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Elashnikov R, Khrystonko O, Trelin A, Kuchař M, Švorčík V, Lyutakov O. Label-free SERS-ML detection of cocaine trace in human blood plasma. JOURNAL OF HAZARDOUS MATERIALS 2024; 472:134525. [PMID: 38743978 DOI: 10.1016/j.jhazmat.2024.134525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
The widespread consumption of cocaine poses a significant threat to modern society. The most effective way to combat this problem is to control the distribution of cocaine, based on its accurate and sensitive detection. Here, we proposed the detection of cocaine in human blood plasma using a combination of surface enhanced Raman spectroscopy and machine learning (SERS-ML). To demonstrate the efficacy of our proposed approach, cocaine was added into blood plasma at various concentrations and drop-deposited onto a specially prepared disposable SERS substrate. SERS substrates were created by deposition of metal nanoclusters on electrospun polymer nanofibers. Subsequently, SERS spectra were measured and as could be expected, the manual distinguishing of cocaine from the spectra proved unfeasible, as its signal was masked by the background signal from blood plasma molecules. To overcome this issue, a database of SERS spectra of cocaine in blood plasma was collected and used for ML training and validation. After training, the reliability of proposed approach was tested on independently prepared samples, with unknown for SERS-ML cocaine presence or absence. As a result, the possibility of rapid determination of cocaine in blood plasma with a probability above 99.5% for cocaine concentrations up to 10-14 M was confirmed. Therefore, it is evident that the proposed approach has the ability to detect trace amounts of cocaine in bioliquids in an express and simple manner.
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Affiliation(s)
- Roman Elashnikov
- Department of Solid State Engineering, University of Chemistry and Technology, 16628 Prague, Czech Republic
| | - Olena Khrystonko
- Department of Solid State Engineering, University of Chemistry and Technology, 16628 Prague, Czech Republic
| | - Andrii Trelin
- Department of Solid State Engineering, University of Chemistry and Technology, 16628 Prague, Czech Republic
| | - Martin Kuchař
- Forensic Laboratory of Biologically Active Substances, Department of Chemistry of Natural Compounds, University of Chemistry and Technology Prague, Prague, Czech Republic
| | - Václav Švorčík
- Department of Solid State Engineering, University of Chemistry and Technology, 16628 Prague, Czech Republic
| | - Oleksiy Lyutakov
- Department of Solid State Engineering, University of Chemistry and Technology, 16628 Prague, Czech Republic.
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Nyashanu T, Scheibe A, Visser M. 'I went for rehab many times and it never worked, but the harm reduction process has given me renewed hope'. Perceptions on the effectiveness of harm reduction and community-based opioid substitution therapy. Health Promot J Austr 2024; 35:653-661. [PMID: 37605794 DOI: 10.1002/hpja.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
ISSUE ADDRESSED The accessibility of opioid substitution therapy (OST), one of the recommended treatments for opioid dependence, remains low. This study sought to explore the perceived effectiveness of OST from the perspectives of peer outreach workers and OST clients in a community-based harm reduction programme. METHODS The research was done within the Community-Oriented Substance Use Programme (COSUP) in Tshwane, South Africa. Fifteen peer educators (13 males and 2 females) took part in two focus group discussions. Thereafter, there were semi-structured interviews in which 15 OST clients (11 males and 4 females) participated. A convenience cross-sectional study was used. Interviews were audio-recorded. Using thematic analysis, themes were examined to evaluate how OST and the harm reduction approach were perceived to contribute to the improved health status of people with opioid dependence. RESULTS Peer outreach workers and COSUP clients significantly endorsed OST as an effective treatment for opioid dependence. Participants perceived greater effectiveness of OST compared to abstinence-centred inpatient rehabilitation programmes. However, there were sentiments that more community education on OST was needed to motivate people with opioid dependence to access services and to address misconceptions about OST. CONCLUSIONS There is a lack of multi-level and multi-sectoral engagement of various stakeholders in opioid dependence services, needed to accelerate utilisation of OST services. SO WHAT?: The research unpacks the need for an integrated approach to service use optimisation, and the need to evaluate the role that increased awareness and community education on harm reduction strategies can play in enhancing the utilisation of OST services.
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Affiliation(s)
- Tichaenzana Nyashanu
- Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Andrew Scheibe
- Community Oriented Primary Care Research Unit, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Maretha Visser
- Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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Illenberger JM, Flores-Ramirez FJ, Pascasio G, Franco M, Mendonsa B, Martin-Fardon R. Pivotal role of orexin signaling in the posterior paraventricular nucleus of the thalamus during the stress-induced reinstatement of oxycodone-seeking behavior. J Psychopharmacol 2024:2698811241260989. [PMID: 38888086 DOI: 10.1177/02698811241260989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND The orexin (OX) system has received increasing interest as a potential target for treating substance use disorder. OX transmission in the posterior paraventricular nucleus of the thalamus (pPVT), an area activated by highly salient stimuli that are both reinforcing and aversive, mediates cue- and stress-induced reinstatement of reward-seeking behavior. Oral administration of suvorexant (SUV), a dual OX receptor (OXR) antagonist (DORA), selectively reduced conditioned reinstatement of oxycodone-seeking behavior and stress-induced reinstatement of alcohol-seeking behavior in dependent rats. AIMS This study tested whether OXR blockade in the pPVT with SUV reduces oxycodone or sweetened condensed milk (SCM) seeking elicited by conditioned cues or stress. METHODS Male Wistar rats were trained to self-administer oxycodone (0.15 mg/kg, i.v., 8 h/day) or SCM (0.1 ml, 2:1 dilution [v/v], 30 min/day). After extinction, we tested the ability of intra-pPVT SUV (15 µg/0.5 µl) to prevent reinstatement of oxycodone or SCM seeking elicited by conditioned cues or footshock stress. RESULTS The rats acquired oxycodone and SCM self-administration, and oxycodone intake correlated with signs of physical opioid withdrawal, confirming dependence. Following extinction, the presentation of conditioned cues or footshock elicited reinstatement of oxycodone- and SCM-seeking behavior. Intra-pPVT SUV blocked stress-induced reinstatement of oxycodone seeking but not conditioned reinstatement of oxycodone or SCM seeking or stress-induced reinstatement of SCM seeking. CONCLUSIONS The results indicate that OXR signaling in the pPVT is critical for stress-induced reinstatement of oxycodone seeking, further corroborating OXRs as treatment targets for opioid use disorder.
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Gesser N. "I was already there once": Cumulative attempt capital of marginalized women exiting substance use and street prostitution contributes to their recovery capital. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:554-567. [PMID: 38584519 DOI: 10.1002/ajcp.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/20/2023] [Accepted: 01/03/2024] [Indexed: 04/09/2024]
Abstract
Despite a move to view substance use as a disease of the brain, relapse into drugs is still often viewed as a personal failure. Low recovery capital has been used to explain relapse among certain marginalized populations. Recovery capital is a recent framework that refers to the individual's sum of all internal and external assets that may assist in their recovery process. It includes four categories: physical, human, social, and cultural capital. However, this framework does not relate to the role of actual relapses in the recovery process, despite their common occurrence. To bridge this gap, in-depth interviews with 29 women formerly engaged in substance use and street prostitution in a large urban area were used to probe women about their relapse and recovery experiences. The current study demonstrates the value in repeat recovery setbacks, what I term "cumulative attempt capital": lessons learned from previous recovery attempts. I argue that previous attempts improve women's social and professional networks, help them learn from past mistakes, improve and maintain their health, and provide them with a sense of self-efficacy. This research expands our understanding of the positive role failed attempts play in one's recovery. Such reframing by service providers can alleviate a sense of shame and low self-worth for women in street prostitution and substance use and has implications for policy and program development.
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Affiliation(s)
- Nili Gesser
- Department of Psychology, University of North Dakota, Grand Forks, North Dakota, USA
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Tummala HP, Bies RR, Ramanathan M. Modelling the progression of illicit substance use patterns from real-world evidence. Br J Clin Pharmacol 2024; 90:700-712. [PMID: 37997480 DOI: 10.1111/bcp.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
AIMS To investigate an innovative pharmacometrics approach that addresses the challenges of using real-world evidence to model the progression of illicit substance use. METHODS The modelling strategy analysed real-world data from the National Longitudinal Study of Adolescent to Adult Health (AddHealth) survey using survival analyses and differential equations. Respondents were categorized into drug-naïve, active users and nonusers. The transitions between categories were modelled using interval-censored parametric survival analysis. The resulting hazard rate functions were used as time-dependent rate constants in a differential equation system. Covariate models for sex and depression status were assessed. RESULTS AddHealth enrolled 6504 American teenagers (median age 16 years, range 11-21 years); this cohort was followed with five interviews over a 22-year period; the median age at the last interview was 38 years (range 34-45 years). The percentages of illicit drug users at Interviews 1-5 were 7.7%, 5.9%, 15.8%, 21.4% and 0.98%, respectively. The generalized gamma distribution emerged as the preferred model for the survival functions for transitions between categories. Age-dependent prevalence was obtained from the differential equation system. Active drug use was more prevalent in males, increased in adolescence and college years, peaked at 24 years, and decreased to low levels by 35 years. Depression, which was more frequent in females, increased the drug-naïve-active user transition rates but not the active user-nonuser and nonuser-active user transition rates. The evidence did not support an interaction between sex and depression. CONCLUSIONS The model provided a satisfactory approximation for the age-dependent progression of illicit substance use from preadolescence to early middle age.
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Affiliation(s)
- Hari Prabhath Tummala
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Robert R Bies
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Lee IH, Kim SY, Park S, Ryu JG, Je NK. Impact of the Narcotics Information Management System on Opioid Use Among Outpatients With Musculoskeletal and Connective Tissue Disorders: Quasi-Experimental Study Using Interrupted Time Series. JMIR Public Health Surveill 2024; 10:e47130. [PMID: 38381481 PMCID: PMC10918548 DOI: 10.2196/47130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/09/2023] [Accepted: 01/07/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Opioids have traditionally been used to manage acute or terminal pain. However, their prolonged use has the potential for abuse, misuse, and addiction. South Korea introduced a new health care IT system named the Narcotics Information Management System (NIMS) with the objective of managing all aspects of opioid use, including manufacturing, distribution, sales, disposal, etc. OBJECTIVE This study aimed to assess the impact of NIMS on opioid use. METHODS We conducted an analysis using national claims data from 45,582 patients diagnosed with musculoskeletal and connective tissue disorders between 2016 and 2020. Our approach included using an interrupted time-series analysis and constructing segmented regression models. Within these models, we considered the primary intervention to be the implementation of NIMS, while we treated the COVID-19 outbreak as the secondary event. To comprehensively assess inappropriate opioid use, we examined 4 key indicators, as established in previous studies: (1) the proportion of patients on high-dose opioid treatment, (2) the proportion of patients receiving opioid prescriptions from multiple providers, (3) the overlap rate of opioid prescriptions per patient, and (4) the naloxone use rate among opioid users. RESULTS During the study period, there was a general trend of increasing opioid use. After the implementation of NIMS, significant increases were observed in the trend of the proportion of patients on high-dose opioid treatment (coefficient=0.0271; P=.01) and in the level of the proportion of patients receiving opioid prescriptions from multiple providers (coefficient=0.6252; P=.004). An abrupt decline was seen in the level of the naloxone use rate among opioid users (coefficient=-0.2968; P=.04). While these changes were statistically significant, their clinical significance appears to be minor. No significant changes were observed after both the implementation of NIMS and the COVID-19 outbreak. CONCLUSIONS This study suggests that, in its current form, the NIMS may not have brought significant improvements to the identified indicators of opioid overuse and misuse. Additionally, the COVID-19 outbreak exhibited no significant influence on opioid use patterns. The absence of real-time monitoring feature within the NIMS could be a key contributing factor. Further exploration and enhancements are needed to maximize the NIMS' impact on curbing inappropriate opioid use.
