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Trends in opioid analgesic utilisation among people with a history of opioid dependence. Drug Alcohol Depend 2022; 238:109548. [PMID: 35841733 DOI: 10.1016/j.drugalcdep.2022.109548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We aimed to characterise opioid analgesic utilisation over a 16-year period among a cohort of people with a history of opioid dependence, comparing rates of use in and out of opioid agonist treatment (OAT). METHODS Retrospective cohort study in New South Wales, Australia, including 28,891 people with documented opioid dependence initiating opioid analgesics between July 2003 and December 2018. Linked administrative records provided data on prescription dispensings, sociodemographics, clinical characteristics, and OAT. Generalised estimating equation models estimated the incidence and adjusted incidence rate ratios (IRR) comparing periods in and out of OAT for the number of opioid analgesic dispensings (overall, for strong opioids, and the most commonly dispensed opioid types) and the amount dispensed in oral morphine equivalent milligrams (OME). RESULTS At initiation, 43.7% of the cohort were enrolled in OAT. The most commonly initiated opioid was codeine (including combinations with paracetamol; 67.8%), and 49.6% of the cohort were dispensed a psychotropic medicine in the previous 90 days. Incidence of all opioid analgesic dispensings was higher during periods out of OAT compared to in OAT (5.8 v. 2.3 dispensings per person-year; IRR 0.39, 95% CI 0.38, 0.41), with findings similar when stratified by type. Being in OAT was associated with a lower OME amount dispensed compared to out of OAT (-57.7%, 95% CI-58.8, -56.7). CONCLUSIONS People with opioid dependence had high rates of recent psychotropic medicine utilisation and current OAT enrolment at the time of opioid analgesic initiation. OAT was associated with a significant reduction in opioid analgesic dispensing.
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Townsend EA, Kim RK, Robinson HL, Marsh SA, Banks ML, Hamilton PJ. Opioid withdrawal produces sex-specific effects on fentanyl-vs.-food choice and mesolimbic transcription. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:112-122. [PMID: 34458885 PMCID: PMC8389189 DOI: 10.1016/j.bpsgos.2021.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Opioid withdrawal is a key driver of opioid addiction and an obstacle to recovery. However, withdrawal effects on opioid reinforcement and mesolimbic neuroadaptation are understudied and the role of sex is largely unknown. METHODS Male (n=13) and female (n=12) rats responded under a fentanyl-vs.-food "choice" procedure during daily 2h sessions. In addition to the daily choice sessions, rats were provided extended access to fentanyl during 12h self-administration sessions. After two weeks of this self-administration regimen, the nucleus accumbens (NAc) and ventral tegmental area (VTA) of a subset of rats were subjected to RNA sequencing. In the remaining rats, a third week of this self-administration regimen was conducted, during which methadone effects on fentanyl-vs.-food choice were determined. RESULTS Prior to opioid dependence, male and female rats similarly allocated responding between fentanyl and food. Abstinence from extended fentanyl access elicited similar increases in somatic withdrawal signs in both sexes. Despite similar withdrawal signs and extended access fentanyl intake, opioid withdrawal was accompanied by a maladaptive increase in fentanyl choice in males, but not females. Behavioral sex differences corresponded with a greater number of differentially expressed genes in the NAc and VTA of opioid-withdrawn females relative to males. Methadone blocked withdrawal-associated increases in fentanyl choice in males, but failed to further decrease fentanyl choice in females. CONCLUSIONS These results provide foundational evidence of sex-specific neuroadaptations to opioid withdrawal, which may be relevant to the female-specific resilience to withdrawal-associated increases in opioid choice and aid in the identification of novel therapeutic targets.
