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Bjørnestad ED, Vederhus JK, Clausen T. Change in self-reported somatic symptoms among patients in opioid maintenance treatment from baseline to 1-year follow-up. BMC Psychiatry 2024; 24:149. [PMID: 38383345 PMCID: PMC10882792 DOI: 10.1186/s12888-024-05590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND High somatic comorbidity is common among patients in treatment for opioid use disorder (OUD). The present study aims to investigate changes in self-reported somatic health conditions and somatic symptoms among patients entering opioid maintenance treatment (OMT) programs. METHODS We used data from the Norwegian Cohort of Patients in OMT and Other Drug Treatment (NorComt) study. Of 283 patients who entered OMT, 176 were included for analysis at a 1-year follow-up. Participants provided self-reported data during structured interviews on somatic conditions, somatic symptoms, substance use severity measures, and mental distress. A multivariable linear regression analysis identified factors associated with changes in the burden of somatic symptoms. RESULTS Patients entering OMT reported a high prevalence of somatic conditions at the beginning of treatment, with 3 of 5 patients reporting at least one. The most prevalent condition was hepatitis C, followed by asthma and high blood pressure. Patients reported experiencing a high number of somatic symptoms. The intensity of these symptoms varied across a wide spectrum, with oral health complaints and reduced memory perceived as the most problematic. Overall, for the entire sample, there was no significant change in somatic symptoms from baseline to 1 year. Further analysis indicated that those who reported a higher burden of somatic symptoms at baseline had the greatest improvement at the 1-year follow-up. A higher number of somatic conditions and higher mental distress at baseline was associated with improvements in somatic symptoms burden at follow-up. CONCLUSIONS Patients in OMT report a range of somatic conditions and somatic symptoms. Given the wide range of symptoms reported by patients in OMT, including some at high intensity levels, healthcare providers should take into consideration the somatic healthcare needs of individuals in OMT populations. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).
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Affiliation(s)
- Endre Dahlen Bjørnestad
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway.
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway.
| | - John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway
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Underner M, Perriot J, Peiffer G, Brousse G, Jaafari N. [Bronchial diseases and heroin use. A systematic review]. Rev Mal Respir 2023; 40:783-809. [PMID: 37925326 DOI: 10.1016/j.rmr.2023.09.006] [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: 07/01/2023] [Accepted: 09/11/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Heroin use can cause respiratory complications including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis (BD). OBJECTIVES A general review of the literature presenting the data on the relationships between heroin consumption and bronchial complications, while underlining the difficulties of diagnosis and management. DOCUMENTARY SOURCES Medline, 1980-2022, keywords "asthma" or "bronchospasm" or "COPD" or "bronchiectasis" and "heroin" or "opiate" or "opiates", with limits pertaining to "Title/Abstract". Concerning asthma, 26 studies were included, as were 16 for COPD and 5 for BD. RESULTS Asthma and COPD are more prevalent among heroin addicts, who are less compliant than other patients with their treatment. The authors found a positive association between frequency of asthma exacerbations, admission to intensive care and heroin inhalation. Late diagnosis of COPD worsens the course of the disease; emphysema and BD are poor prognostic factors. CONCLUSION Bronchial diseases in heroin users can be identified by means of respiratory function exploration and chest CT scans. These tests should be performed frequently in view of optimizing their care, which includes their weaning themselves from addictive substances.
