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Gizdic A, Antičević V, Brajević-Gizdić I. The role of attachment and personality traits in choosing opiate addiction replacement therapy. Sci Rep 2024; 14:14623. [PMID: 38918504 PMCID: PMC11199502 DOI: 10.1038/s41598-024-65695-w] [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: 01/23/2024] [Accepted: 06/24/2024] [Indexed: 06/27/2024] Open
Abstract
Contemporary medical approaches for opioid addiction often include medication-assisted therapy, utilizing methadone and buprenorphine. However, factors influencing patient preferences for starting buprenorphine or methadone therapy are poorly understood. This study aims to explore whether variances in personality traits and attachment styles are related to treatment preferences among individuals undergoing buprenorphine and methadone maintenance therapies. 300 participants completed the Big Five Questionnaire for personality traits and sub-dimensions and the Experiences in Close Relationship Scale for assessing attachment styles. The results indicated that patients with higher levels of Dynamism, Conscientiousness, and Perseverance personality traits were more likely to choose buprenorphine over methadone for achieving and maintaining abstinence. Although attachment styles showed a greater ability to differentiate between groups compared to personality traits, the differences were not significant. However, Conscientiousness stood out for its high discriminant validity, suggesting that scores in this personality dimension could significantly distinguish between groups, with individuals in the buprenorphine group showing higher levels of Conscientiousness compared to the methadone group. The study suggests a partial association between individuals' preference for abstinence therapy and their personality traits. These findings could be considered useful indicators when choosing maintenance therapy to help opiate-addicted patients achieve and maintain abstinence.
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Affiliation(s)
- Alena Gizdic
- University Department of Health Studies, University of Split, Split, Croatia.
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
| | - Vesna Antičević
- University Department of Health Studies, University of Split, Split, Croatia
| | - Igna Brajević-Gizdić
- Teaching Institute of Public Health, County of Split Dalmatia, Service of Mental Health, Split, Croatia
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2
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Bates JN, Baby SM, Getsy PM, Coffee GA, Hsieh YH, Knauss ZT, Dahan A, Bubier JA, MacFarlane PM, Mueller D, Lewis SJ. L-NAC and L-NAC methyl ester prevent and overcome physical dependence to fentanyl in male rats. Sci Rep 2024; 14:9091. [PMID: 38643270 PMCID: PMC11032344 DOI: 10.1038/s41598-024-59551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/11/2024] [Indexed: 04/22/2024] Open
Abstract
N-acetyl-L-cysteine (L-NAC) is a proposed therapeutic for opioid use disorder. This study determined whether co-injections of L-NAC (500 μmol/kg, IV) or its highly cell-penetrant analogue, L-NAC methyl ester (L-NACme, 500 μmol/kg, IV), prevent acquisition of acute physical dependence induced by twice-daily injections of fentanyl (125 μg/kg, IV), and overcome acquired dependence to these injections in freely-moving male Sprague Dawley rats. The injection of the opioid receptor antagonist, naloxone HCl (NLX; 1.5 mg/kg, IV), elicited a series of withdrawal phenomena (i.e. behavioral and cardiorespiratory responses, hypothermia and body weight loss) in rats that received 5 or 10 injections of fentanyl and similar numbers of vehicle co-injections. With respect to the development of dependence, the NLX-precipitated withdrawal phenomena were reduced in rats that received had co-injections of L-NAC, and more greatly reduced in rats that received co-injections of L-NACme. In regard to overcoming established dependence, the NLX-precipitated withdrawal phenomena in rats that had received 10 injections of fentanyl (125 μg/kg, IV) were reduced in rats that had received co-injections of L-NAC, and more greatly reduced in rats that received co-injections of L-NACme beginning with injection 6 of fentanyl. This study provides compelling evidence that co-injections of L-NAC and L-NACme prevent the acquisition of physical dependence and overcome acquired dependence to fentanyl in male rats. The higher efficacy of L-NACme is likely due to its greater cell penetrability in brain regions mediating dependence to fentanyl and interaction with intracellular signaling cascades, including redox-dependent processes, responsible for the acquisition of physical dependence to fentanyl.
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Affiliation(s)
- James N Bates
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Atelerix Life Sciences Inc., 300 East Main Street, Suite 202, Charlottesville, VA, USA
| | - Santhosh M Baby
- Section of Biology, Galleon Pharmaceuticals, Inc, Horsham, PA, USA
- Translational Sciences Treatment Discovery, Galvani Bioelectronics, Inc, 1250 S Collegeville Rd, Collegeville, PA, USA
| | - Paulina M Getsy
- Department of Pediatrics, Division of Pulmonology, Allergy, and Immunology, Case Western Reserve University, Cleveland, OH, USA
| | - Gregory A Coffee
- Department of Pediatrics, Division of Pulmonology, Allergy, and Immunology, Case Western Reserve University, Cleveland, OH, USA
| | - Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Zackery T Knauss
- Department of Biological Sciences, Kent State University, Kent, OH, USA
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Peter M MacFarlane
- Department of Pediatrics, Division of Pulmonology, Allergy, and Immunology, Case Western Reserve University, Cleveland, OH, USA
| | - Devin Mueller
- Department of Biological Sciences, Kent State University, Kent, OH, USA
| | - Stephen J Lewis
- Department of Pediatrics, Division of Pulmonology, Allergy, and Immunology, Case Western Reserve University, Cleveland, OH, USA.
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, USA.
- Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, OH, USA.
- Department of Pediatrics, Division of Pulmonology, Allergy and Immunology, School of Medicine,, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, USA.
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Bates JN, Getsy PM, Coffee GA, Baby SM, MacFarlane PM, Hsieh YH, Knauss ZT, Bubier JA, Mueller D, Lewis SJ. Lipophilic analogues of D-cysteine prevent and reverse physical dependence to fentanyl in male rats. Front Pharmacol 2024; 14:1336440. [PMID: 38645835 PMCID: PMC11026688 DOI: 10.3389/fphar.2023.1336440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024] Open
Abstract
We examined whether co-injections of the cell-permeant D-cysteine analogues, D-cysteine ethyl ester (D-CYSee) and D-cysteine ethyl amide (D-CYSea), prevent acquisition of physical dependence induced by twice-daily injections of fentanyl, and reverse acquired dependence to these injections in freely-moving male Sprague Dawley rats. Injection of the opioid receptor antagonist, naloxone HCl (NLX, 1.5 mg/kg, IV), elicited a series of withdrawal phenomena that included cardiorespiratory and behavioral responses, and falls in body weight and body temperature, in rats that received 5 or 10 injections of fentanyl (125 μg/kg, IV), and the same number of vehicle co-injections. Regarding the development of physical dependence, the NLX-precipitated withdrawal phenomena were markedly reduced in fentanyl-injected rats that had received co-injections of D-CYSee (250 μmol/kg, IV) or D-CYSea (100 μmol/kg, IV), but not D-cysteine (250 μmol/kg, IV). Regarding reversal of established dependence to fentanyl, the NLX-precipitated withdrawal phenomena in rats that had received 10 injections of fentanyl (125 μg/kg, IV) was markedly reduced in rats that received co-injections of D-CYSee (250 μmol/kg, IV) or D-CYSea (100 μmol/kg, IV), but not D-cysteine (250 μmol/kg, IV), starting with injection 6 of fentanyl. This study provides evidence that co-injections of D-CYSee and D-CYSea prevent the acquisition of physical dependence, and reverse acquired dependence to fentanyl in male rats. The lack of effect of D-cysteine suggests that the enhanced cell-penetrability of D-CYSee and D-CYSea into cells, particularly within the brain, is key to their ability to interact with intracellular signaling events involved in acquisition to physical dependence to fentanyl.
