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Getty CA, Weaver T, Metrebian N. A qualitative exploration of patients' experience of mobile telephone-delivered contingency management to promote adherence to supervised methadone. Drug Alcohol Rev 2023; 42:641-651. [PMID: 36269110 DOI: 10.1111/dar.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Despite an increasing evidence base for mobile telephone-delivered contingency management (mCM), there had been no previous qualitative exploration of patients' experience of receiving mCM and the factors that might influence that experience and outcome in a UK setting. The aim of this study was to understand patients' views and experience of receiving mCM by exploring their beliefs, expectations and perceived benefits within the context of the UK's first mCM intervention. METHODS Qualitative interviews (N = 15) were conducted with patients undergoing opioid agonist treatment in a UK drug treatment service and receiving mCM to encourage adherence with supervised methadone as part of an existing study. Interviews were conducted at two time points and analysed using Framework to explore patients' expectations and beliefs during the early stage of the intervention (2 weeks) and their perceived benefits and experience at the end of the intervention (12 weeks). RESULTS The mCM was perceived as a motivator, providing validation of achievement, and involving discreet and positive interactions. Perceived benefits included enhanced methadone adherence, reduced drug use and the development of a supportive and non-judgemental connection that resembled a therapeutic alliance. DISCUSSION AND CONCLUSIONS The mechanisms underpinning contingency management appeared to operate in the absence of human interaction, and the mCM intervention was deemed to be meaningful, acceptable and well received by patients. These findings not only provide support for the application of mCM in this context but also offer insight into the factors that influence outcomes and should be considered in the development of future mCM interventions.
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Affiliation(s)
- Carol-Ann Getty
- National Addiction Centre, King's College London, London, UK
| | - Tim Weaver
- Department of Mental Health and Social Work at Middlesex University, London, UK
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Carlisle VR, Maynard OM, Bagnall D, Hickman M, Shorrock J, Thomas K, Kesten J. Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1526. [PMID: 36674280 PMCID: PMC9865602 DOI: 10.3390/ijerph20021526] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/15/2023]
Abstract
(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government's emphasis on "recovery" may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of the factors that might influence the treatment journeys of people who use OAT. (2) We explored factors at each level of the socioecological system and considered the ways these interact to influence treatment journeys in OAT. We carried out semi-structured interviews with people who use OAT (n = 12) and service providers (n = 13) and analysed data using reflexive thematic analysis. (3) We developed three themes representing participant perceptions of treatment journeys in OAT. These were: (1) The System is Broken; (2) Power Struggles; and (3) Filling the Void. (4) Conclusions: The data suggest that prioritisation of treatment retention is important to preserve the harm-reduction benefits of OAT. Stigma is a systemic issue which presents multiple barriers to people who use OAT living fulfilling lives. There is an urgent need to develop targeted interventions to address stigma towards people who use OAT.
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Affiliation(s)
- Victoria Rice Carlisle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- School of Psychological Sciences, University of Bristol, Bristol BS8 1TU, UK
| | - Olivia M. Maynard
- School of Psychological Sciences, University of Bristol, Bristol BS8 1TU, UK
| | - Darren Bagnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Jon Shorrock
- Avon & Wiltshire NHS Mental Health Trust, Specialist Drug and Alcohol Services, Colston Fort, Montague Place, Bristol BS6 5UB, UK
| | - Kyla Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Joanna Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- The National Institute for Health and Care Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- The National Institute for Health and Care Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol BS8 1TL, UK
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Healy R, Goodwin J, Kelly P. 'As for dignity and respect…. me bollix': A human rights-based exploration of service user narratives in Irish methadone maintenance treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103901. [PMID: 36351318 DOI: 10.1016/j.drugpo.2022.103901] [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: 05/13/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION This paper explores the narratives of service users of contemporary methadone maintenance treatment services (MMT) in the Republic of Ireland to obtain their perspectives in the context of them negotiating their right to health METHODS: Participants were recruited and interviewed by a former service user of MMT services. In-depth qualitative interviews were conducted with 40 current and recent users of MMT services RESULTS: Participants overwhelmingly reported a reduced sense of personal agency because of their experiences in MMT treatment. Participants observed that their perceptions of treatment were forged by a sense of reduced autonomy, coercive and disrespectful approaches from healthcare workers. Within a system which the participants considered to be failing, the services that they accessed were predicated on a process of reward and punishment, where best practice was often ignored by practitioners, all of which resulted in adverse consequences for service users DISCUSSION: The findings indicate that there is a significant 'chasm' between human rights, policy and best practice and how these are operationalised within the structures and practices of Irish MMT services. The treatment of service users, based on human rights principles such as equality, respect, autonomy, empowerment and personal choice remains aspirational and is unlikely to be fulfilled without addressing more systemic challenges such as funding, training of staff, service culture, governance and independent oversight of MMT services.
