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Crepeault H, Ti L, Jutras-Aswad D, Wood E, Le Foll B, Lim R, Bach P, Brar R, Socias ME. Correlates of nonfatal overdose among treatment-seeking individuals with non-heroin opioid use disorder: Findings from a pragmatic, pan-Canadian, randomized control trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209158. [PMID: 37683803 DOI: 10.1016/j.josat.2023.209158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/12/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Misuse of prescription and synthetic opioids is a primary contributor to the escalating overdose crisis in North America. However, factors associated with nonfatal overdose (NFO) in this context are poorly understood. We examined individual and socio-structural level correlates of NFO among treatment-seeking adults with an opioid use disorder (OUD) not attributed to heroin (nonheroin opioid use disorder [NH-OUD]). METHODS The study drew data from OPTIMA, a pan-Canadian, multicenter, pragmatic, two-arm randomized control trial comparing supervised methadone and flexible take-home dosing buprenorphine/naloxone models of care among adults with NH-OUD conducted between 2017 and 2020. We used bivariable and multivariable logistic regression to determine factors associated with a lifetime history of NFO among participants enrolled in the trial. RESULTS Of 267 included participants, 154 (58%) reported a NFO in their lifetime, of whom 83 (55 %) had an NFO in the last 6 months. In multivariable analyses, positive urine drug test (UDT) for methamphetamine/amphetamine (Adjusted Odds Ratio [AOR] = 2.59; 95 % confidence interval [CI]: 1.17-5.80), positive UDT for fentanyl (AOR = 2.31; 95 % CI: 1.01-5.30), receiving income assistance (AOR = 2.17; 95 % CI: 1.18-4.09) and homelessness (AOR = 2.40; 95 % CI: 1.25-4.68) were positively associated with a lifetime history of NFO. CONCLUSIONS We found a high prevalence of NFO history in treatment-seeking adults with NH-OUD, particularly among participants with certain drug use patterns and markers of socio-structural marginalization at the time of enrollment. Given the known impact of prior NFO on future harms, these findings highlight the need for comprehensive care approaches that address polysubstance use and social determinants of health to mitigate future overdose risk.
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Affiliation(s)
- Hannah Crepeault
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Acute Care Programme, CAMH, Toronto, ON, Canada
| | - Ron Lim
- Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rupinder Brar
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Regional Addiction Program, Vancouver Coastal Health, Vancouver, BC, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Chang H, Huang M, Fang S, Lin S. Quality of life and associated factors of heroin-dependent patients receiving methadone and buprenorphine maintenance treatment. Neuropsychopharmacol Rep 2023; 43:607-615. [PMID: 38088122 PMCID: PMC10739136 DOI: 10.1002/npr2.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
AIM Although studies in Western countries have investigated the quality of life (QoL) of heroin users, limited research on this topic has been conducted in Asia. The present study assessed QoL in patients with heroin dependence receiving medications to treat opioid use disorder. METHODS We performed a cross-sectional study of patients with heroin dependence receiving methadone and buprenorphine treatment. The demographic and substance use variables of patients receiving methadone and buprenorphine were compared. The Chinese Health Questionnaire (CHQ-12), Obsessive Compulsive Drug Use Scale (OCDUS), and World Health Organization Quality of Life Short Form Taiwan version (WHOQOL-BREF-T) were administered to measure patient mental health problems, addiction severity, and QoL, respectively. Multivariate regression was used to identify the factors associated with QoL. RESULTS A total of 149 patients receiving methadone and 31 receiving buprenorphine completed the questionnaires. Individuals in the buprenorphine group were more likely to be married (p = 0.024) or employed (p = 0.024), have a higher educational level (p = 0.013), have lower drug craving (OCDUS: p = 0.035), or have higher QoL (WHOQOL-BREF-T: p = 0.004) than those in the methadone group. After adjustment for other variables, employment was positively associated with the physical, psychological, and environmental domains of QoL. Receiving buprenorphine treatment (p = 0.032) and longer treatment duration (p = 0.016) were associated with higher psychological QoL. CONCLUSION Several factors were associated with QoL in patients with heroin dependence. Some measures may improve their QoL, such as reducing employment barriers, improving treatment adherence, or increasing accessibility to buprenorphine treatment.
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Affiliation(s)
- Hu‐Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric CenterTaipei City HospitalTaipeiTaiwan
| | - Ming‐Chyi Huang
- Department of Addiction Sciences, Taipei City Psychiatric CenterTaipei City HospitalTaipeiTaiwan
- School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Su‐Chen Fang
- Department of NursingMackay Medical CollegeTaipeiTaiwan
| | - Shih‐Ku Lin
- School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Department of General PsychiatryChang Gung Memorial HospitalTaoyuanTaiwan
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Morin KA, Marsh TN, Eshakakogan C, Eibl JK, Spence M, Gauthier G, Walker JD, Sayers D, Ozawanimke A, Bissaillion B, Marsh DC. Community trial evaluating the integration of Indigenous healing practices and a harm reduction approach with principles of seeking safety in an Indigenous residential treatment program in northern Ontario. BMC Health Serv Res 2022; 22:1045. [PMID: 35974328 PMCID: PMC9381149 DOI: 10.1186/s12913-022-08406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Our primary objective was to evaluate how the Indigenous Healing and Seeking Safety (IHSS) model impacted residential addiction treatment program completion rates. Our secondary objective was to evaluate health service use 6 months before and 6 months after residential treatment for clients who attended the program before and after implementing IHSS. Methods We observed clients of the Benbowopka Residential Treatment before IHSS implementation (from April 2013 to March 31, 2016) and after IHSS implementation (from January 1, 2018 – March 31, 2020). The program data were linked to health administration data, including the Ontario Health Insurance Plan (OHIP) physician billing, the Registered Persons Database (RPDB), the National Ambulatory Care Reporting System (NACRS), and the Discharge Abstract Database (DAD). Chi-square tests were used to compare patient characteristics in the no-IHSS and IHSS groups. We used logistic regression to estimate the association between IHSS and treatment completion. We used generalized estimating equation (GEE) regression model to evaluate health service use (including primary care visits, ED visits overall and for substance use, hospitalizations and mental health visits), Results: There were 266 patients in the no-IHSS group and 136 in the IHSS group. After adjusting for individual characteristics, we observed that IHSS was associated with increased program completion rates (odds ratio = 1.95, 95% CI 1.02-3.70). There was no significant association between IHSS patients’ health service use at time one or time two. Primary care visits time 1: aOR 0.55, 95%CI 0.72-1.13, time 2: aOR 1.13, 95%CI 0.79-1.23; ED visits overall time 1: aOR 0.91, 95%CI 0.67-1.23, time 2: aOR 1.06, 95%CI 0.75-1.50; ED visits for substance use time 1: aOR 0.81, 95%CI 0.47-1.39, time 2: aOR 0.79, 95%CI 0.37-1.54; Hospitalizations time 1: aOR 0.78, 95%CI 0.41-1.47, time 2: aOR 0.76, 95%CI 0.32-1.80; Mental health visits time 1: aOR 0.66, 95%CI 0.46-0.96, time 2: aOR 0.92 95%CI 0.7-1.40. Conclusions Our results indicate that IHSS positively influenced program completion but had no significant effect on health service use. Trial registration This study was registered with clinicaltrials.gov (identifier number NCT04604574). First registration 10/27/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08406-3.
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Affiliation(s)
- K A Morin
- Northern Ontario School of Medicine, ON, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Ontario, Canada.,ICES North, Sudbury, Ontario, Canada.,Canadian Addiction Treatment Centres, Toronto, Ontario, Canada
| | - T N Marsh
- Northern Ontario School of Medicine, ON, Sudbury, Canada
| | | | - J K Eibl
- Northern Ontario School of Medicine, ON, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - M Spence
- Northern Ontario School of Medicine, ON, Sudbury, Canada
| | - G Gauthier
- Northern Ontario School of Medicine, ON, Sudbury, Canada
| | - J D Walker
- McMaster University, Hamilton, Ontario, Canada
| | - Dean Sayers
- Batchewana First Nation, Sault Ste. Marie, Ontario, Canada
| | | | | | - D C Marsh
- Northern Ontario School of Medicine, ON, Sudbury, Canada. .,Health Sciences North Research Institute, Sudbury, Ontario, Canada. .,ICES North, Sudbury, Ontario, Canada. .,Canadian Addiction Treatment Centres, Toronto, Ontario, Canada.
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Ma Z, Liu Y, Wan C, Jiang J, Li X, Zhang Y. Health-related quality of life and influencing factors in drug addicts based on the scale QLICD-DA: a cross-sectional study. Health Qual Life Outcomes 2022; 20:109. [PMID: 35836188 PMCID: PMC9284692 DOI: 10.1186/s12955-022-02012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drug abuse has many negative effects not only on individuals but also on society. Nowadays, researchers pay a lot of attention to quality of life of drug addicts. However, there are few scales available to measure quality of life of drug addicts. The scale QLICD-DA (quality of life instrument for chronic diseases-drug addition) developed by modular approach could be used to measure quality of life of drug addicts with good validity, reliability and sensitivity. OBJECTIVE This study is aimed to understand the quality of life status and influencing factors in drug addicts by suitable sensitively scale, with the hypothesis of the quality of life in drug addicts being different from that of other peoples and possibly being influenced by many factors. METHODS By cluster random sampling method, 192 drug addicts at Kunming compulsory drug rehabilitation center were recruited to take part in the investigation. All participants completed the general information questionnaire and the scale QLICD-DA. We used a t-test to compare the scores of the quality of life of the participants with the norm (QOL scores from 1953 patients of 10 chronic diseases). A stepwise regression method was applied to explore the influencing factors of the quality of life in drug addicts. RESULTS 192 participants ranged in age from 19 to 59 with an average age of 34.86. Most of them were male (70.3%), high school education level (67.7%) and of Han nationality (82.8%). The quality of life of drug addicts was lower than the norm in the physical domain, psychological domain, social domain, and general module, and the differences were statistically significant (p < 0.001). Sex and mode of drug abuse were the influencing factors in total score (p = 0.006) and specific module (p = 0.019). Past family atmosphere and the mode of drug abuse were the influencing factors in the general module (p = 0.027, p = 0.037). CONCLUSION The quality of life of drug addicts was worse than that of patients with other chronic diseases, and the influencing factors of the quality of life of drug abusers were sex, mode of drug abuse, and past family atmosphere.
