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Paola R, Pavel S, Tatiana D, Hagit BN, Joseph M, Ronny B, Barak S. Impact of opioid maintenance therapy in the community on re-incarceration in individuals with opioid use disorder-A linked cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209393. [PMID: 38754555 DOI: 10.1016/j.josat.2024.209393] [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: 06/27/2023] [Revised: 04/05/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Studies have found associations between Opioid Agonist Maintenance Treatment during incarceration and reduced recidivism among recently released formerly incarcerated persons. However, the role of community-based Opioid Agonist Maintenance Treatment in reducing recidivism post-release remains less explored. This study examines whether pre-release arranged, prison-to-rehabilitation Opioid Agonist Maintenance Treatment in the community following release is associated with reduced rates and lengths of re-incarceration among justice-involved individuals with Opioid Use Disorder. METHODS A retrospective matched cohort study was conducted using linked records of 208 individuals with a history of Opioid Use Disorder and treatment during their incarceration. The primary predictor variable was the duration of Opioid Agonist Maintenance Treatment, with re-incarceration rates and lengths of stay after re-incarceration being the primary outcomes examined. RESULTS Analysis showed a significant decrease in re-incarcerations and or lengths of stay in prison among those who have been re-incarcerated and have undergone Opioid Agonist Maintenance Treatment in the community for >24 months. CONCLUSIONS Maintaining Opioid Agonist Maintenance Treatment over 24 months may reduce re-incarcerations, and may be significantly associated with a reduction in the length of prison stay for re-incarcerated individuals. The effects were consistent across the overall population and the individuals receiving the treatment. Various other unmeasured factors, including judicial discretion, individual motivation, type of offense, and employment status, could influence this association.
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Affiliation(s)
- Rosca Paola
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel; Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Spivak Pavel
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | - Dudkinski Tatiana
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | | | - Mendlovic Joseph
- Israel Ministry of Health, Jerusalem, Israel; Department of Pediatrics, Shaare Zedek Medical Center, affiliated with Haddasah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Berkovitz Ronny
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
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Fixler AL, Jacobs LA, Jones DB, Arnold A, Underwood EE. There goes the neighborhood? The public safety enhancing effects of a mobile harm reduction intervention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104329. [PMID: 38232437 DOI: 10.1016/j.drugpo.2024.104329] [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: 09/05/2023] [Revised: 12/10/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Buprenorphine is a gold-standard treatment for opioid use disorders, but most people with these disorders do not access it. Barriers to treatment access may be diminished by low-threshold mobile treatment programs but concern regarding their impact on local public safety challenges their adoption. METHODS This quasi-experimental study uses difference-in-differences analyses to measure the impact of four mobile buprenorphine clinics in Pittsburgh on neighborhood arrest rates. The study period spans 2018 to 2022, with a pre-intervention period of 11 to 12 quarters and a post-intervention period of 7 to 8 quarters (dependent on neighborhood). A treatment group of 84 census block groups in the areas surrounding clinics during the time period after their establishment were compared to a control group of city census blocks not within one mile of a clinic plus treated block groups in the two years prior to clinic establishment. Outcome variables include drug, non-drug, and total arrests, measured quarterly per 100 in population. RESULTS Compared to block groups further than 1 mile from a clinic, arrests fell by 34.13 % (b = -0.358, 95 % CI = -0.557, -0.158), drug arrests by 33.85 % (b = -0.087, 95 % CI = -0.151, -0.023), and non-drug related arrests by 22.29 % (b = -0.179, 95 % CI = -0.302, -0.057). Drug arrests declined significantly on days when the clinics were not present (b = -0.015, 95 % CI = -0.025, -0.006), with no significant change on clinic operational days (b = -0.002, 95 % CI = -0.016, -0.013). Total arrests declined significantly on days when clinics were and were not present (b = -0.045, 95 % CI = -0.078, -0.012; and b = -0.052, CI = -0.082, -0.023, respectively). CONCLUSIONS Mobile clinics providing medication for opioid use disorders were associated with reduced neighborhood arrest rates. Expansion of mobile services could promote health equity and public safety.
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Affiliation(s)
- Alex L Fixler
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States.
| | - Leah A Jacobs
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States
| | - Daniel B Jones
- Graduate School of Public and International Affairs, University of Pittsburgh, 3424 Wesley W. Posvar Hall, 230 South Bouquet Street, Pittsburgh, PA 15260, United States
| | - Aaron Arnold
- Prevention Point Pittsburgh, 5913 Penn Avenue, Pittsburgh, PA 15206, United States
| | - Emily E Underwood
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States
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3
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Dobischok S, Guh D, Marchand K, MacDonald S, Lock K, Harrison S, Lajeunesse J, Schechter MT, Oviedo-Joekes E. The Impact of Injectable Opioid Agonist Treatment (iOAT) on Involvement in Criminalized Activities: A Secondary Analysis from a Clinical Trial in Vancouver, BC. Subst Abuse Rehabil 2023; 14:147-156. [PMID: 38026787 PMCID: PMC10657756 DOI: 10.2147/sar.s438451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose A significant portion of the economic consequences of untreated Opioid Use Disorder (OUD) relate to individuals' involvement in the criminal justice system. The present study uncovers if treatment with iOAT is related to the number of criminal charges amongst participants, what type of crime participants were involved in, and the frequency with which participants were victims of crime. This study contributes to the body of research on the effectiveness of iOAT reducing criminal involvement. Patients and Methods This is a secondary analysis of police record data obtained from the Vancouver Police Department over a three-year period during the Study to Assess Longer-term Opioid Medication Effectiveness clinical trial. The data was obtained from participants (N = 192) enrolled in the trial through a release of information form. Results During the three-year period, most charges (45.6%) were property offences, and 25.5% of participants were victims of crime. Participants with no treatment prior to randomization into the SALOME trial were 2.61 (95% CI = 1.64-4.14) more likely to have been charged with a crime than during the iOAT state. Conclusion IOAT can reduce individuals' involvement with the criminal justice system and is thus a crucial part of the continuum of care. Addiction should be conceptualized as a healthcare rather than criminal issue.
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Affiliation(s)
- Sophia Dobischok
- Department of Education and Counselling Psychology, McGill University, Montreal, QC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Daphne Guh
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Kirsten Marchand
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Kurt Lock
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Martin T Schechter
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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4
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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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Butler A, Croxford R, Bodkin C, Akbari H, Bayoumi AM, Bondy SJ, Guenter D, McLeod KE, Gomes T, Kanagalingam T, Kiefer LA, Orkin AM, Owusu-Bempah A, Regenstreif L, Kouyoumdjian F. Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015-2020: a whole population retrospective cohort study. BMJ Open 2023; 13:e071867. [PMID: 37164452 DOI: 10.1136/bmjopen-2023-071867] [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: 05/12/2023] Open
Abstract
OBJECTIVES To describe mortality due to opioid toxicity among people who experienced incarceration in Ontario between 2015 and 2020, during the fentanyl-dominant era. DESIGN In this retrospective cohort study, we linked Ontario coronial data on opioid toxicity deaths between 2015 and 2020 with correctional data for adults incarcerated in Ontario provincial correctional facilities. SETTING Ontario, Canada. PARTICIPANTS Whole population data. MAIN OUTCOMES AND MEASURES The primary outcome was opioid toxicity death and the exposure was any incarceration in a provincial correctional facility between 2015 and 2020. We calculated crude death rates and age-standardised mortality ratios (SMR). RESULTS Between 2015 and 2020, 8460 people died from opioid toxicity in Ontario. Of those, 2207 (26.1%) were exposed to incarceration during the study period. Among those exposed to incarceration during the study period (n=1 29 152), 1.7% died from opioid toxicity during this period. Crude opioid toxicity death rates per 10 000 persons years were 43.6 (95% CI=41.8 to 45.5) for those exposed to incarceration and 0.95 (95% CI=0.93 to 0.97) for those not exposed. Compared with those not exposed, the SMR for people exposed to incarceration was 31.2 (95% CI=29.8 to 32.6), and differed by sex, at 28.1 (95% CI=26.7 to 29.5) for males and 77.7 (95% CI=69.6 to 85.9) for females. For those exposed to incarceration who died from opioid toxicity, 10.6% died within 14 days of release and the risk was highest between days 4 and 7 postrelease, at 288.1 per 10 000 person years (95% CI=227.8 to 348.1). CONCLUSIONS The risk of opioid toxicity death is many times higher for people who experience incarceration compared with others in Ontario. Risk is markedly elevated in the week after release, and women who experience incarceration have a substantially higher SMR than men who experience incarceration. Initiatives to prevent deaths should consider programmes and policies in correctional facilities to address high risk on release.