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Affiliation(s)
- Richard Healy
- Department of Sociology, Maynooth University, Ireland
| | - John Goodwin
- School of Nursing & Midwifery, University College Cork, Ireland
| | - Peter Kelly
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
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Holland A, Stevens A, Harris M, Lewer D, Sumnall H, Stewart D, Gilvarry E, Wiseman A, Howkins J, McManus J, Shorter GW, Nicholls J, Scott J, Thomas K, Reid L, Day E, Horsley J, Measham F, Rae M, Fenton K, Hickman M. Analysis of the UK Government's 10-Year Drugs Strategy-a resource for practitioners and policymakers. J Public Health (Oxf) 2022:6779883. [PMID: 36309802 DOI: 10.1093/pubmed/fdac114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/10/2022] [Indexed: 11/12/2022] Open
Abstract
In 2021, during a drug-related death crisis in the UK, the Government published its ten-year drugs strategy. This article, written in collaboration with the Faculty of Public Health and the Association of Directors of Public Health, assesses whether this Strategy is evidence-based and consistent with international calls to promote public health approaches to drugs, which put 'people, health and human rights at the centre'. Elements of the Strategy are welcome, including the promise of significant funding for drug treatment services, the effects of which will depend on how it is utilized by services and local commissioners and whether it is sustained. However, unevidenced and harmful measures to deter drug use by means of punishment continue to be promoted, which will have deleterious impacts on people who use drugs. An effective public health approach to drugs should tackle population-level risk factors, which may predispose to harmful patterns of drug use, including adverse childhood experiences and socioeconomic deprivation, and institute evidence-based measures to mitigate drug-related harm. This would likely be more effective, and just, than the continuation of policies rooted in enforcement. A more dramatic re-orientation of UK drug policy than that offered by the Strategy is overdue.
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Affiliation(s)
- Adam Holland
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Alex Stevens
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, CT2 7NZ
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Dan Lewer
- Public Health Specialty Registrar, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, L3 5UX, UK
| | - Daniel Stewart
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Eilish Gilvarry
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, NE1 7RU, UK
| | - Alice Wiseman
- Association of Directors of Public Health, London, EC4Y 0HA, UK
| | - Joshua Howkins
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Jim McManus
- Association of Directors of Public Health, London, EC4Y 0HA, UK
| | | | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Jenny Scott
- Department of Pharmacy & Pharmacology, University of Bath, Bath, BA2 7AY
| | - Kyla Thomas
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | | | - Edward Day
- Institute of Mental Health, University of Birmingham, Birmingham, B15 2TT
| | - Jason Horsley
- National Institute for Health Research Evaluation Trials and Studies Coordinating Centre, University of Southampton, Southampton, SO17 1BJ, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, L69 3BX
| | - Maggie Rae
- Epidemiological and Public Health Section, Royal Society of Medicine, London, W1G 0AE, UK
| | | | - Matthew Hickman
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
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Scott K, Guigayoma J, Palinkas LA, Beaudoin FL, Clark MA, Becker SJ. The measurement-based care to opioid treatment programs project (MBC2OTP): a study protocol using rapid assessment procedure informed clinical ethnography. Addict Sci Clin Pract 2022; 17:44. [PMID: 35986380 PMCID: PMC9389829 DOI: 10.1186/s13722-022-00327-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Psychosocial interventions are needed to enhance patient engagement and retention in medication treatment within opioid treatment programs. Measurement-based care (MBC), an evidence-based intervention structure that involves ongoing monitoring of treatment progress over time to assess the need for treatment modifications, has been recommended as a flexible and low-cost intervention for opioid treatment program use. The MBC2OTP Project is a two-phase pilot hybrid type 1 effectiveness-implementation trial that has three specific aims: (1) to employ Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) to collect mixed methods data to inform MBC implementation; (2) to use RAPICE data to adapt an MBC protocol; and (3) to conduct a hybrid type 1 trial to evaluate MBC’s preliminary effectiveness and implementation potential in opioid treatment programs. Methods This study will be conducted in two phases. Phase 1 will include RAPICE site visits, qualitative interviews (N = 32–48 total), and quantitative surveys (N = 