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Affiliation(s)
- E. Andrew Townsend
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - R. Kijoon Kim
- Department of Anatomy and Neurobiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Hannah L. Robinson
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Samuel A. Marsh
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Matthew L. Banks
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Peter J. Hamilton
- Department of Anatomy and Neurobiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Liu Y, Liu N, Shen W, Li L, Zhou W, Xu L. The Abuse Characteristics of Amphetamine-Type Stimulants in Patients Receiving Methadone Maintenance Treatment and Buprenorphine Maintenance Treatment. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:2109-2116. [PMID: 34040349 PMCID: PMC8140901 DOI: 10.2147/dddt.s305226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
Objective The purpose of this study was to retrospectively investigate the abuse characteristics of amphetamine-type stimulants (ATS) in patients receiving methadone maintenance treatment (MMT) and buprenorphine maintenance treatment (BMT). Methods A total of 58 MMT and 51 BMT patients abusing ATS were recruited from the drug maintenance treatment clinic of Ningbo Addiction Research and Treatment Center from January 2018 to December 2019. They were assessed using the amphetamine abuse questionnaire (AAQ), addiction severity index (ASI) and Barratt impulsiveness scale (BIS). Moreover, 40 MMT control patients, 40 BMT control patients and 20 healthy controls were also assessed using the BIS. All information was collected using the amphetamine abuse questionnaire (AAQ), Chinese version of addiction severity index (ASI-C) and Chinese version of Barratt impulsiveness scale (BIS-C) conducted by qualified psychologists. Results The interval of amphetamine use in the MMT group was shorter than the BMT group (P < 0.05). The drug use subscale score of ASI was higher in the MMT group than the BMT group (P < 0.05). The respective and total scores of attentional impulsiveness, motor impulsiveness and non-planning impulsiveness in BIS in the MMT group were all higher than the MMT control group (P < 0.05). The scores of motor impulsiveness and non-planning impulsiveness in the BMT group were higher than the BMT control group (P < 0.05). The respective and total scores in BIS in the MMT control group and the BMT control group were all higher than those in the healthy controls. Conclusion The patients showing amphetamine abuse in maintenance therapy had a greater impulsiveness than those having other simple maintenance treatments, and patients under MMT may be more addicted to amphetamines in comparison with those having BMT.
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Affiliation(s)
- Yue Liu
- Department of Academic Research, Ningbo Kangning Hospital, Key Laboratory of Addiction Research of Zhejiang Province, Ningbo, 315201, People's Republic of China
| | - Nina Liu
- Department of Basic Medicine, Ningbo College of Health Sciences, Ningbo, 315100, People's Republic of China
| | - Wenwen Shen
- Department of Academic Research, Ningbo Kangning Hospital, Key Laboratory of Addiction Research of Zhejiang Province, Ningbo, 315201, People's Republic of China
| | - Longhui Li
- Department of Academic Research, Ningbo Kangning Hospital, Key Laboratory of Addiction Research of Zhejiang Province, Ningbo, 315201, People's Republic of China
| | - Wenhua Zhou
- Department of Academic Research, Ningbo Kangning Hospital, Key Laboratory of Addiction Research of Zhejiang Province, Ningbo, 315201, People's Republic of China
| | - Leiting Xu
- Department of Basic Medicine, Ningbo University School of Medicine, Ningbo, 315211, People's Republic of China
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Arnold TD, Lin L(A, Cotton BP, Bryson WC, Polenick CA. Gender Differences in Patterns and Correlates of Continued Substance Use among Patients in Methadone Maintenance Treatment. Subst Use Misuse 2021; 56:529-538. [PMID: 33645425 PMCID: PMC8279751 DOI: 10.1080/10826084.2021.1887242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Continued substance use is common during opioid use disorder (OUD) treatment. There are still inconsistencies in how continued substance use and concurrent patterns of substance use among patients with OUD varies by gender. There is still more to learn regarding how factors associated with continued and concurrent use might differ for men and women in methadone maintenance treatment (MMT). Methods: This cross-sectional study examined predictors of concurrent substance use subgroups among patients receiving MMT. The sample included 341 (n = 161 women) MMT patients aged 18 and older from opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a survey assessing sociodemographic and clinical characteristics including past-month substance use. Latent class analyses were conducted by gender to identify groups based on substance use and determine predictors of those classes. Results: Three-class solutions were the optimal fit for both men and women. For both genders, the first subgroup was characterized as Unlikely Users (59.8% women, 52.8% men). Classes 2 and 3 among women were Cannabis/Opioid Users (23.7%) and Stimulant/Opioid Users (13.0%). Among men, Classes 2 and 3 consisted of Alcohol/Cannabis Users (21.9%) and Cannabis/Stimulant/Opioid Users (25.3%). Ever using Suboxone (buprenorphine/naloxone) and depression/anxiety symptoms were significantly linked to substance use group among women, whereas homelessness and employment status were significantly associated with substance use group among men. Conclusions: This study furthers understanding of gender differences in factors associated with continued substance use and distinctive patterns of concurrent substance use that may guide tailored treatments among patients MMT.