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Affiliation(s)
- Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| | - So Young Kim
- Department of Pharmacy, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Susin Park
- College of Pharmacy, Woosuk University, Wanju, Republic of Korea
| | - Jae Gon Ryu
- Department of Pharmacy, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Nam Kyung Je
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
- Research Institute for Drug Development, Pusan National University, Busan, Republic of Korea
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Javier SJ, Carey EP, Gunzburger E, Chen HYP, Zeliadt SB, Williams EC, Chen JA. Pain Care Disparities and the Use of Virtual Care Among Racial-Ethnic Minority Groups During COVID-19. J Gen Intern Med 2024; 39:68-78. [PMID: 38252245 PMCID: PMC10937888 DOI: 10.1007/s11606-023-08473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/10/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE COVID-19 led to an unprecedented reliance on virtual modalities to maintain care continuity for patients living with chronic pain. We examined whether there were disparities in virtual specialty pain care for racial-ethnic minority groups during COVID-19. DESIGN AND PARTICIPANTS This was a retrospective national cohort study with two comparison groups: primary care patients with chronic pain seen immediately prior to COVID-19 (3/1/19-2/29/20) (N = 1,649,053) and a cohort of patients seen in the year prior (3/1/18-2/28-19; n = 1,536,954). MAIN MEASURES We assessed use of telehealth (telephone or video) specialty pain care, in-person care specialty pain care, and any specialty pain care for both groups at 6 months following cohort inclusion. We used quasi-Poisson regressions to test associations between patient race and ethnicity and receipt of care. KEY RESULTS Prior to COVID-19, there were Black-White (RR = 0.64, 95% CI [0.62, 0.67]) and Asian-White (RR = 0.63, 95% CI [0.54, 0.75]) disparities in telehealth use, and these lessened during COVID-19 (Black-White: RR = 0.75, 95% CI [0.73, 0.77], Asian-White: RR = 0.81, 95% CI [0.74, 0.89]) but did not disappear. Individuals identifying as American Indian/Alaska Native used telehealth less than White individuals during early COVID-19 (RR = 0.98, 95% CI [0.85, 1.13] to RR = 0.87, 95% CI [0.79, 0.96]). Hispanic/Latinx individuals were less likely than non-Hispanic/Latinx individuals to use telehealth prior to COVID-19 but more likely during early COVID-19 (RR = 0.70, 95% CI [0.66, 0.75] to RR = 1.06, 95% CI [1.02, 1.09]). Disparities in virtual pain care occurred over the backdrop of overall decreased specialty pain care during the early phase of the pandemic (raw decrease of n = 17,481 specialty care encounters overall from pre-COVID to COVID-era), including increased disparities in any VA specialty pain care for Black (RR = 0.81, 95% CI [0.80, 0.83] to RR = 0.79, 95% CI [0.77, 0.80]) and Asian (RR = 0.91, 95% CI [0.86, 0.97] to RR = 0.88, 95% CI [0.82, 0.94]) individuals. CONCLUSIONS Disparities in virtual specialty pain care were smaller during the early phases of the COVID-19 pandemic than prior to the pandemic but did not disappear entirely, despite the rapid growth in telehealth. Targeted efforts to increase access to specialty pain care need to be concentrated among racial-ethnic minority groups.
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Affiliation(s)
- Sarah J Javier
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
- Stanford University School of Medicine, Stanford, CA, USA.
| | - Evan P Carey
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elise Gunzburger
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA
| | - Huang-Yuan P Chen
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA
| | - Steven B Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Emily C Williams
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jessica A Chen
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA, USA
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Amaya-Rodriguez CA, Carvajal-Zamorano K, Bustos D, Alegría-Arcos M, Castillo K. A journey from molecule to physiology and in silico tools for drug discovery targeting the transient receptor potential vanilloid type 1 (TRPV1) channel. Front Pharmacol 2024; 14:1251061. [PMID: 38328578 PMCID: PMC10847257 DOI: 10.3389/fphar.2023.1251061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024] Open
Abstract
The heat and capsaicin receptor TRPV1 channel is widely expressed in nerve terminals of dorsal root ganglia (DRGs) and trigeminal ganglia innervating the body and face, respectively, as well as in other tissues and organs including central nervous system. The TRPV1 channel is a versatile receptor that detects harmful heat, pain, and various internal and external ligands. Hence, it operates as a polymodal sensory channel. Many pathological conditions including neuroinflammation, cancer, psychiatric disorders, and pathological pain, are linked to the abnormal functioning of the TRPV1 in peripheral tissues. Intense biomedical research is underway to discover compounds that can modulate the channel and provide pain relief. The molecular mechanisms underlying temperature sensing remain largely unknown, although they are closely linked to pain transduction. Prolonged exposure to capsaicin generates analgesia, hence numerous capsaicin analogs have been developed to discover efficient analgesics for pain relief. The emergence of in silico tools offered significant techniques for molecular modeling and machine learning algorithms to indentify druggable sites in the channel and for repositioning of current drugs aimed at TRPV1. Here we recapitulate the physiological and pathophysiological functions of the TRPV1 channel, including structural models obtained through cryo-EM, pharmacological compounds tested on TRPV1, and the in silico tools for drug discovery and repositioning.
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Affiliation(s)
- Cesar A. Amaya-Rodriguez
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
- Departamento de Fisiología y Comportamiento Animal, Facultad de Ciencias Naturales, Exactas y Tecnología, Universidad de Panamá, Ciudad de Panamá, Panamá
| | - Karina Carvajal-Zamorano
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
| | - Daniel Bustos
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Vicerrectoría de Investigación y Postgrado Universidad Católica del Maule, Talca, Chile
- Laboratorio de Bioinformática y Química Computacional, Departamento de Medicina Traslacional, Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Melissa Alegría-Arcos
- Núcleo de Investigación en Data Science, Facultad de Ingeniería y Negocios, Universidad de las Américas, Santiago, Chile
| | - Karen Castillo
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Vicerrectoría de Investigación y Postgrado Universidad Católica del Maule, Talca, Chile
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Rahman Shah MT, Ali Shah M, Al-Mahmood MR, Nahar K, Miah MS, Chowdhury TY. Cross-cultural adaptation and psychometric validation of the brief assessment of recovery capital (BARC-10) scale into Bangla. Medicine (Baltimore) 2024; 103:e35882. [PMID: 38215142 PMCID: PMC10783311 DOI: 10.1097/md.0000000000035882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/11/2023] [Indexed: 01/14/2024] Open
Abstract
Recovery capital is a construct central to the substance use disorder treatment and recovery field. Lack of structured instrument for its assessment in the local context necessitated the translation of the English self-assessment version of the "Brief Assessment of Recovery Capital" (BARC-10) scale to Bangla and the study of its psychometric properties. The objective was to develop a culturally adapted and validated Bangla version of the BARC-10 scale for substance use disorders patients. This study conducted in the period of January 2021 to March 2022 in the department of Psychiatry of a tertiary hospital and central drug addiction treatment center. Initially BARC-10 questionnaire was translated into Bangla (T1 and T2) by 2 separate translators and then synthesis of a single version (T12) was done based on the previous translations. After that 2 back translations (BT1 and BT2) were done by 2 more translators based on the synthesized version (T12). By reviewing all these forward and backward translations, an expert committee made the pre-final version after making some linguistic modification. Then data collection was done among 100 subjects who were selected purposively. Reliability was assessed by Cronbach alpha. Content validity, face validity and Construct validity by factor analysis were measured. Internal consistency measured by Cronbach alpha found was 0.846. No significant change in Cronbach alpha was observed following deleting any item. Confirmatory factor analysis revealed a good fit to data by a chi-square/df value1.33, RMSEA value 0.058. Kaiser-Meyer-Olkin value (.840) showed sampling adequacy. Exploratory factor analysis of the principal component identified 2 factors which had eigenvalues of more than 1. Scree plot also revealed similar factors. These 2 factors together explained 53.1% of the variance. All items were loaded under 2 factors after varimax rotation. The validated Bangla version of the BARC-10 demonstrated high internal reliability and validity. It can potentially be applied in "recovery-oriented" deaddiction service.
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Affiliation(s)
- Md. Tanvir Rahman Shah
- Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh
- Rangpur Medical College, Rangpur, Bangladesh
| | - Mohsin Ali Shah
- Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh
| | - Md. Rashid- Al-Mahmood
- Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh
- Northern International Medical College, Dhaka, Bangladesh
| | - Kamrun Nahar
- Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh
- Abdul Malek Ukil Medical College, Noakhali, Bangladesh
| | - Md. Sazib Miah
- Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - Taslima Yasmeen Chowdhury
- Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh
- International Organization for Migration, Cox’s Bazar, Bangladesh
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Luo SX, Feaster DJ, Liu Y, Balise RR, Hu MC, Bouzoubaa L, Odom GJ, Brandt L, Pan Y, Hser YI, VanVeldhuisen P, Castillo F, Calderon AR, Rotrosen J, Saxon AJ, Weiss RD, Wall M, Nunes EV. Individual-Level Risk Prediction of Return to Use During Opioid Use Disorder Treatment. JAMA Psychiatry 2024; 81:45-56. [PMID: 37792357 PMCID: PMC10551817 DOI: 10.1001/jamapsychiatry.2023.3596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/11/2023] [Indexed: 10/05/2023]
Abstract
Importance No existing model allows clinicians to predict whether patients might return to opioid use in the early stages of treatment for opioid use disorder. Objective To develop an individual-level prediction tool for risk of return to use in opioid use disorder. Design, Setting, and Participants This decision analytical model used predictive modeling with individual-level data harmonized in June 1, 2019, to October 1, 2022, from 3 multicenter, pragmatic, randomized clinical trials of at least 12 weeks' duration within the National Institute on Drug Abuse Clinical Trials Network (CTN) performed between 2006 and 2016. The clinical trials covered a variety of treatment settings, including federally licensed treatment sites, physician practices, and inpatient treatment facilities. All 3 trials enrolled adult participants older than 18 years, with broad pragmatic inclusion and few exclusion criteria except for major medical and unstable psychiatric comorbidities. Intervention All participants received 1 of 3 medications for opioid use disorder: methadone, buprenorphine, or extended-release naltrexone. Main Outcomes and Measures Predictive models were developed for return to use, which was defined as 4 consecutive weeks of urine drug screen (UDS) results either missing or positive for nonprescribed opioids by week 12 of treatment. Results The overall sample included 2199 trial participants (mean [SD] age, 35.3 [10.7] years; 728 women [33.1%] and 1471 men [66.9%]). The final model based on 4 predictors at treatment entry (heroin use days, morphine- and cocaine-positive UDS results, and heroin injection in the past 30 days) yielded an area under the receiver operating characteristic curve (AUROC) of 0.67 (95% CI, 0.62-0.71). Adding UDS in the first 3 treatment weeks improved model performance (AUROC, 0.82; 95% CI, 0.78-0.85). A simplified score (CTN-0094 OUD Return-to-Use Risk Score) provided good clinical risk stratification wherein patients with weekly opioid-negative UDS results in the 3 weeks after treatment initiation had a 13% risk of return to use compared with 85% for those with 3 weeks of opioid-positive or missing UDS results (AUROC, 0.80; 95% CI, 0.76-0.84). Conclusions and Relevance The prediction model described in this study may be a universal risk measure for return to opioid use by treatment week 3. Interventions to prevent return to regular use should focus on this critical early treatment period.
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Affiliation(s)
- Sean X. Luo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Ying Liu
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Raymond R. Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mei-Chen Hu
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Layla Bouzoubaa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Gabriel J. Odom
- Department of Biostatistics, Stempel College of Public Health, Florida International University, Miami, Florida
| | - Laura Brandt
- Department of Psychology, City College of New York, New York
| | - Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | - Felipe Castillo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Anna R. Calderon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine, New York University, New York, New York
| | - Andrew J. Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Roger D. Weiss
- Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts
| | - Melanie Wall
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Edward V. Nunes
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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11
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Le K, Au J, Hua J, Le KDR. The Therapeutic Potential of Cannabidiol in Revolutionising Opioid Use Disorder Management. Cureus 2023; 15:e50634. [PMID: 38226097 PMCID: PMC10789504 DOI: 10.7759/cureus.50634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
Opioid use disorder (OUD) is a significant cause of morbidity and mortality worldwide and is linked to a complex interplay of biopsychosocial factors as well as the increasing overprescription and availability of opioid medications. Current OUD management relies on the controlled provision of opioid medications, such as methadone or buprenorphine, known as opioid replacement therapy. There is variable evidence regarding the long-term efficacy of these medications in improving the management of OUD, thereby necessitating an exploration into innovative approaches to complement, or even take the place of, existing treatment paradigms. Cannabidiol (CBD), a non-psychoactive compound derived from the cannabis plant, has garnered attention for its diverse pharmacological properties, including anti-inflammatory, analgesic, and anxiolytic effects. Preliminary studies suggest that CBD may target opioid withdrawal pathways that make CBD a potential therapeutic option for OUD. This narrative review synthesises current literature surrounding OUD and offers a nuanced review of the current and future role of CBD in managing this condition. In doing so, we highlight the potential avenues to explore with respect to CBD research for the guidance and development of further research opportunities, framework and policy development, and clinical considerations before medicinal CBD can be integrated into evidence-based clinical guidelines.
