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Stam NC, Gerostamoulos D, Smith K, Pilgrim JL, Drummer OH. Challenges with take-home naloxone in reducing heroin mortality: a review of fatal heroin overdose cases in Victoria, Australia. Clin Toxicol (Phila) 2018; 57:325-330. [PMID: 30451007 DOI: 10.1080/15563650.2018.1529319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM Take-home naloxone (THN) programs have been implemented in order to reduce the number of heroin-overdose deaths. Because of recent legislative changes in Australia, there is a provision for a greater distribution of naloxone in the community, however, the potential impact of these changes for reduced heroin mortality remains unclear. The aim of this study was to examine the characteristics of the entire cohort of fatal heroin overdose cases and assess whether there was an opportunity for bystander intervention had naloxone been available at the location and time of each of the fatal overdose events to potentially avert the fatal outcome in these cases. METHODS The circumstances related to the fatal overdose event for the cohort of heroin-overdose deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated. Coronial data were investigated for all cases and data linkage was performed to additionally investigate the Emergency Medical Services information about the circumstances of the fatal heroin overdose event for each of the decedents. RESULTS AND DISCUSSION There were 235 fatal heroin overdose cases identified over the study period. Data revealed that the majority of fatal heroin overdose cases occurred at a private residence (n = 186, 79%) and where the decedent was also alone at the time of the fatal overdose event (n = 192, 83%). There were only 38 cases (17%) where the decedent was with someone else or there was a witness to the overdose event, and in half of these cases the witness was significantly impaired, incapacitated or asleep at the time of the fatal heroin overdose. There were 19 fatal heroin overdose cases (8%) identified where there was the potential for appropriate and timely intervention by a bystander or witness. CONCLUSION This study demonstrated that THN introduction alone could have led to a very modest reduction in the number of fatal heroin overdose cases over the study period. A lack of supervision or a witness to provide meaningful and timely intervention was evident in most of the fatal heroin overdose cases.
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Affiliation(s)
- Nathan C Stam
- a Department of Forensic Medicine , Monash University , Melbourne , Australia.,b Department of Community Emergency Health and Paramedic Practice , Monash University , Melbourne , Australia
| | | | - Karen Smith
- b Department of Community Emergency Health and Paramedic Practice , Monash University , Melbourne , Australia.,d Centre for Research and Evaluation , Ambulance Victoria , Melbourne , Australia.,e Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia
| | - Jennifer L Pilgrim
- a Department of Forensic Medicine , Monash University , Melbourne , Australia
| | - Olaf H Drummer
- a Department of Forensic Medicine , Monash University , Melbourne , Australia
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2
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Dietze PM, Stare M, Cogger S, Nambiar D, Olsen A, Burns L, Lenton S. Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia: Variations across capital cities. Drug Alcohol Rev 2017; 37:457-463. [DOI: 10.1111/dar.12644] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/11/2017] [Accepted: 11/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Paul M. Dietze
- Centre for Research Excellence into Injecting Drug Use and Burnet Institute; Melbourne Australia
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria
| | | | - Shelley Cogger
- Centre for Research Excellence into Injecting Drug Use and Burnet Institute; Melbourne Australia
| | - Dhanya Nambiar
- Centre for Research Excellence into Injecting Drug Use and Burnet Institute; Melbourne Australia
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria
| | - Anna Olsen
- Australian National University; Canberra Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre; Sydney Australia
| | - Simon Lenton
- National Drug Research Institute; Curtin University; Perth Australia
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3
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McDonald R, Campbell ND, Strang J. Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids-Conception and maturation. Drug Alcohol Depend 2017; 178:176-187. [PMID: 28654870 DOI: 10.1016/j.drugalcdep.2017.05.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 10/25/2022]
Abstract
BACKGROUND Opioid overdose is a major cause of mortality, but injury and fatal outcomes can be prevented by timely administration of the opioid antagonist naloxone. Pre-provision of naloxone to opioid users and family members (take-home naloxone, THN) was first proposed in 1996, and WHO Guidelines were issued in 2014. While widespread in some countries, THN is minimally available or absent elsewhere. This review traces the development of THN over twenty years, from speculative harm reduction proposal to public health strategy. METHOD Medline and PsycINFO were searched for peer-reviewed literature (1990-2016) using Boolean queries: 1) "naloxone OR Narcan"; 2) "(opioid OR opiate) AND overdose AND prevention". Grey literature and specialist websites were also searched. Data were extracted and synthesized as narrative review, with key events presented as chronological timeline. RESULTS Results are presented in 5-year intervals, starting with the original proposal and THN pilots from 1996 to 2001. Lack of familiarity with THN challenged early distribution schemes (2001-2006), leading to further testing, evaluation, and assessment of challenges and perceived medicolegal barriers. From 2006-2011, response to social and legal concerns led to the expansion of THN programs; followed by high-impact research and efforts to widen THN availability from 2011 to 2016. CONCLUSIONS Framed as a public health tool for harm reduction, THN has overcome social, clinical, and legal barriers in many jurisdictions. Nonetheless, the rising death toll of opioid overdose illustrates that current THN coverage is insufficient, and greater public investment in overdose prevention will be required if THN is to achieve its full potential impact.