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Affiliation(s)
- James N. Bates
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Paulina M. Getsy
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Gregory A. Coffee
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Santhosh M. Baby
- Section of Biology, Galleon Pharmaceuticals, Inc., Horsham, PA, United States
| | - Peter M. MacFarlane
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Zackery T. Knauss
- Department of Biological Sciences, Kent State University, Kent, OH, United States
| | | | - Devin Mueller
- Department of Biological Sciences, Kent State University, Kent, OH, United States
| | - Stephen J. Lewis
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, United States
- Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, OH, United States
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Bates JN, Getsy PM, Coffee GA, Baby SM, MacFarlane PM, Hsieh YH, Knauss ZT, Bubier JA, Mueller D, Lewis SJ. L-cysteine ethyl ester prevents and reverses acquired physical dependence on morphine in male Sprague Dawley rats. Front Pharmacol 2023; 14:1303207. [PMID: 38111383 PMCID: PMC10726967 DOI: 10.3389/fphar.2023.1303207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/31/2023] [Indexed: 12/20/2023] Open
Abstract
The molecular mechanisms underlying the acquisition of addiction/dependence on morphine may result from the ability of the opioid to diminish the transport of L-cysteine into neurons via inhibition of excitatory amino acid transporter 3 (EAA3). The objective of this study was to determine whether the co-administration of the cell-penetrant L-thiol ester, L-cysteine ethyl ester (L-CYSee), would reduce physical dependence on morphine in male Sprague Dawley rats. Injection of the opioid-receptor antagonist, naloxone HCl (NLX; 1.5 mg/kg, IP), elicited pronounced withdrawal phenomena in rats which received a subcutaneous depot of morphine (150 mg/kg) for 36 h and were receiving a continuous infusion of saline (20 μL/h, IV) via osmotic minipumps for the same 36 h period. The withdrawal phenomena included wet-dog shakes, jumping, rearing, fore-paw licking, 360° circling, writhing, apneas, cardiovascular (pressor and tachycardia) responses, hypothermia, and body weight loss. NLX elicited substantially reduced withdrawal syndrome in rats that received an infusion of L-CYSee (20.8 μmol/kg/h, IV) for 36 h. NLX precipitated a marked withdrawal syndrome in rats that had received subcutaneous depots of morphine (150 mg/kg) for 48 h) and a co-infusion of vehicle. However, the NLX-precipitated withdrawal signs were markedly reduced in morphine (150 mg/kg for 48 h)-treated rats that began receiving an infusion of L-CYSee (20.8 μmol/kg/h, IV) at 36 h. In similar studies to those described previously, neither L-cysteine nor L-serine ethyl ester (both at 20.8 μmol/kg/h, IV) mimicked the effects of L-CYSee. This study demonstrates that 1) L-CYSee attenuates the development of physical dependence on morphine in male rats and 2) prior administration of L-CYSee reverses morphine dependence, most likely by intracellular actions within the brain. The lack of the effect of L-serine ethyl ester (oxygen atom instead of sulfur atom) strongly implicates thiol biochemistry in the efficacy of L-CYSee. Accordingly, L-CYSee and analogs may be a novel class of therapeutics that ameliorate the development of physical dependence on opioids in humans.
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Affiliation(s)
- James N. Bates
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Paulina M. Getsy
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Gregory A. Coffee
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Santhosh M. Baby
- Section of Biology, Galleon Pharmaceuticals, Inc., Horsham, PA, United States
| | - Peter M. MacFarlane
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Zackery T. Knauss
- Department of Biological Sciences, Kent State University, Kent, OH, United States
| | | | - Devin Mueller
- Department of Biological Sciences, Kent State University, Kent, OH, United States
| | - Stephen J. Lewis
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, United States
- Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, OH, United States
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Carl A, Pasman E, Broman MJ, Lister JJ, Agius E, Resko SM. Experiences of Healthcare and Substance Use Treatment Provider-based Stigma Among Patients Receiving Methadone. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100138. [PMID: 36994374 PMCID: PMC10040326 DOI: 10.1016/j.dadr.2023.100138] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/14/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
Background Medications for Opioid Use Disorder (MOUD) are efficacious, however only one-third of individuals with an opioid use disorder (OUD) enter into treatment. Low rates of MOUD utilization are partially due to stigma. This study examines provider-based stigma toward MOUD and identifies factors associated with experiencing stigma related to MOUD from substance use treatment and healthcare providers among people receiving methadone. Methods Clients receiving MOUD at an opioid treatment program (N = 247) were recruited to complete a cross-sectional computer-based survey assessing socio-demographics, substance use, depression and anxiety symptoms, self-stigma, and recovery supports/barriers. Logistic regression was used to examine factors associated with hearing negative comments about MOUD from substance use treatment and healthcare providers. Results 27.9% and 56.7% of respondents reported they sometimes/often hear negative comments about MOUD from substance use treatment and healthcare providers, respectively. Logistic regression results indicate that individuals who experience more negative consequences resulting from their OUD (OR=1.09, p=.019) had greater odds of hearing negative comments from substance use treatment providers. Age (OR=0.966, p=.017) and treatment stigma (OR=1.42, p=.030) were associated with greater odds of hearing negative comments from healthcare providers. Conclusions Stigma can be a deterrent to seeking substance use treatment, healthcare, and recovery support. Understanding factors associated with experiencing stigma from substance use treatment providers and healthcare providers is important as these individuals may act as advocates for those with OUD. This study highlights individual factors associated with hearing negative comments about methadone and other MOUD and point to areas for targeted education.
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Affiliation(s)
- Alexis Carl
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Emily Pasman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Michael J. Broman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Jamey J. Lister
- School of Social Work, Rutgers University – New Brunswick, 120 Albany Street, Tower One, New Brunswick, NJ 08901, USA
| | - Elizabeth Agius
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Stella M. Resko
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
- Merrill Palmer Skillman Institute, Wayne State University, 71 E Ferry St, Detroit, MI 48202, USA
- Corresponding author.
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6
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Pasman E, Kollin R, Broman M, Lee G, Agius E, Lister JJ, Brown S, Resko SM. Cumulative barriers to retention in methadone treatment among adults from rural and small urban communities. Addict Sci Clin Pract 2022; 17:35. [PMID: 35841076 PMCID: PMC9284487 DOI: 10.1186/s13722-022-00316-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Though methadone has been shown to effectively treat opioid use disorder, many barriers prevent individuals from accessing and maintaining treatment. Barriers are prevalent in less populated areas where treatment options are limited. This study examines barriers to retention in methadone treatment in a small Midwest community and identifies factors associated with greater endorsement of barriers. Methods Patients at an opioid treatment program (N = 267) were recruited to complete a computer-based survey onsite. Surveys assessed demographics, opioid misuse, depression and anxiety symptoms, trauma history and symptoms, social support, and barriers to retention in treatment (e.g., childcare, work, housing, transportation, legal obligations, cost, health). Descriptive statistics were used to examine individual barriers and multiple regression was calculated to identify demographic and psychosocial factors associated with greater cumulative barriers. Results Most participants reported at least one barrier to retention in treatment and more than half reported multiple barriers. Travel hardships and work conflicts were the most highly endorsed barriers. Past year return to use (B = 2.31, p = 0.004) and more severe mental health symptomology (B = 0.20, p = 0.038) were associated with greater cumulative barriers. Greater levels of social support were associated with fewer barriers (B = − 0.23, p < 0.001). Conclusion This study adds to the limited research on barriers to retention in methadone treatment among patients in rural and small urban communities. Findings suggest flexible regulations for dispensing methadone, co-location or care coordination, and family or peer support programs may further reduce opioid use and related harms in small communities. Individuals with past year return to use reported a greater number of barriers, highlighting the time following return to use as critical for wraparound services and support. Those with co-occurring mental health issues may be vulnerable to poor treatment outcomes, as evidenced by greater endorsement of barriers. As social support emerged as a protective factor, efforts to strengthen informal support networks should be explored as adjunctive services to methadone treatment.
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Affiliation(s)
- Emily Pasman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA.
| | - Rachel Kollin
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA
| | - Michael Broman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA
| | - Guijin Lee
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA.,Center for Behavioral Health and Justice, Wayne State University, 5201 Cass Ave, Detroit, MI, 48202, USA
| | - Elizabeth Agius
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA
| | - Jamey J Lister
- School of Social Work, Rutgers University, 120 Albany Street, Tower One, New Brunswick, NJ, 08901, USA
| | - Suzanne Brown
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA
| | - Stella M Resko
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI, 48202, USA.,Merrill Palmer Skillman Institute, Wayne State University, 71 E Ferry St, Detroit, MI, 48202, USA
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Zheng Q, Ren Y, Wang Z, Liu J, Zhang Y, Lin W, Gao J, Thomas KV, Thai PK. Assessing patterns of illicit drug use in a Chinese city by analyzing daily wastewater samples over a one-year period. JOURNAL OF HAZARDOUS MATERIALS 2021; 417:125999. [PMID: 34229374 DOI: 10.1016/j.jhazmat.2021.125999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 06/13/2023]
Abstract
Wastewater-based epidemiology (WBE) has been used extensively around the globe to provide information on illicit drug consumption. In China, most WBE studies to date only include a limited number of samples per catchment, making it difficult to derive any temporal consumption patterns. This study addresses this knowledge gap by identifying the temporal consumption trends of nine drugs in a Chinese megacity using WBE over a one-year period. Daily influent samples (n = 279) were collected from a wastewater treatment plant serving ~500,000 residents. All target drugs showed similar levels of consumption throughout the week. These findings were different to previous WBE studies in developed countries, where amphetamine-type drugs have shown higher consumption on weekends than during the week. Such a difference could be due to the users' demographics and behaviors as reported in previous surveys and warrant more research to help formulate appropriate drug control policies in China. Our study also observed that declining methamphetamine and ketamine consumption between 2012 and 2018, while consumption of MDMA and methadone were stable over the same period.
