cropsey KL. Methadone maintenance treatment may improve completion rates and delay opioid relapse for opioid dependent individuals under community corrections supervision. Addict Behav 2014; 39:1736-40. [PMID: 25117851 DOI: 10.1016/j.addbeh.2014.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/06/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
AIMS Several studies have demonstrated the importance of agonist therapies such as methadone and buprenorphine for preventing relapse for individuals being released from jail or prison to the community. No studies have examined the impact of methadone for increasing the completion of community supervision requirements and preventing opioid relapse for individuals under community corrections supervision. This observational study compared the community corrections completion rate and opioid relapse rate of individuals receiving methadone maintenance therapy (MMT) to individuals who did not. METHODS Of the 2931 individuals enrolled under criminal justice supervision in the community, Treatment Accountability for Safer Communities (TASC), and who met criteria for opioid dependence, 329 (11%) individuals reported receiving MMT in the community. RESULTS The majority of participants were White (79.8%) and male (63.5%), with a mean age of 31.33years (SD=9.18), and were under supervision for 10.4months (SD=9.1). MMT participants were less likely to fail out of supervision compared to individuals not in MMT (39.0% vs. 52.9%, p<0.001), and had a lower rate of relapse (32.9%) and longer time to relapse (average days=89.7, SD=158.9) compared to the relapse rate (55.9%) and time to relapse (average days=60.5, SD=117.9) of those not on MMT. CONCLUSIONS While the observational nature of this study prevents causal inferences, these results suggest that utilization of MMT in community corrections may increase the likelihood of completing supervision requirements and delay time to opioid relapse. Providing agonist therapies to opioid dependent individuals under supervision appears to be a critical strategy in this important population.
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Friedmann PD, Wilson D, Knudsen HK, Ducharme LJ, Welsh WN, Frisman L, Knight K, Lin HJ, James A, Albizu-Garcia CE, Pankow J, Hall EA, Urbine TF, Abdel-Salam S, Duvall JL, Vocci FJ. Effect of an organizational linkage intervention on staff perceptions of medication-assisted treatment and referral intentions in community corrections. J Subst Abuse Treat 2014; 50:50-8. [PMID: 25456091 DOI: 10.1016/j.jsat.2014.10.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/23/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Medication-assisted treatment (MAT) is effective for alcohol and opioid use disorders but it is stigmatized and underutilized in criminal justice settings. METHODS This study cluster-randomized 20 community corrections sites to determine whether an experimental implementation strategy of training and an organizational linkage intervention improved staff perceptions of MAT and referral intentions more than training alone. The 3-hour training was designed to address deficits in knowledge, perceptions and referral information, and the organizational linkage intervention brought together community corrections and addiction treatment agencies in an interagency strategic planning and implementation process over 12 months. RESULTS Although training alone was associated with increases in familiarity with pharmacotherapy and knowledge of where to refer clients, the experimental intervention produced significantly greater improvements in functional attitudes (e.g. that MAT is helpful to clients) and referral intentions. Corrections staff demonstrated greater improvements in functional perceptions and intent to refer opioid dependent clients for MAT than did treatment staff. CONCLUSION Knowledge, perceptions and information training plus interorganizational strategic planning intervention is an effective means to change attitudes and intent to refer clients for medication assisted treatment in community corrections settings, especially among corrections staff.
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Affiliation(s)
- Peter D Friedmann
- Providence Veteran Affairs Medical Center and Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA.
| | | | | | | | | | | | | | | | - Amy James
- University of Connecticut, Storrs, CT, USA
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12
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Friedmann PD, Ducharme LJ, Welsh W, Frisman L, Knight K, Kinlock T, Mitchell SG, Hall E, Urbine T, Gordon M, Abdel-Salam S, O’Connell D, Albizu-Garcia C, Knudsen H, Duval J, Fenster J, Pankow J. A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol. HEALTH & JUSTICE 2013; 1:6. [PMID: 25309847 PMCID: PMC4193542 DOI: 10.1186/2194-7899-1-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/09/2013] [Indexed: 05/30/2023]
Abstract
BACKGROUND Substance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services. METHODS/DESIGN Each of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels. DISCUSSION Through closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits.