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Affiliation(s)
- Rebecca McDonald
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom
| | - Nancy D Campbell
- Department of Science and Technology Studies, Sage Labs 5202, Rensselaer Polytechnic Institute, 110 Eighth Street Troy, NY, 12180, United States
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom.
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4
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Lancaster K, Treloar C, Ritter A. ‘Naloxone works’: The politics of knowledge in ‘evidence-based’ drug policy. Health (London) 2017; 21:278-294. [DOI: 10.1177/1363459316688520] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For over 20 years, drug policy experts have been calling for the wider availability of naloxone, to enable lay overdose witnesses to respond to opioid overdose events. However, the ‘evidence base’ for peer-administered naloxone has become a key point of contention. This contention opens up critical questions about how knowledge (‘evidence’) is constituted and validated in drug policy processes, which voices may be heard, and how knowledge producers secure privileged positions of influence. Taking the debate surrounding peer-administered naloxone as a case study, and drawing on qualitative interviews with individuals (n = 19) involved in the development of naloxone policy in Australia, we examine how particular kinds of knowledge are rendered ‘useful’ in drug policy debates. Applying Bacchi’s poststructuralist approach to policy analysis, we argue that taken-for-granted ‘truths’ implicit within evidence-based policy discourse privilege particular kinds of ‘objective’ and ‘rational’ knowledge and, in so doing, legitimate the voices of researchers and clinicians to the exclusion of others. What appears to be a simple requirement for methodological rigour in the evidence-based policy paradigm actually rests on deeper assumptions which place limits around not only what can be said (in terms of what kind of knowledge is relevant for policy debate) but also who may legitimately speak. However, the accounts offered by participants reveal the ways in which a larger number of ways of knowing are already co-habiting within drug policy. Despite these opportunities for re-problematisation and resistance, the continued mobilisation of ‘evidence-based’ discourse obscures these contesting positions and continues to privilege particular speakers.