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Affiliation(s)
- Zilin Ma
- Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Research Center for Quality of Life and Applied Psychology, School of Humanities and Management, Guangdong Medical University, Dongguan, 523808, China
| | - Yuxi Liu
- Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Research Center for Quality of Life and Applied Psychology, School of Humanities and Management, Guangdong Medical University, Dongguan, 523808, China
| | - Chonghua Wan
- Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Research Center for Quality of Life and Applied Psychology, School of Humanities and Management, Guangdong Medical University, Dongguan, 523808, China.
| | - Jianming Jiang
- First People's Hospital of Honghe Prefecture, Mengzi, 661100, China
| | - Xiaomei Li
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Ying Zhang
- Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Research Center for Quality of Life and Applied Psychology, School of Humanities and Management, Guangdong Medical University, Dongguan, 523808, China
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Le NT, Vu TT, Vu TTV, Khuong QL, Le HTCH, Tieu TTV, Do VD. Quality of life profile of methadone maintenance treatment patients in Ho Chi Minh City, Vietnam. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2084782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ngoc Tu Le
- Department of Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thu Trang Vu
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi City, Vietnam
| | - Thi Tuong Vi Vu
- Center for Population Health Sciences, Vietnam HIV Addiction Technology Transfer Center - University of Medicine and Pharmacy at Ho Chi Minh City, Hanoi City, Vietnam
| | - Quynh Long Khuong
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi City, Vietnam
| | - Huynh Thi Cam Hong Le
- Center for Population Health Sciences, Vietnam HIV Addiction Technology Transfer Center - University of Medicine and Pharmacy at Ho Chi Minh City, Hanoi City, Vietnam
- Center for Population Health Sciences, University of Medicine and Pharmacy at Ho Chi Minh City, Hanoi City, Vietnam
| | - Thi Thu Van Tieu
- Center for Population Health Sciences, Prevention HIV/AIDS Center Ho Chi Minh City HIV/AIDS Association, Hanoi City, Vietnam
| | - Van Dung Do
- Center for Population Health Sciences, Vietnam HIV Addiction Technology Transfer Center - University of Medicine and Pharmacy at Ho Chi Minh City, Hanoi City, Vietnam
- Center for Population Health Sciences, University of Medicine and Pharmacy at Ho Chi Minh City, Hanoi City, Vietnam
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Hazani HM, Naina Mohamed I, Muzaimi M, Mohamed W, Yahaya MF, Teoh SL, Pakri Mohamed RM, Mohamad Isa MF, Abdulrahman SM, Ramadah R, Kamaluddin MR, Kumar J. Goofballing of Opioid and Methamphetamine: The Science Behind the Deadly Cocktail. Front Pharmacol 2022; 13:859563. [PMID: 35462918 PMCID: PMC9021401 DOI: 10.3389/fphar.2022.859563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Globally, millions of people suffer from various substance use disorders (SUD), including mono-and polydrug use of opioids and methamphetamine. Brain regions such as the cingulate cortex, infralimbic cortex, dorsal striatum, nucleus accumbens, basolateral and central amygdala have been shown to play important roles in addiction-related behavioral changes. Clinical and pre-clinical studies have characterized these brain regions and their corresponding neurochemical changes in numerous phases of drug dependence such as acute drug use, intoxication, craving, withdrawal, and relapse. At present, many studies have reported the individual effects of opioids and methamphetamine. However, little is known about their combined effects. Co-use of these drugs produces effects greater than either drug alone, where one decreases the side effects of the other, and the combination produces a prolonged intoxication period or a more desirable intoxication effect. An increasing number of studies have associated polydrug abuse with poorer treatment outcomes, drug-related deaths, and more severe psychopathologies. To date, the pharmacological treatment efficacy for polydrug abuse is vague, and still at the experimental stage. This present review discusses the human and animal behavioral, neuroanatomical, and neurochemical changes underlying both morphine and methamphetamine dependence separately, as well as its combination. This narrative review also delineates the recent advances in the pharmacotherapy of mono- and poly drug-use of opioids and methamphetamine at clinical and preclinical stages.
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Affiliation(s)
- Hanis Mohammad Hazani
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
| | - Mustapha Muzaimi
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Wael Mohamed
- Basic Medical Science Department, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
- Faculty of Medicine, Department of Clinical Pharmacology, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamad Fairuz Yahaya
- Department of Anatomy, Faculty of Medicine, National University of Malaysia, Cheras, Malaysia
| | - Seong Lin Teoh
- Department of Anatomy, Faculty of Medicine, National University of Malaysia, Cheras, Malaysia
| | | | | | | | - Ravi Ramadah
- National Anti-Drugs Agency Malaysia, Selangor, Malaysia
| | - Mohammad Rahim Kamaluddin
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, The National University of Malaysia, Bangi, Malaysia
| | - Jaya Kumar
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
- *Correspondence: Jaya Kumar,
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Simirea M, Baumann C, Bisch M, Rousseau H, Di Patrizio P, Viennet S, Bourion-Bédès S. Health-related quality of life in outpatients with substance use disorder: evolution over time and associated factors. Health Qual Life Outcomes 2022; 20:26. [PMID: 35172824 PMCID: PMC8848823 DOI: 10.1186/s12955-022-01935-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Health-related quality of life (HRQoL) is an important element of patient care and clinical research. The aim of this study was to describe HRQoL changes and identify associated factors during a 6-month follow-up of outpatients starting care for alcohol or opioid dependence. Methods HRQoL was measured at baseline and 3 and 6 months later using the SF-12. Data on the patients’ sociodemographics, clinical characteristics and levels of anxiety and depression were collected using the Hospital Anxiety and Depression Scale (HADS). Repeated-measures analyses were performed to assess factors associated with global HRQoL differences and the evolution of HRQoL indicated by both physical and mental scores (PCS and MCS, respectively). Results The mean PCS and MCS scores were initially low at 45.4 (SD = 8.6) and 36.0 (SD = 10.9), respectively. The improvement in HRQoL was rapid in the first 3-month period and then slowed and remained stable over the subsequent 3-month period. Being employed (p = 0.012), having no comorbidities (p = 0.014) and having no depression (p = 0.004) were associated with significant differences in the average PCS scores at the 3 time points. Patients who had lower overall HRQoL MCS scores on average were those for whom a medication was initiated (p = 0.009), as was the case for patients with anxiety (p < 0.001) and depression (p < 0.001). Patients with depression at baseline were also those for whom a significantly greater increase in MCS score during the 6 months of follow-up was observed. Conclusion Our findings highlight the importance of screening early psychological distress and considering other factors associated with HRQoL changes in outpatients after the first 3-month period of treatment for substance use disorder.
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Affiliation(s)
- Melexima Simirea
- Centre Psychothérapique de Nancy, CSAPA (Health Care Centre of Accompaniment and Prevention in Addictology), 54 520, Laxou, France.
| | - Cédric Baumann
- UMDS (Unit of Methodology, Data Management and Statistics), University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France.,EA4360 APEMAC (Health Adjustment, Measurement and Assessment, Interdisciplinary Approaches) MICS Team, University of Lorraine, 54500, Vandoeuvre-lès-Nancy, France
| | - Michael Bisch
- Centre Psychothérapique de Nancy, CSAPA (Health Care Centre of Accompaniment and Prevention in Addictology), 54 520, Laxou, France
| | - Hélène Rousseau
- UMDS (Unit of Methodology, Data Management and Statistics), University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France
| | - Paolo Di Patrizio
- Centre Psychothérapique de Nancy, CSAPA (Health Care Centre of Accompaniment and Prevention in Addictology), 54 520, Laxou, France
| | - Sarah Viennet
- Centre Psychothérapique de Nancy, CSAPA (Health Care Centre of Accompaniment and Prevention in Addictology), 54 520, Laxou, France
| | - Stéphanie Bourion-Bédès
- EA4360 APEMAC (Health Adjustment, Measurement and Assessment, Interdisciplinary Approaches) MICS Team, University of Lorraine, 54500, Vandoeuvre-lès-Nancy, France.,Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, 78150, Versailles, France
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Gottlieb A, Bakos-Block C, Langabeer JR, Champagne-Langabeer T. Sociodemographic and Clinical Characteristics Associated with Improvements in Quality of Life for Participants with Opioid Use Disorder. Healthcare (Basel) 2022; 10:healthcare10010167. [PMID: 35052330 PMCID: PMC8775674 DOI: 10.3390/healthcare10010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The Houston Emergency Opioid Engagement System was established to create an access pathway into long-term recovery for individuals with opioid use disorder. The program determines effectiveness across multiple dimensions, one of which is by measuring the participant’s reported quality of life (QoL) at the beginning of the program and at successive intervals. Methods: A visual analog scale was used to measure the change in QoL among participants after joining the program. We then identified sociodemographic and clinical characteristics associated with changes in QoL. Results: 71% of the participants (n = 494) experienced an increase in their QoL scores, with an average improvement of 15.8 ± 29 points out of a hundred. We identified 10 factors associated with a significant change in QoL. Participants who relapsed during treatment experienced minor increases in QoL, and participants who attended professional counseling experienced the largest increases in QoL compared with those who did not. Conclusions: Insight into significant factors associated with increases in QoL may inform programs on areas of focus. The inclusion of counseling and other services that address factors such as psychological distress were found to increase participants’ QoL and success in recovery.
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Affiliation(s)
- Assaf Gottlieb
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
| | - Christine Bakos-Block
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
| | - James R. Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
- McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Houston, TX 77030, USA
| | - Tiffany Champagne-Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA; (A.G.); (C.B.-B.); (J.R.L.)
- Correspondence:
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Abstract
Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality-notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.
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Affiliation(s)
- Megan Buresh
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Stern
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Darius Rastegar
- Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Evaluating the effectiveness of concurrent opioid agonist treatment and physician-based mental health services for patients with mental disorders in Ontario, Canada. PLoS One 2020; 15:e0243317. [PMID: 33338065 PMCID: PMC7748134 DOI: 10.1371/journal.pone.0243317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Abstract
Objective The objective of this study was to evaluate the relationship between concurrent physician-based mental health services, all-cause mortality, and acute health service use for individuals enrolled in Opioid Agonist Treatment in Ontario, Canada. Methods A cohort study of patients enrolled in opioid agonist treatment in Ontario was conducted between January 1, 2011, and December 31, 2015, in Ontario with an inverse probability of treatment weights using the propensity score to estimate the effect of physician-based mental health services. Treatment groups were created based on opioid agonist treatment patients’ utilization of physician-based mental health services. Propensity score weighted odds ratios were calculated to assess the relationship between the treatment groups and the outcomes of interest. The outcomes included all-cause mortality using data from the Registered Persons Database, Emergency Department visits from the National Ambulatory Care Database, and hospitalizations using data from the Discharge Abstract Database. Encrypted patient identifiers were used to link across databases. Results A total of 48,679 individuals in OAT with mental disorders. Opioid agonist treatment alone was associated with reduced odds of all-cause mortality (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3–0.4). Patients who received mental health services from a psychiatrist and primary care physician while engaged in OAT, the estimated rate of ED visits per year was higher (OR = 1.3, 95% CI 1.2–1.4) and the rate of hospitalizations (OR = 0.5, 95% CI 0.4–0.6) than in the control group. Conclusion Our findings support the view that opioid agonist treatment and concurrent mental health services can improve clinical outcomes for complex patients, and is associated with enhanced use of acute care services.
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Vuong T, Ritter A, Shanahan M, Ali R, Nguyen N, Minh KP. Quality of life as a predictor of time to heroin relapse among male residents following release from compulsory rehabilitation centres in Vietnam. Drug Alcohol Rev 2020; 40:296-306. [PMID: 32985029 DOI: 10.1111/dar.13176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/10/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Quality of life (QOL) is a relevant and quantifiable outcome of drug dependence treatment. We assessed health-related QOL for people released from three centre-based compulsory treatment (CCT) centres in Vietnam, using the EQ-5D. The study aimed to examine the prognostic value of health-related QOL in relation to time to relapse to heroin use among the participants. DESIGN AND METHODS Two hundred and eight CCT participants with heroin dependence were interviewed at release, and at 3, 6 and 12 months post-release. Health-related QOL was measured with the EQ-5D. Kaplan-Meier survival models were fitted using Cox modelling to examine the rate, timing and prediction of the number of days to heroin relapse and to examine the predictability of the health-related QOL measures for days to relapse. Relapse was defined as first time of heroin use. RESULTS The study found a substantial relapse rate (85.6%) among participants within 12 months following release from CCT centres; the mean number of days to relapse was 57.7 (SD = 31.6). There was no statistically significant change over time in the mean values of health-related QOL (P = 0.11). While the total index score (across the five pre-specified EQ-5D domains) did not have a significant effect in predicting cumulative relapse, lower scores on the Visual Analogue Scale of the EQ-5D were significantly (P < 0.05) predictive of cumulative relapse, with adjusted hazard ratios for relapse of 0.987 (P = 0.013). DISCUSSION AND CONCLUSIONS EQ-5D Visual Analogue Scale score is a useful predictor of cumulative heroin relapse among participants released from CCT centres.