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Affiliation(s)
- Qiuda Zheng
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia
| | - Yuan Ren
- School of Environment and Energy, South China University of Technology, Higher Education Mega Center, Panyu District, Guangzhou 510006, China.
| | - Zhe Wang
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia
| | - Jinhua Liu
- School of Chemistry and Chemical Engineering, Shihezi University, Shihezi 832003, China
| | - Yu Zhang
- School of Chemistry and Chemical Engineering, Shihezi University, Shihezi 832003, China
| | - Wenting Lin
- School of Environment and Energy, South China University of Technology, Higher Education Mega Center, Panyu District, Guangzhou 510006, China
| | - Jianfa Gao
- College of Chemistry and Environmental Engineering, Shenzhen University, 1066 Xueyuan Avenue, Shenzhen 518060, China
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia
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Rezapour T, Hatami J, Farhoudian A, Noroozi A, Daneshmand R, Sofuoglu M, Baldacchino A, Ekhtiari H. Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder. J Subst Abuse Treat 2021; 131:108558. [PMID: 34366202 DOI: 10.1016/j.jsat.2021.108558] [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: 01/10/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impaired cognitive functions, particularly executive function, predicts poor treatment success in people with substance use disorders. The current study investigated the effect of receiving adjunct cognitive rehabilitation and baseline executive function (EF) measures on treatment response among people with opioid use disorder (OUD). METHOD The analysis sample consisted of 113 participants with OUD who were discharged from a compulsory court-mandated methadone maintenance treatment (MMT) and followed for 3 months. We used the Backward digit span/Auditory verbal learning, Stroop, and Trail making tests to assess the three measures of EF, including working memory, inhibition, and shifting, respectively. Treatment response was operationalized as (1) treatment retention and (2) the number of positive urine tests for morphine during 3-month follow-up periods. The study used Cox's proportional hazards model and linear mixed model to identify predictive factors. RESULTS Lower Stroop interference scores predicted increased length of stay in treatment (χ2 = 33.15, P < 0.001). The linear mixed model showed that scores on auditory verbal learning test and group intervention predicted the number of positive urine tests during a 3-month follow-up. CONCLUSION Working memory and inhibitory control, as well as receiving cognitive rehabilitation, could be potentially considered as predictors of treatment response for newly MMT admitted patients with OUD. Assessment of EF before treatment initiation may inform treatment providers about patient's cognitive deficits that may interfere with therapeutic interventions.
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Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Javad Hatami
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Daneshmand
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Alex Baldacchino
- University of St Andrews, School of Medicine, Division of Population and Behavioral Sciences, St Andrews, Scotland, UK
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA.
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9
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O'Carroll A, Duffin T, Collins J. Harm reduction in the time of COVID-19: Case study of homelessness and drug use in Dublin, Ireland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102966. [PMID: 33166825 PMCID: PMC7647898 DOI: 10.1016/j.drugpo.2020.102966] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
Abstract
Dublin appears to have performed very well as compared to various scenarios for COVID-19 mortality amongst homeless and drug using populations. The experience, if borne out by further research, provides important lessons for policy discussions on the pandemic, as well as broader lessons about pragmatic responses to these key client groups irrespective of COVID-19. The overarching lesson seems that when government policy is well coordinated and underpinned by a science-driven and fundamentally pragmatic approach, morbidity and mortality can be reduced. Within this, the importance of strategic clarity and delivery, housing, lowered thresholds to methadone provision, Benzodiazepine (BZD) provision and Naloxone availability were key determinants of policy success. Further, this paper argues that the rapid collapse in policy barriers to these interventions that COVID-19 produced should be secured and protected while further research is conducted.
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Affiliation(s)
- Austin O'Carroll
- COVID-19 Clinical Lead for Homelessness in Dublin, Grangegorman Upper, Arran Quay, Dublin, Ireland
| | - Tony Duffin
- CEO of Ana Liffey Drug Project, 48 Middle Abbey St, North City, Dublin 1, D01 TY74, Ireland.
| | - John Collins
- Director of Academic Engagement, the Global Initiative Against Transnational Organized Crime, Schwarzenbergplatz 1, 1010 Vienna, Austria.
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Marks M, Scheibe A, Shelly S. High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion. Harm Reduct J 2020; 17:25. [PMID: 32295595 PMCID: PMC7161298 DOI: 10.1186/s12954-020-00368-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moral conservatism within government and communities has resulted in a reluctance to support the provision of opioid agonist therapy for people with opioid use disorders in South Africa. In April 2017, South Africa's first low-threshold opioid agonist therapy demonstration project was launched in Durban. The project provided 54 low-income people with heroin use disorders methadone and voluntary access to psychosocial services for 18 months. At 12 months, retention was 74%, notably higher than the global average. In this paper, we aim to make sense of this outcome. METHODS Thirty semi-structured interviews, two focus groups, ten oral histories and ethnographic observations were done at various project time points. These activities explored participants' pathways into drug use and the project, their meaning attributed to methadone, the factors contributing to project success and changes they experienced. Recordings, transcripts, notes and feedback were reviewed and triangulated. Key factors contributing to retention were identified and analysed in light of the existing literature. RESULTS The philosophy and architecture of the project, and social cohesion were identified as the main factors contributing to retention. The use of a harm reduction approach enabled participants to set and be supported to achieve their treatment goals, and was shown to be important for the development of trusting therapeutic relationships. The employment of a restorative justice paradigm provided a sense of acceptance of humanity and flaws as well as an imperative to act responsibly towards others, fostering a culture of respect. Social cohesion was fostered through the facilitation of group sessions, a peace committee and group sport (soccer). In concert, these activities provided opportunities for participants to demonstrate care and interest in one another's life, leading to interdependence and care, contributing to them remaining in the project. CONCLUSIONS We believe that the high retention was achieved through attraction. We argue that opioid agonist therapy programmes should take the principles of harm reduction and restorative justice into consideration when designing low-threshold opioid agonist therapy services. Additionally, ways to support cohesion amongst people receiving agonist therapy should be explored to support their effective scale-up, both in low-middle income countries and in high-income countries.
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Affiliation(s)
- Monique Marks
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
| | - Andrew Scheibe
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Shaun Shelly
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
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Elman I, Howard M, Borodovsky JT, Mysels D, Rott D, Borsook D, Albanese M. Metabolic and Addiction Indices in Patients on Opioid Agonist Medication-Assisted Treatment: A Comparison of Buprenorphine and Methadone. Sci Rep 2020; 10:5617. [PMID: 32221389 PMCID: PMC7101411 DOI: 10.1038/s41598-020-62556-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/03/2020] [Indexed: 12/18/2022] Open
Abstract
Metabolic hormones stabilize brain reward and motivational circuits, whereas excessive opioid consumption counteracts this effect and may impair metabolic function. Here we addressed the role of metabolic processes in the course of the agonist medication-assisted treatment for opioid use disorder (OUD) with buprenorphine or methadone. Plasma lipids, hemoglobin A1C, body composition, the oral glucose tolerance test (oGTT) and the Sweet Taste Test (STT) were measured in buprenorphine- (n = 26) or methadone (n = 32)- treated subjects with OUD. On the whole, the subjects in both groups were overweight or obese and insulin resistant; they displayed similar oGTT and STT performance. As compared to methadone-treated subjects, those on buprenorphine had significantly lower rates of metabolic syndrome (MetS) along with better values of the high-density lipoproteins (HDL). Subjects with- vs. without MetS tended to have greater addiction severity. Correlative analyses revealed that more buprenorphine exposure duration was associated with better HDL and opioid craving values. In contrast, more methadone exposure duration was associated with worse triglycerides-, HDL-, blood pressure-, fasting glucose- and hemoglobin A1C values. Buprenorphine appears to produce beneficial HDL- and craving effects and, contrary to methadone, its role in the metabolic derangements is not obvious. Our data call for further research aimed at understanding the distinctive features of buprenorphine metabolic effects vis-à-vis those of methadone and their potential role in these drugs' unique therapeutic profiles.