64–80 total) with staff at eight programs to build community partnerships and evaluate contextual factors impacting MBC implementation. Mixed methods data will be analyzed using immersion/crystallization and thematic analysis to inform MBC adaptation and site selection. Four programs selected for Phase 2 will participate in MBC electronic medical record integration, training, and ongoing support. Chart reviews will be completed in the 6 months prior-to and following MBC integration (N = 160 charts, 80 pre and post) to evaluate effectiveness (patient opioid abstinence and treatment engagement) and implementation outcomes (counselor MBC exposure and fidelity). Discussion This study is among the first to take forward recommendations to implement and evaluate MBC in opioid treatment programs. It will also employ an innovative RAPICE approach to enhance the quality and rigor of data collection and inform the development of an MBC protocol best matched to opioid treatment programs. Overall, this work seeks to enhance treatment provision and clinical outcomes for patients with opioid use disorder. Trial registration This study will be registered with Clinicaltrials.gov within 21 days of first participant enrollment in Phase 2. Study Phase 1 (RAPICE) does not qualify as a clinical trial, therefore Phase 2 clinical trial registration has not yet been pursued because all elements of Phase 2 will be dependent on Phase 1 outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00327-0.
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Perspectives of Patients Receiving Telemedicine Services for Opioid Use Disorder Treatment: A Qualitative Analysis of User Experiences. J Addict Med 2022; 16:702-708. [PMID: 35861337 PMCID: PMC10075257 DOI: 10.1097/adm.0000000000001006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Telemedicine for opioid use disorder (tele-OUD) has the potential to increase access to medications for OUD (MOUD). Fully virtual tele-OUD services, in which all care is provided via telemedicine, are increasingly common, yet few studies document the experiences of patients who use such services. Understanding patient perspectives is one of multiple considerations to inform the regulation and reimbursement of tele-OUD services. METHODS We conducted semi-structured interviews with 20 adults receiving care from one fully virtual tele-OUD service who had received 3 to 5 weeks of treatment. Analyses were conducted using an inductive and deductive approach informed by the modified Unified Theory of Acceptance and Use of Technology model. RESULTS Over three quarters of patients with past experience receiving in-person MOUD treatment described tele-OUD as more advantageous with its key strength being more patient centered. Over three quarters of patients said they felt tele-OUD helped to ameliorate social barriers to seeking treatment, and nearly all said they appreciated the speed at which they were able to initiate MOUD treatment via tele-OUD. Surprisingly, the pandemic was not among the factors that influenced patient interest in tele-OUD. CONCLUSIONS Patients engaged in one fully virtual tele-OUD service described unique advantages of tele-OUD. More research is needed to determine the appropriateness of tele-OUD for people in various stages of recovery, and data on long-term treatment outcomes are needed to inform decisions regarding the regulation and reimbursement of fully virtual and hybrid care models for OUD.
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Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuéllar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022; 399:555-604. [PMID: 35122753 PMCID: PMC9261968 DOI: 10.1016/s0140-6736(21)02252-2] [Citation(s) in RCA: 190] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amy S B Bohnert
- Department of Psychiatry and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA USA
| | | | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA; Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yasmin L Hurd
- Addiction Institute, Icahn School of Medicine, New York, NY, USA
| | - David N Juurlink
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Erin E Krebs
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery and Outcomes Research, Veterans Affairs Minneapolis Health Care System, Minneapolis, MN, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Timko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Schottenfeld RS, Chawarski MC, Mazlan M. Behavioral counseling and abstinence-contingent take-home buprenorphine in general practitioners' offices in Malaysia: a randomized, open-label clinical trial. Addiction 2021; 116:2135-2149. [PMID: 33404150 DOI: 10.1111/add.15399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/27/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM To address the widespread severe problems with opioid use disorder, buprenorphine-naloxone treatment provided by primary care physicians has greatly expanded treatment access; however, treatment is often provided with minimal or no behavioral interventions. Whether or which