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5
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Das S, Shah N, Ghadiali M. Intravenous use of intranasal naloxone: A case of overdose reversal. Subst Abus 2016; 38:18-21. [DOI: 10.1080/08897077.2016.1267686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Smita Das
- Department of Addiction Psychiatry, University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Nina Shah
- Chemical Dependency Recovery Program, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Murtuza Ghadiali
- Department of Addiction Psychiatry, University of California San Francisco, San Francisco, California, USA
- Department of Addiction Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
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6
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Chronister KJ, Lintzeris N, Jackson A, Ivan M, Dietze PM, Lenton S, Kearley J, van Beek I. Findings and lessons learnt from implementing Australia's first health service based take-home naloxone program. Drug Alcohol Rev 2016; 37:464-471. [PMID: 27071354 DOI: 10.1111/dar.12400] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/30/2015] [Accepted: 02/05/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Opioid overdose prevention programs providing take-home naloxone have been expanding internationally. This paper summarises findings and lessons learnt from the Overdose Prevention and Emergency Naloxone Project which is the first take-home naloxone program in Australia implemented in a health care setting. METHODS The Project intervention provided education and take-home naloxone to opioid-using clients at Kirketon Road Centre and The Langton Centre in Sydney. The evaluation study examined uptake and acceptability of the intervention; participants' knowledge and attitudes regarding overdose and participants' experience in opioid overdose situations six months after the intervention. Participants completed baseline, post-training and follow-up questionnaires regarding overdose prevention and management which were analysed using repeated measures analysis of variance. RESULTS Eighty-three people participated in the intervention, with 35 (42%) completing follow-up interviews-51% reporting using naloxone with 30 overdoses successfully reversed. There were significant improvements in knowledge and attitudes immediately following training with much retained at follow-up, particularly regarding feeling informed enough (97%) and confident to inject naloxone (100%). DISCUSSION Take-home naloxone programs can be successfully implemented in Australian health settings. Barriers to uptake, such as lengthy processes and misperceptions around interest in overdose prevention, should be addressed in future program implementation.
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Affiliation(s)
- Karen J Chronister
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South Eastern Sydney Local Health District, Sydney, Australia.,Division of Addiction Medicine, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Anthony Jackson
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,The Langton Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - Mihaela Ivan
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW Australia, Sydney, Australia
| | | | - Simon Lenton
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - John Kearley
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,The Langton Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - Ingrid van Beek
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, Australia
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7
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Dietze P, Cantwell K. Intranasal naloxone soon to become part of evolving clinical practice around opioid overdose prevention. Addiction 2016; 111:584-6. [PMID: 26995168 DOI: 10.1111/add.13260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Dietze
- Burnet Institute, Centre for Population Health, Melbourne, Victoria, Australia. .,School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
| | - Kate Cantwell
- Burnet Institute, Centre for Population Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
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8
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Abstract
Through the lens of performance, this paper critically examines how “evidence” and the “evidence-based policy” paradigm are constituted in drug policy processes, enacted through the telling of policy stories. I argue that policy stories do not simply describe the drug policy process, but rather frame the notion of “evidence” and “evidence-based policy” in particular ways. Drawing on two Australian case studies and interviews with policy makers, advocates, researchers, and clinicians involved in the establishment of harm reduction programs to extend distribution of injecting equipment through peer networks and make naloxone available for administration by overdose witnesses, I ask: What do participants’ accounts of drug policy perform? And what might this imply? Through this analysis of participants’ accounts, I argue that what we call “evidence” is not fixed, but rather constituted by specific performances and practices. I suggest that these performances of the evidence-based drug policy paradigm are important, as they work to make and sustain (or, at times, interfere with) a set of assumptions about knowledge and rationales for policy action. This, in turn, raises questions about how the evidence-based drug policy endeavor might be reconsidered and remade in other ways.
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Affiliation(s)
- Kari Lancaster
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
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9
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Morris MD, Bates A, Andrew E, Hahn J, Page K, Maher L. More than just someone to inject drugs with: Injecting within primary injection partnerships. Drug Alcohol Depend 2015; 156:275-281. [PMID: 26460140 PMCID: PMC4633359 DOI: 10.1016/j.drugalcdep.2015.09.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Studies have shown intimate injection partners engage in higher rates of syringe and injecting equipment sharing. We examined the drug use context and development of injection drug use behaviors within intimate injection partnerships. METHODS In-depth interviews (n=18) were conducted with both members of nine injecting partnerships in Sydney, Australia. Content analysis identified key domains related to the reasons for injecting with a primary injection partner and development of drug injection patterns. MAIN FINDINGS Most partnerships (n=5) were also sexual; three were blood-relatives and one a friend dyad. The main drug injected was heroin (66%) with high rates of recent sharing behaviors (88%) reported within dyads. Injecting within a primary injection partnership provided perceived protection against overdose events, helped reduce stress, increased control over when, where, and how drugs were used, and promoted the development of an injecting pattern where responsibilities could be shared. Unique to injecting within primary injection partnerships was the social connection and companionship resulted in a feeling of fulfillment while also blinding one from recognizing risky behavior. CONCLUSIONS Findings illuminated the tension between protection and risks within primary injection partnerships. Primary injection partnerships provide a potential platform to expand risk reduction strategies.