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Affiliation(s)
- Igor Elman
- Center for Pain and the Brain, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Margaret Howard
- Rhode Island Department of Behavioral Healthcare, Cranston, RI, USA
| | - Jacob T Borodovsky
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - David Mysels
- Department of Psychiatry, Alpert Medical School of Brown University, Providence, RI, USA
| | - David Rott
- Department of Cardiology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Massachusetts General Hospital and McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Albanese
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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Scheibe A, Shelly S, Gerardy T, von Homeyer Z, Schneider A, Padayachee K, Naidoo SB, Mtshweni K, Matau A, Hausler H, Marks M. Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa. Addict Sci Clin Pract 2020; 15:13. [PMID: 32085807 PMCID: PMC7035721 DOI: 10.1186/s13722-020-00186-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. METHODS We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. RESULTS The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). CONCLUSIONS Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.
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Affiliation(s)
- Andrew Scheibe
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
| | - Shaun Shelly
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Tara Gerardy
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Zara von Homeyer
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Andrea Schneider
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | | | | | - Klaas Mtshweni
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Ayanda Matau
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Harry Hausler
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Monique Marks
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
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Spithoff S, Meaney C, Urbanoski K, Harrington K, Que B, Kahan M, Leece P, Shehadeh V, Sullivan F. Opioid agonist therapy during residential treatment of opioid use disorder: Cohort study on access and outcomes. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e443-e452. [PMID: 31604755 PMCID: PMC6788647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine access to opioid agonist therapy (OAT) for those entering residential treatment for opioid use disorder; to report on treatment outcomes for those taking OAT and those not taking OAT; and to determine the association between OAT use and residential treatment completion. DESIGN Retrospective cohort study. SETTING Ontario. PARTICIPANTS Patients with opioid use disorder admitted to publicly funded residential treatment programs in the province of Ontario between January 1, 2013, and December 31, 2016. MAIN OUTCOME MEASURES Access to OAT during residential treatment using descriptive statistics. Treatment outcomes (ie, completed the program, voluntarily left early, involuntary discharged, and other) for the entire cohort and for the OAT and non-OAT groups using descriptive statistics. Association between OAT use at admission and treatment completion (a binary outcome) using bivariate and multivariate models. RESULTS Among an identified cohort of 1910 patients with opioid use disorder, 52.8% entered programs that permitted access to OAT. Overall, 56.8% of patients completed treatment, 23.3% voluntarily left early (eg, were no-shows, dropped out), 17.0% were involuntarily discharged, and 2.9% were discharged early for other reasons. Those taking OAT were as likely to complete treatment as those not taking OAT (53.9% vs 57.5%, respectively; adjusted odds ratio of 1.07, 95% CI 0.77 to 1.38). CONCLUSION This study demonstrates 2 large gaps in care for patients with opioid use disorder. First, these patients have poor access to OAT-the first-line treatment of opioid use disorder-while in publicly funded residential treatment programs; and second, many are involuntarily discharged from treatment. Additionally, this study indicates that patients taking OAT have similar likelihood of completing residential treatment as those not taking OAT do. Limitations of this study are that it is based on observational data for patients who self-selected before admission to use OAT or not, and it is likely not all confounders were accounted for.
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Affiliation(s)
- Sheryl Spithoff
- Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario, and a family physician and addiction physician in the Department of Family and Community Medicine at Women's College Hospital.
| | - Christopher Meaney
- At the time of manuscript submission, was a biostatistician in the Department of Family and Community Medicine at the University of Toronto
| | - Karen Urbanoski
- Canada Research Chair in Substance Use, Addictions and Health Services Research, a scientist at the Canadian Institute for Substance Use Research, and Assistant Professor in Public Health and Social Policy at the University of Victoria in British Columbia
| | - Katy Harrington
- At the time of writing, was a Family medicine resident with the South East Toronto Family Health Team and in the Department of Family and Community Medicine at the University of Toronto
| | - Bill Que
- IT Specialist, DATIS, Evaluation and Data Management, Provincial System Support Program at the Centre for Addiction and Mental Health in Toronto
| | - Meldon Kahan
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Director of the Substance Use Service at Women's College Hospital
| | - Pamela Leece
- Public health physician at Public Health Ontario in Toronto, and Assistant Professor in the Department of Family and Community Medicine and in the Dalla Lana School of Public Health at the University of Toronto
| | - Vivian Shehadeh
- Project Leader at the Centre for Addiction and Mental Health at the time of submission
| | - Frank Sullivan
- Professor in the Department of Family and Community Medicine at the University of Toronto and Gordon F. Cheesbrough Research Chair in Family and Community Medicine at North York General Hospital
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Chung KS, Wu HC, Hsu CY, Lu YS, Li DJ. Factors impeding switching from methadone to buprenorphine in heroin users receiving methadone maintenance therapy - A naturalistic cohort study. J Subst Abuse Treat 2019; 105:51-56. [PMID: 31443892 DOI: 10.1016/j.jsat.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Switching from methadone to buprenorphine/naloxone remains a challenge for heroin users receiving methadone maintenance treatment (MMT). The present study aimed to investigate the predictors for failed switching from methadone to buprenorphine/naloxone among patients receiving MMT. METHODS This 5-year retrospective study included 168 individuals (138 males and 30 females) with opioid dependence who attempted to switch from methadone to buprenorphine/naloxone at our MMT clinics in Taiwan. We excluded patients with psychiatric comorbidity and other substance use disorders except nicotine. A univariate Cox proportional hazards regression model (Cox model) was used to estimate the potential factors of subsequent failed switching, followed by a multivariate Cox model to identify significant predictors after adjusting for other covariates. RESULTS Seventy of the 168 participants (41.7%) failed switching from methadone to buprenorphine/naloxone. After forward selection in the Cox hazard regression model, a greater average dose of methadone (HR = 1.02; P = 0.01), greater maximal maintenance dose of MMT (HR = 1.02; P < 0.001), greater average dose of buprenorphine (HR = 1.10; P = 0.021), and lower average attendance rate during the three months before switching (HR = 0.09; P = 0.002) were significantly associated with failed switching. CONCLUSIONS This study with limited participants showed that dose of methadone, dose of buprenorphine, and attendance rates were significantly associated with failed switching. Clinicians should discuss with their patients about tapering the dose of methadone and improving their attendance if they want to switch from methadone to buprenorphine. Further studies are necessary to verify whether our findings generalize to other populations.
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Affiliation(s)
- Kuan-Shang Chung
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chih-Yao Hsu
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Yu-Shi Lu
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
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Shiraly R, Taghva M. Factors Associated with Sustained Remission among Chronic Opioid Users. ADDICTION & HEALTH 2019; 10:86-94. [PMID: 31069032 PMCID: PMC6494988 DOI: 10.22122/ahj.v10i2.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Chronic opioid use is a major public health problem with significant morbidity. The aim of this study was to investigate factors associated with sustained remission among a sample of Iranian chronic opioid users in Shiraz, Iran. Methods This was a cross-sectional study to evaluate sustained remission among chronic opiate users aged 20-60 years. Participants included two groups: 365 people who have been in sustained remission for the past year, and 187 persons who did not achieve remission for the past one year. Then, demographic and factors related to drug use pattern and previous treatments were compared between two groups. Pearson chi-square test was used for univariate analysis and backward stepwise logistic regression was used to estimate adjusted odds ratios (AORs). Findings Our findings showed that sustained remission was associated with Narcotic Anonymous (NA) participation [AOR = 3.28, 95% confidence interval (CI): 2.19-4.89, P < 0.001], male gender (AOR = 2.53, 95% CI: 1.45-4.43, P = 0.001), younger age of onset (AOR = 1.63, 95% CI: 1.03-2.58, P = 0.037), higher total years of opioid use (AOR = 2.13, 95% CI: 1.42-3.19, P < 0.001), no history of imprisonment (AOR = 2.11, 95% CI: 1.16-3.85, P = 0.015), and family support (AOR = 2.58, 95% CI: 1.33-5.01, P = 0.005). Conclusion Participation in self-help groups can be a suitable alternative in predicting sustained remission among chronic opiate users. Chronic opioid users should be encouraged by the physicians who are involved in the treatment of drug addiction to participate in NA programs.