behavioral interventions are feasible to implement in various settings and improve treatment outcomes has not been established. This study aimed to evaluate two behavioral interventions to improve buprenorphine-naloxone treatment. DESIGN A 2 × 2 factorial, repeated-measures, open-label, randomized clinical trial. SETTINGS General medical practice offices in Muar, Malaysia. PARTICIPANTS Opioid-dependent individuals (n = 234). INTERVENTIONS Participants were randomly assigned to one of four treatment conditions and received study interventions for 24 weeks: (1) physician management with or without behavioral counseling and (2) physician management with or without abstinence-contingent buprenorphine-naloxone (ACB) take-home doses. MEASUREMENTS The primary outcomes were proportions of opioid-negative urine tests and HIV risk behaviors [assessed by audio computer-assisted AIDS risk inventory (ACASI-ARI)]. FINDINGS The rates of opioid-negative urine tests over 24 weeks of treatment were significantly higher with [68.2%, 95% confidence interval (CI) = 65-71] than without behavioral counseling (59.2%, 95% CI = 56-62, P < 0.001) and with (71.0%, 95% CI = 68-74) than without ACB (56.4%, 95% CI = 53-59, P < 0.001); interaction effects between and among behavioral interventions and time were not statistically significant. Scores on ACASI-ARI decreased significantly from baseline across all treatment groups (P < 0.001) and did not differ significantly with or without behavioral counseling (P = 0.099) or with or without ACB (P = 0.339). CONCLUSIONS Providing opioid-dependent patients in Muar, Malaysia with buprenorphine-naloxone and physician management plus behavioral counseling or abstinence-contingent buprenorphine-naloxone (ACB) resulted in greater reductions of opioid use compared with providing buprenorphine-naloxone and physician management without behavioral counseling or ACB.
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Affiliation(s)
- Richard S Schottenfeld
- Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, DC, USA
| | - Marek C Chawarski
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Rizk MM, Herzog S, Dugad S, Stanley B. Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. CURRENT ADDICTION REPORTS 2021; 8:194-207. [PMID: 33747710 PMCID: PMC7955902 DOI: 10.1007/s40429-021-00361-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/05/2023]
Abstract
Purpose of Review Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior. Recent Findings Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior. Summary Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
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Affiliation(s)
- Mina M. Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry, Faculty of Medicine, Minia University, Egypt, Egypt
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
| | - Sanjana Dugad
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
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Wild TC, Hammal F, Hancock M, Bartlett NT, Gladwin KK, Adams D, Loverock A, Hodgins DC. Forty-eight years of research on psychosocial interventions in the treatment of opioid use disorder: A scoping review. Drug Alcohol Depend 2021; 218:108434. [PMID: 33302176 DOI: 10.1016/j.drugalcdep.2020.108434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mapped the sources and types of evidence available on psychosocial interventions in the treatment of opioid use disorder (OUD), with and without pharmacotherapies. METHODS Six electronic databases were searched for research published until July 1, 2019. Included studies were coded on publication characteristics, evidence sources, treatment settings and modalities, study populations and patient characteristics, intervention(s) offered to patients, research questions addressed in experimental studies, and outcomes investigated. RESULTS We identified 305 empirical studies of 54,607 patients. Most studies (64 %; n = 194) compared psychosocial interventions to alternative treatment(s) (183 RCTs and 11 quasi-experiments) while 28 % (n = 86) used observational designs, and 8% (n = 25) used qualitative methods. Trials infrequently investigated effects of stand-alone psychosocial interventions without pharmacotherapies (20% of all RCTs). Regardless of research question or study design, program retention and illicit drug use were the most common outcomes investigated (> 81% of all studies and RCTs), typically among longstanding male heroin users attending specialty outpatient addiction services. Studies rarely examined (a) OUD treatment in general health care or prescription OUD (each < 6 % of all studies and RCTs), (b) effects of social assistance (employment, education, social support) and harm reduction (each < 6 % of studies; < 7 % of RCTs), and (c) health-related quality of life and satisfaction with care (each < 10 % and < 15 % of all studies and RCTs, respectively). CONCLUSIONS Scant evidence is available on the putative rehabilitative effects of psychosocial interventions, either as stand-alone treatments or in an adjunct role to pharmacotherapies.