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Affiliation(s)
- Thu Vuong
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
| | | | - Khue Pham Minh
- Haiphong University of Medicine and Pharmacy, Hai Phong, Vietnam
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12
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Marquez-Arrico JE, Navarro JF, Adan A. Health-Related Quality of Life in Male Patients under Treatment for Substance Use Disorders with and without Major Depressive Disorder: Influence in Clinical Course at One-Year Follow-Up. J Clin Med 2020; 9:E3110. [PMID: 32993107 PMCID: PMC7601390 DOI: 10.3390/jcm9103110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022] Open
Abstract
Health-related quality of life (HRQoL) assessment has interest as an indicator of degree of affectation and prognosis in mental disorders. HRQoL is impaired in both Substance Use Disorder (SUD) and Major Depressive Disorder (MDD), two conditions highly prevalent, although less studied when both are coexisting (SUD + MDD). Hence, we decided to explore HRQoL with the SF-36 survey in a sample of 123 SUD and 114 SUD + MDD patients (51 symptomatic and 63 asymptomatic of depressive symptoms) under treatment. We performed analyses to examine HRQoL among groups, and its predictive value at 3-, 6- and 12-month follow-ups through regression models. Patients with SUD + MDD had worse HRQoL than SUD patients and population norms. For Mental Health, Vitality, and General Health dimensions, lower scores were observed for SUD + MDD regardless the presence/absence of depressive symptoms. For Physical Functioning and Health Change, depressive symptomatology and not the comorbidity of SUD + MDD diagnoses explained HRQoL limitations. At 3-, 6- and 12-month follow-ups we observed two predictors of relapses, General Health for asymptomatic SUD + MDD, and Physical Functioning for SUD. Improving HRQoL in SUD + MDD may be targeted during patient's treatment; future studies should explore the influence of HRQoL on patient's prognosis taking into account the presence/absence of depressive symptomatology.
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Affiliation(s)
- Julia E. Marquez-Arrico
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d’Hebrón 171, 08035 Barcelona, Spain;
| | - José Francisco Navarro
- Department of Psychobiology, School of Psychology, University of Málaga, Campus de Teatinos s/n, 29071 Málaga, Spain;
| | - Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d’Hebrón 171, 08035 Barcelona, Spain;
- Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
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13
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Morin KA, Eibl JK, Gauthier G, Rush B, Mushquash C, Lightfoot NE, Marsh DC. A cohort study evaluating the association between concurrent mental disorders, mortality, morbidity, and continuous treatment retention for patients in opioid agonist treatment (OAT) across Ontario, Canada, using administrative health data. Harm Reduct J 2020; 17:51. [PMID: 32703310 PMCID: PMC7376938 DOI: 10.1186/s12954-020-00396-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Due to the high prevalence of mental disorders among people with opioid use disorder, the objective of this study was to determine the association between concurrent mental disorders, mortality, morbidity, and continuous treatment retention for patients in opioid agonist treatment in Ontario, Canada. Methods We conducted a retrospective cohort study of patients enrolled in opioid agonist treatment between January 1, 2011, and December 31, 2015. Patients were stratified into two groups: those diagnosed with concurrent mental disorders and opioid use disorder and those with opioid use disorder only, using data from the Ontario Health Insurance Plan Database, Ontario Drug Benefit Plan Database. The primary outcome studied was all-cause mortality using data from the Registered Persons Database. Emergency department visits from the National Ambulatory Care Database, hospitalizations Discharge Abstract Database, and continuous retention in treatment, defined as 1 year of uninterrupted opioid agonist treatment using data from the Ontario Drug Benefit Plan Database were measured as secondary outcomes. Encrypted patient identifiers were used to link information across databases. Results We identified 55,924 individuals enrolled in opioid agonist treatment, and 87% had a concurrent mental disorder diagnosis during this period. We observed that having a mental disorder was associated with an increased likelihood of all-cause mortality (odds ratio (OR) 1.4; 95% confidence interval (CI) 1.2–1.5). For patients diagnosed with mental disorders, the estimated rate of ED visits per year was 2.25 times higher and estimated rate of hospitalization per year was 1.67 times higher than for patients with no mental disorders. However, there was no association between having a diagnosis of a mental disorder and 1-year treatment retention in OAT-adjusted hazard ratio (HR) = 1.0; 95% CI 0.9 to 1.1. Conclusion Our findings highlight the consequences of the high prevalence of mental disorders for individuals with opioid use disorder in Ontario, Canada.
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Affiliation(s)
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | | | - Brian Rush
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Christopher Mushquash
- Northern Ontario, School of Medicine, Sudbury, ON, Canada.,Lakehead University, Department of Psychology, Thunder Bay, ON, Canada
| | | | - David C Marsh
- Northern Ontario, School of Medicine, Sudbury, ON, Canada. .,Health Sciences North Research Institute, Sudbury, ON, Canada. .,Lakehead University, Department of Psychology, Thunder Bay, ON, Canada. .,ICES, Toronto, ON, Canada.
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14
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Ghanbari H, Toozandehjani H, Nejat H. Comparison of the Effectiveness of Acceptance and Commitment Therapy and Quality of Life Improvement Training on Distress Tolerance and Self-Destructive Behaviors in Substance Abusers. INTERNATIONAL JOURNAL OF BASIC SCIENCE IN MEDICINE 2020. [DOI: 10.34172/ijbsm.2020.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Drug addiction is one of the most serious psychological, social, economic, and health hazards that needs prevention and treatment considering its serious consequences for the individual and human society. The purpose of this study was to compare the effectiveness of acceptance and commitment therapy (ACT) and quality of life improvement training (QOLT) on distress tolerance and self-destructive behaviors in substance abusers. Methods: This was a quasi-experimental study with pre- and post-test design and a control group. The statistical population included men over 20 years old referred to addiction treatment centers in Mashhad. The sample consisted of 45 volunteers who were selected by purposive sampling method and were divided into 3 groups (two experimental and one control group). Experimental groups received ACT and skills training based on the quality of life, while the control group did not receive any experimental intervention. The Distress Tolerance Scale (Simons and Gaher) and Self-destructive Behavior Questionnaire (Owens) were used as research tools in the study. Data were analyzed by multivariate analysis of covariance using SPSS version 24.0 software. Results: The results of the analysis of covariance showed that the therapeutic methods used in this study were effective in improving distress tolerance and self-destructive behaviors in men with substance abuse (P<0.001). Moreover, according to the Bonferroni follow-up test, there was no significant difference between the two treatments. Conclusion: ACT and QOLT significantly improved distress tolerance and self-destructive behaviors in substance abusers.
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Affiliation(s)
- Hamidreza Ghanbari
- Department of Psychology, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
| | - Hassan Toozandehjani
- Department of Psychology, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
| | - Hamid Nejat
- Department of Psychology, Quchan Branch, Islamic Azad University, Quchan, Iran
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15
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Müller O, Baumann C, Di Patrizio P, Viennet S, Vlamynck G, Collet L, Clerc-Urmès I, Schwan R, Bourion-Bédès S. Patient's early satisfaction with care: a predictor of health-related quality of life change among outpatients with substance dependence. Health Qual Life Outcomes 2020; 18:6. [PMID: 31910879 PMCID: PMC6947996 DOI: 10.1186/s12955-019-1267-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/23/2019] [Indexed: 12/03/2022] Open
Abstract
Background Although research on health-related quality of life (HRQoL) has increased in the addiction field, few studies have focused on the determinants of HRQoL changes. This study aimed to describe dependent patients’ HRQoL changes at a 3-month follow-up and to assess whether satisfaction with care can predict those changes among outpatients starting care for alcohol or opioid dependence. Methods HRQoL was measured with the SF-12 at baseline and 3 months later in a prospective cohort of dependent outpatients. Satisfaction was assessed with the EQS-C early after inclusion. Data on sociodemographics, clinical characteristics and patients’ levels of anxiety and depression were also collected. A multivariable analysis was performed to identify factors associated with HRQoL changes in both the physical and mental component summary scores (PCS and MCS, respectively). Results Of the 172 patients included at baseline, a total of 136 patients assessed their satisfaction with care. The mean PCS and MCS scores were initially low, and HRQoL improvement was significant after 3 months for both the PCS and MCS. Never having been married (β = 5.5; p = 0.001) and a lower baseline PCS score (β = − 0.6; p < 0.0001) were associated with significant PCS improvement, whereas being legally compelled to undergo drug treatment (β = − 5.9; p = 0.02) was associated with less PCS change. Higher early satisfaction with care (β = 0.1; p = 0.02) and a lower baseline MCS score (β = − 0.7; p < 0.0001) were associated with significant MCS improvement. Conclusion The study supported the hypothesis that greater satisfaction with care may predict HRQoL improvement among dependent outpatients. Further studies are needed to understand the factors that affect patients’ early satisfaction to identify areas of improvement and thus improve HRQoL.
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Affiliation(s)
- Ophélie Müller
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Cédric Baumann
- Unit of Methodology, Data Management and Statistics, University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France.,EA4360 APEMAC (Health adjustment, measurement and assessment, interdisciplinary approaches) MICS team, University of Lorraine, 54500, Vandoeuvre-lès-Nancy, France
| | - Paolo Di Patrizio
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Sarah Viennet
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Guillaume Vlamynck
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Laura Collet
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Isabelle Clerc-Urmès
- Unit of Methodology, Data Management and Statistics, University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France
| | - Raymund Schwan
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France
| | - Stéphanie Bourion-Bédès
- CSAPA (Health Care Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 54000, Nancy, France. .,EA4360 APEMAC (Health adjustment, measurement and assessment, interdisciplinary approaches) MICS team, University of Lorraine, 54500, Vandoeuvre-lès-Nancy, France. .,Service médico-psychologique régional, 1, Rue Seulhotte B.P, 15082 57073, Metz, France.
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16
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Lugoboni F, Bertoldi A, Casari R, Mantovani E, Morbioli L, Tamburin S. Adult Attention-Deficit/Hyperactivity Disorder and Quality of Life in High-Dose Benzodiazepine and Related Z-Drug Users. Eur Addict Res 2020; 26:274-282. [PMID: 32570244 DOI: 10.1159/000507852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Problematic high-dose benzodiazepine (BZD) and related Z-drug use for a long period is a substance use disorder previously found to be associated with adult attention-deficit/hyperactivity disorder (ADHD) and worse quality of life (QoL). Whether adult ADHD impacts QoL in high-dose BZD/Z-drug users has not been explored. AIM The aim of the study was to explore the impact of adult ADHD on QoL in high-dose BZD and related Z-drug users. METHODS We recruited 393 patients (205 men and 188 women) consecutively admitted to the Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Italy, from July 2016 to July 2019 for detoxification from high-dose BZD or Z-drug dependence. Demographic and clinical variables and QoL measures were recorded. The World Health Organization ADHD Self-Report Scale version 1.1 Symptom Checklist Part A was used to detect adult ADHD. RESULTS In our sample, 39.4% of patients were positive to adult ADHD testing (ADHD+), with some clinical features differing in comparison to patients negative to ADHD testing (ADHD-). QoL was worse in high-dose BZD/Z-drug users than the general population. The ADHD+ group showed significantly worse QoL measures than the ADHD- group. Multivariate analysis, including potential covariates showed adult ADHD and age to have the most robust and consistent positive effect for age (i.e., higher QoL) and negative effect for ADHD (i.e., lower QoL) on QoL measures. CONCLUSIONS Adult ADHD is associated with worse QoL measures in high-dose BZD/Z-drug users. Future studies should explore whether appropriate BZD/Z-drug detoxification might improve QoL measures and whether the most appropriate detoxification protocol differs in ADHD+ versus ADHD- populations.