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Affiliation(s)
- Ramin Shiraly
- Assistant Professor, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Taghva
- Resident, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Spithoff S, Kiran T, Khuu W, Kahan M, Guan Q, Tadrous M, Leece P, Martins D, Gomes T. Quality of primary care among individuals receiving treatment for opioid use disorder. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:343-351. [PMID: 31088874 PMCID: PMC6516690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine if people receiving opioid agonist treatment (OAT), a long-term treatment approach, are also receiving high-quality primary care. DESIGN Retrospective cohort study. SETTING Ontario. PARTICIPANTS Recipients of public drug benefits who had at least 6 months of continuous use of methadone or buprenorphine between October 1, 2012, and September 30, 2013. MAIN OUTCOME MEASURES Rates of cancer screening and diabetes monitoring among those who had at least 6 months of continuous OAT were compared with matched controls. Conditional logistic regression models were used to assess differences after adjusting for confounders. In secondary analyses, outcomes by type of OAT and factors related to health care delivery were compared. RESULTS A cohort of 20 406 OAT patients was identified; they had a mean (SD) of 31 (15) physician clinic visits during the 6-month study period. Compared with the control group, OAT patients were less likely to receive screening for cervical cancer (48.7% vs 62.6%; adjusted odds ratio [AOR] of 0.34, 95% CI 0.31 to 0.36), breast cancer (23.3% vs 49.1%; AOR = 0.19, 95% CI 0.16 to 0.24), and colorectal cancer (32.5% vs 49.0%; AOR = 0.34, 95% CI 0.30 to 0.38), and less likely to have monitoring for diabetes (11.7% vs 28.5%; AOR = 0.16, 95% CI 0.13 to 0.21). Patients receiving OAT who were taking buprenorphine, enrolled in a medical home, or seeing a low-volume prescriber were generally more likely to receive cancer screening and diabetes monitoring. CONCLUSION Patients receiving OAT were less likely to receive chronic disease prevention and management than matched controls were despite frequent health care visits, indicating a gap in equitable access to primary care.
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Affiliation(s)
- Sheryl Spithoff
- Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario, a family physician and addiction physician in the Department of Family Medicine at Women's College Hospital, and a researcher at the Women's College Research Institute.
| | - Tara Kiran
- Adjunct Scientist at ICES in Toronto, Associate Scientist in the Li Ka Shing Knowledge Institute at St Michael's Hospital, Fidani Chair in Improvement and Innovation and Vice-Chair of Quality and Innovation in the Department of Family and Community Medicine at the University of Toronto, and a staff physician and clinician investigator in the Department of Family Medicine at St Michael's Hospital
| | | | - Meldon Kahan
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Qi Guan
- Doctoral candidate in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Mina Tadrous
- Fellow at ICES, a research associate in the Li Ka Shing Knowledge Institute, and Assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto
| | - Pamela Leece
- Public health physician at Public Health Ontario in Toronto, and Assistant Professor in the Department of Family and Community Medicine and in the Dalla Lana School of Public Health at the University of Toronto
| | | | - Tara Gomes
- Scientist at ICES and in the Li Ka Shing Knowledge Institute, and Assistant Professor in the Institute of Health Policy, Management and Evaluation and in the Leslie Dan Faculty of Pharmacy at the University of Toronto
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Milano G, Vergani HM, Cattedra S, Carrozzino R, Mattioli F, Robbiano L, Martelli A. Co-Occurring Psychiatric and Substance Use Disorders: Clinical Survey Among a Rural Cohort of Italian Patients. Neuropsychiatr Dis Treat 2019; 15:3453-3459. [PMID: 31908460 PMCID: PMC6927221 DOI: 10.2147/ndt.s222567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/23/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Dual diagnosis (DD) is the co-occurrence of both a mental illness and a substance use disorder (SUD). Lots of studies have analysed the integrated clinical approach, which involves both psychiatry and toxicology medical experts. The purpose of this study is to analyse the socio-demographic characteristics and treatment strategies of patients with DD in a rural area of Italy. PATIENTS AND METHODS Clinical data of 750 patients were collected in 2016 through the analysis of health plan records. RESULTS The rate of co-occurring disorders is highly variable among people with SUD. In the considered area, patients with DD are 24%, of these only 46.1% have been treated with an integrated clinical program. Moreover, this percentage is further reduced (35.8%) if only patients with heroin use disorder are considered. CONCLUSION A comprehensive revision of DD treatment is needed, especially for people suffering from heroin use disorder and living in remote areas. Meticulous data analysis from other addiction health services of rural areas could be necessary to identify a science-based clinical intervention.
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Affiliation(s)
- Giulia Milano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Hayley M Vergani
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Simone Cattedra
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | | | - Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Luigi Robbiano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Antonietta Martelli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
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Stuart GL, Shorey RC, France CR, Macfie J, Bell K, Fortner KB, Towers CV, Schkolnik P, Ramsey S. Empirical Studies Addressing the Opioid Epidemic: An Urgent Call for Research. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2018; 12:1178221818784294. [PMID: 30127614 PMCID: PMC6090487 DOI: 10.1177/1178221818784294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Abstract
Opioid misuse has become one of the most pressing public health problems facing
the country. In this article, we briefly review literature regarding the opioid
epidemic in the United States and the negative consequences of opioid use
disorder. We provide information regarding treatment and relapse using a variety
of intervention approaches. We call for research on people with opioid use
disorder that can contribute to a variety of areas: improving
medication-assisted treatment, addressing chronic pain, examination of
adjunctive behavioral interventions, overdose, high risk behaviors and
infections, pregnancy, diverse populations, and other psychological factors.
Collectively addressing these crucial areas of research will advance the field
and help alleviate suffering and prevent death from opioid use disorder.
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Affiliation(s)
- Gregory L Stuart
- Department of Psychology, The University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Ryan C Shorey
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Jenny Macfie
- Department of Psychology, The University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Kathryn Bell
- Department of Psychology, Capital University, Columbus, OH, USA
| | - Kimberly B Fortner
- The Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Craig V Towers
- The Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA
| | | | - Susan Ramsey
- Departments of Psychiatry & Human Behavior and Medicine, The Warren Alpert Medical School of Brown University, and Rhode Island Hospital, Providence, RI, USA
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Love JS, Perrone J, Nelson LS. Should Buprenorphine Be Administered to Patients With Opioid Withdrawal in the Emergency Department? Ann Emerg Med 2018; 72:26-28. [DOI: 10.1016/j.annemergmed.2017.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 01/04/2023]
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Oueslati B, Moula O, Ghachem R. The impact of OPRM1's genetic polymorphisms on methadone maintenance treatment in opioid addicts: a systematic review. Pharmacogenomics 2018; 19:741-747. [DOI: 10.2217/pgs-2018-0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: Methadone is a long-acting opioid receptor agonist. It is prescribed to patients with opioid-related use disorders. The OPRM1 gene encodes for methadone's main receptor. It appears that polymorphisms in OPRM1 may affect the efficacy of methadone maintenance treatment (MMT). Objective: Our purpose was to identify all relevant published papers dealing with the impact ofOPRM1's SNPs on MMT's efficacy and to summarize results in order to evaluate the relevance of conducting pretherapeutic genotyping in opioid addicts prior to the onset of MMT. Methods: MEDLINE, PsychINFO and Scopus databases were systematically searched up to 1 January 2018 with no year restrictions using the following keyword combination (MMT) AND (mu or OPRM or mu opioid receptors or SNP or polymorphism or gene). Endpoint of the included studies had to be the impact of OPRM1 gene polymorphisms on the efficacy of MMT and/or methadone required doses during MMT. All abstracts were reviewed to assess papers’ relevance. Studies conducted on animals and duplicate papers were excluded. Results: Our literature search identified 438 articles. Eight of them were included in our systematic review. The total number of included participants was equal to 2170, of whom 1718 underwent MMT. One study reported results of a randomized controlled trial. Three were designed as case–control studies and four as cross-sectional studies. rs1799971 (A118G) was the most studied allele. Results were divergent. Other SNPs might affect MMT's efficacy, however they were scarcely studied. Conclusion: Genotyping patients with opioid-related use disorders is a promising way to reach a better outcome in patients willing to be on MMT. Focusing on OPRM1 solely should be balanced since polymorphisms in other genes implicated in methadone pharmacodynamics and/or pharmacokinetics may conjunctly affect the efficacy of MMT. Recommendations cannot be enunciated for the moment.