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Affiliation(s)
- Kelvin Le
- Melbourne Medical School, The University of Melbourne, Melbourne, AUS
| | - Joanne Au
- Department of Anaesthesia & Pain Management, The Royal Melbourne Hospital, Melbourne, AUS
| | - Jean Hua
- Department of Pharmacy, The Royal Melbourne Hospital, Melbourne, AUS
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, AUS
| | - Khang Duy Ricky Le
- Geelong Clinical School, Deakin University, Geelong, AUS
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, AUS
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, AUS
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, AUS
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12
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Miller JC, Brooks MA, Wurzel KE, Cox EJ, Wurzel JF. A Guide to Expanding the Use of Buprenorphine Beyond Standard Initiations for Opioid Use Disorder. Drugs R D 2023; 23:339-362. [PMID: 37938531 PMCID: PMC10676346 DOI: 10.1007/s40268-023-00443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/09/2023] Open
Abstract
Buprenorphine has become an important medication in the context of the ongoing opioid epidemic. However, complex pharmacologic properties and varying government regulations create barriers to its use. This narrative review is intended to facilitate buprenorphine use-including non-traditional initiation methods-by providers ranging from primary care providers to addiction specialists. This article briefly discusses the opioid epidemic and the diagnosis and treatment of opioid use disorder (OUD). We then describe the basic and complex pharmacologic properties of buprenorphine, linking these properties to their clinical implications. We guide readers through the process of initiating buprenorphine in patients using full agonist opioids. As there is no single recommended approach for buprenorphine initiation, we discuss the details, advantages, and disadvantages of the standard, low-dose, bridging-strategy, and naloxone-facilitated initiation techniques. We consider the pharmacology of, and evidence base for, buprenorphine in the treatment of pain, in both OUD and non-OUD patients. Throughout, we address the use of buprenorphine in children and adolescent patients, and we finish with considerations related to the settings of pregnancy and breastfeeding.
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Affiliation(s)
- James C Miller
- Psychiatry Residency Spokane, Providence Sacred Heart Medical Center and Children's Hospital, 101 W Eighth Ave, Spokane, WA, 99204, USA
| | - Michael A Brooks
- Psychiatry Residency Spokane, Providence Sacred Heart Medical Center and Children's Hospital, 101 W Eighth Ave, Spokane, WA, 99204, USA
| | - Kelly E Wurzel
- Psychiatry Residency Spokane, Providence Sacred Heart Medical Center and Children's Hospital, 101 W Eighth Ave, Spokane, WA, 99204, USA
| | - Emily J Cox
- Providence Research Network, Renton, WA, USA
| | - John F Wurzel
- Psychiatry Residency Spokane, Providence Sacred Heart Medical Center and Children's Hospital, 101 W Eighth Ave, Spokane, WA, 99204, USA.
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13
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Wilson J, Mills KL, Sunderland M, Freeman TP, Keaveny M, Haasnoot K, Teesson M, Haber PS, Marel C. Long-term patterns of treatment use for opioid use disorder (OUD): Findings from the 18-20-year Australian Treatment Outcome Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104187. [PMID: 37713938 DOI: 10.1016/j.drugpo.2023.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Opioid-related deaths continue to increase to unprecedented rates in many regions of the world. While long-term stable treatment has been shown to reduce associated morbidity and mortality, discontinuation and numerous treatment episodes are common, limiting our understanding of the common course of treatment and associated characteristics. Therefore, using an 18-20-year follow-up of people with heroin dependence, we aimed to identify i) distinct trajectories of treatment use, ii) whether baseline characteristics predict treatment trajectory group membership, and ii) if group membership is associated with characteristics at 18-20-years post-baseline. METHODS A total of 615 people with heroin dependence were recruited from maintenance therapy, detoxification, residential rehabilitation, or needle and syringe programs as part of the Australian Treatment Outcome Study (ATOS), a longitudinal cohort followed up on seven occasions over 18-20-years between 2001 and 2021. Of those who had complete data (n = 393), group-based trajectory modelling and a series of multinomial logistical regressions were conducted. RESULTS Five trajectories of treatment use were identified: i) 'long-term low treatment' (17.2%), ii) 'rapid increase with gradual decrease' (13.9%), iii) 'late increase' (17.8%), (iv) 'long-term treatment' (27.7%), and (v) 'reduced treatment' (23.5%). Entering maintenance treatment at baseline predicted trajectory group membership, while trajectory group membership was associated with demographics and the use of heroin, methamphetamine, alcohol, and benzodiazepines at 18-20-years. CONCLUSIONS In one of the longest cohort studies of its kind, we characterised distinct trajectories of treatment use in people with heroin dependence over 18-20-years. Clinicians should be aware of the potential impact of demographics and substance use on long-term treatment use. Despite the well-documented benefits of long-term treatment, some patients may be able to achieve abstinence from opioids without engaging in treatment over the life-course.
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Affiliation(s)
- Jack Wilson
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia.
| | - Katherine L Mills
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), University of Bath, BA2 7AY, United Kingdom
| | - Madeleine Keaveny
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Katherine Haasnoot
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
| | - Paul S Haber
- Sydney Medical School, The University of Sydney, 2006, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia
| | - Christina Marel
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, G02, The University of Sydney, 2006, NSW, Australia
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14
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Zemore SE, Ziemer KL, Gilbert PA, Karno MP, Kaskutas LA. Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From the What is Recovery? Study. Subst Abuse 2023; 17:11782218231199372. [PMID: 37731748 PMCID: PMC10508054 DOI: 10.1177/11782218231199372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/19/2023] [Indexed: 09/22/2023]
Abstract
Background Substance use disorder (SUD) resolution typically involves a long-term, comprehensive process of change now widely referred to as "recovery." Yet, definitions of recovery vary substantially, producing significant confusion. To support formal recovery definitions, we aimed to systematically identify recovery elements that are central to those in recovery and shared regardless of subgroup/pathway. Methods Data were from the What is Recovery? Study, involving a diverse, national, online survey of people in recovery (N = 9341). Surveys included a 35-item recovery measure reflecting 4 domains; participants reported whether or not each element definitely belonged in their recovery definitions. Analyses examined item endorsements overall and among 30 subgroups defined a priori (by sociodemographics, substance use characteristics, and help-seeking history) to determine where items met study-specific centrality thresholds (ie, endorsement by ⩾80% and top-10 ranking, by endorsement level). We then classified items as "core" if meeting centrality thresholds both overall and for all 30 subgroups, and "prevalent" if meeting centrality thresholds overall and for 26 to 29 subgroups. Results Four "core" recovery elements emerged, including a process of growth or development; being honest with oneself; taking responsibility for the things one can change; and reacting in a more balanced way. Four "prevalent" recovery elements also emerged, referencing the ability to enjoy life and handle negative feelings without substance use; abstinence and/or nonproblematic substance use; and living a life that contributes. Subgroups differing most in their endorsements included those reporting mild/moderate SUD severity; non-abstinent recovery; and no specialty treatment or mutual-help group attendance. Conclusions Recovery elements identified here partially reflect some stakeholder definitions, but offer greater specificity and include novel elements (eg, personal integrity). Elements may point to areas of functioning that are damaged in the addiction process and can support an addiction-free life. Findings should inform institutional recovery definitions; SUD services and research; and communications about recovery.
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Affiliation(s)
| | - Kelly L Ziemer
- School of Social Welfare, University of California, Berkeley, CA, USA
| | - Paul A Gilbert
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Mitchell P Karno
- Department of Psychiatry and Biobehavioral Sciences, Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
- Independent clinician
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Gong H, Huang Y, Zhu X, Lu W, Cai Z, Zhu N, Huang J, Jin Y, Sun X. Impact of combination of intermittent theta burst stimulation and methadone maintenance treatment in individuals with opioid use disorder: A comparative study. Psychiatry Res 2023; 327:115411. [PMID: 37574603 DOI: 10.1016/j.psychres.2023.115411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
Prior studies indicate that subjects undergoing methadone maintenance therapy (MMT) may experience anxiety, depression and cravings. This study aimed to explore the impact of intermittent theta burst stimulation (iTBS)-MMT combination on craving and emotional symptoms of opioid use disorder. This comparative study included subjects with opioid use disorder at the Methadone Maintenance Clinic of Pudong New Area between September 2019 and March 2020. The subjects were divided into two groups: those who received iTBS-MMT combination treatment (iTBS-MMT) and those who received MMT treatment and sham stimulation treatment (MMT). Outcomes were reduction rate of anxiety, depression and craving. Anxiety was measured by Hamilton Anxiety (HAMA) scale, depression was determined by Hamilton Depression (HAMD) scale and craving was analyzed using visual analog scale. A total of 76 subjects completed the treatment, with 38 subjects in each group. Twenty days after treatment, subjects in the iTBS-MMT group had significant improvement of anxiety (HAMA reduction rate), depression (HAMD reduction rate) and craving (Craving reduction rate) reduction rate compared with MMT group. iTBS-MMT combination treatment may produce better drug craving reduction and emotional improvement than MMT alone.
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Affiliation(s)
- Hengfen Gong
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Mental Disorders, School of Medicine, Tongji University, Shanghai, China.
| | - Ying Huang
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Mental Disorders, School of Medicine, Tongji University, Shanghai, China
| | - Xingjia Zhu
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Wei Lu
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Zhengyi Cai
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Na Zhu
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Juan Huang
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Ying Jin
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Mental Disorders, School of Medicine, Tongji University, Shanghai, China.
| | - Xirong Sun
- Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Clinical Research Center for Mental Disorders, School of Medicine, Tongji University, Shanghai, China.
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16
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Klemperer EM, Wreschnig L, Crocker A, King-Mohr J, Ramniceanu A, Brooklyn JR, Peck KR, Rawson RA, Evans EA. The impact of the implementation of medication for opioid use disorder and COVID-19 in a statewide correctional system on treatment engagement, postrelease continuation of care, and overdose. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209103. [PMID: 37311520 PMCID: PMC10257572 DOI: 10.1016/j.josat.2023.209103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/27/2023] [Accepted: 06/09/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND People with opioid use disorder (OUD) are overrepresented in US correctional facilities and experience disproportionately high risk for overdose after release. Medications for OUD (MOUD) are highly efficacious but not available to most incarcerated individuals. In 2018, Vermont began providing MOUD for all incarcerated individuals with OUD statewide. In 2020, the COVID-19 state of emergency began. We assessed the impact of both events on MOUD utilization and treatment outcomes. METHODOLOGY Analyses linked Vermont Department of Corrections administrative data and Medicaid claims data between 07/01/2017 and 03/31/2021. The study used logistic regression to analyze treatment engagement among all incarcerated individuals in Vermont. Multilevel modeling assessed change in clinical outcomes among release episodes that occurred among individuals with an OUD diagnosis Medicaid claim. RESULTS Prescriptions for MOUD while incarcerated increased from 0.8% to 33.9% of the incarcerated population after MOUD implementation (OR = 67.4) and subsequently decreased with the onset of COVID-19 to 26.6% (OR = 0.7). After MOUD implementation, most prescriptions (63.1%) were to individuals who had not been receiving MOUD prior to incarceration, but this figure decreased to 53.9% with the onset of COVID-19 (OR = 0.7). Prescriptions for MOUD within 30 days after release increased from 33.9% of those with OUD before to 41.0% after MOUD implementation (OR = 1.4) but decreased to 35.6% with the onset of COVID-19 (OR = 0.8). Simultaneously, opioid-related nonfatal overdoses within 30 days after release decreased from 1.2% before to 0.8% after statewide MOUD implementation (OR = 0.3) but increased to 1.9% during COVID-19 (OR = 3.4). Fatal overdoses within 1 year after release decreased from 27 deaths before to ≤10 after statewide MOUD implementation and remained ≤10 during COVID-19. CONCLUSIONS This longitudinal evaluation demonstrated increased treatment engagement and a decrease in opioid-related overdose following implementation of MOUD in a statewide correctional system. In contrast, these improvements were somewhat attenuated with the onset of COVID-19, which was associated with decreased treatment engagement and an increase in nonfatal overdoses. Considered together, these findings demonstrate the benefits of statewide MOUD for incarcerated individuals as well as the need to identify and address barriers to continuation of care following release from incarceration in the context of COVID-19.
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Affiliation(s)
- Elias M Klemperer
- University of Vermont, College of Medicine, Department of Psychiatry, United States of America.
| | | | - Abigail Crocker
- University of Vermont, College of Engineering Mathematical Sciences, Department of Mathematics and Statistics, United States of America
| | - Jessica King-Mohr
- Vermont Agency of Human Services, Department of Corrections, United States of America
| | - Annie Ramniceanu
- Vermont Agency of Human Services, Department of Corrections, United States of America
| | - John R Brooklyn
- University of Vermont, College of Medicine, Department of Family Medicine, United States of America
| | - Kelly R Peck
- University of Vermont, College of Medicine, Department of Psychiatry, United States of America
| | - Richard A Rawson
- University of Vermont, College of Medicine, Department of Psychiatry, United States of America
| | - Elizabeth A Evans
- University of Massachusetts Amherst, School of Public Health & Health Sciences, United States of America
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17
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Peles E, Kim Y, Sason A, Adelson M, Levran O. Predictors of treatment retention and survival among methadone-maintained patients: A possible role for a functional delta opioid receptor gene variant. Drug Alcohol Depend 2023; 250:110903. [PMID: 37531661 PMCID: PMC11015812 DOI: 10.1016/j.drugalcdep.2023.110903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/08/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Variants in the delta opioid receptor gene, OPRD1, were associated with opioid use disorder and response to treatment. The study goal was to assess whether OPRD1 variants predict survival and retention in methadone maintenance treatment (MMT). METHODS Retention and survival time since admission (June 1993 - June 2022) until leaving treatment (for retention), or at the end of follow-up (Dec 2022) (for retention and survival) were analyzed in 488 patients. Vital data was taken from a national registry. Predictors were estimated using Kaplan-Meier and Cox regression models. RESULTS Longer retention and survival were found for carriers of the T allele of SNP rs204076. This SNP is associated with OPRD1 expression in cortex (GTEx). Carriers of the T allele (n = 251) survived longer compared to non-carriers (24.7 vs. 20.2 years, p = 0.005) and had longer retention (11.2 vs. 8.8 years, p = 0.04). Multivariate analysis identified the T allele as an independent predictor of longer survival time (p = 0.003) and retention (p = 0.009). Additional predictors for survival were no benzodiazepine use after one year in MMT, no hepatitis C, <20 years of opioid usage, and admission at age < 30. Additional predictors for longer retention were no use of other drugs except opioids on admission, and no drugs at one year, as well as methadone dose ≥ 100mg/d at one year and axis I & II DSM-5 psychiatric diagnosis. CONCLUSIONS The OPRD1 SNP rs204076 and non-genetic predictors contribute to survival time and retention in MMT patients.