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Affiliation(s)
- Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Anna Bertoldi
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Rebecca Casari
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Morbioli
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,
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17
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Efficacy of Electroacupuncture Combined with Methadone Maintenance Therapy: A Case-Control Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:7032581. [PMID: 31467578 PMCID: PMC6699302 DOI: 10.1155/2019/7032581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/09/2019] [Indexed: 01/22/2023]
Abstract
High compliance with methadone maintenance therapy (MMT) is crucial to successful opioid abstinence in addicts. However, MMT has numerous side effects, including reductions in quality of life and quality of sleep. Many studies have demonstrated that electroacupuncture relieves withdrawal symptoms in opioid addicts. The present study was a case-control study. From January 2015 to September 2016, 106 patients undergoing MMT at a medical center in central Taiwan were recruited and separated into an electroacupuncture treatment group and a control group. Electroacupuncture was performed for 15 minutes twice weekly for 4 weeks. The electroacupuncture treatment group was discovered to have improved quality of life, especially in terms of vitality and mental health. Although electroacupuncture did not significantly improve sleep quality, we found that sleep quality was significantly improved once methadone dosage had been reduced. Electroacupuncture can improve quality of life in patients undergoing MMT. If methadone dosage can be reduced and electroacupuncture can be employed, both sleep and life quality can be improved.
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18
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Morin KA, Eibl JK, Caswell JM, Gauthier G, Rush B, Mushquash C, Lightfoot NE, Marsh DC. Concurrent psychiatry for patients enrolled in opioid agonist treatment: a propensity score matched cohort study in Ontario Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:29. [PMID: 31242949 PMCID: PMC6595572 DOI: 10.1186/s13011-019-0213-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/21/2019] [Indexed: 11/10/2022]
Abstract
Objective The objective was to characterize the relationship between geography, concurrent psychiatric services, all-cause mortality, and acute health care use for individuals enrolled in Opioid Agonist Treatment, in Ontario, Canada. Methods We conducted a propensity score matching study of patients enrolled in Opioid Agonist Treatment in Ontario for the first time between January 1, 2011, and December 31, 2015. We first compared outcomes between patients who were actively engaged and patients who were not actively engaged in Opioid Agonist Treatment. We created treatment and a control groups on the basis of an individual’s access to psychiatric care within an episode of Opioid Agonist Treatment. Relative risk and number needed to treat were calculated to determine the correlation between psychiatric care and health outcomes among patients enrolled in Opioid Agonist Treatment at two time points within an episode of care and for two geographic regions in Ontario (north and south). Results During the first year of Opioid Agonist Treatment, concurrent psychiatric care was associated with a reduction in all-cause mortality in southern Ontario (RR 0.80, 95% CI, 0.73–0.87), a reduction in emergency department visits in both northern and southern Ontario (north: RR = 0.76, 95% CI, 0.72–0.81; south: RR = 0.87, 95% CI, 0.86–0.88), and a reduction in hospitalizations (north: RR = 0.88, 95% CI. 0.82–0.94, south: RR = 0.92, 95% CI, 0.91–0.93). Conclusion Our findings have significant clinical and political implications for health system planning highlighting the need for integrated mental health and addiction services for individuals with Opioid Use Disorder. Electronic supplementary material The online version of this article (10.1186/s13011-019-0213-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Joseph K Eibl
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada
| | - Joseph M Caswell
- Institute of clinical and Evaluative Sciences, Sudbury, ON, Canada
| | - Graham Gauthier
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada
| | - Brian Rush
- , Centre for Addiction and Mental Health, Toronto, Canada
| | - Christopher Mushquash
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada.,Department of Psychology, Lakehead University, Thunder Bay, Canada
| | | | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada. .,Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada.
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19
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Abstract
Our objective was to assess factors associated with the physical (Short-Form 12-physical component summary [SF-12-PCS]) and mental (Short-Form 12-mental component summary [SF-12-MCS]) quality of life (QOL) in the Lebanese population. A cross-sectional study, conducted between July and September 2017, enrolled 57 patients with substance use disorder from the Psychiatric Hospital of the Cross. The SF-12 scale was used to assess the QOL among participants. A first stepwise linear regression, using the SF-12-PCS score as the dependent variable, showed that females compared with males (β = -4.86) and having a family history of substance use disorder (β = -4.70) were associated with lower physical QOL (lower SF-12-PCS scores). A second stepwise linear regression, using the SF-12-MCS score as the dependent variable, showed that having a generalized anxiety disorder (β = -10.52) and having suicidal ideation (β = -8.05) were associated with lower mental QOL (lower SF-12-MCS scores). Strategic interventions are needed to manage the health-related QOL in those with substance abuse.
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20
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Strada L, Schmidt CS, Rosenkranz M, Verthein U, Scherbaum N, Reimer J, Schulte B. Factors associated with health-related quality of life in a large national sample of patients receiving opioid substitution treatment in Germany: A cross-sectional study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:2. [PMID: 30606188 PMCID: PMC6318871 DOI: 10.1186/s13011-018-0187-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/03/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Knowledge of health-related quality of life (HRQOL) of patients receiving opioid substitution treatment (OST) is limited and fragmented. The present study examines the HRQOL of a large national sample of OST patients in Germany and sociodemographic and clinical correlates. METHODS Cross-sectional data on the HRQOL of 2176 OST patients was compared with German general population norms. Patients were recruited from 63 OST practices across Germany. To identify correlates of HRQOL, as measured with the SF-12, we performed bi- and multivariate analyses with sociodemographic and clinical variables, including patient- and clinician-reported outcomes on physical and mental health. RESULTS Patients' HRQOL was significantly poorer than in the general population, especially their mental HRQOL. Factors associated with lower physical HRQOL were older age, longer duration of opioid dependence, hepatitis C virus infection, and HIV infection. Benzodiazepine use was associated with lower mental HRQOL, and amphetamine use with higher physical HRQOL, compared to non-use of these substances. For both mental and physical HRQOL, the factor with the strongest positive association was employment and the factors with the strongest negative associations were physical and mental health symptom severity, psychiatric diagnosis, and psychopharmacological medication. CONCLUSIONS Compared to the general population, we found substantially lower HRQOL in OST patients, especially in their mental HRQOL. OST programs can benefit from further improvement, particularly with regard to mental health services, in order to better serve their patients' needs. Clinicians may consider the use of patient-reported outcome measures to identify patients' subjective physical and psychological needs. Further research is needed to determine if employment is a cause or consequence of improved HRQOL. TRIAL REGISTRATION ClinicalTrials.gov: NCT02395198 , retrospectively registered 16/03/2015.
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Affiliation(s)
- Lisa Strada
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christiane Sybille Schmidt
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Moritz Rosenkranz
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Gesundheit Nord, Kurfürstenallee 130, 28211, Bremen, Germany
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Health Related Quality of Life in Individuals Transferred from a Needle Exchange Program and Starting Opioid Agonist Treatment. JOURNAL OF ADDICTION 2018; 2018:3025683. [PMID: 30662785 PMCID: PMC6313961 DOI: 10.1155/2018/3025683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
Abstract
Background Opioid agonist treatment (OAT), for the treatment of heroin dependence, has been reported to improve overall health and lower mortality. Drug use and retention in treatment have often been used as measures of treatment success. More recently, however, researchers have suggested that measurements of quality of life should be an outcome in substance use treatment evaluations. In a recent randomized controlled trial we demonstrated high rates of successful rapid referral from a needle exchange program (NEP) to OAT. The aim of this study was to see whether an improvement in health related quality of life (HRQoL) could be seen at 3-month follow-up after starting OAT and whether it was associated with any baseline characteristics. We also wanted to compare our sample to a sample from the general population with regard to HRQoL. Methods This was a 3-month follow-up of 71 patients who started OAT. Measurements of HRQoL with EQ-5D (an instrument developed by the EuroQol group) were made at baseline and at three months. Results Mean EQ-5D VAS (visual analogue scale) for the study sample at baseline was 47.3, which was lower than a Swedish reference population reporting 83.3. Individuals reporting being prescribed a drug for a psychiatric condition had significantly lower EQ-5D index values. Improvement in EQ-5D index score was significantly less for individuals reporting previous overdoses (-0.10, p=0.025). Individuals reporting previous suicide attempts had significantly lower EQ-5D VAS score at baseline. A significant increase of the EQ-5D VAS difference over time was found with a mean difference of 10.94 (p=0.008) for the total sample. Conclusion To our knowledge this is the first time HRQoL as an outcome is reported in a population transferred from a NEP to OAT. Our results indicate that OAT can result in increased HRQoL, even with this type of rapid low-threshold referral.
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Morin KA, Eibl JK, Franklyn AM, Marsh DC. The opioid crisis: past, present and future policy climate in Ontario, Canada. Subst Abuse Treat Prev Policy 2017; 12:45. [PMID: 29096653 PMCID: PMC5667516 DOI: 10.1186/s13011-017-0130-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/18/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Addressing opioid use disorder has become a priority in Ontario, Canada, because of its high economic, social and health burden. There continues to be stigma and criticism relating to opioid use disorder and treatment options. The result has been unsystematic, partial, reactive policies and programs developed based on divergent points of view. The aim of this manuscript is to describe how past and present understandings, narratives, ideologies and discourse of opioid use, have impacted policies over the course of the growing opioid crisis. COMMENTARY Assessing the impact of policy is complex. It involves consideration of conceptual issues of what impacts policy change. In this manuscript we argue that the development of polices and initiatives regarding opioids, opioid use disorder and opioid agonist treatment in the last decade, have been more strongly associated with the evolution of ideas, narratives and discourses rather than research relating to opioids. We formulate our argument using a framework by Sumner, Crichton, Theobald, Zulu, and Parkhurs. We use examples from the Canadian context to outline our argument such as: the anti- drug legislation from the Canadian Federal Conservative government in 2007; the removal of OxyContin™ from the drug formulary in 2012; the rapid expansion of opioid agonist treatment beginning in the early 2000s, the unilateral decision made regarding fee cuts for physicians providing opioid agonist treatment in 2015; and the most recent implementation of a narcotics monitoring system, which are all closely linked with the shifts in public opinion and discourse at the time of which these policies and programs are implemented. CONCLUSION We conclude with recommendations to consider a multifactorial response using evidence and stakeholder engagement to address the opioid crisis, rather than a reactive policy approach. We suggest that researchers have an important role in shaping future policy by reframing ideas through knowledge translation, formation of values, creation of new knowledge and adding to the quality of public discourse and debate.
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Affiliation(s)
| | - Joseph K Eibl
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada
| | | | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada.
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada.