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Affiliation(s)
- Amanda Butler
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Croxford
- Statistical Consultant, (freelance), Toronto, Ontario, Canada
| | - Claire Bodkin
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hanaya Akbari
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan J Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dale Guenter
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Tara Gomes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tharsan Kanagalingam
- Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Lori A Kiefer
- Ontario Ministry of the Solicitor General, Toronto, Ontario, Canada
| | - Aaron Michael Orkin
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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6
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Russell C, Pang M, Nafeh F, Farrell Macdonald S, Derkzen D, Rehm J, Fischer B. Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada. Int J Qual Stud Health Well-being 2022; 17:2094111. [PMID: 35787743 PMCID: PMC9258049 DOI: 10.1080/17482631.2022.2094111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. Methods This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed. Results The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers. Conclusions Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Michelle Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Frishta Nafeh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | | | - Dena Derkzen
- Policy Sector, Research Branch, Correctional Service of Canada, Ottawa, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Benedikt Fischer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Nayer C, Sveticic J, Abeysundera H, Bui TA. Comparison of the characteristics of patients treated with sublingual vs. long-acting injectable buprenorphine formulations for treatment of opioid use disorder: A retrospective cohort study. Australas Psychiatry 2022; 30:754-758. [PMID: 36113059 DOI: 10.1177/10398562221120365] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Long-acting injectable buprenorphine (LAI-BPN) was introduced in recent years as a novel treatment for opioid use disorder. Despite growing evidence-base of its effectiveness, there is limited research on the relationship between this treatment and patient characteristics. METHODS This descriptive, retrospective cohort study compared sociodemographic and clinical variables between patients treated with SL-BPN and those treated with LAI-BPN at a large metropolitan health service in Queensland, Australia. RESULTS Patients that transitioned to LAI-BPN were more likely to be single, have a comorbid mental illness, untreated hepatitis C infection and longer duration of unsanctioned opioid use. Patients continuing treatment with SL-BPN were more likely to fail to attend appointments and have urine drug screen results positive for gabapentinoids. CONCLUSIONS The results of this study contribute to currently limited literature on this novel treatment option in an Australian context, highlighting factors which may influence patient and prescriber treatment choices. Clinicians may be more inclined to prescribe LAI-BPN to patients with higher psychosocial comorbidity to facilitate engagement in treatment.
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Affiliation(s)
- Carmen Nayer
- Gold Coast Health, Mental Health and Specialist Services, 60093Gold Coast University Hospital, Southport QLD, Australia
| | | | - Hesitha Abeysundera
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Tuan Anh Bui
- Toowong Specialist Clinic, Outpatient Mental Health Services, Toowong, QLD, Australia
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8
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Zhang J, Song C, Dai J, Li L, Yang X, Chen Z. Mechanism of opioid addiction and its intervention therapy: Focusing on the reward circuitry and mu‐opioid receptor. MedComm (Beijing) 2022; 3:e148. [PMID: 35774845 PMCID: PMC9218544 DOI: 10.1002/mco2.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jia‐Jia Zhang
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Chang‐Geng Song
- Department of Neurology Xijing Hospital The Fourth Military Medical University Xi'an China
| | - Ji‐Min Dai
- Department of Hepatobiliary Surgery Xijing Hospital The Fourth Military Medical University Xi'an China
| | - Ling Li
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Xiang‐Min Yang
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Zhi‐Nan Chen
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
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Marsden J, Kelleher M, Hoare Z, Hughes D, Bisla J, Cape A, Cowden F, Day E, Dewhurst J, Evans R, Hearn A, Kelly J, Lowry N, McCusker M, Murphy C, Murray R, Myton T, Quarshie S, Scott G, Turner S, Vanderwaal R, Wareham A, Gilvarry E, Mitcheson L. Extended-release pharmacotherapy for opioid use disorder (EXPO): protocol for an open-label randomised controlled trial of the effectiveness and cost-effectiveness of injectable buprenorphine versus sublingual tablet buprenorphine and oral liquid methadone. Trials 2022; 23:697. [PMID: 35986418 PMCID: PMC9389497 DOI: 10.1186/s13063-022-06595-0] [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: 10/29/2021] [Accepted: 07/25/2022] [Indexed: 01/04/2023] Open
Abstract
Background Sublingual tablet buprenorphine (BUP-SL) and oral liquid methadone (MET) are the daily, standard-of-care (SOC) opioid agonist treatment medications for opioid use disorder (OUD). A sizable proportion of the OUD treatment population is not exposed to sufficient treatment to attain the desired clinical benefit. Two promising therapeutic technologies address this deficit: long-acting injectable buprenorphine and personalised psychosocial interventions (PSI). This study will determine (A) the effectiveness and cost-effectiveness — monthly injectable, extended-release (BUP-XR) in a head-to-head comparison with BUP-SL and MET, and (B) the effectiveness of BUP-XR with adjunctive PSI versus BUP-SL and MET with PSI. Safety, retention, craving, substance use, quality-adjusted life years, social functioning, and subjective recovery from OUD will be also evaluated. Methods This is a pragmatic, multi-centre, open-label, parallel-group, superiority RCT, with a qualitative (mixed-methods) evaluation. The study population is adults. The setting is five National Health Service community treatment centres in England and Scotland. At each centre, participants will be randomly allocated (1:1) to BUP-XR or SOC. At the London study co-ordinating centre, there will also be allocation of participants to BUP-XR with PSI or SOC with PSI. With 24 weeks of study treatment, the primary outcome is days of abstinence from non-medical opioids during study weeks 2–24 combined with up to 12 urine drug screen tests for opioids. For 90% power (alpha, 5%; 15% inflation for attrition), 304 participants are needed for the BUP-XR versus SOC comparison. With the same planning parameters, 300 participants are needed for the BUP-XR and PSI versus SOC and PSI comparison. Statistical and health economic analysis plans will be published before data-lock on the Open Science Framework. Findings will be reported in accordance with the Consolidated Standards of Reporting Trials and Consolidated Health Economic Evaluation Reporting Standards. Discussion This pragmatic randomised controlled trial is the first evaluation of injectable BUP-XR versus the SOC medications BUP-SL and MET, with personalised PSI. If there is evidence for the superiority of BUP-XR over SOC medication, study findings will have substantial implications for OUD clinical practice and treatment policy in the UK and elsewhere. Trial registration EU Clinical Trials register 2018-004460-63. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06595-0.
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10
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Russell C, Lange S, Kouyoumdjian F, Butler A, Ali F. Opioid agonist treatment take-home doses ('carries'): Are current guidelines resulting in low treatment coverage among high-risk populations in Canada and the USA? Harm Reduct J 2022; 19:89. [PMID: 35948961 PMCID: PMC9363267 DOI: 10.1186/s12954-022-00671-z] [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: 04/05/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
Opioid agonist treatment (OAT) is the primary intervention for opioid use disorder (OUD) in Canada and the USA. Yet, a number of barriers contribute to sub-optimal treatment uptake and retention, including daily-supervised medication administration. Thus, clients are eventually granted access to take-home OAT doses (i.e., ‘carries’) to reduce this burden. However, this decision is based on physician discretion and whether patients can demonstrate stability in various life domains, many of which are inextricably linked to the social determinants of health (SDOH). Current Canadian and USA OAT carry guidance documents are not standardized and do not take the SDOH into consideration, resulting in the potential for inequitable access to OAT carries, which may be the case particularly among marginalized populations such as individuals with OUD who have been released from custody. This perspective article posits that current OAT guidelines contribute to inequities in access to OAT carries, and that these inequities likely result in disproportionately low coverage for OUD treatment among some high-risk groups, including individuals on release from incarceration in particular. Relevant impacts of COVID-19 and related policy changes are considered, and suggestions and recommendations to amend current OAT guidance documents are provided.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada. .,Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, ON, M5S 2S1, Toronto, Canada.
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), ON, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Amanda Butler
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.,Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, ON, M5S 2S1, Toronto, Canada
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Kelly TD, Hawk KF, Samuels EA, Strayer RJ, Hoppe JA. Improving Uptake of Emergency Department-initiated Buprenorphine: Barriers and Solutions. West J Emerg Med 2022; 23:461-467. [PMID: 35980414 PMCID: PMC9391022 DOI: 10.5811/westjem.2022.2.52978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Emergency departments (ED) are increasingly providing buprenorphine to persons with opioid use disorder. Buprenorphine programs in the ED have strong support from public health leaders and emergency medicine specialty societies and have proven to be clinically effective, cost effective, and feasible. Even so, few ED buprenorphine programs currently exist. Given this imbalance between evidence-based practice and current practice, proven behavior change approaches can be used to guide local efforts to expand ED buprenorphine capacity. In this paper, we use the theory of planned behavior to identify and address the 1) clinician factors, 2) institutional factors, and 3) external factors surrounding ED buprenorphine implementation. By doing so, we seek to provide actionable and pragmatic recommendations to increase ED buprenorphine availability across different practice settings.
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Affiliation(s)
- Timothy D. Kelly
- Indiana University Emergency Medicine Residency, Indianapolis, Indiana
| | - Kathryn F. Hawk
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Reuben J. Strayer
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Jason A. Hoppe
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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12
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Russell C, Nafeh F, Pang M, MacDonald SF, Derkzen D, Rehm J, Fischer B. Opioid agonist treatment (OAT) experiences and release plans among federally incarcerated individuals with opioid use disorder (OUD) in Ontario, Canada: a mixed-methods study. BMC Public Health 2022; 22:436. [PMID: 35246083 PMCID: PMC8897889 DOI: 10.1186/s12889-022-12685-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
Background Incarcerated populations experience an elevated prevalence of opioid use disorder (OUD). Federal correctional institutions in Canada have increasingly treated OUD among correctional populations via opioid agonist treatment (OAT) – an evidence based pharmacotherapy that works to reduce drug use and related health harms. However, there is limited evidence regarding incarcerated individuals’ experiences with institutional-based OAT, as well potential OAT-related community release prospects. This information is important for optimal treatment retention and improved health. To address this knowledge gap, we conducted a longitudinal follow-up study examining OAT-related experiences among federally incarcerated individuals before and after community release. This article focuses on the baseline (pre-release) data. Methods This mixed-methods study examined OAT-related experiences and release prospects among n = 46 individuals scheduled for community release, recruited from seven federal prisons located in Ontario, Canada. Participants underwent a comprehensive interviewer-administered on-site assessment, including quantitative and qualitative items. Assessment data was furthermore linked to administrative correctional data. Data were analyzed using thematic qualitative and descriptive quantitative approaches. Results Participants had complex histories with opioid use including related negative health outcomes. Experiences with institutional OAT were divergent and provision was not standardized; those with OAT engagement pre-admission did not experience many challenges, whereas those initiating OAT during incarceration experienced barriers such as treatment waitlists and adverse process experiences. Most participants expressed a preference for buprenorphine-naloxone over methadone, but described difficulties accessing it. Participants were keen to transition into community-based treatment, yet envisaged prospective barriers and facilitators concerning successful reintegration and treatment continuity. Conclusions Major barriers towards the current administration of OAT in federal correctional systems in Canada exist, including extensive waitlists, non-standardized practices, and challenges accessing preferred OAT formulations; this contributes to sub-optimal treatment. Eliminating waitlists, standardizing OAT provision, providing additional OAT options, and more comprehensive release planning may be essential for treatment retention and positive outcomes.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.