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Affiliation(s)
- Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment, and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Yuli Kim
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY, United States
| | - Anat Sason
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment, and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment, and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orna Levran
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY, United States
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18
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Allen D, Hanumantharao SN, McDonell R, Irvine KA, Sahbaie P, Clark D, Blum P. Preclinical characterization of the efficacy and safety of biologic N-001 as a novel pain analgesic for post-operative acute pain treatment. Sci Rep 2023; 13:11778. [PMID: 37479740 PMCID: PMC10362049 DOI: 10.1038/s41598-023-38618-4] [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: 03/23/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023] Open
Abstract
Inhibition of actin remodeling in nerves modulates action potential propagation and therefore could be used to treat acute pain. N-001 is a novel protein analgesic engineered from several C. Botulinum toxins. N-001 targets sensory neurons through ganglioside GT1b binding and ADP-ribosylates G-actin reducing actin remodeling. The activity and efficacy of N-001 was evaluated previously in vitro and in a mouse inflammatory pain model. To assess the relevance of N-001 for treatment of acute post-surgical pain, the current study evaluated the efficacy of N-001 in a mouse hind-paw incision model by peri-incisional and popliteal nerve block administration combined with mechanical testing. N-001 provided relief of pain-like behavior over 3 days and 2 days longer than the conventional long-acting anesthetic bupivacaine. Preclinical safety studies of N-001 indicated the drug produced no toxic or adverse immunological reactions over multiple doses in mice. These results combined with past targeting results encourage further investigation of N-001 as an analgesic for post-operative pain management with the potential to function as a differential nociceptor-specific nerve block.
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Affiliation(s)
- Derek Allen
- Neurocarrus Inc, Monterey, CA, USA
- Microbiology and Environmental Toxicology, University of California-Santa Cruz, Santa Cruz, CA, USA
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Rylie McDonell
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Peyman Sahbaie
- Stanford University School of Medicine, Stanford, CA, USA
| | - David Clark
- Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Health Care, Palo Alto, CA, USA
| | - Paul Blum
- Neurocarrus Inc, Monterey, CA, USA.
- Microbiology and Environmental Toxicology, University of California-Santa Cruz, Santa Cruz, CA, USA.
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA.
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19
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Marciuch A, Birkeland B, Benth JŠ, Solli KK, Tanum L, Mathisen I, Weimand B. Personal recovery among people with opioid use disorder during treatment with extended-release naltrexone. Heliyon 2023; 9:e17516. [PMID: 37449176 PMCID: PMC10336734 DOI: 10.1016/j.heliyon.2023.e17516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Background and aims Recovery from substance use disorders (SUD) has traditionally been equated with abstinence. "Personal recovery" however emphasizes recovery as a unique and personal process, supported by changes in connectedness, hope, identity, meaning and empowerment. This study aimed to examine personal recovery in people receiving extended-release naltrexone (XR-NTX); specifically investigate changes in personal recovery during treatment, identify groups of participants following distinct trajectories of recovery, and characteristics predicting group-belonging. Methods Overall change in recovery (Questionnaire about the Process of Recovery, QPR) score was assessed by linear mixed model in a subsample of 135 people with opioid use disorder (OUD) participating in a 24 + 28-week trial of XR-NTX. Growth mixture model was used to identify potential groups of people following distinct trajectories of personal recovery. Results Overall, there was a significant change in QPR score during treatment. Four groups with distinct recovery trajectories were identified: "initially low- increase" (G1), "initially average- no change" (G2), "initially high- no change" (G3) and "initially high- increase" (G4). The groups were different with regards to level of psychological distress, social support, and the use of benzodiazepines. In addition, previous participation in opioid agonist treatment programs, current pain, life satisfaction, employment, heroin craving and previous use of heroin also differed between groups. Conclusions Personal recovery among people receiving XR-NTX follows different trajectories, and various factors are associated with personal recovery. Particular attention regarding psychological distress, social support and heroin use among patients commencing XR-NTX treatment is important to facilitate successful recovery trajectories.
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Affiliation(s)
- Anne Marciuch
- Department of Research and Development in Mental Health, Akershus University Hospital, Loerenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bente Birkeland
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Klemmetsby Solli
- Department of Research and Development in Mental Health, Akershus University Hospital, Loerenskog, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Norway
- Vestfold Hospital Trust, Toensberg, Norway
| | - Lars Tanum
- Department of Research and Development in Mental Health, Akershus University Hospital, Loerenskog, Norway
- Faculty for Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Ida Mathisen
- Faculty for Health Science, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
| | - Bente Weimand
- Department of Research and Development in Mental Health, Akershus University Hospital, Loerenskog, Norway
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway
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20
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Yuen J, Goyal A, Rusheen AE, Kouzani AZ, Berk M, Kim JH, Tye SJ, Abulseoud OA, Oesterle TS, Blaha CD, Bennet KE, Lee KH, Oh Y, Shin H. Oxycodone-induced dopaminergic and respiratory effects are modulated by deep brain stimulation. Front Pharmacol 2023; 14:1199655. [PMID: 37408764 PMCID: PMC10318172 DOI: 10.3389/fphar.2023.1199655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction: Opioids are the leading cause of overdose death in the United States, accounting for almost 70,000 deaths in 2020. Deep brain stimulation (DBS) is a promising new treatment for substance use disorders. Here, we hypothesized that VTA DBS would modulate both the dopaminergic and respiratory effect of oxycodone. Methods: Multiple-cyclic square wave voltammetry (M-CSWV) was used to investigate how deep brain stimulation (130 Hz, 0.2 ms, and 0.2 mA) of the rodent ventral segmental area (VTA), which contains abundant dopaminergic neurons, modulates the acute effects of oxycodone administration (2.5 mg/kg, i.v.) on nucleus accumbens core (NAcc) tonic extracellular dopamine levels and respiratory rate in urethane-anesthetized rats (1.5 g/kg, i.p.). Results: I.V. administration of oxycodone resulted in an increase in NAcc tonic dopamine levels (296.9 ± 37.0 nM) compared to baseline (150.7 ± 15.5 nM) and saline administration (152.0 ± 16.1 nM) (296.9 ± 37.0 vs. 150.7 ± 15.5 vs. 152.0 ± 16.1, respectively, p = 0.022, n = 5). This robust oxycodone-induced increase in NAcc dopamine concentration was associated with a sharp reduction in respiratory rate (111.7 ± 2.6 min-1 vs. 67.9 ± 8.3 min-1; pre- vs. post-oxycodone; p < 0.001). Continuous DBS targeted at the VTA (n = 5) reduced baseline dopamine levels, attenuated the oxycodone-induced increase in dopamine levels to (+39.0% vs. +95%), and respiratory depression (121.5 ± 6.7 min-1 vs. 105.2 ± 4.1 min-1; pre- vs. post-oxycodone; p = 0.072). Discussion: Here we demonstrated VTA DBS alleviates oxycodone-induced increases in NAcc dopamine levels and reverses respiratory suppression. These results support the possibility of using neuromodulation technology for treatment of drug addiction.
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Affiliation(s)
- Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Abhinav Goyal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States
| | - Aaron E. Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States
| | - Abbas Z. Kouzani
- School of Engineering, Deakin University, Geelong, VIC, Australia
| | - Michael Berk
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Jee Hyun Kim
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Susannah J. Tye
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Behavioral Science, Emory University, Atlanta, GA, United States
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Charles D. Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kevin E. Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Division of Engineering, Mayo Clinic, Rochester, MN, United States
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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Li T, Zeng YW, Zhang F, Zhou X, Ren Y. Acupuncture for protracted opioid abstinence syndrome: study protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e071864. [PMID: 37336541 DOI: 10.1136/bmjopen-2023-071864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Protracted opioid abstinence syndrome (POAS) refers to a series of physical discomforts and neuropsychiatric symptoms after discontinuation of opioid-type substances for a certain amount of time and is one of the main causes of relapse. Studies have shown that acupuncture is effective in the treatment of POAS. We plan to conduct this systematic review and meta-analysis to assess the efficacy and safety of acupuncture for POAS. METHODS AND ANALYSIS A comprehensive search of studies will be carried out in the following databases from inception to 31 January 2023: Web of Science, Embase, PubMed, Chinese Biology Medicine, China National Knowledge Infrastructure, Wan Fang Database and Chinese Scientific Journal Database (VIP). WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and Chinese Clinical Trial Registry will also be searched for ongoing relevant trials, and 'grey literatures' will be identified from GreyNet International, OpenGrey and Google Scholar. Randomised controlled trials regarding acupuncture therapy for treatment of POAS will be included. The primary outcome is the severity of protracted withdrawal symptoms. Two reviewers will screen studies using the inclusion criteria, extract data and assess the risk of bias, respectively. The quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation. Data synthesis will be performed using RevMan V.5.4.1. ETHICS AND DISSEMINATION This study will not invade patients' personal privacy, and so ethical review is not required. The results will be disseminated in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022382978.
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Affiliation(s)
- Tao Li
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Wei Zeng
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Feng Zhang
- Department of Ophthalmology, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Xin Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yulan Ren
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
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22
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Mahu IT, Conrod PJ, Barrett SP, Sako A, Swansburg J, Stewart SH. The four-factor personality model and its qualitative correlates among opioid agonist therapy clients. Front Psychiatry 2023; 14:1129274. [PMID: 37363172 PMCID: PMC10289030 DOI: 10.3389/fpsyt.2023.1129274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Background The Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients' voice. Method Nineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis. Results Themes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected. Conclusion Personality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.
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Affiliation(s)
- Ioan T. Mahu
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Patricia J. Conrod
- Ste-Justine Hospital, Centre de Recherche, Montreal, QC, Canada
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC, Canada
| | - Sean P. Barrett
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Aïssata Sako
- Quebec-Atlantic Node, Canadian Research Initiative in Substance Misuse, Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Jennifer Swansburg
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
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23
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Pischiutta L, Garzitto M, Zamparutti G, Moratti E, Albert U, Colizzi M, Balestrieri M. Mentalization in young patients undergoing opioid agonist treatment: Implications for clinical management. Addict Behav Rep 2023; 17:100497. [PMID: 37249942 PMCID: PMC10212784 DOI: 10.1016/j.abrep.2023.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background Mentalization is the ability to use internal mental states to manage and understand one's own and others' behavior. Inefficient mentalization has been associated to poor neuropsychological outcomes, including substance use disorder (SUD) and addiction. However, studies primarily investigating mentalization in SUD are lacking. Methods Using the Reflective Functioning Questionnaire (RFQ), the Measurements in the Addictions for Triage and Evaluation, version 2.1 (MATE-IT-2.1), and the Mini International Neuropsychiatric Interview, 7th edition (MINI-7), an outpatient assessment investigated inefficient mentalization (i.e., 'hypo-mentalization' or 'uncertainty': concrete thinking with poor attribution of mental states; 'hyper-mentalization' or 'certainty': rigid and biased attribution of mental states) and socio-demographic and clinical characteristics, including SUD-related symptoms and any other psychiatric comorbidity, among opioid addiction (OA) patients in Opioid Agonist Treatment (OAT). Results Thirty-seven consecutive OA patients in OAT (female, 45.9 %; age, M ± SD, 24.3 ± 3.55) were recruited. Patients' mentalization differed from normative data, in terms of higher uncertainty and lower certainty scores. Also, higher uncertainty score was found among younger patients and in those with the most severe SUD in terms of craving and need for care. Finally, lower certainty score was found in those with a more severe substance abuse, previous contacts with pediatric mental-health services, and receiving a therapeutic community support. Conclusions OA patients with inefficient mentalization present with a higher burden in terms of SUD severity, comorbidities, psychosocial disabilities, and service use, with important public health implications. Interventions targeting mentalization may have positive repercussions in preventing SUD, mitigating its severity, and containing its healthcare and social costs.
