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Hall NY, Le L, Majmudar I, Mihalopoulos C. Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective. Drug Alcohol Depend 2021; 221:108651. [PMID: 33667783 DOI: 10.1016/j.drugalcdep.2021.108651] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To update the existing evidence to identify specific barriers to initiation of opioid substitution therapy (OST) for those with opioid use disorder (OUD). METHODS The review follows Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA) guidelines. Six databases were initially searched in November 2019, with the search updated on 11 November 2020, for qualitative or quantitative studies reporting the barriers to initiating OST from the client with OUD perspective. Thematic analysis of the barriers to OST was undertaken to determine barrier themes and subthemes. RESULTS There were 37 studies included in the review; 18 were qualitative, 15 were quantitative and four were mixed methods. The barrier themes identified were stigma and fear, regulatory, logistical, attitudinal and social factors. Within these barrier themes 19 barrier subthemes were identified. The most reported OST barrier subthemes were negative treatment perceptions, cost, stigma and lack of flexibility. CONCLUSION This review discusses important barriers to OST and examines reported barriers from the client perspective. OST guidelines and programs would benefit by introducing programs that reduce stigma, increase treatment knowledge and health literacy, reduce treatment costs, increase treatment flexibility and allow for easier treatment access.
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Affiliation(s)
- Natasha Yvonne Hall
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Long Le
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Ishani Majmudar
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Abstract
Aims and methodA cross-sectional survey was conducted to assess patient knowledge and information provision about opioid substitution treatment among individuals with opiate dependence receiving treatment at four treatment centres in South London.ResultsIn total 118 people were recruited to the study. Participants answered a mean of 14 out of 34 questions assessing a range of factors such as medication, blood-borne viruses and overdose correctly. Participants overestimated their performance on average by almost 40%. Individuals with a history of previous treatments scored significantly higher than those in their first treatment episode. The majority reported having been given written information on most of the topics assessed.Clinical implicationsThe results of this study highlight the need to improve education about opioid dependence and its treatment. Poorly informed patients are unlikely to make optimal treatment choices. Improving patients' knowledge and understanding about treatment may lead to better engagement, retention, treatment adherence and, ultimately, better health outcomes.
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Larance B, Mattick R, Ali R, Lintzeris N, Jenkinson R, White N, Kihas I, Cassidy R, Degenhardt L. Diversion and injection of buprenorphine-naloxone film two years post-introduction in Australia. Drug Alcohol Rev 2015; 35:83-91. [PMID: 26450513 DOI: 10.1111/dar.12344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 08/27/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS We report 2 years of post-marketing surveillance of the diversion and injection of buprenorphine-naloxone (BNX) film following its introduction in 2011. DESIGN AND METHODS Interviews were conducted with people who inject drugs regularly (PWID) (2004-2013), opioid substitution therapy clients (2013, n = 492) and key experts (n = 44). Key outcomes were unsanctioned removal of supervised doses, diversion, injection and street price. Prevalence of past 6-month injection among PWID was adjusted for background availability of opioid substitution therapy medications using sales data. RESULTS Among out-of-treatment PWID, the levels of regular (weekly+) BNX film injection were comparable to methadone and BNX tablets, and lower than mono-buprenorphine, adjusting for background availability. Fewer BNX film clients [3%; 95% (CI) 1-5] regularly injected their medication than mono-buprenorphine clients (25%; 95% CI 11-39), but at levels equivalent to those among methadone (3%; 95% CI 1-6) and BNX tablet clients (2%; 95% CI 0-6). Key experts perceived BNX film needed less supervised dosing time as it dissolved rapidly and was harder to remove from the mouth than sublingual tablets; however, removal of supervised doses was higher among BNX film clients (15%; 95% CI: 10-20) than methadone clients (3%; 95% CI 1-6), and not significantly different from BNX tablet (11%; 95% CI 2-21) and mono-buprenorphine clients (31%; 95% CI 16-46). DISCUSSION AND CONCLUSIONS Two years post-introduction, levels of BNX film diversion and injection remained comparable with those for methadone and BNX tablets, and lower than mono-buprenorphine. We found no evidence that BNX film has lower non-adherence and diversion than the tablet formulation. [Larance B, Mattick R, Ali R, Lintzeris N, Jenkinson R, White N, Kihas I, Cassidy R, Degenhardt L. Diversion and injection of buprenorphine-naloxone film two years post-introduction in Australia. Drug Alcohol Rev 2015].