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Affiliation(s)
- Bilel Oueslati
- Psychiatry Department, Razi Hospital, Manouba, Tunisia
- University of Tunis el Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Olfa Moula
- Psychiatry Department, Razi Hospital, Manouba, Tunisia
- University of Tunis el Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Rim Ghachem
- Psychiatry Department, Razi Hospital, Manouba, Tunisia
- University of Tunis el Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
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Heidebrecht F, MacLeod MB, Dawkins L. Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack. Addict Behav 2018; 77:210-216. [PMID: 29065377 DOI: 10.1016/j.addbeh.2017.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
AIMS To analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors in a clinical non-experimental setting. DESIGN Retrospective study. SETTING A community drug service in London, UK. PARTICIPANTS 325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine). MEASUREMENTS Logistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start (or at the date of transfer to another service). FINDINGS For the general model participants choosing methadone were more likely to use heroin at follow up (OR=2.36, 95% CI: 1.40-3.17) as were daily crack users on methadone (OR=2.62, 95% CI: 0.96-7.16). For the methadone model only daily crack use predicted heroin use at follow up (OR=2.62, 95% CI: 0.96-7.16). For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR=0.85, 95% CI: 0.75-0.95; OR=1.31, 95% CI: 1.06-1.60 and OR=6.04, 95% CI: 1.26-28.92). Both use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR=6.68, 95% CI: 0.37-119.59; OR=106.31, 95% CI: 3.41-3313.30) and daily (OR=57.49 (95% CI: 2.37-1396.46; OR=170.99 (95% CI: 4.61-6339.47) users. CONCLUSIONS Most of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. Crack use was a significant predictor of heroin abstinence at follow up in all models, however for buprenorphine only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.
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Affiliation(s)
| | | | - L Dawkins
- London South Bank University, London, UK
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22
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Meredith SE, Rash CJ, Petry NM. Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients. J Subst Abuse Treat 2017; 83:10-14. [PMID: 29129191 PMCID: PMC5726558 DOI: 10.1016/j.jsat.2017.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/03/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022]
Abstract
People who inject drugs (PWID) are at increased risk of HIV infection. Although methadone maintenance therapy can help lower this risk, many methadone patients continue to engage in HIV risk behaviors, especially patients who use cocaine and alcohol. The purpose of the current study was to investigate relations between alcohol use disorders and HIV risk behavior in 239 cocaine-dependent methadone patients participating in a randomized controlled trial of a behavioral intervention to promote cocaine abstinence. Past 3-month HIV Risk-taking Behavior Scale (HRBS) scores were compared between cocaine-dependent methadone patients who met DSM-IV-TR diagnostic criteria for alcohol abuse or dependence and those who did not meet these criteria. No significant differences in HRBS drug subscale scores were observed between participants with and without alcohol use disorders, indicating risky drug use was similar between groups. However, alcohol use disorder was significantly associated with HRBS sex subscale scores (t=2.59, p=0.01), indicating participants with alcohol use disorders were more likely to engage in risky sexual behavior. Item-level analyses of the sex-related HRBS questions showed participants with alcohol use disorders were significantly more likely than participants without alcohol use disorders to have unprotected sex, engage in transactional (paid) sex, and have anal sex. Interventions are needed to reduce risky sexual behavior and attenuate the spread of HIV in this high-risk population.
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Affiliation(s)
- Steven E Meredith
- University of Connecticut School of Medicine, Calhoun Cardiology Center, 263 Farmington Avenue, Farmington, CT 06030, United States
| | - Carla J Rash
- University of Connecticut School of Medicine, Calhoun Cardiology Center, 263 Farmington Avenue, Farmington, CT 06030, United States
| | - Nancy M Petry
- University of Connecticut School of Medicine, Calhoun Cardiology Center, 263 Farmington Avenue, Farmington, CT 06030, United States.
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Vigil JM, Stith SS, Adams IM, Reeve AP. Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study. PLoS One 2017; 12:e0187795. [PMID: 29145417 PMCID: PMC5690609 DOI: 10.1371/journal.pone.0187795] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives. PURPOSE A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use. METHODS Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected. RESULTS By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001). CONCLUSIONS The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.
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Affiliation(s)
- Jacob M. Vigil
- University of New Mexico, Department of Psychology, Albuquerque, New Mexico, United States of America
| | - Sarah S. Stith
- University of New Mexico, Department of Economics, Albuquerque, New Mexico, United States of America
| | - Ian M. Adams
- Industrial Rehabilitation Clinics, Albuquerque, New Mexico, United States of America
| | - Anthony P. Reeve
- Industrial Rehabilitation Clinics, Albuquerque, New Mexico, United States of America
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Isbister GK, Brown AL, Gill A, Scott AJ, Calver L, Dunlop AJ. QT interval prolongation in opioid agonist treatment: analysis of continuous 12-lead electrocardiogram recordings. Br J Clin Pharmacol 2017; 83:2274-2282. [PMID: 28488266 PMCID: PMC5595951 DOI: 10.1111/bcp.13326] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/18/2017] [Accepted: 05/01/2017] [Indexed: 12/17/2022] Open
Abstract
AIMS Methadone is a widely used opioid agonist treatment associated with QT prolongation and torsades de pointes. We investigated the QT interval in patients treated with methadone or buprenorphine using continuous 12-lead Holter recordings. METHODS We prospectively made 24-h Holter recordings in patients prescribed methadone or buprenorphine, compared to controls. After their normal dose a continuous 12-lead Holter recorder was attached for 24 h. Digital electrocardiograms were extracted hourly from the Holter recordings. The QT interval was measured automatically (H-scribe software, Mortara Pty Ltd) and checked manually. The QT interval was plotted against heart rate (HR) on the QT nomogram to determine abnormality. Demographics, dosing, medical history and laboratory investigations were recorded. RESULTS There were 58 patients (19 methadone, 20 buprenorphine and 19 control); median age 35 years (20-56 years); 33 males. Baseline characteristics were similar. Median dose of methadone was 110 mg day-1 (70-170 mg day-1 ) and buprenorphine was 16 mg day-1 (12-32 mg day-1 ). Seven participants had abnormal QT intervals. There was a significant difference in the proportion of prescribed methadone with abnormal QT intervals, 7/19 (37%; 95% confidence interval: 17-61%), compared to controls 0/19 (0%; 95% confidence interval: 0-21%; P = 0.008), but no difference between buprenorphine and controls (0/20). QT vs. HR plots showed patients prescribed methadone had higher QT-HR pairs over 24 h compared to controls. There was no difference in dose for patients prescribed methadone with abnormal QT intervals and those without. CONCLUSIONS Methadone is associated with prolonged QT intervals, but there was no association with dose. Buprenorphine did not prolong the QT interval. Twenty four-hour Holter recordings using the QT nomogram is a feasible method to assess the QT interval in patients prescribed methadone.
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Affiliation(s)
- Geoffrey K. Isbister
- School of Medicine and Public HealthUniversity of NewcastleNew South WalesAustralia
- Department of Clinical Toxicology and PharmacologyCalvary Mater NewcastleNewcastleNew South WalesAustralia
| | - Amanda L. Brown
- School of Medicine and Public HealthUniversity of NewcastleNew South WalesAustralia
- Drug and Alcohol Clinical ServicesHunter New England Local Health DistrictNew South WalesAustralia
- Centre for Brain and Mental HealthUniversity of Newcastle and Hunter Medical Research InstituteNew South WalesAustralia
| | - Anthony Gill
- Drug and Alcohol Clinical ServicesHunter New England Local Health DistrictNew South WalesAustralia
- Alcohol and Drug ServicesSt Vincents Hospital, DarlinghurstNew South WalesAustralia
- Drug and Alcohol Services, Central Coast Local Health DistrictNew South WalesAustralia
| | - Alexander J. Scott
- School of Medicine and Public HealthUniversity of NewcastleNew South WalesAustralia
| | - Leonie Calver
- School of Medicine and Public HealthUniversity of NewcastleNew South WalesAustralia
| | - Adrian J. Dunlop
- School of Medicine and Public HealthUniversity of NewcastleNew South WalesAustralia
- Drug and Alcohol Clinical ServicesHunter New England Local Health DistrictNew South WalesAustralia
- Centre for Brain and Mental HealthUniversity of Newcastle and Hunter Medical Research InstituteNew South WalesAustralia
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25
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[Substance abuse detection in substitution therapy : Oral fluid versus urine screening]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:1261-1268. [PMID: 28929198 DOI: 10.1007/s00103-017-2630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND A patient's health in an opioid maintenance program is potentially endangered due to concurrent consumption of drugs. Therefore, the German Medical Association requests evidence of compliant substitute intake while type and frequency of drug screening is chosen by the physician. This study comparatively assessed the feasibility and potential advantage of oral fluid drug testing versus urine screening in day-to-day practice. METHODS Urine and oral fluid-samples of a randomly chosen third of a total of 361 patients, treated in four different practices in a major German city, were tested. The detection rates were compared bivariate and the illicit substance intake of subgroups were analysed. Additionally, patients' and employees' satisfaction with the test procedures were assessed. RESULTS A total of 117 paired urine and oral fluid samples were considered for this study. A dual sample collection was not obtainable with 29 patients due to insufficient sample volume or refusal. Other than methadone or buprenorphine, 155 substances were found in urine samples, whereas only 82 other substances were detected in oral fluids. Significant differences existed within substance groups with THC being positive in 50 (42.7%) urine samples and only three (2.6%) positive oral fluid samples (p < 0.0001) and with benzodiazepines with 41 (35%) positive urine and 28 (23.9%) positive oral fluid samples (p < 0.0001), respectively. In total 75.2% of the urine samples were positive for concurrent drug consumption. Employees and patients did not prefer one test type over the other. CONCLUSION The confirmation of concurrent drug intake in maintenance setting is generally possible by the use of oral fluid, but inferior to urine screening.