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Affiliation(s)
- Livia Pischiutta
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Giuliano Zamparutti
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Enrico Moratti
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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Giang K, Charlesworth R, Thulien M, Mulholland A, Barker B, Brar R, Pauly B, Fast D. Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104023. [PMID: 37059025 PMCID: PMC10067449 DOI: 10.1016/j.drugpo.2023.104023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Across North America, overlapping overdose and COVID-19 emergencies have had a substantial impact on young people who use drugs (YPWUD). New risk mitigation guidance (RMG) prescribing practices were introduced in British Columbia, Canada, in 2020 to allow people to decrease risk of overdose and withdrawal and better self-isolate. We examined how the prescribing of hydromorphone tablets specifically impacted YPWUD's substance use and care trajectories. Between April 2020 and July 2021, we conducted virtual interviews with 30 YPWUD who had accessed an RMG prescription of hydromorphone in the previous six months and 10 addiction medicine physicians working in Vancouver. A thematic analysis was conducted. YPWUD participants highlighted a disjuncture between risk mitigation prescriptions and the safe supply of unadulterated substances such as fentanyl, underscoring that having access to the latter is critical to reducing their reliance on street-based drug markets and overdose-related risks. They described re-appropriating these prescriptions to meet their needs, stockpiling hydromorphone so that it could be used as an “emergency backup” when they were unable to procure unregulated, illicit opioids. In the context of entrenched poverty, hydromorphone was also used to generate income for the purchase of drugs and various necessities. For some YPWUD, hydromorphone prescriptions could be used alongside opioid agonist therapy (OAT) to reduce withdrawal and cravings and improve adherence to OAT. However, some physicians were wary of prescribing hydromorphone due to the lack of evidence for this new approach. Our findings underscore the importance of providing YPWUD with a safe supply of the substances they are actively using alongside a continuum of substance use treatment and care, and the need for both medical and community-based safe and safer supply models.
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Affiliation(s)
- Karen Giang
- Department of Family Practice, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Reith Charlesworth
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Madison Thulien
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Alanna Mulholland
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Vancouver Coastal Health Authority, 520 West 6(th) Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Brittany Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Canadian Institute of Substance Use Research, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Vancouver Coastal Health Authority, 520 West 6(th) Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Bernie Pauly
- Canadian Institute of Substance Use Research, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada; School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria BC V8W 2Y2, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine (Division of Social Medicine), 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
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25
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O'Neil MM, Johnson RA, Córdova D, Pryor J, Pinals DA. A legal dispute resolution intervention for patients with substance use disorders: a study protocol for a randomized controlled trial. BMC Public Health 2023; 23:435. [PMID: 36879259 PMCID: PMC9990301 DOI: 10.1186/s12889-023-15296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) represent major public health concerns and are linked to enhanced risk of legal consequences. Unresolved legal issues may prevent individuals with SUD from completing treatment. Interventions aimed at improving SUD treatment outcomes are limited. Filling that gap, this randomized controlled trial (RCT) tests the ability of a technology-assisted intervention to increase SUD treatment completion rates and improve post-treatment health, economic, justice-system, and housing outcomes. METHODS A randomized controlled trial with a two-year administrative follow-up period will be conducted. Eight hundred Medicaid eligible and uninsured adults receiving SUD treatment will be recruited at community-based non-profit health care clinics in Southeast, Michigan, USA. Using an algorithm embedded in a community-based case management system, we randomly assign all eligible adults to one of two groups. The treatment/intervention group will receive hands-on assistance with a technology aimed at resolving unaddressed legal issues and the control group receives no treatment. Upon enrollment into the intervention, both treatment (n = 400) and control groups (n = 400) retain traditional options to resolve unaddressed legal issues, such as hiring an attorney, but only the treatment group is targeted the technology and offered personalized assistance in navigating the online legal platform. To develop baseline and historical contexts for participants, we collect life course history reports from all participants and intend to link those in each group to administrative data sources. In addition to the randomized controlled trial (RCT), we used an exploratory sequential mixed methods and participatory-based design to develop, test, and administer our life course history instruments to all participants. The primary objective is to test whether targeting no-cost online legal resources to those experiencing SUD improves their long-term recovery and decreases negative health, economic, justice-system, and housing outcomes. DISCUSSION Findings from this RCT will improve our understanding of the acute socio-legal needs faced by those experiencing SUD and provide recommendations to help target resources toward the areas that best support long-term recovery. The public health impact includes making publicly available a deidentified, longitudinal dataset of uninsured and Medicaid eligible clients in treatment for SUD. Data include an overrepresentation of understudied groups including African American and American Indian Alaska Native persons documented to experience heightened risk for SUD-related premature mortality and justice-system involvement. Within these data, several intended outcome measures can inform the health policy landscape: (1) health, including substance use, disability, mental health diagnosis, and mortality; (2) financial health, including employment, earnings, public assistance receipt, and financial obligations to the state; (3) justice-system involvement, including civil and criminal legal system encounters; (4) housing, including homelessness, household composition, and homeownership. TRIAL REGISTRATION Retrospectively registered # NCT05665179 on December 27, 2022.
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Affiliation(s)
- Meghan M O'Neil
- Institute for Social Research, Population Studies Center, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Rebecca A Johnson
- Georgetown University, McCourt School of Public Policy, 37th and O Streets NW, Washington, DC, 20057, USA
| | - David Córdova
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI, 48109, USA
| | - Jenna Pryor
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI, 48109, USA
| | - Debra A Pinals
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
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Sandbrink F, Murphy JL, Johansson M, Olson JL, Edens E, Clinton-Lont J, Sall J, Spevak C. The Use of Opioids in the Management of Chronic Pain: Synopsis of the 2022 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 2023; 176:388-397. [PMID: 36780654 DOI: 10.7326/m22-2917] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
DESCRIPTION In May 2022, leadership within the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the use of opioids when managing chronic pain. This synopsis summarizes the recommendations that the authors believe are the most important to highlight. METHODS In December 2020, the VA/DoD Evidence-Based Practice Work Group assembled a team to update the 2017 VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain. The guideline development team included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline team developed key questions to guide a systematic evidence review that was done by an independent third party and distilled 20 recommendations for care using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The guideline team also created 3 one-page algorithms to help guide clinical decision making. This synopsis presents the recommendations and highlights selected recommendations on the basis of clinical relevance. RECOMMENDATIONS This guideline is intended for clinicians who may be considering opioid therapy to manage patients with chronic pain. This synopsis reviews updated recommendations for the initiation and continuation of opioid therapy; dose, duration, and taper of opioids; screening, assessment, and evaluation; and risk mitigation. New additions are highlighted, including recommendations about the use of buprenorphine instead of full agonist opioids; assessing for behavioral health conditions and factors associated with higher risk for harm, such as pain catastrophizing; and the use of pain and opioid education to reduce the risk for prolonged opioid use for postsurgical pain.
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Affiliation(s)
- Friedhelm Sandbrink
- National Pain Management, Opioid Safety, and Prescription Drug Monitoring Program, Veterans Health Administration, Washington DC VA Medical Center, and Department of Neurology, George Washington University, Washington, DC (F.S.)
| | - Jennifer L Murphy
- Pain Management, Opioid Safety, and Prescription Drug Monitoring Program, Veterans Health Administration, Washington, DC (J.L.M.)
| | - Melanie Johansson
- Walter Reed National Military Medical Center, Bethesda, Maryland (M.J.)
| | | | - Ellen Edens
- Opioid Reassessment Clinic, Yale Addiction Psychiatry Service, National TeleMental Health Center, VA Connecticut Healthcare System, West Haven, Connecticut (E.E.)
| | | | - James Sall
- Evidence Based Practice, Quality and Patient Safety, Veterans Health Administration, Washington, DC (J.S.)
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Hamilton M, Kwok WS, Hsu A, Mathieson S, Gnjidic D, Deyo R, Ballantyne J, Von Korff M, Blyth F, Lin CWC. Opioid deprescribing in patients with chronic noncancer pain: a systematic review of international guidelines. Pain 2023; 164:485-493. [PMID: 36001299 DOI: 10.1097/j.pain.0000000000002746] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT In response to the overuse of prescription opioid analgesics, clinical practice guidelines encourage opioid deprescribing (ie, dose reduction or cessation) in patients with chronic noncancer pain. Therefore, this study evaluated and compared international clinical guideline recommendations on opioid deprescribing in patients with chronic noncancer pain. We searched PubMed, EMBASE, PEDro, National Institute for Health and Care Excellence (United Kingdom), and MAGICapp databases from inception to June 4, 2021, with no language or publication restrictions. In addition, we searched the National Guideline Clearinghouse and International Guideline Network databases from inception to December 2018. Two independent reviewers conducted the initial title and abstract screening. After discrepancies were resolved through discussion, 2 independent reviewers conducted the full-text screening of each potentially eligible reference. Four independent reviewers completed the prepiloted, standardized data extraction forms of each included guideline. Extracted information included bibliographical details; strength of recommendations; and the outcomes, such as when and how to deprescribe, managing withdrawal symptoms, additional support, outcome monitoring, and deprescribing with coprescription of sedatives. A narrative synthesis was used to present the results. This study found that clinical practice guidelines agree on when and how to deprescribe opioid analgesics but lack advice on managing a patient's withdrawal symptoms, outcome monitoring, and deprescribing with coprescription of sedatives. Quality assessment of the guidelines suggests that greater discussion on implementation and dissemination is needed.
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Affiliation(s)
- Melanie Hamilton
- Institute for Musculoskeletal Health, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wing S Kwok
- Institute for Musculoskeletal Health, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Arielle Hsu
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Richard Deyo
- Oregon Health and Science University, Portland, OR, United States
| | | | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Fiona Blyth
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Abstract
BACKGROUND This analysis describes participants' opioid use disorder (OUD) outcomes for 18 months after discontinuing extended-release buprenorphine injection (BUP-XR, SUBLOCADE). METHODS The RECOVER (Remission From Chronic Opioid Use: Studying Environmental and Socioeconomic Factors on Recovery) study recruited participants from BUP-XR clinical trials (NCT02357901, NCT025100142, and NCT02896296) to assess whether there were sustained benefits after leaving the trial. Abstinence from opioids and from all illicit substances (excluding medical cannabis), health-related quality of life, depression, and employment were measured after BUP-XR discontinuation and change in outcomes assessed at 6, 12, and 18 months. Results were analyzed within the full cohort and by duration of BUP-XR treatment (0-2 months, 3-5 months, 6-11 months, 12 months, or 13-18 months) with and without inverse probability weights adjusting for differences in baseline characteristics. RESULTS Of 533 participants, 529 were assessed over the 18-month study period. Further posttrial pharmacotherapy was reported by 33% of participants. At RECOVER baseline, longer BUP-XR was associated with higher abstinence (0-2 months BUP-XR [n = 116]: 38.8%; 3-5 months BUP-XR [n = 61]: 41.0%; 6-11 months BUP-XR [n = 86]: 68.6%; 12 months BUP-XR [n = 135]: 71.9%; 18 months BUP-XR [n = 131]: 88.2%) and greater 12-Item Short Form Health Survey mental component scores. Over 60% of participants had stable or improved outcomes at 6, 12, and 18 months assessments. Overall 47% of participants self-reported sustained opioid abstinence for the full 18-month follow-up, with greater sustained abstinence associated with longer BUP-XR treatment duration. A sensitivity analysis, removing patients receiving medications for OUD, yielded similar results. CONCLUSIONS Participants from BUP-XR clinical trials who continued into RECOVER maintained or improved on numerous outcomes over 18 months, demonstrating the long-term positive impact of OUD pharmacotherapy.
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Exploring Problematic Substance use Trajectory in Hong Kong: A Life Course Perspective. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231157256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The purpose of this study is to take a life course perspective to explore how experiences at different life course stages of substance users and contextual factors influence their drug use behaviors. Using the life history narrative approach to interview 31 persons who were taking part in rehabilitation treatment in Hong Kong, this study maps out substance use trajectory into four stages (onset, persistence, escalation, and desistance) addressing three interrelated themes: (1) substance use behavior characteristics, (2) critical life events, (3) and social and structural factors. The results showed an interaction between substance use behaviors and their experience in different life stages. Because substance use has become more hidden in the stage of persistence and escalation, particularly in dense cities like Hong Kong, early social support is advocated to be provided in prevention and rehabilitation, such as offering better vocational training support and follow-up service to rebuild relationships with families.