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Robert Ali
- School of Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South East Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Rebecca Jenkinson
- Center for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | - Nancy White
- School of Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Ivana Kihas
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Rosemary Cassidy
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Larance B, Carragher N, Mattick RP, Lintzeris N, Ali R, Degenhardt L. A latent class analysis of self-reported clinical indicators of psychosocial stability and adherence among opioid substitution therapy patients: do stable patients receive more unsupervised doses? Drug Alcohol Depend 2014; 142:46-55. [PMID: 25015687 DOI: 10.1016/j.drugalcdep.2014.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 05/21/2014] [Accepted: 05/21/2014] [Indexed: 11/15/2022]
Abstract
AIMS To develop a stability typology among opioid substitution therapy patients using a range of adherence indicators derived from clinical guidelines, and determine whether stable patients receive more unsupervised doses. METHODS An interviewer-administered cross-sectional survey was used in opioid substitution therapy programmes in three Australian jurisdictions, totalling 768 patients in their current treatment episode for ≥4 weeks. A structured questionnaire collated data from patients about their demographics, treatment characteristics, past 6-month drug use and medication adherence, psychosocial stability, comorbidity, child welfare concerns and levels of supervised dosing. Latent class analysis (LCA) was used to derive a stability typology. Linear regression models examined predictors of unsupervised dosing in the past month. RESULTS LCA identified two classes: (i) a higher-adherence group (67%) who had low-moderate probabilities of endorsing the opioid substitution therapy stability indicators and (ii) a lower-adherence group (33%) who had moderate-high probabilities of endorsing the stability indicators. There was no association between adherence profile and the number of unsupervised doses. Significant predictors of receiving larger numbers of unsupervised doses included being older, living in New South Wales or South Australia (vs. Victoria), receiving methadone (vs. mono-buprenorphine), being prescribed in private clinic or general practice (vs. public clinic), reporting a longer current treatment episode, not receiving a urine drug screen in the past month, being currently employed and not having a prison history. CONCLUSIONS This study suggested that system-level factors and observable indicators of social functioning were more strongly associated with the receipt of less supervised treatment. Future research should examine this issue using prospectively collected data.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, UNSW Australia, Randwick Campus, 22-32 King Street, Sydney NSW 2052, Australia.
| | - Natacha Carragher
- National Drug and Alcohol Research Centre, UNSW Australia, Randwick Campus, 22-32 King Street, Sydney NSW 2052, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, UNSW Australia, Randwick Campus, 22-32 King Street, Sydney NSW 2052, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South Eastern Sydney Local Health District (SESLHD), 591 South Dowling Street, Surry Hills NSW 2010, Australia; Discipline of Addiction Medicine, The University of Sydney, Drug Health Services, Royal Prince Alfred Hospital, Level 6 KGV Building, 83-117 Missenden Road, Camperdown, Sydney NSW 2050, Australia
| | - Robert Ali
- Discipline of Pharmacology, The University of Adelaide, Medical School South Building, Frome Road, Adelaide SA 5005, Australia; Drug and Alcohol Services South Australia, 161 Greenhill Road, Parkside SA 5063, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Randwick Campus, 22-32 King Street, Sydney NSW 2052, Australia; School of Population and Global Health, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Department of Global Health, School of Public Health, University of Washington, USA