| | - Frishta Nafeh
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
| | - Michelle Pang
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
| | - Shanna Farrell MacDonald
- Research Branch, Correctional Service Canada, 340 Laurier Avenue West, Ottawa, ON, K1P 0P9, Canada
| | - Dena Derkzen
- Research Branch, Correctional Service Canada, 340 Laurier Avenue West, Ottawa, ON, K1P 0P9, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Campbell Family Mental Health Research InstituteCentre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada.,Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1, Moscow, Russia, 119146
| | - Benedikt Fischer
- Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, V6B 5K3, Canada.,School of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland, 1023, New Zealand.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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13
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Smart R, Reuter P. Does heroin-assisted treatment reduce crime? A review of randomized-controlled trials. Addiction 2022; 117:518-531. [PMID: 34105206 DOI: 10.1111/add.15601] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Several randomized controlled trials (RCTs) conclude that heroin-assisted-treatment (HAT) has a larger benefit-cost ratio than oral methadone because HAT more reliably and substantially reduces participants' criminal activity. This review: (1) summarizes results from RCTs concerning the comparative effectiveness of HAT for reducing criminal activity and (2) examines the role of different mechanisms for explaining changes in crime. DESIGN Systematic search of five databases for RCTs evaluating comparative effectiveness of HAT on participant crime outcomes and potential mediators of crime. Narrative synthesis with tabular comparisons of outcomes extracted across RCTs. SETTING Europe and Canada. PARTICIPANTS Twenty studies, spanning 10 RCTs with 2427 participants, met inclusion criteria. INTERVENTIONS HAT compared to other treatments for opioid use disorder, primarily oral methadone. MEASUREMENTS The primary outcome was criminal activity. Mediator outcomes included illicit heroin use, drug expenditures, employment and earnings and social functioning. FINDINGS All trials found significantly reduced criminal activity among HAT participants, and four found significantly larger reductions for HAT compared to control condition [median odds ratios (ORs) = 0.45]. Reductions in crime are concentrated in drug-related and property offenses (ORs range from 0.14 to 0.90 and from 0.12 to 1.89, respectively). Comparative efficacy of HAT for reducing illicit heroin use probably explains reductions in drug possession offenses, but does not show consistent correlation with drug dealing or property offenses. While three trials showed reductions in drug expenditures as possibly driving crime reductions, others did not report expenditures. There is little evidence that treatment effects on economic and social functioning outcomes explain within-trial changes in criminal activity. CONCLUSIONS Existing literature suggests that heroin-assisted treatment reduces criminal activity, but trials varied in whether these effects exceeded those from oral methadone treatment. Inconsistency in outcome measures across trials complicates understanding drivers of heterogeneity. More detailed information on legal and illegal income, drug expenditures and social interactions could improve our understanding of the causal mechanisms underlying the effect of heroin-assisted-treatment on crime.
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Affiliation(s)
| | - Peter Reuter
- RAND Corporation, Santa Monica, CA, USA.,Department of Criminology and School of Public Policy, University of Maryland, College Park, MD, USA
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14
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Soyka M, Steinböck H. [Substitution Treatment for Opiate Addicts in Forensic Hospitals under the Penal System]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:559-564. [PMID: 35100637 DOI: 10.1055/a-1669-9033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Opiate addiction is common among offenders, and many opiate-dependent lawbreakers are treated in the correctional system according to § 64 STGB. While substitution treatment in prisons has become common practice, substitution treatment in forensic hospitals in the traditionally abstinence-oriented prison system is controversial and also varies from region to region. Basic data on this are lacking so far. The problem is discussed against the background of a current expert opinion case. Current figures from a large forensic hospital in Munich-East show that almost 30% of the patients are treated with substitutes (n=186). The problem of substitution treatment in the prison system is discussed.
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Affiliation(s)
- Michael Soyka
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik, LMU München, München, Deutschland
| | - Herbert Steinböck
- Klinik für forensische Psychiatrie und Psychotherapie, kbo-Isar-Amper-Klinikum München-Ost, Haar bei München
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15
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Bodkin C, Bondy S, Regenstreif L, Kiefer L, Kouyoumdjian F. Rates of opioid agonist treatment prescribing in provincial prisons in Ontario, Canada, 2015-2018: a repeated cross-sectional analysis. BMJ Open 2021; 11:e048944. [PMID: 34794988 PMCID: PMC8603292 DOI: 10.1136/bmjopen-2021-048944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To describe opioid agonist treatment prescribing rates in provincial prisons and compare with community prescribing rates. DESIGN We used quarterly, cross-sectional data on the number and proportion of people prescribed opioid agonist treatment in prison populations. Trends were compared with Ontario surveillance data from prescribers, reported on a monthly basis. SETTING Provincial prisons and general population in Ontario, Canada between 2015 and 2018. PARTICIPANTS Adults incarcerated in provincial prisons and people ages 15 years and older in Ontario. MAIN OUTCOMES AND MEASURES Opioid agonist treatment prescribing prevalence, defined as treatment with methadone or buprenorphine/naloxone. RESULTS In prison, 6.9%-8.4% of people were prescribed methadone; 0.8% to 4.8% buprenorphine/naloxone; and 8.2% to 13.2% either treatment over the study period. Between 2015 and 2018, methadone prescribing prevalence did not substantially change in prisons or in the general population. The prevalence rate of buprenorphine/naloxone prescribing increased in prisons by 1.70 times per year (95% CI 1.47 to 1.96), which was significantly higher than the increase in community prescribing: 1.20 (95% CI 1.19 to 1.21). Buprenorphine/naloxone prescribing prevalence was significantly different across prisons. CONCLUSIONS The increase in opioid agonist treatment prescribing between 2015 and 2018 in provincial prisons shows that efforts to scale up access to treatment in the context of the opioid overdose crisis have included people who experience incarceration in Ontario. Further work is needed to understand unmet need for treatment and treatment impacts.
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Affiliation(s)
- Claire Bodkin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Leonora Regenstreif
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lori Kiefer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Ministry of Community Safety and Correctional Services, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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16
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Bharat C, Larney S, Barbieri S, Dobbins T, Jones NR, Hickman M, Gisev N, Ali R, Degenhardt L. The effect of person, treatment and prescriber characteristics on retention in opioid agonist treatment: a 15-year retrospective cohort study. Addiction 2021; 116:3139-3152. [PMID: 33979008 DOI: 10.1111/add.15514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/30/2020] [Accepted: 03/24/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment and prescriber characteristics. DESIGN Retrospective longitudinal study. SETTING New South Wales, Australia. PARTICIPANTS People entering the opioid agonist treatment programme for the first time between August 2001 and December 2015. MEASUREMENTS Time in opioid agonist treatment (primary outcome) was modelled using a generalized estimating equation model to estimate associations with person, treatment and prescriber characteristics. FINDINGS The impact of medication type on opioid agonist treatment retention reduced over time; the risk of leaving treatment when on buprenorphine compared with methadone was higher among those who entered treatment earlier [e.g. 2001-03: odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.45-1.75] and lowest among those who entered most recently (2013-15: OR = 1.23, 95% CI = 1.11-1.36). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR = 0.94, 95% CI = 0.93-0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past-year psychosis disorder and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment. CONCLUSION In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in opioid agonist treatment.
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Affiliation(s)
- Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- Université de Montréal and Centre de Recherche du CHUM, Montreal, Canada
| | | | - Timothy Dobbins
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Nicola R Jones
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Robert Ali
- Department of Pharmacology, University of Adelaide, Adelaide, SA, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
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17
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Comparing characteristics and outcomes of different opioid agonist treatment modalities among opioid-dependent federal men correctional populations in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103480. [PMID: 34656817 DOI: 10.1016/j.drugpo.2021.103480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Limited evidence exists in Canada on outcomes related to Opioid Agonist Treatment (OAT) and/or differences between OAT modalities among persons in correctional institutions. This study addresses this knowledge gap by examining key characteristics and outcomes of men in Canadian federal correctional institutions across treatment modalities. METHODS A retrospective cohort of men incarcerated in federal correctional institutions (N = 2833) were classified into four groups - three OAT participant groups: prescribed methadone (M-OAT), prescribed buprenorphine/naloxone (Suboxone®; S-OAT) and those who switched between the two OAT modalities at least once (X-OAT). The fourth group was a non-treatment comparison group (Non-OAT). Two-thirds of study participants were released and examined for post-release outcomes. Descriptive statistics and multi-variate Cox proportional hazards regression were used. RESULTS The X-OAT group was more likely than the other study groups to have positive urinalysis tests, disciplinary charges, or institutional security or behavioral incidents. Survival analysis indicated that the X-OAT had an adjusted hazard of a return to custody that was 57% greater than the other groups. CONCLUSIONS This study indicates that individuals switching OAT modalities are a more complex group needing additional supports, especially for community reintegration. Although few of the returns to custody were due to new offences, a third of participants in the OAT groups had their release revoked, indicating a high need population mostly due to their substance use.