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Evaluation of post-discharge engagement for emergency department patients with opioid use history who received telehealth recovery coaching services. Subst Abuse Treat Prev Policy 2023; 18:9. [PMID: 36774507 PMCID: PMC9922103 DOI: 10.1186/s13011-023-00523-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/09/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND In recent years, emergency departments (EDs) across the nation have implemented peer recovery coach (PRC) services to support patients who use opioids. The majority of such interventions discussed in the literature follow an in-person modality where PRCs engage patients directly at the ED bedside. However, the use of telehealth services in EDs is becoming more popular. These services connect PRCs with ED patients in real-time via secure communications technology, and very little is known about the service- and clinical-based outcomes with which they are associated. The current study sought to assess factors associated with successful post-discharge follow-up of patients with a history of opioid use who received PRC telehealth services while in the ED. METHOD Data come from records for 917 patients who engaged with a telehealth PRC one or more times (1208 total engagements) at 1 of 13 EDs within the same health system. A multilevel Poisson regression model was used to assess the degree to which variables predicted successful post-discharge follow-up, defined as the number of times a PRC successfully spoke with the patient each month after ED discharge. RESULTS At least one follow-up was successfully completed by a PRC for 23% of enrolled patients. Significant predictors of successful follow-up included patient employment at baseline (Incidence Rate Ratio [IRR]: 2.8, CI: 2.05-3.9), living in a rural area (IRR: 1.8, CI: 1.04-3.2), PRC provision of referrals (IRR: 1.7, CI: 1.2-2.2), number of ED encounters in the previous 365 days (IRR: 0.99, CI: 0.98-0.99), and duration of the initial PRC telehealth interaction (IRR: 0.87, CI: 0.85-0.88). CONCLUSION Given that relationship development is a key tool in the PRC profession, understanding successful follow-up associated with telehealth engagement has unique importance. The results have potential utility for planning and implementing peer telehealth services in EDs and other locations, which is needed for the development of the PRC profession and the likely expansion of peer telehealth services.
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Kukushliev VV, Sherman KA, Kurylo CM, Ortmann SD, Scheidt RA, Scheidt KB. Tapered Dose Postoperative Opioid Prescriptions Following Inpatient Total Hip and Knee Arthroplasty: Quality Improvement Study and Retrospective Review. J Arthroplasty 2023; 38:239-244. [PMID: 36075313 DOI: 10.1016/j.arth.2022.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Overprescription of pain medications directly fuels the opioid epidemic. Veterans are profoundly impacted. Tapered dose protocols may reduce excessive prescribing. METHODS A retrospective study of adult veterans who presented to our institution for primary total knee arthroplasty or total hip arthroplasty (THA) was performed. Postdischarge opioid use was reviewed before and after an opioid taper prescription protocol. The preprotocol and postprotocol groups had 299 and 89 veterans, respectively. Total Morphine Milligram Equivalent (MME) prescribed postdischarge, number of tablets prescribed, number of refills issued, 30-day emergency department visits, and 30-day readmissions were compared. Opioid naïve and chronic opioid users were both included. RESULTS Preprotocol and postprotocol implementation group, in combination with surgery type (total knee arthroplasty versus THA) and opioid naïve status, predicted MME. On average, the postprotocol group received 224 MME less, THA patients received 177 MME less, and nonopioid naïve patients received 152 MME more. CONCLUSION The opioid taper protocol led to less opioid administration after discharge. Taper protocols should be considered for postoperative pain management. LEVEL OF EVIDENCE III, retrospective comparison study.
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Affiliation(s)
- Vasil V Kukushliev
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Christopher M Kurylo
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen D Ortmann
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert A Scheidt
- Washington University in St. Louis School of Medicine, Saint Louis, Missouri
| | - Karl B Scheidt
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin
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McDonald JE, Cook JM, Tocci BA. A Grounded Theory of the Process of Healing From Opioid Addiction. JOURNAL OF HUMANISTIC PSYCHOLOGY 2023. [DOI: 10.1177/00221678221143546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Centers for Disease Control and Prevention found that opioids are involved in almost 71% of all drug overdose deaths. Although there is increased attention on the lethal potential of opioid addiction, narratives about healing, wherein people have sustained long-term health and well-being from opioid addiction, are few. Our purpose with this study was to develop a biopsychosocial understanding of how people heal from opioid addiction, not only maintain abstinence. The Theory of Healing from Opioid Addiction yielded five categories, 15 themes, and seven subthemes. Results showed four phases of healing (i.e., Inactive Healing, Early Active Healing, Middle Active Healing, and Late Active Healing), four Continuous Core Components of healing (i.e., 12-Step Programs, Psychotherapy, Spirituality, and Relationships with Others), and 15 themes ranging from Substance Use Treatment to Effectively Processing Trauma to Self-Love. Participants’ ( N = 11) healing journey began during opioid addiction itself and continued through to the last phase of healing, wherein participants had transformed their lives and concretized a sense of personal empowerment.
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Affiliation(s)
- James E. McDonald
- Marquette University, Milwaukee, WI, USA
- Veterans Affairs San Diego Healthcare System, CA, USA
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Ramey OL, Bonny AE, Silva Almodóvar A, Nahata MC. Gaps in Evidence-based Treatment of Concurrent Attention Deficit Hyperactivity Disorder and Opioid Use Disorder: A Scoping Review. Ann Pharmacother 2022:10600280221141065. [PMID: 36510631 DOI: 10.1177/10600280221141065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To describe the effectiveness of medications for the treatment of opioid use disorder (OUD) and attention deficit/hyperactivity disorder (ADHD). DATA SOURCES Literature search of PubMed, Embase, Web of Science, CINAHL, Medline, PsycINFO, and Google Scholar was performed for studies published from inception to October 25, 2022. STUDY SELECTION AND DATA EXTRACTION Studies were included if patients were diagnosed with OUD and ADHD and had pharmacotherapy for either condition. Abstracts, commentaries, reviews, case reports, case series, non-English articles, and animal studies were omitted. DATA SYNTHESIS This review found 18 studies. Treatment of ADHD was evaluated for impact on ADHD and OUD outcomes, while treatment of OUD was evaluated for OUD-related outcomes. Outcomes assessed included markers for symptom intensity, adherence, and treatment failure. While results were mixed, treatment of ADHD was largely associated with improvements in ADHD severity and retention in OUD treatment programs. ADHD severity was associated with higher rates of illicit substance abuse and worse OUD-related outcomes. It could not be determined which medications for treatment of OUD should be prioritized. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review summarized key findings from studies that treated ADHD or OUD among dually diagnosed patients and highlighted methodological considerations for future research. CONCLUSIONS Treatment of ADHD is warranted among patients with OUD and ADHD to improve retention in OUD treatment programs and reduce illicit substance abuse. Pharmacotherapy for the treatment of ADHD or OUD should continue to be determined based on patients' characteristics and the capabilities of the treatment program.
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Affiliation(s)
- Olivia L Ramey
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Andrea E Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Armando Silva Almodóvar
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Milap C Nahata
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
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Svensson J, Bergström J, Kåberg M, Becker P. Patterns of mortality risk among patients with substance use disorder: an opportunity for proactive patient safety? BMC Psychiatry 2022; 22:770. [PMID: 36476580 PMCID: PMC9730660 DOI: 10.1186/s12888-022-04437-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with substance use disorder (SUD) suffer from excess mortality compared to the overall population. This study aims to identify patterns in death rates among patients with SUD visiting a SUD emergency ward and to explore whether this knowledge can be used as input to identify patients at risk and increase patient safety. METHODS Hospital visit data to a SUD emergency ward were collected between 2010 and 2020 through medical records. Data included gender, age, SUD diagnosis, and the time of death. The Kruskal-Wallis rank sum test was used to test between ordinal variables, and risk ratio was used to quantify the difference in mortality risk. All statistical tests were two-sided, with a 95% confidence interval and a minimum significance level of 0.05. RESULTS The male patients in the study group had 1.41-1.59 higher mortality risk than the female patients. The study revealed an average death rate of 0.14 among all patients during the study period. Although patients with a diagnosed alcohol use disorder constituted 73.7% of the cohort, having an opioid use disorder or sedative hypnotics use disorder was associated with the highest death rates; 1.29-1.52 and 1.47-1.74 higher mortality risk than those without such diagnoses. CONCLUSION This study demonstrates that data from visits to SUD emergency wards can be used to identify mortality risk factors, such as gender, type of diagnosis, number of diagnoses, and number of visits to the SUD emergency ward. Knowledge about patterns of patient visits and mortality risk could be used to increase patient safety through a decision support tool integrated with the electronic medical records. An improved system for early detection of increased mortality risk offers an opportunity for an adaptive patient safety system.
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Affiliation(s)
- Jakob Svensson
- Division of Risk Management and Societal Safety, Lund University, Box 118, SE-22100, Lund, Sweden.
| | - Johan Bergström
- grid.4514.40000 0001 0930 2361Division of Risk Management and Societal Safety, Lund University, Box 118, SE-22100 Lund, Sweden
| | - Martin Kåberg
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Per Becker
- grid.4514.40000 0001 0930 2361Division of Risk Management and Societal Safety, Lund University, Box 118, SE-22100 Lund, Sweden ,grid.25881.360000 0000 9769 2525Unit for Environmental Sciences and Management, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
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Yaccarino V, Jin MY, Abd-Elsayed A, Kraemer JM, Sehgal N. Peripheral Nerve Stimulation in Painful Conditions of the Upper Extremity-An Overview. Biomedicines 2022; 10:2776. [PMID: 36359295 PMCID: PMC9687108 DOI: 10.3390/biomedicines10112776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 08/01/2023] Open
Abstract
Our objective is to present a brief history of the evolution of peripheral nerve stimulation, the current understanding of peripheral nerve stimulation mechanisms in chronic pain, peripheral nerve stimulation applications in upper extremity chronic pain conditions, and complications of peripheral nerve stimulation. The evolution of peripheral nerve stimulation from the early ages to the current status has been facilitated by discoveries in neurobehavioral mechanisms of pain, advances in technology and percutaneous lead development, and the availability of high-quality portable ultrasound units. Peripheral nerve stimulation application in managing upper extremity pain of amputated limbs, post-stroke shoulder pain, complex regional pain syndrome (CRPS), and median, ulnar, and radial neuropathies are discussed. Finally, we describe complications of peripheral nerve stimulation. The availability of ultrasound-guided peripheral nerve stimulation techniques and superior peripheral nerve stimulation technology have opened up new and minimally invasive treatment options for chronic intractable neuropathic pain of the upper extremity. Additionally, the ability to place peripheral nerve stimulation leads percutaneously without open peripheral nerve surgery expands the pool of implanting physicians, while simultaneously decreasing the risks and complications that are associated with open surgery.
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Affiliation(s)
- Vincent Yaccarino
- Department of Orthopedics & Rehabilitation, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, USA
| | - Max Y. Jin
- Department of Anesthesiology, University of Wisconsin, Madison, WI 53792, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI 53792, USA
| | | | - Nalini Sehgal
- Department of Orthopedics & Rehabilitation, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, USA
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Paterson LM, Barker D, Cro S, Mozgunov P, Phillips R, Smith C, Nahar L, Paterson S, Lingford-Hughes AR. FORWARDS-1: an adaptive, single-blind, placebo-controlled ascending dose study of acute baclofen on safety parameters in opioid dependence during methadone-maintenance treatment-a pharmacokinetic-pharmacodynamic study. Trials 2022; 23:880. [PMID: 36258248 PMCID: PMC9579625 DOI: 10.1186/s13063-022-06821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Treatment of opiate addiction with opiate substitution treatment (e.g. methadone) is beneficial. However, some individuals desire or would benefit from abstinence but there are limited options to attenuate problems with opiate withdrawal. Preclinical and preliminary clinical evidence suggests that the GABA-B agonist, baclofen, has the desired properties to facilitate opiate detoxification and prevent relapse. This study aims to understand whether there are any safety issues in administering baclofen to opioid-dependent individuals receiving methadone. Methods Opiate-dependent individuals (DSM-5 severe opioid use disorder) maintained on methadone will be recruited from addiction services in northwest London (NHS and third sector providers). Participants will be medically healthy with no severe chronic obstructive pulmonary disease or type 2 respiratory failure, no current dependence on other substances (excluding nicotine), no current severe DSM-5 psychiatric disorders, and no contraindications for baclofen or 4800 IU vitamin D (placebo). Eligible participants will be randomised in a 3:1 ratio to receive baclofen or placebo in an adaptive, single-blind, ascending dose design. A Bayesian dose-escalation model will inform the baclofen dose (10, 30, 60, or 90 mg) based on the incidence of ‘dose-limiting toxicity’ (DLT) events and participant-specific methadone dose. A range of respiratory, cardiovascular, and sedative measures including the National Early Warning Score (NEWS2) and Glasgow Coma Scale will determine DLT. On the experimental day, participants will consume their usual daily dose of methadone followed by an acute dose of baclofen or placebo (vitamin D3) ~ 1 h later. Measures including oxygen saturation, transcutaneous CO2, respiratory rate, QTc interval, subjective effects (sedation, drug liking, craving), plasma levels (baclofen, methadone), and adverse events will be obtained using validated questionnaires and examinations periodically for 5 h after dosing. Discussion Study outcomes will determine what dose of baclofen is safe to prescribe to those receiving methadone, to inform a subsequent proof-of-concept trial of the efficacy baclofen to facilitate opiate detoxification. To proceed, the minimum acceptable dose is 30 mg of baclofen in patients receiving ≤ 60 mg/day methadone based on the clinical experience of baclofen’s use in alcoholism and guidelines for the management of opiate dependence. Trial registration Clinicaltrials.gov NCT05161351. Registered on 16 December 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06821-9.