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Larance B, Lintzeris N, Ali R, Dietze P, Mattick R, Jenkinson R, White N, Degenhardt L. The diversion and injection of a buprenorphine-naloxone soluble film formulation. Drug Alcohol Depend 2014; 136:21-7. [PMID: 24461476 DOI: 10.1016/j.drugalcdep.2013.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/05/2013] [Accepted: 12/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND We compared the diversion and injection of a new formulation of buprenorphine, a buprenorphine-naloxone film product (BNX film), with buprenorphine-naloxone tablets (BNX tablets), mono-buprenorphine (BPN) and methadone (MET) in Australia. METHODS Surveys were conducted with people who inject drugs regularly (PWID) (2004-2012) and opioid substitution treatment (OST) clients (2012, N=543). Key outcome measures: the unsanctioned removal of supervised doses, diversion, injection, motivations, drug liking and street price. Levels of injection among PWID were adjusted for background availability of medication using sales data. Doses not taken as directed by OST clients were adjusted by total number of daily doses dispensed. RESULTS Among out-of-treatment PWID, levels of injection for BNX film were comparable to those for MET and BNX tablet formulations, adjusting for background availability; BPN injecting levels were higher. Among OST clients, recent injecting of one's medication was similar among clients in all OST types; weekly or more frequent injection of prescribed doses was reported by fewer BNX film clients (3%; 95% CI: 1-6) than BPN clients (11%; 95% CI: 3-17), but at levels similar to those observed among MET and BNX tablet clients. The proportion of BNX film doses injected was lower than that for BPN and BNX tablets, and equivalent to that for MET. The majority of BNX film doses injected by OST clients were unsupervised doses, although some injection of supervised doses of BNX film did occur. The median price of all buprenorphine forms on the illicit market was the same. CONCLUSIONS Non-adherence and diversion of the BNX film formulation was similar to MET and BNX tablet formulations; BPN had higher levels of all indicators of non-adherence and diversion.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Nicholas Lintzeris
- The Langton Centre, South East Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW 2050, Australia; Mental Health and Drug and Alcohol Office, NSW Department of Health, 73 Miller Street, North Sydney, NSW 2060, Australia
| | - Robert Ali
- School of Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Paul Dietze
- Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Rebecca Jenkinson
- Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Nancy White
- School of Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3000, Australia
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Xu H, Gu J, Lau JT, Zhong Y, Fan L, Zhao Y, Hao C, He W, Ling W. Misconceptions toward methadone maintenance treatment (MMT) and associated factors among new MMT users in Guangzhou, China. Addict Behav 2012; 37:657-62. [PMID: 22353775 DOI: 10.1016/j.addbeh.2012.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 12/12/2011] [Accepted: 01/31/2012] [Indexed: 10/14/2022]
Abstract
The methadone maintenance treatment (MMT) program is scaling up in China, but little is known about drug users' cognitions of MMT. To investigate the prevalence and associated factors of MMT-related misconceptions, a totally of 300 newly admitted MMT users were interviewed in three MMT clinics in Guangzhou. Four statements were used to assess MMT-related misconceptions. The results showed that the majority of participants misconceived that MMT is intended primarily for detoxification (92.3%), that one could be completely detoxified and quit using methadone after using it for 2-3months (64.2%), that MMT is not a long-term or even lifetime treatment (77.9%); and that one should attempt to reduce its treatment dosage as methadone is harmful to one's health (84.3%); 48.5% of the respondents possessed all four types of misconceptions. Prior experience of methadone use in voluntary drug detoxification centers (OR=1.82 to 2.55, p<0.05) was associated with some misconception items, whilst being introduced by some peer drug users or community members to use MMT (versus not being introduced by anyone; OR=0.38 to 0.50, p<0.05), having taken up HIV voluntary counseling and testing prior to admission (OR=0.52, p<0.05), and a higher HIV-related knowledge level (OR=0.38, p<0.05) were associated with lower likelihoods for possessing some of the misconceptions. The findings suggested that MMT-related misconceptions were very prevalent among newly recruited MMT users in China. Misconceptions are potential factors causing drop-outs. Interventions targeting such misconceptions are greatly warranted.