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Affiliation(s)
- Peter D Friedmann
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Lori J Ducharme
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Wayne Welsh
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Linda Frisman
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Kevin Knight
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Timothy Kinlock
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | | | - Elizabeth Hall
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Terry Urbine
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Michael Gordon
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Sami Abdel-Salam
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Dan O’Connell
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | | | - Hannah Knudsen
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Jamieson Duval
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Juliane Fenster
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
| | - Jennifer Pankow
- 593 Eddy Street - Plain St Building Rm. 123, Providence, RI 02903 USA
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Physicians' attitudes towards office-based delivery of methadone maintenance therapy: results from a cross-sectional survey of Nova Scotia primary-care physicians. Harm Reduct J 2012; 9:20. [PMID: 22694814 PMCID: PMC3444893 DOI: 10.1186/1477-7517-9-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 05/27/2012] [Indexed: 11/29/2022] Open
Abstract
Background Approximately 90,000 Canadians use opioids each year, many of whom experience health and social problems that affect the individual user, families, communities and the health care system. For those who wish to reduce or stop their opioid use, methadone maintenance therapy (MMT) is effective and supporting evidence is well-documented. However, access and availability to MMT is often inconsistent, with greater inequity outside of urban settings. Involving community based primary-care physicians in the delivery of MMT could serve to expand capacity and accessibility of MMT programs. Little is known, however, about the extent to which MMT, particularly office-based delivery, is acceptable to physicians. The aim of this study is to survey physicians about their attitudes towards MMT, particularly office-based delivery, and the perceived barriers and facilitators to MMT delivery. Methods In May 2008, facilitated by the College of Physicians and Surgeons of Nova Scotia, a cross-sectional, e-mail survey of 950 primary-care physicians practicing in Nova Scotia, Canada was administered via the OPINIO on-line survey software, to assess the acceptability of office-based MMT. Logistic regressions, adjusted for physician sociodemographic characteristics, were used to examine the association between physicians’ willingness to participate in office-based MMT, and a series of measures capturing physician attitudes and knowledge about treatment approaches, opioid use, and methadone, as well as perceived barriers to MMT. Results Overall, 19.8% of primary-care physicians responded to the survey, with 56% who indicated that they would be willing to be involved in MMT under current or similar circumstances; however, willingness was associated with numerous attitudinal and systemic factors. The barriers to involvement in MMT that were frequently cited included a lack of training or experience in MMT, lack of support services, and potential challenges of working with an MMT patient population. Conclusions Study findings provide valuable information to help facilitate greater involvement of primary-care physicians in MMT, while highlighting concerns around administration, support, and training. Even limited uptake by primary-care physicians would greatly enhance MMT access in Nova Scotia, particularly for methadone clients located in rural communities. These findings are applicable broadly, to any jurisdictions where office-based MMT is not currently available.
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Go F, Dykeman M, Santos J, Muxlow J. Supporting clients on methadone maintenance treatment: a systematic review of nurse's role. J Psychiatr Ment Health Nurs 2011; 18:17-27. [PMID: 21214680 DOI: 10.1111/j.1365-2850.2010.01628.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper discusses findings from a systematic review of literature pertaining to methadone maintenance in relation to the role of the nurse working in a general practice setting. Five electronic databases were searched for period of 2000-2008: Medline, CINAHL, Embase, PsycINFO and Cochrane Database of Systematic Reviews. Included studies were peer-reviewed literature articles that: (1) were dated no earlier than the year 2000; (2) represented a primary study (qualitative and quantitative), systematic review or meta-analysis; (3) focused on methadone maintenance for treatment of opiate dependence, not for pain; and (4) were published in English. In this review, three broad themes emerged as being significant to the role of the nurse in relation to methadone maintenance treatment (MMT) programming. These themes included: (1) identifying the client's personal characteristics; (2) having knowledge about methadone; and (3) supporting clients in MMT programmes. In conclusion, it is important to address the needs of health professionals working with clients on MMT, in order for them to provide the necessary care for this patient population. In particular, nurses need to gain knowledge about MMT to assist them in carrying out their nursing role competently when caring for this vulnerable population.
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Affiliation(s)
- Frederick Go
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, and Clinical Nurse Specialist, First Nations and Inuit Health, Atlantic Region, Halifax, NS, Canada.