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Affiliation(s)
| | - Fadi Hammal
- School of Public Health, University of Alberta, Canada
| | - Myles Hancock
- School of Public Health, University of Alberta, Canada
| | | | | | - Denise Adams
- School of Public Health, University of Alberta, Canada
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Jones NR, Hickman M, Larney S, Nielsen S, Ali R, Murphy T, Dobbins T, Fiellin DA, Degenhardt L. Hospitalisations for non-fatal overdose among people with a history of opioid dependence in New South Wales, Australia, 2001-2018: Findings from the OATS retrospective cohort study. Drug Alcohol Depend 2021; 218:108354. [PMID: 33121866 DOI: 10.1016/j.drugalcdep.2020.108354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To examine, among a cohort of opioid dependent people with a history of opioid agonist treatment (OAT), the frequency and incidence rates of non-fatal overdose (NFOD) hospital separations over time, by age and sex. METHODS Retrospective cohort study of people with a history of OAT using state-wide linked New South Wales (NSW) data. The incidence of NFOD hospital separations involving an opioid, sedative, stimulant or alcohol was defined according to the singular or combination of poisoning/toxic effect using ICD-10-AM codes. Crude incidence rates were calculated by gender, age group and calendar year. RESULTS There were 31.8 (31.3-32.3) NFOD per 1,000 person-years (PY). Opioid NFOD incidence was higher in women than men: incidence rate ratio (IRR) 1.11 per 1,000PY; 95 %CI: [1.06-1.17]; women had higher sedative NFOD rates than men, IRR 1.27 per 1,000PY [1.21-1.34]. Participants ≤25 years, 26-30yrs, and 31-35yrs had higher incidence of opioid NFOD compared to 46+yrs, with IRRs of: 1.45 per 1,000PY; [1.32-1.59]; 1.20 per 1,000PY; [1.11-1.30] and 1.22 per 1,000PY; [1.13-1.32], respectively. Between 2006-7 and 2016-17, the cohort accounted for 19 % of NSW opioid NFOD episodes, 12 % of sedative, 14 % of stimulant and 5 % of acute alcohol-related NFOD. CONCLUSIONS Hospital stays due to NFOD are a relatively frequent occurrence among opioid-dependent people. There are clear differences in rates and substances involved by sex, age and over time. Evidence-based interventions that prevent overdose among people who are opioid dependent need to be delivered to scale, including widespread community provision of naloxone.
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Affiliation(s)
- Nicola R Jones
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia.
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS2 8DZ, UK.
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia; Department of Family Medicine and Emergency Medicine, Université de Montréal and Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada.
| | - Suzanne Nielsen
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Melbourne, Australia.
| | - Robert Ali
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia; School of Medicine, The University of Adelaide, Australia.
| | - Thomas Murphy
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia.
| | - Timothy Dobbins
- School of Public Health and Community Medicine, UNSW Sydney, Australia.
| | - David A Fiellin
- Yale Schools of Medicine and Public Health, New Haven, CT, USA.
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, 2052, Australia.
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12
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Busch AB, Greenfield SF, Reif S, Normand SLT, Huskamp HA. Outpatient care for opioid use disorder among the commercially insured: Use of medication and psychosocial treatment. J Subst Abuse Treat 2020; 115:108040. [PMID: 32600627 PMCID: PMC7687676 DOI: 10.1016/j.jsat.2020.108040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence-based outpatient treatment for opioid use disorder (OUD) consists of medications that treat OUD (MOUD) and psychosocial treatments (e.g., psychotherapy or counseling, case management). Prior studies have not examined the use of these components of care in a commercially insured population. METHODS We analyzed claims data from a large national commercial insurer of enrollees age 17-64 identified with OUD (2008-2016, N = 87,877 persons and 122,708 person-years). Multinomial logistic regression models identified factors associated with receiving in a given year: 1) both MOUD and psychosocial visits, 2) MOUD without psychosocial visits, 3) psychosocial visits without MOUD, or 4) neither. We estimated predicted probabilities for key variables of interest. RESULTS Identification of OUD nearly tripled during the observation period (0.17% in 2008, 0.45% in 2016). Among person-years identified as having OUD, 36.3% included MOUD (8.1% both MOUD and psychosocial visits and 28.2% MOUD without psychosocial visits). In adjusted analyses, women had a lower probability of receiving either treatment alone or in combination (e.g.,MOUD plus psychosocial visits: women = 6.7% [6.5%-6.9%] vs. men = 9.2% [9.0%-9.4%]). Moderate/severe vs. mild OUD was associated with a higher probability of receiving MOUD (e.g., MOUD plus psychosocial visits: 8.7% [8.6%-8.9%] vs. 0.9% [0.7%-1.0%]). In contrast, an OUD overdose was associated with a greater probability of receiving neither treatment (78.2% [77.4%-79.0%] vs. 55.5% [55.2%-55.8%]). Over time, the probability of receiving each MOUD and psychosocial treatment category increased relative to 2008, but reached a peak and then plateaued or declined, by the end of the study period. CONCLUSIONS A significant treatment gap exists among individuals identified with OUD in this commercially insured population, with greater risks of receiving no treatment for women and for individuals with mild versus moderate or severe OUD. Overdose is associated with receiving neither MOUD nor psychosocial treatment. While treated prevalence initially increased relative to 2008, rates of treatment subsequently plateaued. Additional study and monitoring to elucidate barriers to OUD treatment in commercially insured populations are warranted.