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Affiliation(s)
- L M Paterson
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
| | - D Barker
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - S Cro
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - P Mozgunov
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - R Phillips
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - C Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - L Nahar
- Toxicology Unit, Imperial College London, London, UK
| | - S Paterson
- Toxicology Unit, Imperial College London, London, UK
| | - A R Lingford-Hughes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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Williams JR, Alam IZ, Ranapurwala SI. Trajectories and correlates of opioid prescription receipt among patients experiencing interpersonal violence. PLoS One 2022; 17:e0273846. [PMID: 36083884 PMCID: PMC9462725 DOI: 10.1371/journal.pone.0273846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Interpersonal violence increases vulnerability to the deleterious effects of opioid use. Increased opioid prescription receipt is a major contributor to the opioid crisis; however, our understanding of prescription patterns and risk factors among those with a history of interpersonal violence remains elusive. This study sought to identify 5-year longitudinal patterns of opioid prescription receipt among patients experiencing interpersonal violence within a large healthcare system and sociodemographic and clinical characteristics associated with prescription patterns. This secondary analysis examined electronic health record data from January 2004–August 2019 for a cohort of patients (N = 1,587) referred for interpersonal violence services. Latent class growth analysis was used to estimate trajectories of opioid prescription receipt over a 5-year period. Standardized differences were calculated to assess variation in sociodemographic and clinical characteristics between classes. Our cohort had a high prevalence of prescription opioid receipt (73.3%) and underlying co-morbidities, including chronic pain (54.6%), substance use disorders (39.0%), and mental health diagnoses (76.9%). Six prescription opioid receipt classes emerged, characterized by probability of any prescription opioid receipt at the start and end of the study period (high, medium, low, never) and change in probability over time (increasing, decreasing, stable). Classes with the highest probability of prescription opioids also had the highest proportions of males, chronic pain diagnoses, substance use disorders, and mental health diagnoses. Black, non-Hispanic and Hispanic patients were more likely to be in low or no prescription opioid receipt classes. These findings highlight the importance of monitoring for synergistic co-morbidities when providing pain management and offering treatment that is trauma-informed, destigmatizing, and integrated into routine care.
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Affiliation(s)
- Jessica R. Williams
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Ishrat Z. Alam
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Shabbar I. Ranapurwala
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Buchanan A, Sun T, Wu J, Aroke H, Bratberg J, Rich J, Kogut S, Hogan J. Toward evaluation of disseminated effects of medications for opioid use disorder within provider-based clusters using routinely-collected health data. Stat Med 2022; 41:3449-3465. [PMID: 35673849 PMCID: PMC9288976 DOI: 10.1002/sim.9427] [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: 02/12/2021] [Revised: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 08/17/2023]
Abstract
Routinely-collected health data can be employed to emulate a target trial when randomized trial data are not available. Patients within provider-based clusters likely exert and share influence on each other's treatment preferences and subsequent health outcomes and this is known as dissemination or spillover. Extending a framework to replicate an idealized two-stage randomized trial using routinely-collected health data, an evaluation of disseminated effects within provider-based clusters is possible. In this article, we propose a novel application of causal inference methods for dissemination to retrospective cohort studies in administrative claims data and evaluate the impact of the normality of the random effects distribution for the cluster-level propensity score on estimation of the causal parameters. An extensive simulation study was conducted to study the robustness of the methods under different distributions of the random effects. We applied these methods to evaluate baseline prescription for medications for opioid use disorder among a cohort of patients diagnosed with opioid use disorder and adjust for baseline confounders using information obtained from an administrative claims database. We discuss future research directions in this setting to better address unmeasured confounding in the presence of disseminated effects.
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Affiliation(s)
- Ashley Buchanan
- Department of Pharmacy Practice, University of Rhode Island, Rhode Island, USA
| | - Tianyu Sun
- Department of Pharmacy Practice, University of Rhode Island, Rhode Island, USA
| | - Jing Wu
- Department of Computer Science and Statistics, University of Rhode Island, Rhode Island, USA
| | - Hilary Aroke
- Department of Pharmacy Practice, University of Rhode Island, Rhode Island, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice, University of Rhode Island, Rhode Island, USA
| | - Josiah Rich
- The Warren Alpert Medical School, Brown University, Rhode Island, USA
| | - Stephen Kogut
- Department of Pharmacy Practice, University of Rhode Island, Rhode Island, USA
| | - Joseph Hogan
- Department of Biostatistics, Brown University, Rhode Island, USA
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Fiddian-Green A, Gubrium A, Harrington C, Evans EA. Women-Reported Barriers and Facilitators of Continued Engagement with Medications for Opioid Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159346. [PMID: 35954700 PMCID: PMC9368271 DOI: 10.3390/ijerph19159346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 12/07/2022]
Abstract
Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling “safe” within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population.
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Affiliation(s)
- Alice Fiddian-Green
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA
- Correspondence:
| | - Aline Gubrium
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
| | - Calla Harrington
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; (A.G.); (C.H.); (E.A.E.)
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Mesoporous Materials as Elements of Modern Drug Delivery Systems for Anti-Inflammatory Agents: A Review of Recent Achievements. Pharmaceutics 2022; 14:pharmaceutics14081542. [PMID: 35893798 PMCID: PMC9331996 DOI: 10.3390/pharmaceutics14081542] [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: 06/27/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 12/04/2022] Open
Abstract
Interest in the use of mesoporous materials as carriers of medicinal substances has been steadily increasing in the last two decades. Mesoporous carriers have application in the preparation of delivery systems for drugs from various therapeutic groups; however, their use as the carriers of anti-inflammatory agents is particularly marked. This review article, with about 170 references, summarizes the achievements in the application of mesoporous materials as the carriers of anti-inflammatory agents in recent years. This article will discuss a variety of mesoporous carriers as well as the characteristics of their porous structure that determine further use of these materials in the field of medical applications. Special attention will be paid to the progress observed in the construction of stimuli-responsive drug carriers and systems providing site-specific drug delivery. Subsequently, a review of the literature devoted to the use of mesoporous matrices as the carriers of anti-inflammatory drugs was carried out.
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Patients' experiences of continued treatment with extended-release naltrexone: a Norwegian qualitative study. Addict Sci Clin Pract 2022; 17:36. [PMID: 35850782 PMCID: PMC9290197 DOI: 10.1186/s13722-022-00317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background The opioid antagonist extended-release naltrexone (XR-NTX) in the treatment of opioid use disorder (OUD) is effective in terms of safety, abstinence from opioid use and retention in treatment. However, it is unclear how patients experience and adjust to losing the possibility of achieving an opioid effect. This qualitative study is the first to explore how people with opioid dependence experience XR-NTX treatment, focusing on the process of treatment over time. Methods Using a purposive sampling strategy, semi-structured interviews were undertaken with 19 persons with opioid use disorder (15 men, four women, 22–55 years of age) participating in a clinical trial of XR-NTX in Norway. The interviewees had received at least three XR-NTX injections. Qualitative content analysis with an inductive approach was used. Findings Participants described that XR-NTX treatment had many advantages. However they still faced multiple challenges, some of which they were not prepared for. Having to find a new foothold and adapt to no longer gaining an effect from opioids due to the antagonist medication was challenging. This was especially true for those struggling emotionally and transitioning into the harmful use of non-opioid substances. Additional support was considered crucial. Even so, the treatment led to an opportunity to participate in society and reclaim identity. Participants had strong goals for the future and described that XR-NTX enabled a more meaningful life. Expectations of a better life could however turn into broken hopes. Although participants were largely optimistic about the future, thinking about the end of treatment could cause apprehension. Conclusions XR-NTX treatment offers freedom from opioids and can facilitate the recovery process for people with OUD. However, our findings also highlight several challenges associated with XR-NTX treatment, emphasizing the importance of monitoring emotional difficulties and increase of non-opioid substances during treatment. As opioid abstinence in itself does not necessarily equal recovery, our findings underscore the importance of seeing XR-NTX as part of a comprehensive, individualized treatment approach. Trial registration: Clinicaltrials.gov # NCT03647774, first Registered: Aug 28, 2018.
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Gholami J, Baheshmat S, Rostam-Abadi Y, Hamzehzadeh M, Mojtabai R, Rahimi-Movaghar A, Amin-Esmaeili M. Mortality and negative outcomes of opioid use and opioid use disorder: a 6-year follow-up study. Addiction 2022; 117:2059-2066. [PMID: 35037359 DOI: 10.1111/add.15805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS There is a paucity of data on outcomes of opioid use disorder (OUD) from low- and middle-income countries. We aimed to investigate the mortality as well as negative social and health outcomes in a 6-year follow-up study of a cohort of individuals with opioid use, including those with OUD, in Iran. DESIGN AND SETTING Participants with opioid use initially interviewed in late 2011 in the Iranian National Mental Health Survey (IranMHS)-a household survey of 15-64-year-old population-were followed-up in early 2018. PARTICIPANTS All respondents (n = 236) who had reported use of any opioids at least five times during the 12-month period prior to the index interview were included in the study. MEASUREMENTS Composite International Diagnostic Interview (CIDI) version 2.1 was used for assessment of opioid use and OUD at baseline. Vital status in the follow-up was ascertained through contact with participants/informants, primarily via telephone calls and also through the death registration systems. Weighted incidence rates of negative consequences of opioid use (e.g. incarceration, suicide attempts, violent behavior) were estimated for those who were interviewed. FINDINGS Seven (3.3%) of the 236 participants with opioid use including four (3.1%) of the 136 with OUD had died by the time of the follow-up interview, resulting in death rates of 0.49 [95% confidence interval (CI) = 0.21-1.38] and 0.53 (95% CI = 0.16-2.62) per 100 person-years, respectively. Overall, 35.0% of participants with opioid use and 44.0% of those with OUD among the 145 individuals interviewed at follow-up experienced non-fatal serious adverse outcomes. CONCLUSIONS In Iran, opioid use and opioid use disorder are associated with increased mortality and other adverse outcomes.
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Affiliation(s)
- Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Baheshmat
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Hamzehzadeh
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Heikkinen M, Taipale H, Tanskanen A, Mittendorfer‐Rutz E, Lähteenvuo M, Tiihonen J. Real-world effectiveness of pharmacological treatments of opioid use disorder in a national cohort. Addiction 2022; 117:1683-1691. [PMID: 35072314 PMCID: PMC9305765 DOI: 10.1111/add.15814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the real-world effectiveness of pharmacological treatments (buprenorphine, methadone) of opioid use disorder (OUD). DESIGN A nation-wide, register-based cohort study. SETTING Sweden. PARTICIPANTS All residents aged 16-64 years living in Sweden using OUD medication from July 2005 to December 2016 (n = 5757, 71.8% men) were identified from registers of prescriptions, inpatient and specialized outpatient care, causes of death, sickness absence and disability pensions. MEASUREMENTS Main outcome: hospitalization due to OUD. SECONDARY OUTCOMES hospitalization due to any cause; death due to all, natural and external causes. Mortality was analyzed with between-individual multivariate-adjusted Cox hazards regression model. Recurrent outcomes, such as hospitalizations, were analyzed with within-individual analyses to eliminate selection bias. OUD medication use versus non-use was modelled with PRE2DUP (from prescription drug purchases to drug use periods) method. FINDINGS Buprenorphine [hazard ratio (HR) = 0.73, 95% confidence interval (CI) = 0.54-0.97] and methadone (HR = 0.74, 95% CI = 0.59-0.93) use were associated with significantly lower risk of OUD hospitalization, but not any-cause hospitalizations, compared with the time-periods when the same individual did not use OUD medication. The use of buprenorphine and methadone were both associated with significantly lower risk of all-cause mortality (HR = 0.45, 95% CI = 0.34-0.59; HR = 0.51, 95% CI = 0.41-0.63, respectively), compared with non-use of both medications. Similar results were found for risk of mortality due to external causes (HR = 0.39; 95% CI = 0.27-0.54; HR = 0.40; 95% CI = 0.29-0.53, respectively), but not for mortality due to natural causes. The risk of OUD hospitalization and all-cause mortality was decreased in all duration categories of studied medications (< 30, 31-180, 181-365 and >365 days), except for methadone use less than 30 days. CONCLUSIONS The use of buprenorphine and methadone are both associated with a significantly lower risk of hospitalization due to opioid use disorder and death due to all and external causes, when compared with non-use.