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Daigre C, Grau-López L, Rodríguez-Cintas L, Ros-Cucurull E, Sorribes-Puertas M, Esculies O, Bones-Rocha K, Roncero C. The role of dual diagnosis in health-related quality of life among treatment-seeking patients in Spain. Qual Life Res 2017; 26:3201-3209. [PMID: 28786018 DOI: 10.1007/s11136-017-1668-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE The comorbidity of any substance use disorder and another mental disorder is defined as dual diagnosis. Dual diagnosis is very common and clinical and therapeutic consequences have been described. This cross-sectional study aimed to analyse health-related quality of life (HRQoL) according to clinical characteristics and psychiatric comorbidities in patients with substance dependence. METHODS A total of 1276 substance-dependent patients seeking treatment were recruited. HRQoL was evaluated by the Short-Form 36 (SF-36) questionnaire. The SCID-I, SCID-II and Conners' adult ADHD diagnostic interview were used to evaluate dual diagnosis. A visual analogue scale was used to measure craving. Bivariate and multivariate analyses were performed, and correction for multiple tests was conducted. RESULTS Substance-dependent patients had impaired quality of life, especially in the mental component. SF-36 physical and mental component scores were 47.7 ± 10.9 and 36.1 ± 14.1, respectively. Furthermore, 65% of the patients had dual diagnosis, 51% had an Axis I DSM-IV-TR mental disorder and 35% had some personality disorder. Impaired physical quality of life was independently associated with medical condition, age, being female, depressive disorder and anxiety disorder. Depression disorder, any personality disorder, active consumption last month, Attention deficit hyperactivity disorder, anxiety disorder, suicide attempt were independently associated with worse mental quality of life. CONCLUSION These findings emphasize the significance of dual diagnosis in the impairment of HRQoL in substance-dependent patients, particularly with regard to mental component. In addicted patients with low scores on SF-36, psychiatric comorbidity should be evaluated and treated in an integrated approach.
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Affiliation(s)
- Constanza Daigre
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain.
| | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
| | - Elena Ros-Cucurull
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
| | - Marta Sorribes-Puertas
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
| | | | - Katia Bones-Rocha
- Faculty of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlos Roncero
- Addiction and Dual Diagnosis Unit, Psychiatry Deparment, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Agencia de Salud Pública de Barcelona, CIBERSAM, Barcelona, Spain
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Frem Y, Torrens M, Domingo-Salvany A, Gilchrist G. Gender differences in lifetime psychiatric and substance use disorders among people who use substances in Barcelona, Spain. ADVANCES IN DUAL DIAGNOSIS 2017. [DOI: 10.1108/add-01-2017-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine gender differences in lifetime substance use and non-substance use (non-SUD) psychiatric disorders among illicit drug users and determine factors associated with non-SUD psychiatric disorders independently for males and for females.
Design/methodology/approach
Secondary analysis of five cross-sectional studies conducted in Barcelona, Spain during 2000-2006. Lifetime DSM-IV substance use and non-SUD psychiatric diagnoses were assessed using the Spanish Psychiatric Research Interview for Substance and Mental disorders (PRISM) among 629 people who use substances (68 per cent male) recruited from treatment (n=304) and out of treatment (n=325) settings. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using binary logistic regression.
Findings
The prevalence of any lifetime psychiatric (non-SUD) disorder was 41.8 per cent, with major depression (17 per cent) and antisocial personality disorder (17 per cent) being the most prevalent disorders. After adjusting for age and study, the odds of having any lifetime non-SUD (OR 2.10; 95%CI 1.48, 2.96); any mood disorder (OR 2.13; 95%CI 1.46, 3.11); any anxiety disorder (OR 1.86; 95%CI 1.19; 2.92); any eating disorder (OR 3.09; 95%CI 1.47, 6.47); or borderline personality disorder (OR 2.30; 95%CI 1.36, 3.84) were greater for females than males. Females were less likely than males to meet criteria for antisocial personality disorder (OR 0.59; 95%CI 0.36, 0.96) and attention deficit disorder (OR 0.37; 95%CI 0.17, 0.78).
Research limitations/implications
Psychiatric disorders are common among people who use substances, with gender differences reported for specific disorders. Gender-sensitive integrated treatment approaches are required to prevent and to address comorbidity psychiatric disorders among this population.
Originality/value
This secondary analysis of five cross-sectional studies included a large sample size allowing sufficient power to examine the differences between men and women. An additional strength of the methodology is the use of the gold standard PRISM which was used to assess disorders.
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Bray JW, Aden B, Eggman AA, Hellerstein L, Wittenberg E, Nosyk B, Stribling JC, Schackman BR. Quality of life as an outcome of opioid use disorder treatment: A systematic review. J Subst Abuse Treat 2017; 76:88-93. [PMID: 28190543 PMCID: PMC5402314 DOI: 10.1016/j.jsat.2017.01.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The recent opioid epidemic has prompted renewed interest in opioid use disorder treatment, but there is little evidence regarding health-related quality-of-life (HRQoL) outcomes in treatment programs. Measuring HRQoL represents an opportunity to consider outcomes of opioid use disorder treatment that are more patient-centered and more relevant to overall health than abstinence alone. We conducted a systematic literature review to explore the extent to which the collection of HRQoL by opioid treatment programs is documented in the treatment program literature. MATERIALS AND METHODS We searched PubMed, Embase PsycINFO and Web of Science for papers published between 1965 and 2015 that reported HRQoL outcome measures from substance abuse treatment programs. RESULTS Of the 3014 unduplicated articles initially identified for screening, 99 articles met criteria for further review. Of those articles, 7 were unavailable in English; therefore 92 articles were reviewed. Of these articles, 44 included any quality-of-life measure, 17 of which included validated HRQoL measures, and 10 supported derivation of quality-adjusted life year utility weights. The most frequently used validated measure was the Addiction Severity Index (ASI). Non-U.S. and more recent studies were more likely to include a measure of HRQoL. CONCLUSIONS HRQoL measures are rarely used as outcomes in opioid treatment programs. The field should incorporate HRQoL measures as standard practice, especially measures that can be used to derive utility weights, such as the SF-12 or EQ-5D. These instruments provide policy makers with evidence on the impact of programs on patients' lives and with data to quantify the value of investing in opioid use disorder treatments.
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Affiliation(s)
- Jeremy W Bray
- Department of Economics, The University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC 27402, United States.
| | - Brandon Aden
- Department of Medicine, Weill Cornell Medical College, 409 E 60th Street, New York, NY 10022, United States; Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Ashley A Eggman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Leah Hellerstein
- Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA 02115, United States.
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, B.C. V5A 1S6, Canada.
| | - Judy C Stribling
- Samuel J. Wood Library, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States.
| | - Bruce R Schackman
- Department of Medicine, Weill Cornell Medical College, 409 E 60th Street, New York, NY 10022, United States; Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
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Tamburin S, Federico A, Faccini M, Casari R, Morbioli L, Sartore V, Mirijello A, Addolorato G, Lugoboni F. Determinants of Quality of Life in High-Dose Benzodiazepine Misusers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010038. [PMID: 28054975 PMCID: PMC5295289 DOI: 10.3390/ijerph14010038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/20/2016] [Accepted: 12/29/2016] [Indexed: 02/04/2023]
Abstract
Benzodiazepines (BZDs) are among the most widely prescribed drugs in developed countries, but they have a high potential for tolerance, dependence and misuse. High-dose BZD misuse represents an emerging addiction phenomenon, but data on quality of life (QoL) in high-dose BZD misusers are scant. This study aimed to explore QoL in high-dose BZD misuse. We recruited 267 high-dose BZD misusers, compared the QoL scores in those who took BZD only to poly-drug misusers, and explored the role of demographic and clinical covariates through multivariable analysis. Our data confirmed worse QoL in high-dose BZD misusers and showed that (a) QoL scores were not negatively influenced by the misuse of alcohol or other drugs, or by coexisting psychiatric disorders; (b) demographic variables turned out to be the most significant predictors of QoL scores; (c) BZD intake significantly and negatively influenced QoL. Physical and psychological dimensions of QoL are significantly lower in high-dose BZD misusers with no significant effect of comorbidities. Our data suggest that the main reason for poor QoL in these patients is high-dose BZD intake per se. QoL should be considered among outcome measures in these patients.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, Verona 37134, Italy.
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, Verona 37134, Italy.
| | - Marco Faccini
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Rebecca Casari
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Laura Morbioli
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Valentina Sartore
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Antonio Mirijello
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Rome 00168, Italy.
| | - Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Rome 00168, Italy.
| | - Fabio Lugoboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
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Bourion-Bédès S, Schwan R, Di Patrizio P, Vlamynck G, Viennet S, Schvartz M, Gaunard A, Bédès A, Clerc-Urmès I, Baumann C. The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study. Patient Prefer Adherence 2017; 11:887-896. [PMID: 28507432 PMCID: PMC5428790 DOI: 10.2147/ppa.s134242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence. METHODS Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level. RESULTS A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (β=7.2; P=0.029) and with the doctor consultation (β=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction. CONCLUSION The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.
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Affiliation(s)
- Stéphanie Bourion-Bédès
- Regional Medical and Psychological Service (SMPR)
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
- EA4360 APEMAC, University of Lorraine, Nancy
- Correspondence: Stéphanie Bourion-Bédès, Service Médico-Psychologique Régional, 1 Rue Seulhotte, 57 073 Metz, France, Tel +33 3 87 38 51 05, Fax +33 3 87 38 51 09, Email
| | - Raymund Schwan
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Paolo Di Patrizio
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Guillaume Vlamynck
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Sarah Viennet
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Maxime Schvartz
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Anne Gaunard
- CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy
| | - Alex Bédès
- ANPAA 15-CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), Saint-Flour, Cantal
| | - Isabelle Clerc-Urmès
- Platform of Clinical Research Facility PARC, Unit MDS, University Hospital of Nancy, Nancy, France
| | - Cédric Baumann
- EA4360 APEMAC, University of Lorraine, Nancy
- Platform of Clinical Research Facility PARC, Unit MDS, University Hospital of Nancy, Nancy, France
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Biernacki K, McLennan SN, Terrett G, Labuschagne I, Rendell PG. Decision-making ability in current and past users of opiates: A meta-analysis. Neurosci Biobehav Rev 2016; 71:342-351. [DOI: 10.1016/j.neubiorev.2016.09.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/04/2016] [Accepted: 09/15/2016] [Indexed: 02/06/2023]
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Roncero C, Barral C, Rodríguez-Cintas L, Pérez-Pazos J, Martinez-Luna N, Casas M, Torrens M, Grau-López L. Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study. Psychiatry Res 2016; 243:174-81. [PMID: 27416536 DOI: 10.1016/j.psychres.2016.06.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 12/31/2022]
Abstract
Opioid-dependent patients show a high rate of psychiatric comorbidities. The prevalence and characteristics of patients with dual diagnosis have not been well established in Spanish opioid agonist treatment (OAT) programmes. Thus, 621 opioid-dependent patients enrolled in OAT programmes were assessed, using the EuropASI questionnaire, for psychiatric comorbidities, which were detected in 67% of patients (anxiety 53%, mood disorders 48%, sleep disorders 41%, substance-related disorders 36%). In addition, compared with patients without a dual diagnosis, patients with dual pathology were significantly older, used benzodiazepines and cannabis in significantly greater percentages, and showed significantly more frequent infectious and non-infectious comorbidities, worse overall working status, a lower proportion of drivers and higher levels of severity regarding medical, employment, alcohol, legal, family and psychological issues. Therefore, the data showed a very high prevalence of psychiatric comorbidity in opioid-dependent patients receiving OAT in Spain and several problems frequently associated with patients with dual diagnosis. Physicians treating opioid-dependent patients should be aware of these facts to correctly identify and manage patients with a dual diagnosis.