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Affiliation(s)
- Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America.
| | | | - Sharon Reif
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America.
| | - Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America.
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America.
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13
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Joseph JW, Marshall KD, Reich BE, Boyle KL, Hill KP, Weiner SG, Derse AR. How Emergency Physicians Approach Refusal of Observation after Naloxone Resuscitation. J Emerg Med 2020; 58:148-159. [PMID: 31753755 DOI: 10.1016/j.jemermed.2019.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients who are resuscitated with naloxone frequently refuse a period of observation, even though they may be suffering from a variety of medical and psychiatric comorbidities. Emergency physicians (EPs) are then confronted with the challenge of how best to serve patients' interests while respecting autonomy. OBJECTIVES We sought to characterize how EPs think about this kind of dilemma and the strategies they use to resolve them. METHODS We conducted qualitative semi-structured interviews with a convenience sample of 59 emergency physicians attending the American College of Emergency Physicians' Scientific Assembly in October 2018. Three case vignettes highlighting different clinical and ethical features served as prompts. Interviews were analyzed using a constant comparative method to identify patterns of responses and derive key themes. RESULTS Across the vignettes, EPs demonstrated diverse approaches to observation, assessing decision-making capacity and encouraging compliance. Some EPs refused to comply with a patient's wishes even when they had determined a patient demonstrated capacity. Conversely, a few EPs were willing to allow patients to leave the emergency department (ED) without assessing capacity, or despite determining that the patient lacked capacity. Common reasons for complying with patients' demands were concerns about the patients' rights and concerns about the safety of staff. Most physicians interviewed reported no institutional guidelines or education on the topic, and many physicians expressed an interest in providing medication for addiction treatment in the ED. CONCLUSIONS EPs approach this clinical and ethical dilemma in widely divergent ways. Consensus about strategies for navigating patients' wishes relative to clinical concerns are needed to help EPs manage these challenging cases.
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Affiliation(s)
- Joshua W Joseph
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kenneth D Marshall
- Department of Emergency Medicine, University of Kansas Health System, Kansas City, Kansas; University of Kansas Medical School, Kansas City, Kansas
| | - Betzalel E Reich
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Katherine L Boyle
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kevin P Hill
- Harvard Medical School, Boston, Massachusetts; Division of Addiction Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Scott G Weiner
- Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arthur R Derse
- Center for Bioethics and Medical Humanities, Institute for Health and Society, Milwaukee, Wisconsin; Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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14
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Kiluk BD, Yip SW, DeVito EE, Carroll KM, Sofuoglu M. Anhedonia as a key clinical feature in the maintenance and treatment of opioid use disorder. Clin Psychol Sci 2019; 7:1190-1206. [PMID: 32042509 PMCID: PMC7009780 DOI: 10.1177/2167702619855659] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is a critical need for research on clinical features that may influence response to treatment for opioid use disorder (OUD). Given its neurobiology and relevance to opioid use, anhedonia may be one such promising clinical feature. We identified and reviewed 11 studies that measured anhedonia in humans with OUD to characterize the current state of evidence and highlight potential implications for treatment. The majority of studies were cross-sectional, indicating higher anhedonia scores in opioid-dependent samples compared to healthy controls. Rates of participants with clinically significant anhedonia ranged from 21% to 48%. Anhedonia scores were correlated with opioid craving and use, however there are significant knowledge gaps regarding its time course and impact on treatment adherence and outcomes. Repeated assessment of anhedonia early in treatment for OUD is recommended, as it may be a unique predictor of dropout or non-response, and a potential target for behavioral and/or pharmacological intervention.