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Affiliation(s)
- Milja Heikkinen
- Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska InstitutetStockholmSweden
| | - Heidi Taipale
- Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska InstitutetStockholmSweden,School of PharmacyUniversity of Eastern FinlandKuopioFinland
| | - Antti Tanskanen
- Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska InstitutetStockholmSweden
| | - Ellenor Mittendorfer‐Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska InstitutetStockholmSweden
| | - Markku Lähteenvuo
- Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland
| | - Jari Tiihonen
- Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,Department of Clinical Neuroscience, Karolinska Institutet and Centre for Psychiatry ResearchStockholm Health Care Services, Region StockholmStockholmSweden,Neuroscience CenterUniversity of HelsinkiHelsinkiFinland
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St. Ville M, Bergen AW, Baurley JW, Bible JD, McMahan CS. Assessing Opioid Use Disorder Treatments in Trials Subject to Non-Adherence via a Functional Generalized Linear Mixed-Effects Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095456. [PMID: 35564851 PMCID: PMC9104047 DOI: 10.3390/ijerph19095456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/10/2022]
Abstract
The opioid crisis in the United States poses a major threat to public health due to psychiatric and infectious disease comorbidities and death due to opioid use disorder (OUD). OUD is characterized by patterns of opioid misuse leading to persistent heavy use and overdose. The standard of care for treatment of OUD is medication-assisted treatment, in combination with behavioral therapy. Medications for opioid use disorder have been shown to improve OUD outcomes, including reduction and prevention of overdose. However, understanding the effectiveness of such medications has been limited due to non-adherence to assigned dose levels by study patients. To overcome this challenge, herein we develop a model that views dose history as a time-varying covariate. Proceeding in this fashion allows the model to estimate dose effect while accounting for lapses in adherence. The proposed model is used to conduct a secondary analysis of data collected from six efficacy and safety trials of buprenorphine maintenance treatment. This analysis provides further insight into the time-dependent treatment effects of buprenorphine and how different dose adherence patterns relate to risk of opioid use.
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Affiliation(s)
- Madeleine St. Ville
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634, USA; (M.S.V.); (J.D.B.)
| | - Andrew W. Bergen
- Oregon Research Institute, Eugene, OR 97403, USA;
- BioRealm, LLC, Walnut, CA 91789, USA;
| | | | - Joe D. Bible
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634, USA; (M.S.V.); (J.D.B.)
| | - Christopher S. McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634, USA; (M.S.V.); (J.D.B.)
- Correspondence:
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45
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Jones G, Ricard JA, Lipson J, Nock MK. Associations between classic psychedelics and opioid use disorder in a nationally-representative U.S. adult sample. Sci Rep 2022; 12:4099. [PMID: 35393455 PMCID: PMC8990065 DOI: 10.1038/s41598-022-08085-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 02/06/2023] Open
Abstract
Opioid use disorder (OUD) is a major source of morbidity and mortality in the U.S. and there is a pressing need to identify additional treatments for the disorder. Classic psychedelics (psilocybin, peyote, mescaline, LSD) have been linked to the alleviation of various substance use disorders and may hold promise as potential treatments for OUD. The aim of this study was to assess whether the aforementioned classic psychedelic substances conferred lowered odds of OUD. Furthermore, this study aimed to replicate and extend findings from Pisano et al. (2017) who found classic psychedelic use to be linked to lowered odds of OUD in a nationally representative sample. We used recent data from the National Survey on Drug Use and Health (2015–2019) (N = 214,505) and multivariable logistic regression to test whether lifetime use (yes/no) of classic psychedelics was associated with lowered odds of OUD. Lifetime psilocybin use was associated with lowered odds of OUD (aOR: 0.70; 95% CI [0.60, 0.83]). No other substances, including other classic psychedelics, were associated with lowered odds of OUD. Additionally, sensitivity analyses revealed psilocybin use to be associated with lowered odds of seven of the 11 DSM-IV criteria for OUD (aOR range: 0.66–0.83). Future clinical trials and longitudinal studies are needed to determine whether these associations are causal.
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Affiliation(s)
- Grant Jones
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, 02138, USA.
| | | | - Joshua Lipson
- Teachers College, Columbia University, New York, USA
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Ameral V, Hocking E, Leviyah X, Newberger NG, Timko C, Livingston N. Innovating for real-world care: A systematic review of interventions to improve post-detoxification outcomes for opioid use disorder. Drug Alcohol Depend 2022; 233:109379. [PMID: 35255353 DOI: 10.1016/j.drugalcdep.2022.109379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inpatient detoxification is a common health care entry point for people with Opioid Use Disorder (OUD). However, many patients return to opioid use after discharge and also do not access OUD treatment. This systematic review reports on the features and findings of research on interventions developed specifically to improve substance use outcomes and treatment linkage after inpatient detoxification for OUD. METHODS Of 6419 articles, 64 met inclusion criteria for the current review. Articles were coded on key domains including sample characteristics, study methods and outcome measures, bias indicators, intervention type, and findings. RESULTS Many studies did not report sample characteristics, including demographics and co-occurring psychiatric and substance use disorders, which may impact postdetoxification OUD treatment outcomes and the generalizability of interventions. Slightly more than half of studies examined interventions that were primarily medical in nature, though only a third focused on initiating medication treatment beyond detoxification. Medical and combination interventions that focused on initiating medications for OUD generally performed well, as did psychological interventions with one or more reinforcement-based components. CONCLUSIONS Research efforts to improve post-detoxification outcomes would benefit from clearer reporting of sample characteristics that are associated with treatment and recovery outcomes, including diagnostic comorbidities. Findings also support the need to identify ways to introduce medication for opioid use disorder (MOUD) and other effective treatments including reinforcement-based interventions during detoxification or soon after.
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Affiliation(s)
- Victoria Ameral
- VISN 1 Mental Illness Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
| | | | - Xenia Leviyah
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Noam G Newberger
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Christine Timko
- VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford University School of Medicine, Stanford, CA, USA
| | - Nicholas Livingston
- VA Boston Healthcare System, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Ghosh A, Sharma N, Noble D, Basu D, Mattoo SK, Bhagyalakshmi Nanjayya S, Pillai RR. Predictors of Five-year Readmission to an Inpatient Service among Patients with Opioid Use Disorders. J Psychoactive Drugs 2022; 55:213-223. [PMID: 35348049 DOI: 10.1080/02791072.2022.2057260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Opioid use disorder (OUD), a relapsing-remitting chronic medical disease, accounts for a sizable proportion of all-cause adult inpatient stays. We evaluated the incidence and predictors of any and multiple readmissions to inpatient care for OUD. Methods This retrospective, register-based cohort study assessed consecutive patients with OUD admitted to a federally-funded inpatient service of an addiction treatment center in North India between January 2007 and December 2014. Binary logistic regression was used to determine independent readmission predictors based on demographic, clinical, and treatment variables that significantly differed in bivariate analysis. Results Among 908 patients, 306 (33.7%) and 106 (11.7%) had any and multiple readmissions, respectively. Injection drug use (Odds ratio [OR] 2.92, 95% confidence interval [CI] 1.90-4.49), comorbid severe mental illness (OR 2.80, 95% CI 1.42-5.55) and common mental disorder (OR 3.4 95% CI 1.65-6.95), antagonist treatment (OR 1.6 95% CI 1.14-2.27), and urban residence (OR 1.38 95% CI 1.01-1.90) increased odds of readmission. 'Improved' discharge status (OR 0.48 95% CI 0.34-0.70) in first admissions reduced odds of any readmission. Similar risk factors also influenced multiple readmissions with higher odds ratios. Conclusions Identification and adequate treatment of risk factors may reduce the chances of readmission.
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Affiliation(s)
- Abhishek Ghosh
- & Treatment Centre & Department of Psychiatry, Postgraduate Institute of medical Education & ResearchDrug De-addiction, Chandigarh, India
| | - Nidhi Sharma
- Department of Psychiatry, Indira Gandhi Medical College, Shimla, India
| | - Dalton Noble
- Department of Psychiatry, Ivy Hospital, Nawanshahr, India
| | - Debasish Basu
- & Treatment Centre & Department of Psychiatry, Postgraduate Institute of medical Education & ResearchDrug De-addiction, Chandigarh, India
| | - S K Mattoo
- Consultant Psychiatrist, Community Mental Health Clinic, Cumbria Northumberland Tyne and Wear Foundation Nhs Trust, Molineux Nhs Centre, Byker, UK
| | - Subodh Bhagyalakshmi Nanjayya
- & Treatment Centre & Department of Psychiatry, Postgraduate Institute of medical Education & ResearchDrug De-addiction, Chandigarh, India
| | - R R Pillai
- & Treatment Centre & Department of Psychiatry, Postgraduate Institute of medical Education & ResearchDrug De-addiction, Chandigarh, India
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Tatara E, Gutfraind A, Collier NT, Echevarria D, Cotler SJ, Major ME, Ozik J, Dahari H, Boodram B. Modeling hepatitis C micro-elimination among people who inject drugs with direct-acting antivirals in metropolitan Chicago. PLoS One 2022; 17:e0264983. [PMID: 35271634 PMCID: PMC8912265 DOI: 10.1371/journal.pone.0264983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease and mortality worldwide. Direct-acting antiviral (DAA) therapy leads to high cure rates. However, persons who inject drugs (PWID) are at risk for reinfection after cure and may require multiple DAA treatments to reach the World Health Organization's (WHO) goal of HCV elimination by 2030. Using an agent-based model (ABM) that accounts for the complex interplay of demographic factors, risk behaviors, social networks, and geographic location for HCV transmission among PWID, we examined the combination(s) of DAA enrollment (2.5%, 5%, 7.5%, 10%), adherence (60%, 70%, 80%, 90%) and frequency of DAA treatment courses needed to achieve the WHO's goal of reducing incident chronic infections by 90% by 2030 among a large population of PWID from Chicago, IL and surrounding suburbs. We also estimated the economic DAA costs associated with each scenario. Our results indicate that a DAA treatment rate of >7.5% per year with 90% adherence results in 75% of enrolled PWID requiring only a single DAA course; however 19% would require 2 courses, 5%, 3 courses and <2%, 4 courses, with an overall DAA cost of $325 million to achieve the WHO goal in metropolitan Chicago. We estimate a 28% increase in the overall DAA cost under low adherence (70%) compared to high adherence (90%). Our modeling results have important public health implications for HCV elimination among U.S. PWID. Using a range of feasible treatment enrollment and adherence rates, we report robust findings supporting the need to address re-exposure and reinfection among PWID to reduce HCV incidence.
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Affiliation(s)
- Eric Tatara
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
- Decision and Infrastructure Sciences, Argonne National Laboratory, Argonne, Illinois, United States of America
- * E-mail: (ET); (HD); (BB)
| | - Alexander Gutfraind
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, United States of America
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Nicholson T. Collier
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
- Decision and Infrastructure Sciences, Argonne National Laboratory, Argonne, Illinois, United States of America
| | - Desarae Echevarria
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, United States of America
| | - Scott J. Cotler
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, United States of America
| | - Marian E. Major
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
- Decision and Infrastructure Sciences, Argonne National Laboratory, Argonne, Illinois, United States of America
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, United States of America
- * E-mail: (ET); (HD); (BB)
| | - Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail: (ET); (HD); (BB)
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George TP, Welsh L, Franchuk SL, Vaccarino FJ. Why Integrating Medications and Psychosocial Interventions is Important to Successfully Address the Opioid Crisis in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:176-178. [PMID: 34424059 PMCID: PMC8935597 DOI: 10.1177/07067437211037625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tony P George
- Addictions Division, 7978Centre for Addiction and Mental Health, Toronto, Ontario.,Departments of Psychiatry, Family and Community Medicine, 7938University of Toronto, Toronto, Ontario
| | - Lauren Welsh
- Addictions Division, 7978Centre for Addiction and Mental Health, Toronto, Ontario.,Family and Community Medicine, 7938University of Toronto, Toronto, Ontario
| | - Susan L Franchuk
- Addictions Division, 7978Centre for Addiction and Mental Health, Toronto, Ontario.,Departments of Psychiatry, Family and Community Medicine, 7938University of Toronto, Toronto, Ontario
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Victor G, Zettner C, Huynh P, Ray B, Sightes E. Jail and overdose: assessing the community impact of incarceration on overdose. Addiction 2022; 117:433-441. [PMID: 34251065 DOI: 10.1111/add.15640] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/23/2021] [Accepted: 06/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Incarceration produces a specific public health threat for drug overdose, and correctional settings do not offer medication for opioid use disorder. This study examined the overall impact of jail incarceration on overdose, the specific hazard for those booked on a syringe-related charge and the proportion of all overdose decedents in the community who were in the jail prior to death. DESIGN AND SETTING A cohort study of fatal overdose outcomes among a sample of individuals booked into and released from jail between 1 January 2017 and 31 December 2019. Marion County, IN, USA. PARTICIPANTS All individuals released from one county jail between 1 January 2017 and 31 December 2017 and decedents who died within the county from an accidental fatal overdose between January 2017 and December 2019. MEASUREMENTS AND FINDINGS Using information on all jail booking events, including charge type, during a 5-year period (January 2015-December 2019), we looked at the hazard of accidental fatal overdose post-release, controlling for age, sex and race. Of all overdose deaths in the county, 21% (n = 237) had been in the county jail within 2 years prior to their death. Each prior booking increased the hazard of mortality by approximately 20% [hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.15, 1.28], while the presence of a syringe charge at most recent booking prior to release more than tripled the hazard of mortality (HR = 3.55, 95% CI = 2.55, 4.93). CONCLUSIONS In Marion County, IN, USA, there appears to be an association between increased risk of fatal drug overdose and both syringe-related arrests and repeat jail bookings.
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Affiliation(s)
- Grant Victor
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Catherine Zettner
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Philip Huynh
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Bradley Ray
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
| | - Emily Sightes
- School of Social Work, Center for Behavioral Health and Justice, Wayne State University, Detroit, MI, USA
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