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Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - J Perriot
- Dispensaire Émile-Roux, CLAT, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - G Brousse
- Service d'addictologie, CHU de Clermont-Ferrand, université Clermont Auvergne, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Troberg K, Lundqvist K, Hansson H, Håkansson A, Dahlman D. Healthcare seeking among Swedish patients in opioid substitution treatment – a mixed methods study on barriers and facilitators. Subst Abuse Treat Prev Policy 2022; 17:8. [PMID: 35123518 PMCID: PMC8817477 DOI: 10.1186/s13011-022-00434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients in opioid substitution treatment (OST) have poorer health than the general population. Thus, they do not seek somatic health care to the extent that is medically motivated. Barriers hindering patients from seeking medical help through the conventional healthcare system result in a high degree of unmet healthcare needs. Barriers to, and facilitators of, OST patients’ healthcare seeking have been sparsely examined. Methods Mixed methods were employed. The quantitative part consisted of a cross-sectional questionnaire covering questions on physical health, healthcare seeking, and barriers thereof, which was collected from 209 patients in OST. A sub-sample of eleven OST patients participated in semi-structured interviews, for the qualitative part of the study, covering experience of healthcare, lifestyle, and self-images, expectations, and ideals of Swedish healthcare. Results Confirmed by qualitative data, quantitative data revealed deprioritization, fear of stigma and of being treated badly, and problems in navigation throughout the healthcare system, leading to unsuccessful establishment of contact, being most common reasons for not seeking somatic healthcare. Thus, interviewees provided a deeper knowledge of the barriers stigma, lack of means to prioritize health and difficulties navigating throughout the healthcare system, leading to resignation and deprioritization. On-site primary healthcare (PHC) seemed to contribute to increased access and utilization of healthcare. Conclusion Individual and structural barriers decreasing access to healthcare lead to increased inequalities in healthcare utilization, adding to an already deteriorating health of this ageing population. Integration of on-site primary healthcare and OST could provide acceptable and accessible healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00434-w.
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Vikbladh T, Troberg K, Håkansson A, Dahlman D. Healthcare utilization for somatic conditions among Swedish patients in opioid substitution treatment, with and without on-site primary healthcare. BMC Health Serv Res 2022; 22:971. [PMID: 35906595 PMCID: PMC9338550 DOI: 10.1186/s12913-022-08351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Opioid substitution treatment (OST) populations are aging and have increased mortality and somatic morbidity compared to general populations internationally. While OST patients have poor self-rated physical health and unmet healthcare needs, documented healthcare utilization has been sparsely investigated. The aim of this study was to assess registered healthcare utilization for somatic conditions in a sample of Swedish OST patients, and compare healthcare utilization among OST patients with and without use of on-site primary healthcare (PHC). Methods Patients in OST in Malmö, Sweden, were recruited for a survey study conducted in 2017–2018. Survey data were compared with comprehensive patient records from specialized and primary care during one year prior to study inclusion (total n = 190). All patient records were examined for healthcare utilization, source of healthcare (PHC, emergency care and secondary care), and documented diagnoses and symptoms. Factors associated with healthcare utilization were analyzed by using logistic regression analysis. Patients with and without on-site PHC were compared by using descriptive statistics and Chi-2 test. Results A total of 88% of the sample had been in direct or indirect contact with somatic healthcare during one year (PHC 66%; emergency care 28%; secondary care 67%). The most prevalent somatic diagnoses were infectious diseases (39%) and symptom diagnoses (37%). Respiratory, dermatological and musculoskeletal diagnoses, and trauma/intoxication were documented in 21–26% of the sample, respectively. PHC utilization was associated with older age and being born in Sweden. Among patients with on-site PHC (n = 25), the number utilizing secondary care was 84%, and certain diagnostic codes were more frequent in this group. Conclusion OST patients are seemingly underserved as regards their physical health. Since increased OST access decreases opioid overdose fatalities, the life expectancy among OST patients is likely to increase and thereby also increases the risk of age-related conditions. Thus, easily accessible physical healthcare is of great importance in this group. On-site PHC might be a way to establish healthcare contact with OST patients, especially for non-acute conditions, although further research is needed.