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26
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Liu C, Liu PL, Dong QL, Luo L, Xu J, Zhou W, Wang X. Social-demographic shift in drug users at the first-ever- methadone maintenance treatment in Wuhan, China. Sci Rep 2017; 7:11446. [PMID: 28904357 PMCID: PMC5597614 DOI: 10.1038/s41598-017-11888-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/31/2017] [Indexed: 11/09/2022] Open
Abstract
The methadone maintenance treatment (MMT) has been initiated in Wuhan, China since early 2006. To understand the social-demographic, behavioral, and infectious diseases characteristics of drug users enrolled in their first-ever-MMT between 2006 and 2015, a retrospective observational study was implemented to also provide evidence for health policy-decisions to reduce harm and control disease. Pearson chi-square tests and t-tests were used to assess significant differences between two 5-year periods, 2006-2010 and 2011-2015. We observed increases in the mean age (38.65 vs. 42.43 years, P < 0.001), mean age of initial opioid drug use (28.18 vs. 31.07 years, P < 0.001), employment (11.9% vs. 30.7%, P < 0.001), married/co-habiting (42.4% vs. 47.8%, P < 0.001), and declines in higher education level (93.6% vs. 84.8%, P < 0.001), injection (82.3% vs. 75.1%, P < 0.001), syringe sharing (27.7% vs. 9.9%, P < 0.001), HCV infection rates (72.9% vs. 70.5%, P = 0.017). The number of drug users enrolling each year reduced following a continuous rapid growth in the first 3 years. The findings imply for adjusting in treatment services and allocation of resources to respond to emerging trends. In addition, the data will also be helpful for identifying needs and getting a baseline insight of the social-demographic and behavioral characteristics of the opioid abusers in the area.
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Affiliation(s)
- Cong Liu
- Wuhan centers for disease prevention and control, Hubei province, China
| | - Pu-Lin Liu
- Wuhan centers for disease prevention and control, Hubei province, China
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College,, Huazhong University of Science and Technology, Hubei province, China
| | - Quan-Lin Dong
- Wuhan centers for disease prevention and control, Hubei province, China
| | - Li Luo
- Wuhan centers for disease prevention and control, Hubei province, China
| | - Jun Xu
- Wuhan centers for disease prevention and control, Hubei province, China
| | - Wang Zhou
- Wuhan centers for disease prevention and control, Hubei province, China
| | - Xia Wang
- Wuhan centers for disease prevention and control, Hubei province, China.
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Krause D, Plörer D, Koller G, Martin G, Winter C, Adam R, Canolli M, Al-Iassin J, Musselmann R, Walcher S, Schäfer F, Pogarell O. High Concomitant Misuse of Fentanyl in Subjects on Opioid Maintenance Treatment. Subst Use Misuse 2017; 52:639-645. [PMID: 28157415 DOI: 10.1080/10826084.2016.1246571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Concomitant opioid misuse is an increasing problem in opioid maintenance treatment as it interferes with treatment success. OBJECTIVE Therefore, the rates of concomitant fentanyl misuse in opioid maintained patients were investigated. METHODS We conducted a cross-sectional study which consisted in collecting data via urine samples and questionnaires in Germany. Urine samples of patients on opioid maintenance treatment were gathered and fentanyl concentrations were measured from 2008 to 2012. An anonymous questionnaire provided data on the consumption of fentanyl as concomitant drug. Data were analyzed with descriptive statistics and group differences were calculated using the Chi-Square test. RESULTS Among the total sample (urine probes of 960 patients), 6.8% opioid maintained patients had positive urine samples for fentanyl and 37.9% reported concomitant fentanyl misuse (401 of these patients filled out the questionnaire). A significant age-related association of concomitant fentanyl misuse was identified in the urine analyses (χ2 = 7.489; p = .024) and also in the questionnaire data (χ2 = 11.899, p = .003), indicating that young age increased the probability of fentanyl consumption. Patients receiving methadone had the highest rates of concomitant fentanyl misuse with 18.4% according to urine analysis. In addition, the results show that patients who are on diamorphine are significantly less likely to misuse fentanyl. CONCLUSIONS Fentanyl is a frequently used concomitant drug. Especially young patients and patients taking methadone are at high risk. Because of the life-threatening consequences of fentanyl overdose, patients taking fentanyl should be intensively medically surveilled.
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Affiliation(s)
- Daniela Krause
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Diana Plörer
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Gabriele Koller
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Gabi Martin
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Catja Winter
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Roland Adam
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Minavere Canolli
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Jori Al-Iassin
- b Outpatient Clinic for Opioid Substitution , Munich , Germany
| | | | | | | | - Oliver Pogarell
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
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28
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Woo J, Bhalerao A, Bawor M, Bhatt M, Dennis B, Mouravska N, Zielinski L, Samaan Z. "Don't Judge a Book Its Cover": A Qualitative Study of Methadone Patients' Experiences of Stigma. Subst Abuse 2017; 11:1178221816685087. [PMID: 28469424 PMCID: PMC5398333 DOI: 10.1177/1178221816685087] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT. METHODS Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes. RESULTS In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies. DISCUSSION AND CONCLUSION Stigma is a widespread and serious issue that adversely affects MMT patients' quality of life and treatment. More efforts are needed to combat MMT-related stigma.
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Affiliation(s)
- Julia Woo
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Anuja Bhalerao
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Meha Bhatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Brittany Dennis
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Natalia Mouravska
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Laura Zielinski
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
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Soyka M, Mutschler J. Treatment-refractory substance use disorder: Focus on alcohol, opioids, and cocaine. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:148-61. [PMID: 26577297 DOI: 10.1016/j.pnpbp.2015.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/23/2015] [Accepted: 11/11/2015] [Indexed: 12/20/2022]
Abstract
Substance use disorders are common, but only a small minority of patients receive adequate treatment. Although psychosocial therapies are effective, relapse is common. This review focusses on novel pharmacological and other treatments for patients with alcohol, opioid, or cocaine use disorders who do not respond to conventional treatments. Disulfiram, acamprosate, and the opioid antagonist naltrexone have been approved for the treatment of alcoholism. A novel, "as needed" approach is the use of the mu-opioid antagonist and partial kappa agonist nalmefene to reduce alcohol consumption. Other novel pharmacological approaches include the GABA-B receptor agonist baclofen, anticonvulsants such as topiramate and gabapentin, the partial nicotine receptor agonist varenicline, and other drugs. For opioid dependence, opioid agonist therapy with methadone or buprenorphine is the first-line treatment option. Other options include oral or depot naltrexone, morphine sulfate, depot or implant formulations, and heroin (diacetylmorphine) in treatment-refractory patients. To date, no pharmacological treatment has been approved for cocaine addiction; however, 3 potential pharmacological treatments are being studied, disulfiram, methylphenidate, and modafinil. Pharmacogenetic approaches may help to optimize treatment response in otherwise treatment-refractory patients and to identify which patients are more likely to respond to treatment, and neuromodulation techniques such as repeated transcranial magnetic stimulation and deep brain stimulation also may play a role in the treatment of substance use disorders. Although no magic bullet is in sight for treatment-refractory patients, some novel medications and brain stimulation techniques have the potential to enrich treatment options at least for some patients.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstrasse 7, 80336 Munich, Germany; Privatklinik Meiringen, Postfach 612, CH-3860 Meiringen, Switzerland.