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18
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Soyka M, Franke AG. Recent advances in the treatment of opioid use disorders-focus on long-acting buprenorphine formulations. World J Psychiatry 2021; 11:543-552. [PMID: 34631459 PMCID: PMC8474991 DOI: 10.5498/wjp.v11.i9.543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/06/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023] Open
Abstract
Oral methadone or sublingual buprenorphine are first-line medications for pharmacotherapy of opioid use disorders (OUDs). Three long-acting buprenorphine depot or implant formulations are currently available for the treatment of OUDs: (1) CAM 2038 (Buvidal) for subcutaneous weekly and monthly application; (2) RBP-6000 (Sublocade™) as a monthly depot formulation; and (3) A six-month buprenorphine implant [Probuphine™]. The pharmacology, clinical efficacy and prospects of these medications are discussed.
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Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, University of Munich, München 80336, Germany
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19
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Soyka M, Groß G. Transition from methadone to subcutaneous buprenorphine depot in patients with opioid use disorder in custodial setting - a case series. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:599-604. [PMID: 34407703 DOI: 10.1080/00952990.2021.1963757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Methadone, a full opioid agonist, and buprenorphine, a partial agonist at the opioid receptor, are established first-line medications for opioid maintenance therapy. Transition from methadone to sublingual buprenorphine may precipitate withdrawal and is usually performed only in patients on low dose of methadone (<30-40 mg). Transition from methadone to a novel subcutaneous buprenorphine depot (Buvidal) has not been previously described. OBJECTIVES To test the hypothesis that a rapid transition from methadone to buprenorphine depot after a single dose of buprenorphine 4 mg sublingual is safe and well tolerated. METHODS Retrospective chart analysis of a case series of seven opioid users under custodial setting (prison) who were switched from methadone to buprenorphine depot (initial dose 16 mg weekly subcutaneously) after an initial test dose of buprenorphine 4 mg sublingual within 48 hours. RESULTS Clinical data indicate that a rapid transition from methadone to depot buprenorphine is feasible (six patients within 48 hours, one within 4 days). All patients were successfully switched to buprenorphine depot and the transfer period was completed without dropouts or major medical problems. Further dose adjustments were performed in 4 of 7 patients. CONCLUSIONS Transition of opioid users from methadone to buprenorphine depot is feasible and safe via 4 mg buprenorphine sublingual. This procedure may facilitate induction of buprenorphine depot formulations in patients treated with methadone.
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Affiliation(s)
- Michael Soyka
- Psychiatric Hospital University of Munich, Munich, Germany
| | - Gregor Groß
- Psychiatric Department, Justizvollzugsanstalt Straubing, Straubing, Germany
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20
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Hesse M, Thylstrup B, Karsberg SH, Pedersen MM, Pedersen MU. ILC-OPI: impulsive lifestyle counselling versus cognitive behavioral therapy to improve retention of patients with opioid use disorders and externalizing behavior: study protocol for a multicenter, randomized, controlled, superiority trial. BMC Psychiatry 2021; 21:183. [PMID: 33827495 PMCID: PMC8028234 DOI: 10.1186/s12888-021-03182-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Substance use disorders show a high comorbidity with externalizing behavior difficulties, creating treatment challenges, including difficulties with compliance, a high risk of conflict, and a high rate of offending post-treatment. Compared with people with other substance use disorders those with opioid use disorders have the highest risk of criminal activity, but studies on the evidence base for psychosocial treatment in opioid agonist treatment (OAT) are scarce. The Impulsive Lifestyle Counselling (ILC) program may be associated with better retention and outcomes among difficult-to-treat patients with this comorbidity. METHODS The study is a multicenter, randomized, controlled, superiority clinical trial. Participants will be a total of 137 hard-to-treat individuals enrolled in opioid agonist treatment (OAT). Participants will be randomized to either a standard treatment (14 sessions of individual manual-based cognitive behavioral therapy and motivational interviewing (MOVE-I)) or six sessions of ILC followed by nine sessions of MOVE-I. All participants will receive personalized text reminders prior to each session and vouchers for attendance, as well as medication as needed. The primary outcome is retention in treatment. Secondary measures include severity of drug use and days of criminal offending for profit three and nine months post-randomization. A secondary aim is, through a case-control study, to investigate whether participants in the trial differ from patients receiving treatment as usual in municipalities where ILC and MOVE-I have not been implemented in OAT. This will be done by comparing number of offences leading to conviction 12 months post-randomization recorded in the national criminal justice register and number of emergency room contacts 12 months post-randomization recorded in the national hospital register. DISCUSSION This is the first randomized, controlled clinical trial in OAT to test the effectiveness of ILC against a standardized comparison with structural elements to increase the likelihood of exposure to the elements of treatment. Results obtained from this study may have important clinical, social, and economic implications for publicly funded treatment of opioid use disorder. TRIAL REGISTRATION ISRCTN, ISRCTN19554367 , registered on 04/09/2020.
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Affiliation(s)
- Morten Hesse
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000, Aarhus C, Denmark.
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark
| | | | | | - Mads Uffe Pedersen
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000 Aarhus C, Denmark
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21
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Morse E, Binswanger IA, Taylor E, Gray C, Stimmel M, Timko C, Harris AHS, Smelson D, Finlay AK. Strategies to improve implementation of medications for opioid use disorder reported by veterans involved in the legal system: A qualitative study. J Subst Abuse Treat 2021; 129:108353. [PMID: 34080564 DOI: 10.1016/j.jsat.2021.108353] [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: 09/19/2020] [Revised: 12/07/2020] [Accepted: 02/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Veterans involved in the legal system have a high risk of overdose mortality but limited utilization of medications for opioid use disorder (MOUD). To increase the use of MOUD in Veterans Health Administration (VHA) facilities and reduce overdose mortality, the VHA should incorporate strategies identified by legal-involved veterans to improve quality of care and ensure that their patients' experiences are integrated into care delivery. This study aims to determine strategies to increase use of MOUD from the perspective of legal-involved veterans with a history of opioid use or opioid use disorder (OUD). METHODS Between February 2018 and March 2019, we conducted semistructured interviews with 18 veterans with a history of opioid use or OUD and legal involvement (15 men and 3 women; mean age 41, standard deviation 13, range 28-61). Veterans were from 9 geographically dispersed United States VHA facilities. The study analyzed verbatim transcripts using the framework method. The primary focus was themes that represented legal-involved veteran-identified strategies to improve the use of MOUD. RESULTS The 18 veterans interviewed had legal involvement directly related to their opioid use and most (n = 15; 83%) had previously used MOUD. Veteran-identified strategies to improve access to and use of MOUD included: (1) VHA should provide transportation or telehealth services; (2) legal agencies should increase access to MOUD during incarceration; (3) the VHA should reduce physician turnover; (4) the VHA should improve physician education to deliver compassionate, patient-centered treatment; (5) the VHA should improve veteran education about MOUD; and (6) the VHA should provide social support opportunities to veterans. CONCLUSIONS Legal-involved veterans provided strategies that can inform and expand MOUD to better meet their needs and the treatment needs of all patients with OUD. The VHA should consider incorporating these strategies into care, and should evaluate their impact on patients' experience, initiation of and retention on medications, and overdose rates.
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Affiliation(s)
- Erica Morse
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave #300, Denver, CO 80231, USA.
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave #300, Denver, CO 80231, USA; Colorado Permanente Medical Group, 1835 Franklin St, Denver, CO 80218, USA; Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA.
| | - Emmeline Taylor
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Clinical Psychology, University of Colorado, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, USA.
| | - Caroline Gray
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Matthew Stimmel
- Veterans Justice Programs, U.S. Department of Veterans Affairs (MS), 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1199 Welch Road, Stanford, CA 94304, USA.
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Surgery, Stanford University School of Medicine, Always Building, Suite M121, 300 Pasteur Drive, Stanford, CA 94305-2200, USA.
| | - David Smelson
- Center for Organization and Implementation Science, Edith Nourse Rogers VA Medical Center, 200 Springs Road, Bedford, MA 01730, USA.
| | - Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; National Center on Homelessness Among Veterans, Department of Veterans Affairs, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
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Larney S, Jones N, Fiellin DA, Nielsen S, Hickman M, Dobbins T, Murphy T, Ali R, Degenhardt L. Data Resource Profile: The Opioid Agonist Treatment and Safety (OATS) Study, New South Wales, Australia. Int J Epidemiol 2021; 49:1774-1775. [PMID: 33063106 PMCID: PMC7825957 DOI: 10.1093/ije/dyaa125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/23/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nicola Jones
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - David A Fiellin
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | | | - Timothy Dobbins
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - Thomas Murphy
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Robert Ali
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Dong H, Hayashi K, Fairbairn N, Milloy MJ, DeBeck K, Wood E, Kerr T. Long term pre-treatment opioid use trajectories in relation to opioid agonist therapy outcomes among people who use drugs in a Canadian setting. Addict Behav 2021; 112:106655. [PMID: 32977270 DOI: 10.1016/j.addbeh.2020.106655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Opioid agonist therapy (OAT) models are generally provided without consideration of how pre-treatment characteristics may be associated with outcome. Therefore, we aimed to first characterize longitudinal trajectories of opioid use before initiating OAT. Then we explored the impact of OAT on opioid use across these pre-treatment trajectories. METHODS Data were derived from three prospective cohort studies involving people who use drugs in Vancouver, Canada. Latent class growth analysis was applied to identify opioid use trajectories based on individual-level observations three years before starting OAT. Multivariable generalized linear mixed model was used to examine whether engaging in OAT was associated with lower risk of illicit opioid use among participants with different pre-treatment opioid use trajectories. RESULTS 464 participants were included in the study between September 2005 and November 2018. Two pre-treatment opioid use trajectories were identified: high frequency users (246, 53.0%) and gradually increasing frequency users (218, 47.0%). We observed different strengths of association between OAT engagement and illicit opioid use among high frequency users (adjusted odds ratio [AOR] = 0.36, 95% Confidence Interval [CI]: 0.20 - 0.63) and gradually increasing frequency users (AOR = 0.91, 95% CI: 0.53 - 1.56). Unstable housing, any stimulant use, experiencing violence, drug dealing, sex work involvement, and incarceration were independently and positively associated with ongoing illicit opioid use. CONCLUSIONS Distinct pre-treatment opioid use trajectories are likely to influence treatment outcomes. Research is required to determine if tailored strategies specific to people with different pre-treatment opioid use patterns have potential to improve outcomes of OAT.