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Affiliation(s)
- Teodor Vikbladh
- Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503, 22, Malmö, Sweden
| | - Katja Troberg
- Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden.,Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Håkansson
- Malmö Addiction Centre, Skåne University Hospital, Malmö, Sweden.,Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503, 22, Malmö, Sweden. .,Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
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Bech AB, Clausen T, Waal H, Delaveris GJM, Skeie I. Organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder: a nation-wide 2-year cross-sectional study. Addiction 2022; 117:977-985. [PMID: 34648218 DOI: 10.1111/add.15705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
AIMS To document organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder and estimate the extent to which individual characteristics are associated with pulmonary, cardiovascular, hepatic or renal pathologies. DESIGN Two-year cross-sectional nation-wide study. SETTING Norway. PARTICIPANTS Among all 200 patients who died during opioid agonist treatment between 1 January 2014 and 31 December 2015, 125 patients (63%) were autopsied. Among these, 122 patients (75% men) had available autopsy reports and were included. The mean age at the time of death was 48 years. MEASUREMENTS Information on pulmonary, cardiovascular, hepatic and renal pathologies were retrieved from forensic or medical autopsy reports, with no (0) and yes (1) as outcome variables and age, sex and body mass index as covariates in logistic regression analyses. FINDINGS Pathologies in several organs were common. Two-thirds (65%) of the decedents had more than two organ system diseases. The most common organ pathologies were chronic liver disease (84%), cardiovascular disease (68%) and pulmonary emphysema (41%). In bivariate analyses, only older age was associated with any pulmonary pathology [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.01-1.10], cardiovascular pathology (OR = 1.11; 95% CI = 1.05-1.17) and renal pathology (OR = 1.05; 95% CI = 1.00-1.11). Older age remained independently associated with cardiovascular pathology (OR = 1.10; 95% CI = 1.04-1.16) and renal pathology (OR = 1.06; 95% CI = 1.01-1.12) adjusted for body mass index and sex. CONCLUSIONS Among autopsied Norwegians who died during opioid agonist treatment in 2014 and 2015, two-thirds had more than two organ system diseases, despite their mean age of 48 years at the time of death. Older age was independently associated with at least one cardiovascular or renal pathology after adjusting for sex and body mass index.
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Affiliation(s)
- Anne Berit Bech
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Helge Waal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
- National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | | | - Ivar Skeie
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
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Drug use disorder and risk of incident and fatal prostate cancer among Swedish men: a nationwide epidemiological study. Cancer Causes Control 2021; 33:213-222. [PMID: 34743253 PMCID: PMC8776671 DOI: 10.1007/s10552-021-01513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
Purpose Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden. Methods We performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD. Results DUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis. Conclusions Men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01513-2.
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Garpenhag L, Dahlman D. Perceived healthcare stigma among patients in opioid substitution treatment: a qualitative study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:81. [PMID: 34702338 PMCID: PMC8549326 DOI: 10.1186/s13011-021-00417-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/02/2022]
Abstract
Background People with substance use disorders (SUD) including patients in opioid substitution treatment (OST) are subject to stigma, and have generally poor health and barriers towards seeking healthcare. Experience of stigma might negatively affect healthcare seeking, but this topic is sparsely investigated. The aim of this study was to explore OST patients’ past and present experiences of substance use stigma in healthcare settings, in order to provide insight into the challenges that people with opioid use disorder may face when using health services, and the strategies they use to cope with them. Methods Six focus groups with 23 OST patients were moderated by OST staff, and conducted with a questioning route focusing on health literacy. Experiences associated with stigma and its consequences that were spontaneously brought up by participants were assessed in a secondary analysis using a thematic approach. Results Experiences of stigma from a wide range of healthcare settings were reported. Medical records and patients’ oral information regarding substance use, OST medication or hepatitis C infection were identified as circumstances bringing unwanted attention to the SUD. Participants reported various forms of poor treatment, believed to reflect views of people with SUD as morally culpable, intimidating, curious, untrustworthy and less valuable than other patients, sometimes with tangible effects on the quality of healthcare. Stigma in healthcare settings affected healthcare seeking behaviors, and could result in patients concealing their OST status or substance use history. Conclusion This study highlights several aspects of perceived healthcare stigma that can shed light on difficulties that OST patients might experience when navigating the healthcare system. The results implicate a need to investigate attitudes towards OST patients, and the aptitude to deal with patients with SUD, among healthcare professionals, as well as a need for interventions addressing knowledge deficits and issues tied to values and patient reception among healthcare staff. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00417-3.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University/Region Skåne, Sweden, Box, 503 22, Malmö, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University/Region Skåne, Sweden, Box, 503 22, Malmö, Sweden. .,Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.