| | - Jochen Mutschler
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Selnaustrasse 9, 8001 Zurich, Switzerland
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Delorme J, Chenaf C, Kabore JL, Pereira B, Mulliez A, Tremey A, Brousse G, Zenut M, Laporte C, Authier N. Incidence of high dosage buprenorphine and methadone shopping behavior in a retrospective cohort of opioid-maintained patients in France. Drug Alcohol Depend 2016; 162:99-106. [PMID: 27006272 DOI: 10.1016/j.drugalcdep.2016.02.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/09/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Opioid Substitution Treatment (OST) misuse and diversion have significantly increased worldwide. Obtaining OST prescriptions from multiple prescribers, known as doctor shopping, is a way in which opioids may be diverted. OBJECTIVES The aim of this study was to assess the incidence of OST (high dosage buprenorphine (HDB) and methadone (MTD)) shopping behavior and identify associated risk factors, and its impact on mortality. METHODS A retrospective cohort of patients treated by OST between April 1, 2004 and December 31, 2012 from a sample of the French Health Insurance database was established. Doctor shopping was defined as ≥1 day of overlapping prescriptions written by ≥2 different prescribers and filled in ≥3 different pharmacies. RESULTS A total of 2043 patients were enrolled, 1450HDB and 593 MTD. The one-year incidence of shopping behavior was 8.4% (95% CI: 7.0-10.1) in HDB group and 0% in MTD group, compared to 0.2% (95% CI: 0.1-0.2) for diuretics. On multivariate analysis, factors associated with HDB shopping behavior were: male gender HR: 1.74 (95% CI: 1.20-2.54); low-income status HR: 2.95 (95% CI: 2.07-4.44); mental health disorders HR: 1.43 (95% CI: 1.06-1.94); concurrent hypnotics use HR: 1.90 (95% CI: 1.39-2.61); concurrent use of weak opioids HR: 1.48 (95% CI: 1.09-1.99) and morphine HR: 1.69 (95% CI: 1.02-2.80). HDB shoppers had a higher, yet non-significant risk of death (HR: 1.56 (95% CI: 0.64-3.81)) than non HDB shoppers. CONCLUSION Shopping behavior was only found in high dosage buprenorphine patients and concerned almost one out ten patients.
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Affiliation(s)
- Jessica Delorme
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France.
| | - Chouki Chenaf
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France
| | - Jean-Luc Kabore
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, BP69, 63003 Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, BP69, 63003 Clermont-Ferrand, France
| | - Aurore Tremey
- CHU Clermont-Ferrand, Service de Psychiatrie et Addictologie, CMPB, BP69, 63003 Clermont-Ferrand, France
| | - Georges Brousse
- CHU Clermont-Ferrand, Service de Psychiatrie et Addictologie, CMPB, BP69, 63003 Clermont-Ferrand, France
| | - Marie Zenut
- CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; EA 4681 PEPRADE, Université d'Auvergne (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), France
| | - Catherine Laporte
- Département de Médecine Générale, Faculté de Médecine, BP38, 63001 Clermont- Ferrand, France
| | - Nicolas Authier
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France; Institut Analgesia, Faculté de Médecine, BP38, 63001 Clermont-Ferrand, France
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Hser YI, Evans E, Huang D, Weiss R, Saxon A, Carroll KM, Woody G, Liu D, Wakim P, Matthews AG, Hatch-Maillette M, Jelstrom E, Wiest K, McLaughlin P, Ling W. Long-term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi-site trial. Addiction 2016; 111:695-705. [PMID: 26599131 PMCID: PMC4801718 DOI: 10.1111/add.13238] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/19/2015] [Accepted: 11/13/2015] [Indexed: 12/12/2022]
Abstract
AIMS To compare long-term outcomes among participants randomized to buprenorphine or methadone. DESIGN, SETTING AND PARTICIPANTS Follow-up was conducted in 2011-14 of 1080 opioid-dependent participants entering seven opioid treatment programs in the United States between 2006 and 2009 and randomized (within each program) to receive open-label buprenorphine/naloxone or methadone for up to 24 weeks; 795 participants completed in-person interviews (~74% follow-up interview rate) covering on average 4.5 years. MEASUREMENTS Outcomes were indicated by mortality and opioid use. Covariates included demographics, site, cocaine use and treatment experiences. FINDINGS Mortality was not different between the two randomized conditions, with 23 (3.6%) of 630 participants randomized to buprenorphine having died versus 26 (5.8%) of 450 participants randomized to methadone. Opioid use at follow-up was higher among participants randomized to buprenorphine relative to methadone [42.8 versus 31.7% positive opioid urine specimens, P < 0.01, effect size (h) = 0.23 (0.09, 0.38); 5.8 days versus 4.4 days of past 30-day heroin use, P < 0.05, effect size (d) = 0.14 (0.00, 0.28)]. Opioid use during the follow-up period by randomization condition was also significant (F(7,39,600) = 3.16; P < 0.001) due mainly to less treatment participation among participants randomized to buprenorphine than methadone. Less opioid use was associated with both buprenorphine and methadone treatment (relative to no treatment); no difference was found between the two treatments. Individuals who are white or used cocaine at baseline responded better to methadone than to buprenorphine. CONCLUSIONS There are few differences in long-term outcomes between buprenorphine and methadone treatment for opioid dependence, and treatment with each medication is associated with a strong reduction in opioid use.
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Fiumana V, Zamboni L, Mazza M, Janiri L, Cibin M, GICS , Lugoboni F. Quality of Life in Heroin Users Attending Substitution Treatment: A Multicenter Study in Italy. Health (London) 2016. [DOI: 10.4236/health.2016.812123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Worley MJ, Heinzerling KG, Shoptaw S, Ling W. Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain. Exp Clin Psychopharmacol 2015; 23:428-35. [PMID: 26302337 PMCID: PMC4658240 DOI: 10.1037/pha0000039] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (odds ratio = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. A 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence. The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain.
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Affiliation(s)
- Matthew J. Worley
- Department of Family Medicine, University of California, Los Angeles
| | | | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles
| | - Walter Ling
- Integrated Substance Abuse Program, University of California Los Angeles
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34
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Christie MJ, Connor M, Traynor JR. Themed section. Br J Pharmacol 2014; 172:247-50. [PMID: 25537825 DOI: 10.1111/bph.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- M J Christie
- Discipline of Pharmacology, University of Sydney, NSW, Australia
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Somogyi AA, Barratt DT, Ali RL, Coller JK. Pharmacogenomics of methadone maintenance treatment. Pharmacogenomics 2014; 15:1007-27. [DOI: 10.2217/pgs.14.56] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Methadone is the major opioid substitution therapy for opioid dependence. Dosage is highly variable and is often controlled by the patient and prescriber according to local and national policy and guidelines. Nevertheless many genetic factors have been investigated including those affecting its metabolism (CYP2B6-consistent results), efflux transport (P-gp-inconsistent results), target μ-opioid receptor (μ-opioid receptor-inconsistent results) and a host of other receptors (DRD2) and signaling elements (GIRK2 and ARRB2; not replicated). None by themselves have been able to substantially explain dosage variation (the major but not sole end point). When multiple genes have been combined such as ABCB1, CYP2B6, OPRM1 and DRD2 a greater contribution to dosage variation was found but not as yet replicated. As stabilization of dosage needs to be made rapidly, it is imperative that larger internationally based studies be instigated so that genetic contribution to dosage can be properly assessed, which may or may not tailor to different ethnic groups and each country’s policy towards an outcome that benefits all.
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Affiliation(s)
- Andrew A Somogyi
- Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, 5005, Australia
| | - Daniel T Barratt
- Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Robert L Ali
- Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
- DASSA World Health Organization Collaborating Centre for Research in the Treatment of Drug & Alcohol Problems, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Janet K Coller
- Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, Australia
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Malizia AL, Ferro A. Drugs for addiction: a therapeutic area in need of a 'shot in the arm'. Br J Clin Pharmacol 2014; 77:225-7. [PMID: 24450545 DOI: 10.1111/bcp.12316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Andrea L Malizia
- Clinical Psychopharmacology and Neurostimulation, Department of Neurosurgery, Frenchay hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK
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