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Affiliation(s)
- Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6 Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6 Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada.
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Soyka M. Novel Long-Acting Buprenorphine Medications for Opioid Dependence: Current Update. PHARMACOPSYCHIATRY 2020; 54:18-22. [PMID: 33212514 DOI: 10.1055/a-1298-4508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Opioid maintenance treatment with oral methadone or sublingual buprenorphine is the first-line treatment in opioid dependence. Three novel long-acting buprenorphine formulations have been approved or will be available soon: for subcutaneous weekly and monthly application, the depot formulations CAM 2038 (Buvidal®), the monthly depot formulation RBP-6000 (Sublocade™), and a 6-month buprenorphine implant (Probuphine™). Clinical data available so far on the efficacy of these 3 medications are given, and possible clinical implications are discussed.
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25
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Finlay AK, Morse E, Stimmel M, Taylor E, Timko C, Harris AHS, Smelson D, Yu M, Blue-Howells J, Binswanger IA. Barriers to Medications for Opioid Use Disorder Among Veterans Involved in the Legal System: a Qualitative Study. J Gen Intern Med 2020; 35:2529-2536. [PMID: 32583337 PMCID: PMC7459011 DOI: 10.1007/s11606-020-05944-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Veterans involved in the legal system are at high risk for overdose but have lower receipt of medications for opioid use disorder than other veterans. OBJECTIVE The study aimed to understand barriers to medication access from the perspective of legally involved veterans with opioid use disorder and people who work with these veterans in the Veterans Health Administration (VHA) and the legal system. DESIGN This national qualitative study interviewed veterans and stakeholders from 14 geographically diverse VHA facilities to explore perceptions of barriers to medications for opioid use disorder. PARTICIPANTS Participants included veterans with a history of opioid use disorder and legal involvement (n = 18), VHA Veterans Justice Programs Specialists (n = 15), VHA and community substance use disorder treatment providers (n = 5), and criminal justice staff (n = 12). APPROACH We conducted interviews based on the Consolidated Framework for Implementation Research. Interview transcripts were analyzed using a team-based approach. KEY RESULTS Four key barriers, noted by group, were identified: (1) a preference for counseling along with or instead of medications (veterans, Specialists, treatment providers, criminal justice staff); (2) concerns about veterans using medications without a prescription, selling them, or providing them to others (veterans, Specialists, treatment providers, criminal justice staff); (3) concerns about perceived stigma towards medication use (veterans, Specialists, treatment providers, criminal justice staff); and (4) concerns about medication discontinuation after recurrent opioid use (veterans, criminal justice staff). A fifth theme, education, was noted by all stakeholders except providers as important to facilitating use of medications for opioid use disorder. All five themes mapped to the framework construct of knowledge and beliefs about the intervention. CONCLUSIONS Based on identified barriers, interventions focused on enhancing medication knowledge, reducing stigma towards use of medications, and increasing knowledge that opioid use may recur during treatment may help increase access to medication for veterans with legal involvement.
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Affiliation(s)
- Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA. .,Department of Veterans Affairs, National Center on Homelessness Among Veterans, 795 Willow Road, Menlo Park, 94025, USA.
| | - Erica Morse
- Institute for Health Research, Kaiser Permanente Colorado, Denver, USA
| | - Matthew Stimmel
- Veterans Justice Programs, U.S. Department of Veterans Affairs, , Menlo Park, USA
| | - Emmeline Taylor
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA.,Department of Clinical Psychology, University of Colorado, Colorado Springs, Colorado Springs, USA
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, USA
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, USA
| | - David Smelson
- Center for Organization and Implementation Science, Edith Nourse Rogers VA Medical Center, Bedford, USA
| | - Mengfei Yu
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA
| | - Jessica Blue-Howells
- Veterans Justice Programs, U.S. Department of Veterans Affairs, , Menlo Park, USA
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Denver, USA.,Colorado Permanente Medical Group, Denver, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, USA
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Chao E, Hung CC, Lin CP, Ku YCJ, Ain QU, Metzger DS, Lee TSH. Adherence among HIV-positive injection drug users undergoing methadone treatment in Taiwan. BMC Psychiatry 2020; 20:346. [PMID: 32616019 PMCID: PMC7331024 DOI: 10.1186/s12888-020-02764-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS The study aims were to investigate adherence to methadone maintenance treatment (MMT) and to identify associated clinical factors in patients who inject drugs diagnosed with human immunodeficiency virus (HIV) infection in Taiwan. METHODS Data were from the National Health Surveillance System on HIV and the National Drug Treatment System on MMT. HIV-positive people who inject drugs (HIVPWID) were defined as the study population. Information obtained included age, sex, education, marital status, employment, methadone dose, and date of diagnosis of HIV infection. Adherence was defined as taking methadone for the past 90, 180 and 365 days, then categorized as high (> 90%), moderate (51 to 90%), or low (<=50%) adherent respectively. RESULTS Of 1641 HIVPWID registered in the datasets from 2007 to 2012, 961 (58.56%) had received MMT. For HIVPWID evaluated at 90 days (n = 951), 271 (28.5%), 382 (40.2%), and 298 (31.3%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 180 days (n = 936), 190 (20.3%), 349 (37.3%), and 397 (42.4%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 365 days (n = 919), 133 (14.5%), 271 (29.5%), and 515 (56.0%) were classified as high, moderate, and low adherent respectively. After controlling for sociodemographics, results showed that methadone dose, location of MMT clinic, and date of HIV diagnosis were significantly associated with MMT adherence. CONCLUSIONS Study findings underscore the importance to MMT adherence of methadone dosage, early diagnosis of patient's HIV infection, and area of patient residence.
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Affiliation(s)
- En Chao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Chia-Chun Hung
- Institute of Brain Science, National Yang Ming University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ching-Po Lin
- Institute of Brain Science, National Yang Ming University, Taipei, Taiwan
| | - Yi-Chien Jacob Ku
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Qurat Ul Ain
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | - David S Metzger
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
- CTBC Center for Addiction Prevention and Policy Research, National Taiwan Normal University, No 162 Sec. 1 He-Ping East Road, Taipei, 10610, Taiwan.
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27
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Dong H, Hayashi K, Milloy MJ, DeBeck K, Singer J, Wong H, Wood E, Kerr T. Changes in substance use in relation to opioid agonist therapy among people who use drugs in a Canadian setting. Drug Alcohol Depend 2020; 212:108005. [PMID: 32370932 PMCID: PMC7462099 DOI: 10.1016/j.drugalcdep.2020.108005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although previous studies have shown that opioid agonist therapy (OAT) is linked to reductions in illicit opioid use, less is known about how OAT impacts the use of other psychoactive substances. We aimed to examine the changes in use of different substances by comparing patterns before and after initiating OAT. METHODS Data for this study was derived from three ongoing prospective cohorts involving people who use drugs in Vancouver, Canada from 1996 to 2018. We assessed use patterns for heroin, illicit prescription opioid, cocaine, crack cocaine, crystal methamphetamine, cannabis, daily alcohol use, and benzodiazepines. Segmented regression was conducted to compare the trends of substance use between pre-treatment and post-treatment periods. RESULTS The study included 1107 participants. After OAT engagement, we observed an immediate decline in the proportion as well as a decreasing trend for heroin (Adjusted Odds Ratio (AOR): 0.80, 95% confidence interval (CI): 0.77, 0.83), illicit prescription opioid (AOR: 0.87, 95% CI: 0.83, 0.90), and benzodiazepines (AOR: 0.73, 95 % CI: 0.67, 0.80). There was no significant difference comparing the pre-treatment and post-treatment trends for cocaine, crack cocaine, crystal methamphetamine, and cannabis. However, higher growth slope was noted during the post-treatment period for daily alcohol use (P = 0.016). CONCLUSIONS We observed significant reduction in illicit opioids use following OAT initiation, but not for stimulant and cannabis. The increasing problematic use of alcohol may pose challenges to the safety and effectiveness of OAT. Development of comprehensive and tailored treatment strategies is needed for poly-substance users accessing OAT.
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Affiliation(s)
- Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia V5Z 1Y6, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia V5Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada.