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Bäckström E, Troberg K, Håkansson A, Dahlman D. Healthcare Contacts Regarding Circulatory Conditions among Swedish Patients in Opioid Substitution Treatment, with and without On-Site Primary Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094614. [PMID: 33925318 PMCID: PMC8123605 DOI: 10.3390/ijerph18094614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/10/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
Patients in Opioid Substitution Treatment (OST) have increased mortality and morbidity, with circulatory conditions suggested to be a contributing factor. Since OST patients tend to have unmet physical healthcare needs, a small-scale intervention providing on-site primary healthcare (PHC) in OST clinics was implemented in Malmö, Sweden in 2016. In this study, we assessed registered circulatory conditions and healthcare utilization in OST patients with and without use of on-site PHC. Patients from four OST clinics in Malmö, Sweden, were recruited to a survey study in 2017–2018. Medical records for the participants were retrieved for one year prior to study participation (n = 192), and examined for circulatory diagnoses, examinations and follow-ups. Patients with and without on-site PHC were compared through descriptive statistics and univariate analyses. Eighteen percent (n = 34) of the sample had 1≤ registered circulatory condition, and 6% (n = 12) attended any clinical physiology examination or follow-up, respectively. Among patients utilizing on-site PHC (n = 26), the numbers were 27% (n = 7) for circulatory diagnosis, 15% (n = 4) for examinations, and 12% (n = 3) for follow-up. OST patients seem underdiagnosed in regard to their circulatory health. On-site PHC might be a way to diagnose and treat circulatory conditions among OST patients, although further research is needed.
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Affiliation(s)
- Eric Bäckström
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Region Skåne, 205 02 Malmö, Sweden;
| | - Katja Troberg
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden; (K.T.); (A.H.)
- Malmö Addiction Centre, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Anders Håkansson
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden; (K.T.); (A.H.)
- Malmö Addiction Centre, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Region Skåne, 205 02 Malmö, Sweden;
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden; (K.T.); (A.H.)
- Malmö Addiction Centre, Skåne University Hospital, 205 02 Malmö, Sweden
- Correspondence:
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Dahlman D, Ekefäll M, Garpenhag L. Health Literacy among Swedish Patients in Opioid Substitution Treatment: A Mixed-Methods Study. Drug Alcohol Depend 2020; 214:108186. [PMID: 32721789 DOI: 10.1016/j.drugalcdep.2020.108186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Poor health and unmet healthcare needs is common among people with substance use disorder (SUD) including patients in opioid substitution treatment (OST). Low health literacy (HL) is associated with poverty, low education and physical limitations, but is unexplored in an OST context. METHODS Mixed-methods were used. Participants were consecutively recruited by clinic staff or researcher, from five OST clinics in Malmö, Sweden, during September - November 2019. HL level was measured through HLS-EU-Q16 (n?=?286). Self-reported socioeconomic correlates of HL were analyzed through logistic regression. Patients' experiences of HL-related problems were assessed through six focus group interviews (n?=?23) moderated by an OST employee. RESULTS While 46% had sufficient HL (13-16 points of maximum 16), 32% did not receive a HL score due to too many missing answers. No correlates of sufficient HL level were found. Missing HL level was associated with low educational attainment (Ajusted odds ratio [AOR] 1.94; 95% Confidence interval [CI] 1.13-3.32) and negatively associated with employment (AOR 0.28; 95% CI 0.11-0.71). Qualitative data revealed a diversity in participants' self-assessed capabilities, and problems associated with access, comprehension, trust and dependency on addiction-specific services. CONCLUSIONS This study highlights that HL level is low, and identifies a number of concrete problems related to HL in the studied population. The results implicate a need for tailored interventions regarding health information among OST patients.