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Affiliation(s)
- Carlos Roncero
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Carmen Barral
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Pérez-Pazos
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nieves Martinez-Luna
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Casas
- Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torrens
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institute of Neuropsychiatry and Addiction, Hospital del Mar, Barcelona, Spain
| | - Lara Grau-López
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vergara-Moragues E, Mestre-Pintó JI, Gómez PA, Rodríguez-Fonseca F, Torrens M, González-Saiz F. Can symptoms help in differential diagnosis between substance-induced vs independent psychosis in adults with a lifetime diagnosis of cocaine use disorder? Psychiatry Res 2016; 242:94-100. [PMID: 27267440 DOI: 10.1016/j.psychres.2016.05.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/12/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
The main goal of this study it is explore the psychopathological differences between IPD and SIPD in a sample of 125 adults with a lifetime diagnosis of cocaine disorder recruited from treatment setting and through street contacts. A secondary analysis of six cross-sectional studies was conducted between 2000 and 2010. SIPD and IPD were diagnosed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). 38 subjects (30.4%) were diagnosed with lifetime IPD and 87 (69.6%) with lifetime SIPD. A binomial logistic regression analysis using SIPD as the reference group showed that only previous prison admissions (OR 2.59; 95% CI 1.05, 6.36) and visual hallucinations (OR 5.21; 95% CI 1.54, 17.65) remained significant variables in the group with lifetime SIPD. In the group with lifetime IPD, grandiose delusions (OR 0.19; 95% CI 0.06, 0.60) and disorganized speech (OR 0.16; 95% CI 0.04, 0.61) remained significant. Model predicts the diagnosis of lifetime SIPD with a sensitivity of 80.3% and a specificity of 78.2%. This clinical profile of lifetime SIPD could help distinguish between IPD and SIPD among adults with lifetime diagnosis of cocaine disorder.
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Affiliation(s)
- Esperanza Vergara-Moragues
- Department of Education and Psychobiology, Universidad Internacional de la Rioja (UNIR). Gran Vía Rey Juan Carlos I, 41, 26002 Logroño, La Rioja, Spain; Red de Trastornos Adictivos, Grupo de Investigación en Neurociencias Traslacional en Adicciones (GRINTA), Universidad de Granada, Spain
| | - Joan I Mestre-Pintó
- Institut Hospital del Mar d'Investigacions Mèdiques, Parc de Salut Mar, Passeig Maritim, 25-29, 08003, Barcelona, Spain; Institut de Neuropsiquiatria i Addictions, Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Maritim, 25-29, 08003, Barcelona, Spain
| | - Pedro Araos Gómez
- FIMABIS, Mental Health Clinical Management Unit, Hospital Carlos Haya, Avda Carlos Haya 82, Pabellón de Gobierno Sótano, 29010 Málaga, Spain
| | - Fernando Rodríguez-Fonseca
- FIMABIS, Mental Health Clinical Management Unit, Hospital Carlos Haya, Avda Carlos Haya 82, Pabellón de Gobierno Sótano, 29010 Málaga, Spain
| | - Marta Torrens
- Institut Hospital del Mar d'Investigacions Mèdiques, Parc de Salut Mar, Passeig Maritim, 25-29, 08003, Barcelona, Spain; Institut de Neuropsiquiatria i Addictions, Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Maritim, 25-29, 08003, Barcelona, Spain
| | - Francisco González-Saiz
- Red de Trastornos Adictivos, Grupo de Investigación en Neurociencias Traslacional en Adicciones (GRINTA), Universidad de Granada, Spain; Community Mental Health Unit of Villamartin, Jerez Hospital, Andalusian Health Service, Avda Feria 58 Villamartin, 11650 Cádiz, Spain.
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Krebs E, Kerr T, Wood E, Nosyk B. Characterizing Long-Term Health Related Quality of Life Trajectories of Individuals With Opioid Use Disorder. J Subst Abuse Treat 2016; 67:30-7. [PMID: 27296659 DOI: 10.1016/j.jsat.2016.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/30/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Health related quality of life (HRQoL) has been increasingly considered an endpoint in evaluations of treatment for substance use disorders. We aimed to characterize longitudinal patterns of HRQoL in individuals with opioid use disorder (OUD) and with a history of opioid agonist treatment (OAT) with methadone. METHODS The EuroQol EQ-5D, a preference-weighted measure of HRQoL, was assessed in individuals with OUD and with a history of OAT enrolled in three prospective cohort studies between December 2011 and May 2014, with a maximum of five biannual assessments. We used latent class growth analysis to identify HRQoL trajectory classes and their association with self-reported current OAT receipt. Class assignment was derived from posterior probabilities and we explored time-invariant and time-varying determinants of trajectory class membership. RESULTS Our study included 443 individuals (median age 47, 37% female); 24.6% reported use of illicit opioids at every follow-up, 69.1% during at least one follow-up. We identified three latent HRQoL trajectory classes that were stable regardless of current OAT receipt: stably high (n=107, 24.2%), stably moderate (n=260, 58.7%) and stably low HRQoL (n=76, 17.2%). A history of either a physical disability or of a mental health illness increased the probability of membership assignment to a lower HRQoL class. CONCLUSIONS The non-significant association of OAT with HRQoL may suggest that the modest immediate HRQoL gains after OAT engagement, observed in short-term studies, may not persist over time. Implications for cost-effectiveness analysis and clinical practice are discussed.
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Affiliation(s)
- Emanuel Krebs
- BC Centre for Excellence in HIV/AIDS; Vancouver, British Columbia, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS; Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS; Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS; Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.
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Lozano ÓM, Rojas AJ, Fernández Calderón F. Psychiatric comorbidity and severity of dependence on substance users: how it impacts on their health-related quality of life? J Ment Health 2016; 26:119-126. [PMID: 27128492 DOI: 10.1080/09638237.2016.1177771] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the impact of psychiatric comorbidity and severity of dependence on health-related quality of life (HRQoL). METHODS One hundred and ninety-eight substance use disorder (SUD) patients were recruited from an outpatient center that provides treatment for SUD. The International Personality Disorder Examination Screening Questionnaire (IPDE-SQ), Mini International Neuropsychiatric Interview (MINI), Substance Dependence Severity Scale (SDSS) and Health-Related Quality of Life for Drug Abusers test (HRQoLDA test) were administered. RESULTS Patients with psychiatric comorbidity evaluated their HRQoL more negatively than patients without psychiatric comorbidity. An analysis of the relationship between severity of dependence and HRQoL scores indicated significant correlations among alcohol-, cocaine-, heroin- and cannabis-dependent patients. According to multivariate analyses, anxiety disorders, mood disorders, severity of dependence on alcohol, cannabis, cocaine, paranoid, borderline and avoidant personality disorders (PDs) were observed to have a major impact on HRQoL. CONCLUSIONS SUD (severity of dependence on alcohol, cannabis and cocaine) and other mental disorders (anxiety disorders; mood disorders; paranoid, borderline and avoidant PDs) are involved in the deterioration of the SUD patients' HRQoL. This study demonstrates the need for integrated treatment for SUD patients. Treating only a part of the problem (whether SUD or other mental disorders are present) is insufficient for improving quality of life.
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Affiliation(s)
- Óscar M Lozano
- a Department of Social , Experimental and Clinical Psychology, University of Huelva , Avda. Fuerzas Armadas, Huelva , Spain and
| | - Antonio J Rojas
- b Department of Psychology , University of Almería , La Cañada de San Urbano, Almería , Spain
| | - Fermín Fernández Calderón
- a Department of Social , Experimental and Clinical Psychology, University of Huelva , Avda. Fuerzas Armadas, Huelva , Spain and
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Temperament and character dimensions in male patients with substance use disorders: Differences relating to psychiatric comorbidity. Psychiatry Res 2016; 237:1-8. [PMID: 26921044 DOI: 10.1016/j.psychres.2016.01.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 11/22/2022]
Abstract
Previous research has not considered the influence of the Comorbid Mental Disorder (CMD) among Substance Use Disorders (SUD) patients. We explored the possible differences in personality dimensions among SUD patients taking into account their CMD (Schizophrenia, SZ; Bipolar Disorder, BD; Major Depressive Disorder, MDD); and elucidated clinical factors related to personality dimensions according to the CMD. The Temperament and Character Inventory Revised was used to assess a sample of 102 SUD male patients, considered in three groups according to their CMD: SUD+SZ (N=37), SUD+BD (N=30) and SUD+MDD (N=35). SUD+BD patients had the highest levels of Novelty Seeking and Persistence, SUD+SZ patients showed the highest levels of Harm Avoidance, and SUD+MDD patients reported a lower level of Self-transcendence. Novelty Seeking was positively associated with severity of addiction for SUD+BD; Harm Avoidance was positively associated with psychiatric symptoms for SUD+SZ; and the age of SUD onset was positively linked to Cooperativeness for SUD+BD and to Self-transcendence for SUD+MDD. The different personality characteristics associated to the type of CMD among SUD patients are related to several clinical variables. Interventions in these patients should be tailored according the personality traits that could influence treatment outcomes and patients' prognoses.
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Fiumana V, Zamboni L, Mazza M, Janiri L, Cibin M, GICS , Lugoboni F. Quality of Life in Heroin Users Attending Substitution Treatment: A Multicenter Study in Italy. Health (London) 2016. [DOI: 10.4236/health.2016.812123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nosyk B, Bray JW, Wittenberg E, Aden B, Eggman AA, Weiss RD, Potter J, Ang A, Y-I H, Ling W, Schackman BR. Short term health-related quality of life improvement during opioid agonist treatment. Drug Alcohol Depend 2015; 157:121-8. [PMID: 26511766 PMCID: PMC4778423 DOI: 10.1016/j.drugalcdep.2015.10.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Opioid dependence is associated with high levels of morbidity, yet sparse data exists regarding the health-related quality of life (HRQoL) of individuals with opioid dependence, particularly following treatment initiation. To inform cost-effectiveness analyses of treatment modalities, this study investigates short-term changes in HRQoL following enrollment into opioid agonist treatment (OAT), across treatment modalities and patient subgroups. METHODS Data was analyzed from the Starting Treatment with Agonist Replacement Therapies (START) and Prescription Opioid Addiction Treatment Studies (POATS) randomized controlled trials. Participants included individuals dependent on prescription opioids (POs) or heroin, receiving limited-term or time-unlimited treatment. PO- or heroin-users in START received buprenorphine/naloxone (BUP/NX) or methadone (MET) over 24 weeks. PO-users in POATS received psychosocial care and short-term (4-week) taper with BUP/NX, with non-responders offered subsequent extended (12-week) stabilization and taper. HRQoL was assessed using the short-form SF-6D while in and out of OAT, with distinction between MMT and BUP/NX in START. Linear mixed effects regression models were fitted to determine the independent effects of OAT on HRQoL and characterize HRQoL trajectories. RESULTS Treatment had a similar immediate and modest positive association with HRQoL in each patient subgroup. The association of OAT on HRQoL was statistically significant in each model, with effect sizes between 0.039 (heroin-users receiving BUP/NX) and 0.071 (PO-users receiving MET). After initial improvement, HRQoL decreased slightly, or increased at a diminished rate. CONCLUSIONS OAT, whether delivered in time-limited or unlimited form, using BUP/NX or MET, is associated with modest immediate HRQoL improvements, with diminishing benefits thereafter.
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Affiliation(s)
- B Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - JW Bray
- University of North Carolina, Greensboro,Research Triangle International
| | | | - B Aden
- Department of Healthcare Policy and Research, Weill Cornell Medical College
| | - AA Eggman
- Department of Healthcare Policy and Research, Weill Cornell Medical College
| | - RD Weiss
- Harvard Medical School, Boston, MA,McLean Hospital, Belmont, MA
| | - J Potter
- Departments of Psychiatry and Anesthesiology (Pain Medicine), Faculty of Medicine, University of Texas Health Science Center, San Antonio, TX
| | - A Ang
- UCLA Integrated Substance Abuse Programs, Los Angeles CA
| | - Hser Y-I
- UCLA Integrated Substance Abuse Programs, Los Angeles CA
| | - W Ling
- UCLA Integrated Substance Abuse Programs, Los Angeles CA
| | - BR Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College
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Ramos-Quiroga JA, Díaz-Digon L, Comín M, Bosch R, Palomar G, Chalita JP, Roncero C, Nogueira M, Torrens M, Casas M. Criteria and Concurrent Validity of Adult ADHD Section of the Psychiatry Research Interview for Substance and Mental Disorders. J Atten Disord 2015; 19:999-1006. [PMID: 22915013 DOI: 10.1177/1087054712454191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Prevalence of ADHD in adults is around 2% to 4%. Comorbidity is frequent in ADHD; 75% of patients develop a comorbid disorder across life span, substance use disorder (SUD) being one of the most prevalent. METHOD A case-control study was performed to check the criteria and concurrent validity of psychiatric research interview for substance and mental disorders (PRISM) adult ADHD section. Validation was done comparing PRISM with the Conners' Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). A convenient sample (N = 80) participated, 40 had diagnosis of SUD and ADHD and 40 had diagnosis of SUD without ADHD. The statistics hypothesis was bivariant, and the confidence level was 95%. RESULTS Kappa index concordance was .78, sensitivity of PRISM adult ADHD module was 90%, specificity was 87.5%, positive predictive value was 87.8%, and the negative predictive value was 89.7%. CONCLUSION PRISM has good psychometric properties to detect ADHD associated with SUD.