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15
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Degenhardt L, Grebely J, Stone J, Hickman M, Vickerman P, Marshall BDL, Bruneau J, Altice FL, Henderson G, Rahimi-Movaghar A, Larney S. Global patterns of opioid use and dependence: harms to populations, interventions, and future action. Lancet 2019; 394:1560-1579. [PMID: 31657732 PMCID: PMC7068135 DOI: 10.1016/s0140-6736(19)32229-9] [Citation(s) in RCA: 411] [Impact Index Per Article: 82.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022]
Abstract
We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3-47·9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Succursale Centre-Ville, Montreal, QC, Canada
| | | | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
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16
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Hiebler-Ragger M, Unterrainer HF. The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications. Front Psychiatry 2019; 10:579. [PMID: 31507461 PMCID: PMC6720034 DOI: 10.3389/fpsyt.2019.00579] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Substance use disorders (SUDs) represent a worldwide epidemic with extensive costs to the individual and to society. Occasionally described as an attachment disorder, they have been linked to various impairments in self-regulation and social functioning. However, while there have been significant advances in the development and validation of treatment strategies for SUD in recent years, the components of these treatment approaches have yet to be fully explored. The characteristics of polydrug use disorder (PUD) especially need to be addressed in more detail, as this diagnosis is highly common in individuals seeking treatment, while simultaneously being associated with poor treatment success. Aim and Scope: This review aims at further exploring the relevance of attachment in PUD and its treatment. To this end, this review provides a concise summary of relevant theories on the development and treatment of SUD in general, including related parameters of attachment, emotion regulation, and neuroscience. Furthermore, several studies focused specifically on PUD are described in more detail. These studies explored the connections between attachment, personality structure, primary and higher emotions (including spirituality), as well as structural and functional neural parameters in inpatients with PUD as well as in healthy controls. Most notably, the described studies highlight that insecure attachment and impairments in personality structure are present in inpatients with PUD. In addition, these characteristics are paralleled by extensive impairments in white matter integrity, especially in tracts connected to facets of emotion regulation. Conclusions: Based on our findings, we emphasize conceptualization of PUD as an Attachment Disorder, on a behavioral as well as on a neural level. Furthermore, we point out the importance of an integrated bio-psycho-social approach in this research area. Consequently, future studies might more closely focus on the influence of attachment-based interventions on emotion regulation abilities as well as a potentially related neuroplasticity. Neuroplastic changes, which are still rather unexplored, might represent important parameters for the assessment of treatment outcomes especially in long-term SUD treatment.
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Affiliation(s)
- Michaela Hiebler-Ragger
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
- Center for Integrative Addiction Research (CIAR), Gruener Kreis Society, Vienna, Austria
| | - Human-Friedrich Unterrainer
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
- Center for Integrative Addiction Research (CIAR), Gruener Kreis Society, Vienna, Austria
- Department of Religious Studies, University of Vienna, Vienna, Austria
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17
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Abstract
Opioid maintenance treatment is the first-line approach in opioid dependence. Both the full opioid agonist methadone (MET) and the partial agonist buprenorphine (BUP) are licensed for the treatment of opioid dependence. BUP differs significantly from MET in its pharmacology, side effects, and safety issues. For example, the risk of respiratory depression is lower than with MET. The risk of diversion and injection of BUP have been reduced by also making it available as a tablet containing the opioid antagonist naloxone. This review summarizes the clinical effects of BUP and examines possible factors that can support decisions regarding the use of BUP or MET in opioid-dependent people.