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Affiliation(s)
- Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden.
| | - Malin Ekefäll
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
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Hulin J, Brodie A, Stevens J, Mitchell C. Prevalence of respiratory conditions among people who use illicit opioids: a systematic review. Addiction 2020; 115:832-849. [PMID: 31692109 DOI: 10.1111/add.14870] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/28/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS There are growing concerns over the respiratory health of people who use illicit opioids due to high rates of opioid inhalation and tobacco smoking in this group. This study aimed to summarize the evidence relating illicit opioid use with poor respiratory health. METHODS A systematic review of the literature on the association between illicit opioid use and respiratory health was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance (PROSPERO ID = CRD42017059953). Electronic searches of MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library databases were undertaken (English language, published January 1980-November 2018). All study designs excluding case studies were considered. Studies were undertaken in community and hospital settings in the United States (n = 23), United Kingdom (n = 7), Australia (n = 7), the Netherlands (n = 2), Canada (n = 2), Ireland (n = 1), Spain (n = 1) and Iran (n = 1). Measurements of respiratory disease, including asthma and chronic obstructive pulmonary disease (COPD) and related symptoms were extracted. Data on respiratory-related deaths and hospital admissions were also extracted. Meta-analysis of prevalence data was undertaken using a random effects meta-analysis model with parameters estimated using Markov chain Monte Carlo simulation. RESULTS Meta-analyses estimated prevalence of asthma in people who inject illicit opioids as 8.5% [95% predictive interval (PrI) = 0.2%, 74.0%] and as 20.2% (95% PrI = 4.2%, 59.2%) in people who inhale illicit opioids. Prevalence of COPD in people who inject illicit opioids was estimated as 2.7% (95% PrI = 0.0%, 50.4%) and as 17.9% (95% PrI = 0.6%, 89.5%) in people who inhale illicit opioids. There was evidence of moderate to extreme heterogeneity across studies. CONCLUSIONS There is evidence of increased burden of respiratory diseases in people who use illicit opioids. Due to the heterogeneity of study design and samples, it is difficult to gain accurate estimates of the prevalence of respiratory disease in this population.
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Affiliation(s)
- Joe Hulin
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Arjuna Brodie
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
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The provision of preventive care for modifiable health risk behaviours by clinicians within substance use treatment settings: A systematic review. Prev Med 2020; 130:105870. [PMID: 31678584 DOI: 10.1016/j.ypmed.2019.105870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 11/20/2022]
Abstract
People who use substances have a high prevalence of other modifiable health risk behaviours such as tobacco smoking which contribute to an increased mortality and morbidity. Preventive care can reduce the prevalence of such behaviours and is recommended by clinical practice guidelines. This review describes the prevalence of preventive care delivery by substance use treatment healthcare providers and examines differences by treatment setting. Five databases were searched for studies published between 2005 and 2017. Eligible studies reported levels of preventive care (assessment, brief advice and/or referral/follow-up) in substance use treatment services for tobacco smoking, nutrition or physical activity. Two reviewers independently conducted article screening, data extraction and methodological quality assessment. Sixteen studies were included and all except one investigated care provision for tobacco smoking only. Four studies reported care levels as a proportion and 12 studies reported care as a score-based mean. Client-reported receipt of smoking cessation care ranged from: 79-90% for assessment; 15-79% for brief advice; 0-30% for referral/follow-up. Meta-regression analyses of 12 studies found clinician-reported preventative care for tobacco smoking was more frequently reported in studies assessing care occurring across multiple substance use treatment settings, compared to studies reporting provision in inpatient only. This review indicated that, compared to smoking cessation care, little is known about the level of preventive care for nutrition or physical activity. Overall, the delivery of smoking cessation care reported was sub-optimal. High levels of assessment relative to brief advice and low levels of referral to ongoing assistance were indicated.