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Affiliation(s)
- Meghan D. Morris
- University of California at San Francisco, San Francisco, California, USA
| | - Anna Bates
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Erin Andrew
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Judith Hahn
- University of California at San Francisco, San Francisco, California, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Sydney, Australia
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10
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A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2015; 8:153-63. [PMID: 24874759 DOI: 10.1097/adm.0000000000000034] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Community-based opioid overdose prevention programs (OOPPs) that include the distribution of naloxone have increased in response to alarmingly high overdose rates in recent years. This systematic review describes the current state of the literature on OOPPs, with particular focus on the effectiveness of these programs. We used systematic search criteria to identify relevant articles, which we abstracted and assigned a quality assessment score. Nineteen articles evaluating OOPPs met the search criteria for this systematic review. Principal findings included participant demographics, the number of naloxone administrations, percentage of survival in overdose victims receiving naloxone, post-naloxone administration outcome measures, OOPP characteristics, changes in knowledge pertaining to overdose responses, and barriers to naloxone administration during overdose responses. The current evidence from nonrandomized studies suggests that bystanders (mostly opioid users) can and will use naloxone to reverse opioid overdoses when properly trained, and that this training can be done successfully through OOPPs.
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11
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Darke S. Opioid overdose and the power of old myths: what we thought we knew, what we do know and why it matters. Drug Alcohol Rev 2014; 33:109-14. [PMID: 24589077 DOI: 10.1111/dar.12108] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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12
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Lenton S, Dietze P, Olsen A, Wiggins N, McDonald D, Fowlie C. Working together: Expanding the availability of naloxone for peer administration to prevent opioid overdose deaths in the Australian Capital Territory and beyond. Drug Alcohol Rev 2014; 34:404-11. [PMID: 25272281 DOI: 10.1111/dar.12198] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/31/2014] [Indexed: 11/28/2022]
Abstract
ISSUE Since the mid-1990s, there have been calls to make naloxone, a prescription-only medicine in many countries, available to heroin and other opioid users and their peers and family members to prevent overdose deaths. CONTEXT In Australia there were calls for a trial of peer naloxone in 2000, yet at the end of that year, heroin availability and harm rapidly declined, and a trial did not proceed. In other countries, a number of peer naloxone programs have been successfully implemented. Although a controlled trial had not been conducted, evidence of program implementation demonstrated that trained injecting drug-using peers and others could successfully administer naloxone to reverse heroin overdose, with few, if any, adverse effects. APPROACH In 2009 Australian drug researchers advocated the broader availability of naloxone for peer administration in cases of opioid overdose. Industrious local advocacy and program development work by a number of stakeholders, notably by the Canberra Alliance for Harm Minimisation and Advocacy, a drug user organisation, contributed to the rollout of Australia's first prescription naloxone program in the Australian Capital Territory (ACT). Over the subsequent 18 months, prescription naloxone programs were commenced in four other Australian states. IMPLICATIONS The development of Australia's first take-home naloxone program in the ACT has been an 'ice-breaker' for development of other Australian programs. Issues to be addressed to facilitate future scale-up of naloxone programs concern scheduling and cost, legal protections for lay administration, prescribing as a barrier to scale-up; intranasal administration, administration by service providers and collaboration between stakeholders.