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Stöver H, Michels II. Drug use and opioid substitution treatment for prisoners. Harm Reduct J 2010; 7:17. [PMID: 20642849 PMCID: PMC2918585 DOI: 10.1186/1477-7517-7-17] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 07/19/2010] [Indexed: 11/10/2022] Open
Abstract
Drug use is prevalent throughout prison populations, and, despite advances in drug treatment programmes for inmates, access to and the quality of these programmes remain substantially poorer than those available for non-incarcerated drug users. Because prisoners may be at greater risk for some of the harms associated with drug use, they deserve therapeutic modalities and attitudes that are at least equal to those available for drug users outside prison. This article discusses drug use by inmates and its associated harms. In addition, this article provides a survey of studies conducted in prisons of opioid substitution therapy (OST), a clinically effective and cost-effective drug treatment strategy. The findings from this overview indicate why treatment efforts for drug users in prison are often poorer than those available for drug users in the non-prison community and demonstrate how the implementation of OST programmes benefits not only prisoners but also prison staff and the community at large. Finally, the article outlines strategies that have been found effective for implementing OST in prisons and offers suggestions for applying these strategies more broadly.
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Affiliation(s)
- Heino Stöver
- Institute of Addiction Research, University of Applied Sciences, Nibelungenplatz 1, D-60318 Frankfurt am Main, Germany.
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Gjersing L, Caplehorn JRM, Clausen T. Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol 2010; 10:13. [PMID: 20144247 PMCID: PMC2831007 DOI: 10.1186/1471-2288-10-13] [Citation(s) in RCA: 387] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 02/10/2010] [Indexed: 11/30/2022] Open
Abstract
Background Research questionnaires are not always translated appropriately before they are used in new temporal, cultural or linguistic settings. The results based on such instruments may therefore not accurately reflect what they are supposed to measure. This paper aims to illustrate the process and required steps involved in the cross-cultural adaptation of a research instrument using the adaptation process of an attitudinal instrument as an example. Methods A questionnaire was needed for the implementation of a study in Norway 2007. There was no appropriate instruments available in Norwegian, thus an Australian-English instrument was cross-culturally adapted. Results The adaptation process included investigation of conceptual and item equivalence. Two forward and two back-translations were synthesized and compared by an expert committee. Thereafter the instrument was pretested and adjusted accordingly. The final questionnaire was administered to opioid maintenance treatment staff (n=140) and harm reduction staff (n=180). The overall response rate was 84%. The original instrument failed confirmatory analysis. Instead a new two-factor scale was identified and found valid in the new setting. Conclusions The failure of the original scale highlights the importance of adapting instruments to current research settings. It also emphasizes the importance of ensuring that concepts within an instrument are equal between the original and target language, time and context. If the described stages in the cross-cultural adaptation process had been omitted, the findings would have been misleading, even if presented with apparent precision. Thus, it is important to consider possible barriers when making a direct comparison between different nations, cultures and times.
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Affiliation(s)
- Linn Gjersing
- SERAF- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
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Larney S. Does opioid substitution treatment in prisons reduce injecting-related HIV risk behaviours? A systematic review. Addiction 2010; 105:216-23. [PMID: 20078480 DOI: 10.1111/j.1360-0443.2009.02826.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To review systematically the evidence on opioid substitution treatment (OST) in prisons in reducing injecting-related human immunodeficiency virus (HIV) risk behaviours. METHODS Systematic review in accordance with guidelines of the Cochrane Collaboration. Electronic databases were searched to identify studies of prison-based opioid substitution treatment programmes that included assessment of effects of prison OST on injecting drug use, sharing of needles and syringes and HIV incidence. Published data were used to calculate risk ratios for outcomes of interest. Risk ratios were not pooled due to the low number of studies and differences in study designs. RESULTS Five studies were included in the review. Poor follow-up rates were reported in two studies, and representativeness of the sample was uncertain in the remaining three studies. Compared to inmates in control conditions, for treated inmates the risk of injecting drug use was reduced by 55-75% and risk of needle and syringe sharing was reduced by 47-73%. No study reported a direct effect of prison OST on HIV incidence. CONCLUSIONS There may be a role for OST in preventing HIV transmission in prisons, but methodologically rigorous research addressing this question specifically is required. OST should be implemented in prisons as part of comprehensive HIV prevention programmes that also provide condoms and sterile injecting and tattooing equipment.
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Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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Kolind T, Frank VA, Dahl H. Drug treatment or alleviating the negative consequences of imprisonment? A critical view of prison-based drug treatment in Denmark. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:43-8. [DOI: 10.1016/j.drugpo.2009.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 03/19/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
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