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28
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Stevens ER, Nucifora KA, Hagan H, Jordan AE, Uyei J, Khan B, Dombrowski K, des Jarlais D, Braithwaite RS. Cost-effectiveness of Direct Antiviral Agents for Hepatitis C Virus Infection and a Combined Intervention of Syringe Access and Medication-assisted Therapy for Opioid Use Disorders in an Injection Drug Use Population. Clin Infect Dis 2020; 70:2652-2662. [PMID: 31400755 PMCID: PMC7286369 DOI: 10.1093/cid/ciz726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/29/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There are too many plausible permutations and scale-up scenarios of combination hepatitis C virus (HCV) interventions for exhaustive testing in experimental trials. Therefore, we used a computer simulation to project the health and economic impacts of alternative combination intervention scenarios for people who inject drugs (PWID), focusing on direct antiviral agents (DAA) and medication-assisted treatment combined with syringe access programs (MAT+). METHODS We performed an allocative efficiency study, using a mathematical model to simulate the progression of HCV in PWID and its related consequences. We combined 2 previously validated simulations to estimate the cost-effectiveness of intervention strategies that included a range of coverage levels. Analyses were performed from a health-sector and societal perspective, with a 15-year time horizon and a discount rate of 3%. RESULTS From a health-sector perspective (excluding criminal justice system-related costs), 4 potential strategies fell on the cost-efficiency frontier. At 20% coverage, DAAs had an incremental cost-effectiveness ratio (ICER) of $27 251/quality-adjusted life-year (QALY). Combinations of DAA at 20% with MAT+ at 20%, 40%, and 80% coverage had ICERs of $165 985/QALY, $325 860/QALY, and $399 189/QALY, respectively. When analyzed from a societal perspective (including criminal justice system-related costs), DAA at 20% with MAT+ at 80% was the most effective intervention and was cost saving. While DAA at 20% with MAT+ at 80% was more expensive (eg, less cost saving) than MAT+ at 80% alone without DAA, it offered a favorable value compared to MAT+ at 80% alone ($23 932/QALY). CONCLUSIONS When considering health-sector costs alone, DAA alone was the most cost-effective intervention. However, with criminal justice system-related costs, DAA and MAT+ implemented together became the most cost-effective intervention.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, New York University School of Medicine, New York, New York, USA
- New York University College of Global Public Health, New York, New York, USA
| | - Kimberly A Nucifora
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Holly Hagan
- New York University College of Global Public Health, New York, New York, USA
- Center for Drug Use and Human Immunodeficiency Virus Research, New York University College of Global Public Health, New York, New York, USA
| | - Ashly E Jordan
- Center for Drug Use and Human Immunodeficiency Virus Research, New York University College of Global Public Health, New York, New York, USA
- School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Jennifer Uyei
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Bilal Khan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Kirk Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Don des Jarlais
- New York University College of Global Public Health, New York, New York, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, New York, USA
- Center for Drug Use and Human Immunodeficiency Virus Research, New York University College of Global Public Health, New York, New York, USA
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29
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Bell J, Strang J. Medication Treatment of Opioid Use Disorder. Biol Psychiatry 2020; 87:82-88. [PMID: 31420089 DOI: 10.1016/j.biopsych.2019.06.020] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 12/19/2022]
Abstract
Opioid use disorder (OUD) is a chronic, relapsing condition, often associated with legal, interpersonal, and employment problems. Medications demonstrated to be effective for OUD are methadone (a full opioid agonist), buprenorphine (a partial agonist), and naltrexone (an opioid antagonist). Methadone and buprenorphine act by suppressing opioid withdrawal symptoms and attenuating the effects of other opioids. Naltrexone blocks the effects of opioid agonists. Oral methadone has the strongest evidence for effectiveness. Longer duration of treatment allows restoration of social connections and is associated with better outcomes. Treatments for OUD may be limited by poor adherence to treatment recommendations and by high rates of relapse and increased risk of overdose after leaving treatment. Treatment with methadone and buprenorphine has the additional risk of diversion and misuse of medication. New depot and implant formulations of buprenorphine and naltrexone have been developed to address issues of safety and problems of poor treatment adherence. For people with OUD who do not respond to these treatments, there is accumulating evidence for supervised injectable opioid treatment (prescribing pharmaceutical heroin). Another medication mode of minimizing risk of overdose is take-home naloxone. Naloxone is an opioid antagonist used to reverse opioid overdose, and take-home naloxone programs aim to prevent fatal overdose. All medication-assisted treatment is limited by lack of access and by stigma. In seeking to stem the rising toll from OUD, expanding access to approved treatment such as methadone, for which there remains the best evidence of efficacy, may be the most useful approach.
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Affiliation(s)
- James Bell
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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30
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Vorspan F, Hjelmström P, Simon N, Benyamina A, Dervaux A, Brousse G, Jamain T, Kosim M, Rolland B. What place for prolonged-release buprenorphine depot-formulation Buvidal® in the treatment arsenal of opioid dependence? Insights from the French experience on buprenorphine. Expert Opin Drug Deliv 2019; 16:907-914. [PMID: 31364884 DOI: 10.1080/17425247.2019.1649252] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Since the 1990s, opioid maintenance treatments (OMTs), i.e. mostly methadone and buprenorphine, have represented the therapeutic cornerstone of opioid dependence. In France, the public health strategy on opioid dependence, identified here as the 'French model', has consisted of offering a facilitated access to buprenorphine, to reach a large treatment coverage and reduce opioid-related mortality. Areas covered: Recently, a new formulation of subcutaneous buprenorphine depot (Buvidal®) has been approved in Europe for treatment of opioid dependence. The place of Buvidal® among the pre-existing arsenal of OMTs is discussed in the light of the pharmacological specificities of this new formulation, and with the particular standpoint of the French model on opioid dependence. Expert opinion: Buvidal® could constitute a promising treatment option mainly in case of: 1) OMT initiation, including in non-specialized addiction medicine care; 2) Discharge from prison or hospital; Diversion/misuse of 3) buprenorphine or 4) methadone; 5) Clinically stabilized patients wishing to avoid daily oral taking of the medication. As such, this new formulation should be highly accessible, which will require specific pathways through care as the product is intended to be administered by a healthcare professional.
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Affiliation(s)
- Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique - Hôpitaux de Paris , Paris , France.,Faculté de Médecine, Université Paris Diderot et INSERM UMRS 1144, Université Paris Descartes, Université Paris Diderot , Paris , France
| | | | - Nicolas Simon
- INSERM, IRD, SESSTIM, Hop Sainte Marguerite, Service de Pharmacologie Clinique, CAP, Aix Marseille Univ , Marseille , France
| | - Amine Benyamina
- CESP, centre d'enseignement, de recherche et de traitement des addictions, université Paris Sud , Villejuif , France
| | - Alain Dervaux
- Service de Psychiatrie et Addictologie de liaison, CHU Sud , Amiens Cedex , France.,Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247 , Amiens , France
| | - Georges Brousse
- EA NPsy-Sydo, université Clermont-Auvergne , Clermont-Ferrand , France
| | | | - Margaux Kosim
- Consultations de médecine-Alcoologie PASS, Groupe Hospitalier Pitié Salpêtrière , Paris , France.,Camurus SAS , Paris , France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier , Bron , France.,Université de Lyon, UCBL1, INSERM, INSERM U1028, CNRS UMR 5292, CRNL , Bron , France
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31
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Rezansoff SN, Moniruzzaman A, Somers JM. Temporal associations between medication adherence for patients with schizophrenia and opioid dependence: A 17-year Canadian Cohort Study. Schizophr Res 2019; 210:157-163. [PMID: 31202570 DOI: 10.1016/j.schres.2019.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 05/26/2019] [Indexed: 11/16/2022]
Abstract
The current study investigated whether a previously reported beneficial effect of methadone maintenance therapy (MMT) on antiretroviral adherence is also present in relation to antipsychotic treatment for schizophrenia. Administrative data were linked over a 17-year period for 1996 people who were dually diagnosed with schizophrenia and opioid dependence and, as an indicator of further marginalization, experienced at least one episode of correctional supervision in British Columbia. Adherence was estimated using the medication possession ratio (MPR ≥ 0.80), calculated in each 120-day period beginning with the first date of concurrent use of MMT and antipsychotic medication. Generalized Estimating Equations were used to estimate the association between independent and dependent variables. The probability of antipsychotic adherence doubled in periods that were preceded by a period of MMT adherence (AOR: P: 2.07; 95% CI: 1.90-2.26). Subgroup and sensitivity analyses yielded results similar to those derived through the primary analysis, examining: conviction history; length of follow-up; initiation of MMT prior to antipsychotic induction; excluding participants who died during the study period; and restricted to participants who received methadone exclusively as part of a MMT program. Despite a strong temporal association between MMT and antipsychotic adherence, overall MPRs for both prescriptions remained <0.50 throughout the study period. Antipsychotic adherence was more than twice as likely following periods of adherence to MMT among dually-diagnosed patients. Research is needed to identify the conditions responsible for MMT adherence, and to further clarify the relationship between opioid agonist treatment and antipsychotic pharmacotherapy in this vulnerable and under-studied population.
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Affiliation(s)
- Stefanie N Rezansoff
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
| | - Julian M Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
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Evans EA, Zhu Y, Yoo C, Huang D, Hser YI. Criminal justice outcomes over 5 years after randomization to buprenorphine-naloxone or methadone treatment for opioid use disorder. Addiction 2019; 114:1396-1404. [PMID: 30916463 PMCID: PMC6626574 DOI: 10.1111/add.14620] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/17/2018] [Accepted: 03/15/2019] [Indexed: 11/29/2022]
Abstract
AIMS To compare long-term criminal justice outcomes among opioid-dependent individuals randomized to receive buprenorphine or methadone. DESIGN, SETTING AND PARTICIPANTS A 5-year follow-up was conducted in 2011-14 of 303 opioid-dependent participants entering three opioid treatment programs in California, USA in 2006-09 and randomized to receive either buprenorphine/naloxone or methadone. INTERVENTION AND COMPARATOR Participants received buprenorphine/naloxone (BUP; n = 179) or methadone (MET; n = 124) for 24 weeks and then were tapered off their treatment over ≤ 8 weeks or referred for ongoing clinical treatment. Midway through the study, the randomization scheme was switched from 1 : 1 BUP : MET to 2 : 1 because of higher dropout in the BUP arm. MEASUREMENTS Study outcomes included arrests and self-reported incarceration. Predictors included randomization condition (buprenorphine versus methadone), age, gender, race/ethnicity, use of cocaine, drug injection in the 30 days prior to baseline and study site. Treatment status (buprenorphine, methadone, none) during follow-up was included as a time-varying covariate. FINDINGS There was no significant difference by randomization condition in the proportion arrested (buprenorphine: 55.3%, methadone: 54.0%) or incarcerated (40.9%, 47.3%) during follow-up. Among methadone-randomized individuals, arrest was less likely with methadone treatment (0.50, 0.35-0.72) during follow-up (relative to no treatment) and switching to buprenorphine had a lower likelihood of arrest than those receiving no treatment (0.39, 0.18-0.87). Among buprenorphine-randomized individuals, arrest was less likely with receipt of buprenorphine (0.49, 0.33-0.75) during follow-up and switching to methadone had a similar likelihood of arrest as methadone-randomized individuals receiving no treatment. Likelihood of arrest was also negatively associated with older age (0.98, 0.96-1.00); it was positively associated with Hispanic ethnicity (1.63, 1.04-2.56), cocaine use (2.00, 1.33-3.03), injection drug use (2.19, 1.26-3.83), and study site. CONCLUSIONS In a US sample of people treated for opioid use disorder, continued treatment with either buprenorphine or methadone was associated with a reduction in arrests relative to no treatment. Cocaine use, injection drug use, Hispanic ethnicity and younger age were associated with higher likelihood of arrest.