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Affiliation(s)
- Simon Lenton
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Paul Dietze
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | - Anna Olsen
- Kirby Institute, University of NSW, Sydney, Australia
| | - Nicole Wiggins
- Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australia
| | - David McDonald
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Carrie Fowlie
- Alcohol Tobacco and Other Drug Association ACT, Canberra, Australia
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13
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Lancaster K, Ritter A. Making change happen: A case study of the successful establishment of a peer-administered naloxone program in one Australian jurisdiction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:985-91. [DOI: 10.1016/j.drugpo.2014.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/07/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022]
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Degenhardt L, Larney S, Randall D, Burns L, Hall W. Causes of death in a cohort treated for opioid dependence between 1985 and 2005. Addiction 2014; 109:90-9. [PMID: 23961881 DOI: 10.1111/add.12337] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/25/2013] [Accepted: 08/13/2013] [Indexed: 12/18/2022]
Abstract
AIMS To examine changes in causes of death in a cohort treated for opioid dependence, across time and age; quantify years of potential life lost (YPLL); and identify avoidable causes of death. DESIGN People in New South Wales (NSW) who registered for opioid substitution therapy (OST), 1985-2005, were linked to a register of all deaths in Australia. SETTING NSW, Australia. MEASUREMENTS Crude mortality rates (CMRs), age-sex-standardized mortality rates (ASSRs) and standardized mortality ratios (SMRs) across time, sex and age. Years of potential life lost (YPLL) were calculated with reference to Australian life tables and by calculating years lost before the age of 65 years. FINDINGS There were 43 789 people in the cohort, with 412 216 person-years of follow-up. The proportion of the cohort aged 40+ years increased from 1% in 1985 to 39% in 2005. Accidental opioid overdoses, suicides, transport accidents and violent deaths declined with age; deaths from cardiovascular disease, liver disease and cancer increased. Among men, 89% of deaths were potentially avoidable; among women, 86% of deaths were avoidable. There were an estimated 160 555 YPLL in the cohort, an average of 44 YPLL per decedent and an average of 29 YPLL before age 65 years. CONCLUSIONS Among a cohort of opioid-dependent people in New South Wales, 1985-2005, almost nine in 10 deaths in the cohort were avoidable. There is huge scope to improve mortality among opioid-dependent people.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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15
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Pecoraro A, Ma M, Woody GE. The science and practice of medication-assisted treatments for opioid dependence. Subst Use Misuse 2012; 47:1026-40. [PMID: 22676570 DOI: 10.3109/10826084.2012.663292] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper briefly reviews the evolution of opioid addiction treatment from humanitarian to scientific and evidence-based, the evidence bases supporting major medication-assisted treatments and adjunctive psychosocial techniques, as well as challenges faced by clinicians and treatment providers seeking to provide those treatments. Attitudes, politics, policy, and financial issues are discussed.
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Affiliation(s)
- Anna Pecoraro
- Perelman School of Medicine, University of Pennsylvania, 150 S.Independence Mall West, Philadelphia, PA 19106-3414, USA
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16
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Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, Hickman M, McLaren J. Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction 2011; 106:32-51. [PMID: 21054613 DOI: 10.1111/j.1360-0443.2010.03140.x] [Citation(s) in RCA: 595] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To review the literature on mortality among dependent or regular users of opioids across regions, according to specific causes, and related to a number of demographic and clinical variables. METHODS Multiple search strategies included searches of Medline, EMBASE and PsycINFO, consistent with the methodology recommended by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group; grey literature searches; and contact of experts for any additional unpublished data from studies meeting inclusion criteria. Random-effects meta-analyses were conducted for crude mortality rates (CMRs) and standardized mortality ratios (SMRs), with stratified analyses where possible. Meta-regressions examined potentially important sources of heterogeneity across studies. RESULTS Fifty-eight prospective studies reported mortality rates from opioid-dependent samples. Very high heterogeneity across studies was observed; pooled all-cause CMR was 2.09 per 100 person-years (PY; 95% CI; 1.93, 2.26), and the pooled SMR was 14.66 (95% CI: 12.82, 16.50). Males had higher CMRs and lower SMRs than females. Out-of-treatment periods had higher mortality risk than in-treatment periods (pooled RR 2.38 (CI: 1.79, 3.17)). Causes of death varied across studies, but overdose was the most common cause. Multivariable regressions found the following predictors of mortality rates: country of origin; the proportion of sample injecting; the extent to which populations were recruited from an entire country (versus subnational); and year of publication. CONCLUSIONS Mortality among opioid-dependent users varies across countries and populations. Treatment is clearly protective against mortality even in non-randomized observational studies. Study characteristics predict mortality levels; these should be taken into account in future studies.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW, Australia.
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