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Affiliation(s)
- Michael Soyka
- Medical Park Chiemseeblick, Bernau, Germany; Psychiatric Hospital, University of Munich, Munich, Germany
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18
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Day E. Commentary on Jones et al. (2018): An inconvenient truth-complex problems require complex solutions. Addiction 2018; 113:287-288. [PMID: 29314403 DOI: 10.1111/add.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ed Day
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Solihull Integrated Addiction Service, Solihull, UK
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19
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Day E, Copello A, Seddon JL, Christie M, Bamber D, Powell C, Bennett C, Akhtar S, George S, Ball A, Frew E, Goranitis I, Freemantle N. A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services. BMC Psychiatry 2018; 18:8. [PMID: 29334921 PMCID: PMC5769270 DOI: 10.1186/s12888-018-1600-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. METHODS A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support). RESULTS A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall). CONCLUSIONS Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. TRIAL REGISTRATION ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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Affiliation(s)
- Ed Day
- Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG, UK. .,Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Alex Copello
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK ,0000 0004 1936 7486grid.6572.6School of Psychology, The University of Birmingham, Birmingham, UK
| | - Jennifer L. Seddon
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK ,0000 0004 1936 7486grid.6572.6School of Psychology, The University of Birmingham, Birmingham, UK
| | | | | | | | - Carmel Bennett
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Shabana Akhtar
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Sanju George
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Andrew Ball
- Leicester City Drug and Alcohol Service, Leicester, UK
| | - Emma Frew
- 0000 0004 1936 7486grid.6572.6Health Economics Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ilias Goranitis
- 0000 0004 1936 7486grid.6572.6Health Economics Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nick Freemantle
- 0000000121901201grid.83440.3bInstitute of Clinical Trials and Methodology, University College London, London, UK
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20
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Dematteis M, Auriacombe M, D’Agnone O, Somaini L, Szerman N, Littlewood R, Alam F, Alho H, Benyamina A, Bobes J, Daulouede JP, Leonardi C, Maremmani I, Torrens M, Walcher S, Soyka M. Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus. Expert Opin Pharmacother 2017; 18:1987-1999. [DOI: 10.1080/14656566.2017.1409722] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Maurice Dematteis
- Department of Addiction Medicine, Grenoble Alpes University Hospital, Grenoble, France
- Faculty of Medicine, Grenoble Alpes University, Grenoble, France
| | - Marc Auriacombe
- Université de Bordeaux, Bordeaux, France
- Addiction Psychiatry Team, SANPsy CNRS USR, Bordeaux, France
- Pôle Addictologie, CH Ch. Perrens and CHU Bordeaux, Bordeaux, France
| | - Oscar D’Agnone
- Faculty of Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | | | - Néstor Szerman
- Department of Psychiatry, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | | | - Farrukh Alam
- Divisional Medical Director, Central & North West London NHS Foundation Trust, London, UK
| | - Hannu Alho
- Abdominal Center, University Hospital and University of Helsinki, Helsinki, Finland
| | - Amine Benyamina
- Centre d’Enseignement, de Recherche et de Traitement des Addictions, AP-HP, Paris-Sud University Hospital Group, Paul Brousse site, Paris-Sud University, Villejuif, France
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo-CIBERSAM, Oviedo, Spain
| | - Jean Pierre Daulouede
- Université de Bordeaux, Bordeaux, France
- Addiction Psychiatry Team, SANPsy CNRS USR, Bordeaux, France
- Centre d׳Addictologie, BIZIA and CH Bayonne, Bayonne, France
| | - Claudio Leonardi
- Drug Addiction Department, Local Public Health ASL Rome 2, Rome, Italy
| | - Icro Maremmani
- Santa Chiara University Hospital, University of Pisa, Pisa, Italy
| | - Marta Torrens
- Department of Psychiatry and Legal Medicine, Universidad Autonoma de Barcelona, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institut), Barcelona, Spain
| | | | - Michael Soyka
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
- Medical Park Ciemseeblick, Bernau-Felden, Germany
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21
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Flynn PM. Pharmacotherapies as standalone treatments for addictions: why lessening won't work. Addiction 2017; 112:1337-1338. [PMID: 28124510 DOI: 10.1111/add.13707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Patrick M Flynn
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, 76129, USA
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22
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Day E, Mitcheson L. Response to commentaries: Neither optimism or nihilism… but reasons for hope. Addiction 2017; 112:1342-1344. [PMID: 28244175 DOI: 10.1111/add.13775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Ed Day
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Solihull Integrated Addiction Service, Solihull, UK
| | - Luke Mitcheson
- South London and Maudsley NHS Foundation Trust, London, UK
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23
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Raistrick D. Are UK opioid substitution treatment agencies fit for purpose? Addiction 2017; 112:1340-1342. [PMID: 28155249 DOI: 10.1111/add.13737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Duncan Raistrick
- Leeds Addiction Unit, The Coach House, 19 Springfield Mount, Leeds, LS2 9NG, UK
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24
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Selin J. Widening the perspective on opioid substitution treatment. Addiction 2017; 112:1339-1340. [PMID: 28127858 DOI: 10.1111/add.13725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jani Selin
- National Institute for Health and Welfare, Helsinki, Finland
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25
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Strike CJ, Guta A. Patient-centred care and patient engagement to inform the use of psychosocial interventions with opioid substitution treatment: another path for Day & Mitcheson to follow. Addiction 2017; 112:1338-1339. [PMID: 28124391 DOI: 10.1111/add.13708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Carol J Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
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