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Affiliation(s)
- Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Yuhui Zhu
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA,UCLA Epidemiology, Fielding School of Public Health, Los Angeles, CA, USA
| | - Caroline Yoo
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - David Huang
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Marsden J, Tai B, Ali R, Hu L, Rush AJ, Volkow N. Measurement-based care using DSM-5 for opioid use disorder: can we make opioid medication treatment more effective? Addiction 2019; 114:1346-1353. [PMID: 30614096 PMCID: PMC6766896 DOI: 10.1111/add.14546] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/05/2018] [Accepted: 12/28/2018] [Indexed: 12/28/2022]
Abstract
CONTEXT AND PURPOSE Measurement-based care (MBC) is an evidence-based health-care practice in which indicators of disease are tracked to inform clinical actions, provide feedback to patients and improve outcomes. The current opioid crisis in multiple countries provides a pressing rationale for adopting a basic MBC approach for opioid use disorder (OUD) using DSM-5 to increase treatment retention and effectiveness. PROPOSAL To stimulate debate, we propose a basic MBC approach using the 11 symptoms of OUD (DSM-5) to inform the delivery of medications for opioid use disorder (MOUD; including methadone, buprenorphine and naltrexone) and their evaluation in office-based primary care and specialist clinics. Key features of a basic MBC approach for OUD using DSM-5 are described, with an illustration of how clinical actions are guided and outcomes communicated. For core treatment tasks, we propose that craving and drug use response to MOUD should be assessed after 2 weeks, and OUD remission status should be evaluated at 3, 6 and 12 months (and exit from MOUD treatment) and beyond. Each of the 11 DSM-5 symptoms of OUD should be discussed with the patient to develop a case formulation and guide selection of adjunctive psychological interventions, supplemented with information on substance use, and optionally extended with information from other clinical instruments. A patient-reported outcome measure should be recorded and discussed at each remission assessment. CONCLUSIONS MBC can be used to tailor and adapt MOUD treatment to increase engagement, retention and effectiveness. MBC practice principles can help promote patient-centred care in OUD, personalized addiction therapeutics and facilitate communication of outcomes.
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Affiliation(s)
- John Marsden
- Addictions DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonUK
| | - Betty Tai
- National Institute on Drug Abuse, National Institutes of HealthRockvilleMDUSA
| | - Robert Ali
- Discipline of Pharmacology, School of MedicineThe University of AdelaideSouth Australia
| | - Lian Hu
- National Institute on Drug Abuse, National Institutes of HealthRockvilleMDUSA
- The Emmes CorporationRockvilleMDUSA
| | - A. John Rush
- Duke‐National University of SingaporeSingapore
- Department of PsychiatryDuke University Medical SchoolDurhamUSA
- Department of PsychiatryTexas Tech Health Sciences CenterTXUSA
| | - Nora Volkow
- National Institute on Drug Abuse, National Institutes of HealthRockvilleMDUSA
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Gisev N, Bharat C, Larney S, Dobbins T, Weatherburn D, Hickman M, Farrell M, Degenhardt L. The effect of entry and retention in opioid agonist treatment on contact with the criminal justice system among opioid-dependent people: a retrospective cohort study. Lancet Public Health 2019; 4:e334-e342. [PMID: 31201133 PMCID: PMC6673674 DOI: 10.1016/s2468-2667(19)30060-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence on the effectiveness of opioid agonist treatment (OAT) in reducing crime is mixed. We aimed to assess the effect of OAT on crime in terms of delaying time to first charge and reducing overall charge rates, as well as the relationship between OAT retention and overall charge rates. METHODS We did a retrospective cohort study of opioid-dependent people who entered OAT for the first time between Jan 1, 2004, and Dec 30, 2010, in New South Wales (NSW), Australia. We used three linked NSW and national administrative datasets. Data on OAT were obtained from the Pharmaceutical Drugs of Addiction System, data on charges were obtained from the Reoffending Database, and data on mortality were obtained from the National Death Index. The cohort was followed up until Dec 31, 2011. Time-dependent OAT exposure was modelled using Cox proportional hazards models (time to first charge) and Andersen-Gill intensity models (total charge-days). Retention in OAT was modelled using two features of treatment engagement, number of OAT episodes and proportion of follow-up time in OAT (presented in quartile groupings: lowest, low-mid, low-high, highest) using zero-inflated negative binomial regression (total charges). All models were adjusted for sociodemographic, criminographic, and treatment-related variables. FINDINGS 10 744 new OAT entrants were included in the study. 5751 (53·5%) people were charged with an offence. In adjusted analyses, OAT was associated with an initial benefit in delaying the time to first charge (hazard ratio 0·43, 95% CI 0·33-0·55) and reducing total charge-days (0·39, 95% CI 0·30-0·52); however, these protective effects reduced over time. Total charge rates were higher as the number of OAT episodes increased (incident rate ratio [IRR] 1·13, 95% CI 1·11-1·15), and when relatively lower proportions of time were spent in OAT (IRR among the lowest three quartiles ranged from 1·11 [95% CI 1·02-1·21] to 1·22 [95% CI 1·12-1·33]). INTERPRETATION OAT was associated with a reduction in overall charge rates and was more protective as treatment engagement increased. Maximising treatment retention is crucial to achieving long-term health and social benefits of OAT. FUNDING Australian National Health and Medical Research Council, Australian Institute of Criminology, National Institute on Drug Abuse, Australian Government Department of Health, UNSW Sydney.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Don Weatherburn
- New South Wales Bureau of Crime Statistics and Research, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
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Russolillo A, Moniruzzaman A, Somers JM. Association of Methadone Treatment With Substance-Related Hospital Admissions Among a Population in Canada With a History of Criminal Convictions. JAMA Netw Open 2019; 2:e190595. [PMID: 30874778 PMCID: PMC6484638 DOI: 10.1001/jamanetworkopen.2019.0595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE People with criminal histories experience high rates of opioid dependence and are frequent users of acute health care services. It is unclear whether methadone adherence prevents hospitalizations. OBJECTIVE To compare hospital admissions during medicated and nonmedicated methadone periods. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study involving linked population-level administrative data among individuals in British Columbia, Canada, with provincial justice contacts (n= 250 884) and who filled a methadone prescription between April 1, 2001, and March 31, 2015. Participants were followed from the date of first dispensed methadone prescription until censoring (date of death, or March 31, 2015). Data analysis was conducted from May 1 to August 31, 2018. EXPOSURES Methadone treatment was divided into medicated (methadone was dispensed) and nonmedicated (methadone was not dispensed) periods and analyzed as a time-varying exposure. MAIN OUTCOME AND MEASURES Adjusted hazard ratios (aHRs) of acute hospitalizations for any cause and cause-specific (substance use disorder [SUD], non-substance-related mental disorders [NSMDs], and medical diagnoses [MEDs]) were estimated using multivariable Cox proportional hazards regression. RESULTS A total of 11 401 people (mean [SD] age, 34.9 [9.4] years; 8230 [72.2%] men) met inclusion criteria and were followed up for a total of 69 279.3 person-years. During a median follow-up time of 5.5 years (interquartile range, 2.8-9.1 years), there were 19 160 acute hospital admissions. Dispensed methadone was associated with a 50% lower rate of hospitalization for any cause (aHR, 0.50; 95% CI, 0.46-0.53) during the first 2 years (≤2.0 years) following methadone initiation, demonstrating significantly lower rates of admission for SUD (aHR, 0.32; 95% CI, 0.27-0.38), NSMD (aHR, 0.41; 95% CI, 0.34-0.50), and MED (aHR, 0.57; 95% CI, 0.52-0.62). As duration of time increased (2.1 to ≤5.0 years; 5.1 to ≤10.0 years), methadone was associated with a significant but smaller magnitude of effect: SUD (aHR, 0.43; 95% CI, 0.36-0.52; aHR, 0.47; 95% CI, 0.37-0.61), NSMD (aHR, 0.51; 95% CI, 0.41-0.64; aHR, 0.60; 95% CI, 0.47-0.78), and MED (aHR, 0.71; 95% CI, 0.65-0.77; aHR, 0.85; 95% CI, 0.76-0.95). CONCLUSIONS AND RELEVANCE In this study, methadone was associated with a lower rate of hospitalization among a large cohort of Canadian individuals with histories of convictions and prevalent concurrent health and social needs. Practices to improve methadone adherence are warranted.