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Bech AB, Clausen T, Waal H, Šaltytė Benth J, Skeie I. Mortality and causes of death among patients with opioid use disorder receiving opioid agonist treatment: a national register study. BMC Health Serv Res 2019; 19:440. [PMID: 31266495 PMCID: PMC6604272 DOI: 10.1186/s12913-019-4282-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/19/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Mortality rates and causes of death among individuals in opioid agonist treatment (OAT) vary according to several factors such as geographical region, age, gender, subpopulations, drug culture and OAT status. Patients in OAT are ageing due to effective OAT as well as demographic changes, which has implications for morbidity and mortality. Norway has one of the oldest OAT populations in Europe. Because of the varying mortality rates and causes of death in different subgroups and countries, research gaps still exist. The aims of this study were to describe the causes of death among OAT patients in Norway, to estimate all-cause and cause-specific crude mortality rates (CMRs) during OAT and to explore characteristics associated with drug-induced cause of death compared with other causes of death during OAT. METHODS This was a national, observational register study. Data from the Norwegian Cause of Death Registry and the Norwegian Patient Registry were combined with data from medical records. We included all patients in the Norwegian OAT programme who died not more than 5 days after the last intake of OAT medication, between 1 January 2014 and 31 December 2015. RESULTS In the 2-year observation period, 200 (1.4%) of the OAT patients died. A forensic or medical autopsy was performed in 63% of the cases. The mean age at the time of death was 48.9 years (standard deviation 8.4), and 74% were men. Somatic disease was the most common cause of death (45%), followed by drug-induced death (42%), and violent death (12%). In general, CMRs increased with age, and they were higher in men and in patients taking methadone compared with buprenorphine. Increasing somatic comorbidity, measured by the Charlson comorbidity index, reduced the odds of dying of a drug-induced cause of death compared with other causes of death. CONCLUSIONS Both somatic and drug-induced causes of death were common during OAT. Improved treatment and follow-up of chronic diseases, especially in patients aged > 40 years, and continuous measures to reduce drug-induced deaths appear to be essential to reduce future morbidity and mortality burdens in this population.
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Affiliation(s)
- Anne Berit Bech
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, P.O. Box 104, N-2381, Brumunddal, Norway. .,Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway
| | - Helge Waal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Sognsvannsveien 21, Bygg 6, P.O. Box 4959 Nydalen, N-0424, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, P.O. Box 1000, N-1478, Lørenskog, Norway
| | - Ivar Skeie
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, N-0318, Oslo, Norway.,Regional Psychiatric Centre Gjøvik, Innlandet Hospital Trust, Kyrre Grepps gate 11, N-2819, Gjøvik, Norway
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13
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Self-Rated Physical Health and Unmet Healthcare Needs among Swedish Patients in Opioid Substitution Treatment. JOURNAL OF ADDICTION 2019; 2019:7942145. [PMID: 31139491 PMCID: PMC6500657 DOI: 10.1155/2019/7942145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 01/16/2023]
Abstract
Background Individuals with opioid dependence are at increased risk of deteriorating health due to the lifestyle connected to heroin use. Barriers surrounding the healthcare system seem to hinder patients to seek help through conventional healthcare, even after entering opioid substitution treatment (OST), resulting in a high level of unmet healthcare needs. However, this field is still unexplored, with only a few studies focusing on general health within this population. The first step, in order to provide suitable and accessible primary healthcare, is to assess the extent of physical symptoms and unmet healthcare needs within the OST population, which, to this point, has been sparsely studied. Aim To assess OST patients' self-rated physical health and healthcare seeking behaviour. Methods Two-hundred and eighteen patients from four different OST sites answered a questionnaire regarding physical health and healthcare seeking. Results Patients in OST have a high degree of physical symptoms and a high degree of unmet healthcare needs. Sixty-six percent reported suffering from musculoskeletal pain. Fifty-six percent reported gastrointestinal symptoms. Genital problems and airway symptoms were reported by 47%, respectively, and dental problems were reported by 69% of the respondents. General unmet healthcare needs were reported by 82%. Musculoskeletal pain was positively correlated with having an unstable housing situation (AOR 4.26 [95% CI 1.73-10.48]), negatively correlated with male sex (AOR 0.45 [95% CI 0.22-0.91]), and positively correlated with age (AOR 1.04 [95% CI 1.01-1.07]). No statistically significant correlates of respiratory, gastrointestinal, genital, or dental symptoms were found. Conclusion Patients in OST carry a heavy burden of physical symptoms and unmet healthcare needs, potentially due to societal barriers. Patients' frequent visits to the OST clinics offer a unique opportunity to build a base for easily accessible on-site primary healthcare.