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Affiliation(s)
- Josep Antoni Ramos-Quiroga
- Servei de Psiquiatria. Hospital Universitari Vall d'Hebron, Barcelona, Spain Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain Departament de Psiquiatria i Medicina Legal. Universitat Autònoma de Barcelona, Spain
| | - Laura Díaz-Digon
- Institut de Neuropsiquiatria i Addiccions, Centre Fòrum, Barcelona, Spain IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
| | - Marina Comín
- Servei de Psiquiatria. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rosa Bosch
- Servei de Psiquiatria. Hospital Universitari Vall d'Hebron, Barcelona, Spain Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain Departament de Psiquiatria i Medicina Legal. Universitat Autònoma de Barcelona, Spain
| | - Gloria Palomar
- Servei de Psiquiatria. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Pablo Chalita
- Servei de Psiquiatria. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Roncero
- Servei de Psiquiatria. Hospital Universitari Vall d'Hebron, Barcelona, Spain Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain Departament de Psiquiatria i Medicina Legal. Universitat Autònoma de Barcelona, Spain
| | - Mariana Nogueira
- Servei de Psiquiatria. Hospital Universitari Vall d'Hebron, Barcelona, Spain Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain Departament de Psiquiatria i Medicina Legal. Universitat Autònoma de Barcelona, Spain
| | - Marta Torrens
- Departament de Psiquiatria i Medicina Legal. Universitat Autònoma de Barcelona, Spain IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Miguel Casas
- Servei de Psiquiatria. Hospital Universitari Vall d'Hebron, Barcelona, Spain Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain Departament de Psiquiatria i Medicina Legal. Universitat Autònoma de Barcelona, Spain
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Chang KC, Lin CY. Effects of publicly funded and quality of life on attendance rate among methadone maintenance treatment patients in Taiwan: an 18-month follow-up study. Harm Reduct J 2015; 12:40. [PMID: 26471342 PMCID: PMC4608217 DOI: 10.1186/s12954-015-0076-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/07/2015] [Indexed: 02/06/2023] Open
Abstract
Background Methadone maintenance treatment programs (MMTPs) are important public health intervention to control the human immunodeficiency virus (HIV) and the drug use problems. For expanding treatment coverage, publicly funded programs may be necessary for heroin users with low socio-economic status. We evaluated the difference of demographics, clinical features, and quality of life (QoL) of heroin users enrolled in publicly funded and self-paid MMTP and explored determinants influencing their attendance rate, respectively, for these two groups. Methods A total of 234 heroin users enrolled in MMTP (129 in publicly funded and 105 in self-paid) between 2006 and 2008 self-reported the Taiwan version of the World Health Organization Quality of Life Instrument, Brief Version (WHOQOL-BREF) at baseline. Data regarding demographic and clinical features were collected during baseline interview. Methadone per 3-month attendance rates up to 18 months were conducted for each participant beginning from the index date. Results Self-paid group had a better QoL but lower treatment adherence than did the publicly funded group. Male and living alone were positive predictors on attendance rate for publicly funded group, and age of first heroin use and hepatitis C virus (HCV) seropositive were negative predictors. However, predictors on attendance rate for self-paid group were different from publicly funded group: HCV seropositive was a positive predictor and social QoL was a negative predictor. Conclusions Findings of this study should be concerned with modifying original funding eligibility. Additional measures to explore what could impede treatment adherence are needed.
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Affiliation(s)
- Kun-Chia Chang
- Department of General Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 70101, Taiwan
| | - Chung-Ying Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 70101, Taiwan.
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Lin CY, Chang KC, Wang JD, Lee LJH. Quality of life and its determinants for heroin addicts receiving a methadone maintenance program: Comparison with matched referents from the general population. J Formos Med Assoc 2015; 115:714-27. [PMID: 26422442 DOI: 10.1016/j.jfma.2015.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/03/2015] [Accepted: 07/05/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND/PURPOSE Quality of life (QoL) is found to be lower in heroin addicts; however, few studies examine detailed QoL performance and related factors in heroin patients attending a methadone maintenance treatment program (MMTP). The study thus aimed to explore QoL and its determinants for publicly-funded and self-paid patients attending an MMTP. METHODS Participants were recruited in Jianan Psychiatric Center, Tainan, Taiwan, during their first clinic visit for the MMTP. Age-, sex-, education-, and municipality-matched referents were collected from the 2001 Taiwan National Health Interview Survey database. The participants had a mean age of 38.29 years [standard deviation (SD) = 7.65 years] for publicly-funded (n = 129) and 37.97 years (SD = 7.16 years) for self-paid (n = 105) MMTP patients. Matched referents (n = 217) were 37.74 years (SD = 7.44 years). All participants were measured with the brief version of the World Health Organization's Quality of Life (WHOQOL-BREF) assessment. MMTP patients additionally went through tests for the hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV). RESULTS Both publicly-funded and self-paid MMTP patients had lower QoL scores than their matched counterparts in the physical and psychological domains (p < 0.05) after control for confounding by age, sex, education, and municipality. Detailed individual item analyses showed that publicly-funded MMTP patients had lower scores for almost all items related to the physical, psychological, and social domains as compared to the referents because of HIV infection (p < 0.05). CONCLUSION To improve the QoL of heroin users coming for MMTP, we recommend that clinicians pay attention to the comorbidity of HIV infection and individual items/facets.
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Affiliation(s)
- Chung-Ying Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kun-Chia Chang
- Department of General Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Lukas Jyuhn-Hsiarn Lee
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Griffin ML, Bennett HE, Fitzmaurice GM, Hill KP, Provost SE, Weiss RD. Health-related quality of life among prescription opioid-dependent patients: Results from a multi-site study. Am J Addict 2015; 24:308-14. [PMID: 25808055 DOI: 10.1111/ajad.12188] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/07/2014] [Accepted: 12/04/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although prescription opioid use disorder has recently increased sharply in the United States, relatively little is known about the general well-being of this population. Assessment of quality of life in patients with substance use disorders has been recommended to improve clinical care. OBJECTIVES Health-related quality of life was examined in prescription opioid-dependent patients at entry to a national multi-site clinical trial, to compare quality of life scores in the study sample to other populations; further, background variables associated with quality of life in the literature were examined. METHODS Prescription opioid-dependent patients (N = 653) were compared to general populations on the Medical Outcome Study Short Form-36 (SF-36) quality of life measure; and the association between patient background variables and quality of life was examined. RESULTS Compared to a general population, the current sample of prescription opioid-dependent patients had worse physical (-1.7 points, p < .001) and mental quality of life (-12.3 points, p < .001) as measured by the SF-36, similar to other opioid-use disorder populations. Within our sample, women showed more impairment than men in mental quality of life (-4.3 points, p < .001); older patients scored worse on physical (-5.2 points, p < .001), but not mental, quality of life. Chronic pain was associated with poorer physical quality of life (-9.0 points, p < .001). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The growing focus on wellness underscores the importance of measuring quality of life in addition to substance use outcomes. Routine assessment of health-related quality of life can add an important dimension to overall evaluation of patients' treatment response.
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Affiliation(s)
- Margaret L Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Comorbid Psychopathology and Alcohol Use Patterns among Methadone Maintenance Treatment Patients. JOURNAL OF ADDICTION 2015; 2015:197652. [PMID: 25878919 PMCID: PMC4386644 DOI: 10.1155/2015/197652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/27/2015] [Accepted: 03/08/2015] [Indexed: 11/23/2022]
Abstract
130 patients from a methadone maintenance treatment program agreed to complete Symptoms Checklist 90-Revised (SCL-90R) and Alcohol Use Disorders Identification Test (AUDIT) self-report scales. Scores higher than the proposed cut-score on SCL-90R scale were observed on depression, obsessions-compulsions, paranoid ideation, anxiety, anger-hostility, somatization, interpersonal sensitivity, and psychoticism subscales. In sum, 42.9% of our sample exhibited depressive symptomatology, 34.9% obsessive-compulsive symptoms, 29.1% somatization, 27.2% anxiety symptoms, 22.2% paranoid ideation, 19% phobic anxiety, 15.1% psychoticism, and 15.1% hostility and 11.9% presented with symptoms of interpersonal sensitivity. Mean score on AUDIT scale was 6.9 ± 7.9. 63.0% of our participants scored below cut-off and were classified as having a low level of alcohol-related problems; 24.4% scored in the range of 8–15 which is an indication of alcohol abuse whereas 12.6% scored 16 and above indicative of serious abuse/addiction. Scores on AUDIT scale were positively correlated with length of time on methadone treatment, but not with length of time on drug use or age of our participants. Positive correlations were observed among AUDIT and SCL-90R scores, namely, with global severity index score, positive symptom distress index, positive symptom total, and all primary symptom dimensions subscales except phobic anxiety.
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Chahua M, Sánchez-Niubò A, Torrens M, Sordo L, Bravo MJ, Brugal MT, Domingo-Salvany A. Quality of life in a community sample of young cocaine and/or heroin users: the role of mental disorders. Qual Life Res 2015; 24:2129-37. [PMID: 25682367 DOI: 10.1007/s11136-015-0943-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Drug addiction and psychiatric disorders are frequently concomitant; however, few studies have investigated the impact of psychiatric disorders other than substance use disorder (SUD) on health-related quality of life (HRQoL) in drug users not in treatment. We studied the association of psychiatric disorders other than SUD with HRQoL in a street-recruited sample of cocaine and/or heroin users. METHODS It is a cross-sectional study involving 287 young users of cocaine and/or heroin in Barcelona, Spain. HRQoL was assessed with the Nottingham health profile (NHP). Patterns of drug use and mental disorders were assessed using the Spanish version of the psychiatric research interview for substance and mental disorders IV, and degree of dependence through the severity of dependence scale (SDS). The association of mental disorders with HRQoL was assessed through a Tobit regression analysis. RESULTS The overall NHP score was 23.9 (SD = 20.5, range 0-91.7). Sixty-one percent of the sample had two or more SUDs; 22 % had at least one non-SUD Axis I disorder (anxiety, mood, psychotic, or eating disorder); and 27.2 % had a borderline personality disorder (BPD) and/or antisocial personality disorder. Variables negatively associated with the global NHP score were psychosis [transformed beta coefficient: 15.23; 95 % confidence interval [CI] 4.48-25.97], BPD (9.55; 95 % CI 2.95-16.15), severity of dependence (8.12; 95 % CI 3.37-12.87), having two or more SUDs (for two or three SUDs: 6.83; 95 % CI 2.08-11.59) (>3 SUDs: 7.70; 95 % CI 1.72-13.68) and the intravenous use of some substance (10.20; 95 % CI 6.00-14.40). CONCLUSION HRQoL among street-recruited illegal substance users was impaired, particularly among those with psychiatric comorbidity, psychosis, and BPD being especially relevant.