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Affiliation(s)
- Angela Russolillo
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julian M. Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Eastwood B, Strang J, Marsden J. Change in alcohol and other drug use during five years of continuous opioid substitution treatment. Drug Alcohol Depend 2019; 194:438-446. [PMID: 30502545 DOI: 10.1016/j.drugalcdep.2018.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND English national prospective, observational cohort study of patients continuously enrolled for five years in opioid substitution treatment (OST) with oral methadone and sublingual buprenorphine. This is a secondary outcome analysis of change in use of alcohol and other drug use (AOD) following identification of heroin use trajectories during OST. METHODS All adults admitted to community OST in 2008/09 and enrolled to 2013/14 (n = 7717). Data from 11 sequential, six-monthly clinical reviews were used to identify heroin and AOD use trajectories by multi-level Latent Class Growth Analysis. OST outcome in the sixth and seventh year was 'successful completion and no re-presentation' (SCNR) to structured treatment and was assessed using multi-level logistic regression. RESULTS With 'rapid decreasing' heroin use trajectory as referent, 'continued high-level' heroin use predicted 'continued high-level' crack cocaine use (relative risk ratio [RRR] 58.7; 95% confidence interval [CI] 34.2-100.5),'continued high-level' alcohol use (RRR 1.2; 95% CI 1.0-1.5), 'increasing' unspecified drug use (RRR 1.7; 95% CI 1.4-2.1) and less 'high and increasing' cannabis use (RRR 0.5; 95% CI 0.4-0.6). 'Increasing' crack use was negatively associated with SCNR outcome for the 'decreasing then increasing' and 'gradual decreasing' heroin use groups (adjusted odds ratio [AOR] 0.5; 95% CI 0.3-0.9 and AOR 0.2; 95% CI 0.1-0.7, respectively). CONCLUSIONS Continued high-level heroin use non-response during long-term OST is associated with high-level crack cocaine and alcohol use, increasing unspecified drug use, but less high and increasing cannabis use. Increasing use of crack cocaine is negatively associated with the likelihood that long-term OST is completed successfully.
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Affiliation(s)
- Brian Eastwood
- King's College London, Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London SE5 8AF, United Kingdom; Alcohol, Drugs, Tobacco and Justice Division, Health Improvement Directorate, Public Health England, 7th Floor Wellington House, 133-155 Waterloo Road, London SE1 8UG, United Kingdom.
| | - John Strang
- King's College London, Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London SE5 8AF, United Kingdom.
| | - John Marsden
- King's College London, Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London SE5 8AF, United Kingdom; Alcohol, Drugs, Tobacco and Justice Division, Health Improvement Directorate, Public Health England, 7th Floor Wellington House, 133-155 Waterloo Road, London SE1 8UG, United Kingdom.
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Higgins C, Smith BH, Matthews K. Substance misuse in patients who have comorbid chronic pain in a clinical population receiving methadone maintenance therapy for the treatment of opioid dependence. Drug Alcohol Depend 2018; 193:131-136. [PMID: 30368067 DOI: 10.1016/j.drugalcdep.2018.08.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 12/17/2022]
Abstract
AIMS To compare specific substance misuse in treatment-seeking, opioid-dependent patients with and without comorbid chronic pain, and to assess the respective value of urinalysis and patient reports in assessing substance misuse. METHODS Participants comprised a clinical population in a regional NHS Substance Misuse Service in the East of Scotland (N = 521). The Brief Pain Inventory - Short Form was used to assess pain, and the Maudsley Addiction Profile and urinalysis were used to assess substance misuse at study inception. Urinalysis was used to assess substance misuse during the 5-year follow-up period. Data were hosted, linked, anonymized and analyzed within a national Safe Haven. RESULTS Compared with opioid-dependent patients with no pain, a significantly higher proportion of treatment-seeking, opioid-dependent patients with chronic pain were engaged in non-medical benzodiazepine use (69% versus 58%; p = 0.016) and illicit cannabinoid use (84% versus 65%; p = 0.025) at study inception. Furthermore, a significantly higher proportion of this group was shown to continue non-medical benzodiazepine use (70% versus 42%; p = 0.037) and illicit cannabinoid use (100% versus 31%; p = 0.002) during the 5-year follow-up period. There were significant correlations between drug screen results and patient-reported use of opioids (Tetrachoric ϱ = 0.4944; p < 0.001), benzodiazepines (Tetrachoric ϱ = 0.2641; p = 0.001) and cannabinoids (Tetrachoric ϱ = 0.8384; p < 0.001). CONCLUSIONS Whilst gaining control of illicit opioid use during treatment, opioid-dependent patients with comorbid chronic pain demonstrated persistent problematic use of benzodiazepines and cannabinoids. This pattern of misuse was shown to persist during the 5-year follow-up period.
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Affiliation(s)
- Cassie Higgins
- Division of Neuroscience, University of Dundee, Mailbox 6, Level 6, Laboratories Block, Ninewells Hospital and Medical School, Dundee, DD1 9SY Scotland, UK.
| | - Blair H Smith
- Division of Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Ninewells Hospital and Medical School, Dundee, DD2 4RB Scotland, UK.
| | - Keith Matthews
- Division of Neuroscience, University of Dundee, Mailbox 6, Level 6, Laboratories Block, Ninewells Hospital and Medical School, Dundee, DD1 9SY Scotland, UK.
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Larney S, Hickman M, Fiellin DA, Dobbins T, Nielsen S, Jones NR, Mattick RP, Ali R, Degenhardt L. Using routinely collected data to understand and predict adverse outcomes in opioid agonist treatment: Protocol for the Opioid Agonist Treatment Safety (OATS) Study. BMJ Open 2018; 8:e025204. [PMID: 30082370 PMCID: PMC6078240 DOI: 10.1136/bmjopen-2018-025204] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION North America is amid an opioid use epidemic. Opioid agonist treatment (OAT) effectively reduces extramedical opioid use and related harms. As with all pharmacological treatments, there are risks associated with OAT, including fatal overdose. There is a need to better understand risk for adverse outcomes during and after OAT, and for innovative approaches to identifying people at greatest risk of adverse outcomes. The Opioid Agonist Treatment and Safety study aims to address these questions so as to inform the expansion of OAT in the USA. METHODS AND ANALYSIS This is a retrospective cohort study using linked, routinely collected health data for all people seeking OAT in New South Wales, Australia, between 2001 and 2017. Linked data include hospitalisation, emergency department presentation, mental health diagnoses, incarceration and mortality. We will use standard regression techniques to model the magnitude and risk factors for adverse outcomes (eg, mortality, unplanned hospitalisation and emergency department presentation, and unplanned treatment cessation) during and after OAT, and machine learning approaches to develop a risk-prediction model. ETHICS AND DISSEMINATION This study has been approved by the Population and Health Services Research Ethics Committee (2018HRE0205). Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely-collected health Data statement.
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Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David A Fiellin
- Schools of Medicine and Public Health, Yale University, New Haven, Connecticut, USA
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Nicola R Jones
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert Ali
- Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Russolillo A, Moniruzzaman A, Somers JM. Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada. PLoS Med 2018; 15:e1002625. [PMID: 30063699 PMCID: PMC6067717 DOI: 10.1371/journal.pmed.1002625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Individuals with criminal histories have high rates of opioid dependence and mortality. Excess mortality is largely attributable to overdose deaths. Methadone maintenance treatment (MMT) is one of the best evidence-based opioid substitution treatments (OSTs), but there is uncertainty about whether methadone treatment reduces the risk of mortality among convicted offenders over extended follow-up periods. The objective of this study was to investigate the association between adherence to MMT and overdose fatality as well as other causes of mortality. METHODS AND FINDINGS We conducted a retrospective cohort study involving linked population-level administrative data among individuals in British Columbia (BC), Canada with a history of conviction and who filled a methadone prescription between January 1, 1998 and March 31, 2015. Participants were followed from the date of first-dispensed methadone prescription until censoring (date of death or March 31, 2015). Methadone was divided into medicated (methadone was dispensed) and nonmedicated (methadone was not dispensed) periods and analysed as a time-varying exposure. Hazard ratios (HRs) with 95% CIs were estimated using multivariable Cox regression to examine mortality during the study period. All-cause and cause-specific mortality rates were compared during medicated and nonmedicated methadone periods. Participants (n = 14,530) had a mean age of 34.5 years, were 71.4% male, and had a median follow-up of 6.9 years. A total of 1,275 participants died during the observation period. The overall all-cause mortality rate was 11.2 per 1,000 person-years (PYs). Participants were significantly less likely to die from both nonexternal (adjusted HR [AHR] 0.27 [95% CI 0.23-0.33]) and external (AHR 0.41 [95% CI 0.33-0.51]) causes during medicated periods, independent of sociodemographic, criminological, and health-related factors. Death due to infectious diseases was 5 times lower (AHR 0.20 [95% CI 0.13-0.30]), and accidental poisoning (overdose) deaths were nearly 3 times lower (AHR 0.39 [95% CI 0.30-0.50]) during medicated periods. A competing risk regression demonstrated a similar pattern of results. The use of a Canadian offender population may limit generalizability of results. Furthermore, our observation period represents community-based methadone prescribing and may omit prescriptions administered during hospital separations. Therefore, the magnitude of the protective effects of methadone from nonexternal causes of death should be interpreted with caution. CONCLUSIONS Adherence to methadone was associated with significantly lower rates of death in a population-level cohort of Canadian convicted offenders. Achieving higher rates of adherence may reduce overdose deaths and other causes of mortality among offenders and similarly marginalized populations. Our findings warrant examination in other study centres in response to the crisis of opiate-involved deaths.
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Affiliation(s)
- Angela Russolillo
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julian M. Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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