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14
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Tremain D, Freund M, Wye P, Bowman J, Wolfenden L, Dunlop A, Bartlem K, Lecathelinais C, Wiggers J. Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention. BMJ Open 2018; 8:e020042. [PMID: 30121589 PMCID: PMC6104796 DOI: 10.1136/bmjopen-2017-020042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined. DESIGN A pre-post trial conducted from May 2012 to May 2014. SETTING Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia. PARTICIPANTS Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up. INTERVENTIONS A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. PRIMARY AND SECONDARY OUTCOME MEASURES Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up. RESULTS Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24% vs 54%, p<0.001), brief advice (26% vs 46%, p<0.001), and clinicians speaking about (10% vs 31%, p<0.001) and arranging a referral (1% vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22% vs 63%, p<0.001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care. CONCLUSION This study reported increases in preventive care for insufficient fruit and/or vegetable consumption; however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed. TRIALREGISTRATION NUMBER ACTRN12614000469617.
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Affiliation(s)
- Danika Tremain
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Megan Freund
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Paula Wye
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Faculty of Science and Information Technology, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jenny Bowman
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Faculty of Science and Information Technology, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Adrian Dunlop
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Centre for Translational Neuroscience and Mental Health, Waratah, New South Wales, Australia
| | - Kate Bartlem
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Faculty of Science and Information Technology, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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15
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Tremain D, Freund M, Wye P, Wolfenden L, Bowman J, Dunlop A, Gillham K, Bartlem K, McElwaine K, Doherty E, Wiggers J. Provision of Chronic Disease Preventive Care in Community Substance Use Services: Client and Clinician Report. J Subst Abuse Treat 2016; 68:24-30. [PMID: 27431043 DOI: 10.1016/j.jsat.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/08/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION People with substance use problems have a higher prevalence of modifiable health risk behaviors. Routine clinician provision of preventive care may be effective in reducing such health behaviors. This study aimed to examine clinician provision of preventive care to clients of community substance use treatment services. METHODS A cross-sectional survey was undertaken with 386 clients and 54 clinicians of community substance use treatment services in one health district in New South Wales, Australia. Client- and clinician-reported provision of three elements of care (assessment, brief advice and referral) for three health risk behaviors (tobacco smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity) was assessed, with associations with client characteristics examined. RESULTS Provision was highest for tobacco smoking assessment (90% client reported, 87% clinician reported) and brief advice (79% client reported, 80% clinician reported) and lowest for fruit and vegetable consumption (assessment 23%, brief advice 25%). Few clients reported being offered a referral (<10%). Assessment of physical activity and brief advice for all behaviors was higher for clients residing in rural/remote areas. CONCLUSION Assessment and brief advice were provided to the majority of clients for smoking, but sub-optimally for the other behaviors. Further investigation of barriers to the provision of preventive care within substance use treatment settings is required, particularly for referral to ongoing support.
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Affiliation(s)
- Danika Tremain
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Paula Wye
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny Bowman
- Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Adrian Dunlop
- Faculty of Health, The University of Newcastle, Callaghan, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia; Centre for Translational Neuroscience and Mental Health, Waratah, Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kate Bartlem
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Kathleen McElwaine
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
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