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Affiliation(s)
- M Chahua
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
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Manchikanti L, Boswell MV, Hirsch JA. Lessons learned in the abuse of pain-relief medication: a focus on healthcare costs. Expert Rev Neurother 2013; 13:527-43; quiz 544. [PMID: 23621310 DOI: 10.1586/ern.13.33] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The increasing prevalence of chronic pain with its major societal impact and the escalating use of opioids in managing it, along with their misuse, abuse, associated fatalities and costs, are epidemics in modern medicine. Over the past two decades, multiple lessons have been learned addressing various issues of abuse. Multiple measures have already been incorporated and more are expected to be incorporated in the future, which in turn may curtail the abuse of drugs and reduce healthcare costs, but these measures may also jeopardize access to appropriate pain treatment. This manuscript describes the lessons learned from the misuse, abuse and diversion of opioids, escalating healthcare costs and the means to control this epidemic.
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Lin SH, Chen KC, Lee SY, Hsiao CY, Lee IH, Yeh TL, Chen PS, Lu RB, Yang YK. The economic cost of heroin dependency and quality of life among heroin users in Taiwan. Psychiatry Res 2013; 209:512-7. [PMID: 23477899 DOI: 10.1016/j.psychres.2013.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 08/22/2012] [Accepted: 01/13/2013] [Indexed: 11/25/2022]
Abstract
Heroin dependence may cause an economic burden and has an impact on quality of life (QOL). However, assessments of economic cost are scarce and the relationship between economic cost and QOL is unclear in the Asian population. In the present study, an established questionnaire was modified to assess the economic cost and its association with QOL. A total of 121 volunteer subjects in a methadone maintenance therapy programme and 157 normal controls were enrolled. The total economic cost of heroin dependency is US$ 18,310 per person-year. The direct cost is US$ 11,791 per person-year (64% of the total cost), mostly consisting of the cost of heroin and other illegal drugs. The indirect cost is US$ 6519 (36% of the total cost) per person-year, most of which arises from productivity loss caused by unemployment and incarceration. The QOL of heroin-dependent patients is poorer than that of healthy controls in all domains. The overall QOL is negatively related to direct cost and total cost. The economic cost of heroin dependency is huge, equal to 1.07 times the average gross domestic product per capita. Reduction of the economic cost to society and the economic burden for heroin users is important.
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Affiliation(s)
- Shih-Hsien Lin
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
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Moreira TDC, Figueiró LR, Fernandes S, Justo FM, Dias IR, Barros HMT, Ferigolo M. Quality of life of users of psychoactive substances, relatives, and non-users assessed using the WHOQOL-BREF. CIENCIA & SAUDE COLETIVA 2013; 18:1953-62. [DOI: 10.1590/s1413-81232013000700010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/17/2012] [Indexed: 11/21/2022] Open
Abstract
Quality of life is related to one of the basic human desires, which is to live well and feel good. The scope of this study was to evaluate the quality of life of psychoactive substance users and relatives, compared to non-users, analyzed by socioeconomic strata. A cross-sectional study with users of psychoactive substances, relatives, and other individuals who called the Information and Orientation Service regarding drug abuse. Data collection took place between November 2009 and December 2010. Data was collected from users, relatives, and non-users, including socioeconomic characteristics and data regarding substance consumption when appropriate. In addition to this the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was given to 347 individuals. Among the 138 users (70%) used alcohol, 76 (39%), marijuana, 111 (57%) tobacco, 78 (40%) cocaine and 70 (36%) crack. Control subjects had higher, scores than the relatives of users and users in all areas of the questionnaire (p < 0.05). Psychoactive substance users scored lower in almost all domains and overall score in the WHOQOL-BREF questionnaire in comparison with the sample of non-drug users. These findings reflect poor quality of life of patients and their relatives.
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Affiliation(s)
| | | | - Simone Fernandes
- Fundação Universidade Federal de Ciências da Saúde de Porto Alegre
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Vergara-Moragues E, González-Saiz F, Lozano OM, Betanzos Espinosa P, Fernández Calderón F, Bilbao-Acebos I, Pérez García M, Verdejo García A. Psychiatric comorbidity in cocaine users treated in therapeutic community: substance-induced versus independent disorders. Psychiatry Res 2012; 200:734-41. [PMID: 22910475 DOI: 10.1016/j.psychres.2012.07.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 07/05/2012] [Accepted: 07/29/2012] [Indexed: 11/15/2022]
Abstract
This is a cross-sectional study of 227 cocaine dependent individuals in six different therapeutic communities (TCs) within a single treatment network in Andalusia (Spain). The primary aim of the study is to examine the prevalence of lifetime psychiatric comorbidity in this sample using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Diagnoses were assessed 15-20 days after admission. The data indicate that more than 65% of the sample experienced a lifetime co-occurring psychiatric comorbidity. Substance-induced mood (21.6%) and psychotic (11.5%) disorders were more prevalent in this population than independent mood (12.3%) and psychotic (7.5%) disorders. These data suggest the need to introduce changes in these centers, both in the diagnostic aspects and in the treatment programs.
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Benaiges I, Prat G, Adan A. Health-related quality of life in patients with dual diagnosis: clinical correlates. Health Qual Life Outcomes 2012; 10:106. [PMID: 22950596 PMCID: PMC3512505 DOI: 10.1186/1477-7525-10-106] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/31/2012] [Indexed: 12/04/2022] Open
Abstract
Background Although the studies published so far have found an affectation in the Health Related Quality of Life (HRQOL) in both psychiatric and substance use dependence disorders, very few studies have applied HRQOL as an assessment measure in patients suffering both comorbid conditions, or Dual Diagnosis. The aim of the current study was to assess HRQOL in a group of patients with Dual Diagnosis compared to two other non-comorbid groups and to determine what clinical factors are related to HRQOL. Methods Cross-sectional assessment of three experimental groups was made through the Short Form – 36 Item Health Survey (SF-36). The sample consisted of a group with Dual Diagnosis (DD; N = 35), one with Severe Mental Illness alone (SMI; N = 35) and another one with Substance Use Dependence alone (SUD; N = 35). The sample was composed only by males. To assess the clinical correlates of SF-36 HRQOL, lineal regression analyses were carried out. Results The DD group showed lower scores in most of the subscales, and in the mental health domain. The group with SUD showed in general a better state in the HRQOL while the group with SMI held an intermediate position with respect to the other two groups. Daily medication, suicidal attempts and daily number of coffees were significantly associated to HRQOL, especially in the DD group. Conclusions The DD group showed lower self-reported mental health quality of life. Assessment of HRQOL in dual patients allows to identify specific needs in this population, and may help to establish therapeutic goals to improve interventions.
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Affiliation(s)
- Irina Benaiges
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain
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Tiffany ST, Friedman L, Greenfield SF, Hasin DS, Jackson R. Beyond drug use: a systematic consideration of other outcomes in evaluations of treatments for substance use disorders. Addiction 2012; 107:709-18. [PMID: 21981638 PMCID: PMC3257402 DOI: 10.1111/j.1360-0443.2011.03581.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Across the addictions field, the primary outcome in treatment research has been reduction in drug consumption. A comprehensive view of the impact of substance use disorders on human functioning suggests that effective treatments should address the many consequences and features of addiction beyond drug use, a recommendation forwarded by multiple expert panels and review papers. Despite recurring proposals, and a compelling general rationale for moving beyond drug use as the sole standard for evaluating addiction treatment, the field has yet to adopt any core set of 'other' measures that are routinely incorporated into treatment research. Among the many reasons for the limited impact of previous proposals has been the absence of a clear set of guidelines for selecting candidate outcomes. This paper is the result of the deliberations of a panel of substance abuse treatment and research experts convened by the National Institute on Drug Abuse to discuss appropriate outcome measures for clinical trials of substance abuse treatments. This paper provides an overview of previous recommendations and outlines specific guidelines for consideration of candidate outcomes. A list of outcomes meeting those guidelines is described and illustrated in detail with two outcomes: craving and quality of life. The paper concludes with specific recommendations for moving beyond the outcome listing offered in this paper to promote the programmatic incorporation of these outcomes into treatment research.
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Affiliation(s)
- Stephen T Tiffany
- University at Buffalo, The State University of New York, 14260, USA.
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Stephen JH, Halpern CH, Barrios CJ, Balmuri U, Pisapia JM, Wolf JA, Kampman KM, Baltuch GH, Caplan AL, Stein SC. Deep brain stimulation compared with methadone maintenance for the treatment of heroin dependence: a threshold and cost-effectiveness analysis. Addiction 2012; 107:624-34. [PMID: 21919988 DOI: 10.1111/j.1360-0443.2011.03656.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To determine the success threshold at which a theoretical course of deep brain stimulation (DBS) would provide the same quality of life (QoL) and cost-effectiveness for heroin dependence as methadone maintenance treatment (MMT). DESIGN We constructed a decision analysis model to calculate QoL after 6 months of MMT and compared it to a theoretical course of DBS. We also performed a cost-effectiveness analysis using societal costs of heroin dependence, MMT and DBS. SETTING Systematic literature review and meta-analysis. PARTICIPANTS Patients (n = 1191) from 15 trials administering 6 months of MMT and patients (n = 2937) from 45 trials of DBS for movement disorders. MEASUREMENTS Data on QoL before and after MMT, retention in MMT at 6 months, as well as complications of DBS and their impact on QoL in movement disorders. FINDINGS We found a QoL of 0.633 (perfect health = 1) in heroin addicts initiating MMT. Sixty-six per cent of patients completed MMT, but only 47% of them had opiate-free urine samples, resulting in an average QoL of 0.7148 (0.3574 quality-adjusted life years (QALYs) over 6 months). A trial of DBS is less expensive ($81,000) than untreated (or relapsed) heroin dependence ($100,000), but more expensive than MMT ($58,000). A theoretical course of DBS would need a success rate of 36.5% to match MMT, but a success rate of 49% to be cost-effective. CONCLUSIONS The success rate, defined as the percentage of patients remaining heroin-free after 6 months of treatment, at which deep brain stimulation would be similarly cost-effective in treating opiate addiction to methadone maintenance treatment, is estimated at 49%.
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Affiliation(s)
- James H Stephen
- Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Wang PW, Wu HC, Yen CN, Yeh YC, Chung KS, Chang HC, Yen CF. Change in Quality of Life and Its Predictors in Heroin Users Receiving Methadone Maintenance Treatment in Taiwan: An 18-Month Follow-Up Study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:213-9. [DOI: 10.3109/00952990.2011.649222] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Casati A, Sedefov R, Pfeiffer-Gerschel T. Misuse of medicines in the European Union: a systematic review of the literature. Eur Addict Res 2012; 18:228-45. [PMID: 22572594 DOI: 10.1159/000337028] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 01/30/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although awareness of the misuse of medicines is increasing, data on the extent of the problem in the European Union (EU) are lacking. METHODS In order to assess the magnitude and severity of the problem, a systematic review of the literature on the misuse of analgesics, opioid substitution medicines and sedatives/hypnotics (with the exception of benzodiazepines) was conducted using the PubMed and Web of Science databases. Relevant literature was identified between 2001 and 2011. RESULTS The main groups of misused medicines include opioid analgesics, methadone, buprenorphine and Z-drugs. Regional trends in medicine misuse indicate heterogeneity across the EU with respect to misused medicine types and research activities. Prevalence, high-risk populations and factors contributing to medicine misuse are discussed. CONCLUSION The implications of these findings for prevention, treatment, and policy in the EU are considered.
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