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Winstock AR, Lea T, Sheridan J. Problems experienced by community pharmacists delivering opioid substitution treatment in New South Wales and Victoria, Australia. Addiction 2010; 105:335-42. [PMID: 20078490 DOI: 10.1111/j.1360-0443.2009.02774.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers. DESIGN ross-sectional postal survey. SETTING All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia. PARTICIPANTS Completed questionnaires were received from 669 pharmacists (68% response rate). MEASUREMENTS The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers. FINDINGS In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or > or issed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P < 0.001). Treatment termination in last month was predicted having more clients (P < 0.001), the provision of buprenorphine treatment (P = 0.008), having a separate dosing area (P = 0.021), and being a female pharmacist (P = 0.013). Past month refusal to dose was predicted by the pharmacy being in VIC (P < 0.001) and having more clients (P < 0.001). Problems experienced most commonly in the past month with prescribers were difficulty contacting prescriber (21%) and provision of takeaway doses to clients considered unstable by the pharmacist (19%) (higher in VIC: both P < 0.001). CONCLUSIONS This study highlights the range of problems experienced by community pharmacists in the delivery of OST and the consequences for people in treatment. Particular attention should be focused upon considering number of clients per pharmacy and improving professional communication between pharmacists and prescribers.
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Affiliation(s)
- Adam R Winstock
- Drug Health Services, Sydney South West Area Health Service, Sydney, NSW, Australia.
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Degenhardt L, Larance BK, Bell JR, Winstock AR, Lintzeris N, Ali RL, Scheuer N, Mattick RP. Injection of medications used in opioid substitution treatment in Australia after the introduction of a mixed partial agonist–antagonist formulation. Med J Aust 2009; 191:161-5. [DOI: 10.5694/j.1326-5377.2009.tb02729.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 01/15/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Briony K Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - James R Bell
- The Langton Centre, South Eastern Sydney and Illawarra Area Health Service, Sydney, NSW
| | - Adam R Winstock
- Drug Health Services, Sydney South West Area Health Service, Sydney, NSW
| | - Nicholas Lintzeris
- Drug Health Services, Sydney South West Area Health Service, Sydney, NSW
| | - Robert L Ali
- WHO Collaborating Centre for the Treatment of Drug and Alcohol Problems, University of Adelaide, Adelaide, SA
| | - Nicolas Scheuer
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
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Burns L, Randall D, Hall WD, Law M, Butler T, Bell J, Degenhardt L. Opioid agonist pharmacotherapy in New South Wales from 1985 to 2006: patient characteristics and patterns and predictors of treatment retention. Addiction 2009; 104:1363-72. [PMID: 19549053 DOI: 10.1111/j.1360-0443.2009.02633.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS The aims of this study were to: examine the number and characteristics of patients entering and re-entering opioid replacement treatment between 1985 and 2006, to examine select demographic and treatment correlates of leaving treatment between 1985 and 2000, and to compare retention rates in methadone and buprenorphine maintenance treatment from 2001 to 2006. DESIGN A retrospective cohort study using register data from the Pharmaceutical Drugs of Addiction System. SETTING Opioid substitution treatment in New South Wales (NSW), Australia. PARTICIPANTS A total of n = 42 690 individuals prescribed opioid replacement treatment between 1985 and 2006 in NSW. MEASUREMENTS Client characteristics over time, retention in days in first treatment episode, number of episodes of treatment and proportion switching medication. FINDINGS Overall, younger individuals were significantly more likely to leave their first treatment episode than older individuals. In 2001-06, after controlling for age, sex and first administration point, the hazard of leaving treatment was 1.9 times for those on buprenorphine relative to those on methadone. Retention in treatment varied somewhat across historical time, with those entering during 1995-2000 more likely to leave at an earlier stage than those who entered before that time. CONCLUSIONS Retention in treatment appears to fluctuate in inverse proportion to the availability of heroin. Individuals in contemporary treatment are older users with a lengthy treatment history. This study has provided population-level evidence to suggest that retention in methadone and buprenorphine differ in routine clinical practice. Future work might investigate ways in which patient adherence and retention may be improved.
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Affiliation(s)
- Lucy Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney.
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Winstock AR, Lea T, Jackson AP. Methods and Motivations for Buprenorphine Diversion from Public Opioid Substitution Treatment Clinics. J Addict Dis 2009; 28:57-63. [DOI: 10.1080/10550880802545036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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