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Affiliation(s)
- Tomorrow D. Arnold
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Department of Psychology, University of Tennessee, Chattanooga, TN 37403
| | - Lewei (Allison) Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109
| | - Brandi P. Cotton
- College of Nursing, University of Rhode Island, Kingston, RI 02881
| | - William C. Bryson
- Department of Psychiatry, Oregon Health and Sciences University, Portland, OR, USA
| | - Courtney A. Polenick
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
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Homayra F, Pearce LA, Wang L, Panagiotoglou D, Sambo TF, Smith N, McKendry R, Wilson B, Joe R, Hawkins K, Barrios R, Mitton C, Nosyk B. Cohort profile: The provincial substance use disorder cohort in British Columbia, Canada. Int J Epidemiol 2021; 49:1776. [PMID: 33097934 PMCID: PMC7825959 DOI: 10.1093/ije/dyaa150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/27/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Fahmida Homayra
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, BC, Canada
| | - Lindsay A Pearce
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, BC, Canada
| | - Linwei Wang
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, BC, Canada
| | - Dimitra Panagiotoglou
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, BC, Canada
| | - Tamunoibim F Sambo
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, BC, Canada
| | - Neale Smith
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | | | - Bonnie Wilson
- Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Ronald Joe
- Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Ken Hawkins
- Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | | | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Polenick CA, Kaba D, Zhou AN, Han BH, Cotton BP. Dyadic associations between relationship quality and risk of opioid use among couples receiving methadone for opioid use disorder. Drug Alcohol Depend 2021; 218:108397. [PMID: 33276296 PMCID: PMC8115745 DOI: 10.1016/j.drugalcdep.2020.108397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Social relationships may serve as both protective factors and risk factors for opioid use (nonmedical prescription opioid or illicit opioid use) among patients receiving methadone for opioid use disorder (OUD). Yet little is known about how relationship quality is linked to outcomes among couples receiving methadone. We evaluated the links between relationship quality and risk of opioid use among couples in which both partners received methadone. METHODS Participants included 53 heterosexual married or cohabiting couples aged 18 and older who were drawn from two opioid treatment programs in Rhode Island and Massachusetts. Both members of the couple completed a self-administered survey assessing their sociodemographic information, relationship and treatment characteristics, and risk of opioid use. RESULTS Roughly half of women (47.2%) and men (52.8%) had a moderate to high risk of nonmedical prescription opioid use and almost two-thirds (64.2%) had a moderate to high risk of street opioid use. Risk of street opioid use was highly correlated within couples. Actor-partner interdependence models revealed that when women reported higher positive relationship quality, they had a lower risk of nonmedical prescription opioid use and their partners had a lower risk of street opioid use. Negative relationship quality was not significantly linked to risk of opioid use. CONCLUSIONS Couples in which both partners receive methadone for OUD may be at risk of return to use, and positive partner relationships may play a role in lowering this risk. Women's perceptions of relationship quality might be a particularly important target for clinical care and interventions.
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Affiliation(s)
- Courtney A. Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109,Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
| | - Diarratou Kaba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Annie N. Zhou
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Benjamin H. Han
- Department of Medicine, University of California San Diego, San Diego CA 92161
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Pearce LA, Homayra F, Dale LM, Moallef S, Barker B, Norton A, Hayashi K, Nosyk B. Non-disclosure of drug use in outpatient health care settings: Findings from a prospective cohort study in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102873. [PMID: 32731111 PMCID: PMC7832509 DOI: 10.1016/j.drugpo.2020.102873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Illicit drug use is associated with severe health-related harms, yet people who use drugs (PWUD) face substantial barriers to healthcare. We sought to identify factors associated with disclosure of drug use to a healthcare provider and describe differences in self-reported quality of care received based on disclosure status. METHODS A client-reported experience questionnaire on healthcare access and quality, adapted from the World Health Organization Survey on Health and Health System Responsiveness, was administered within two ongoing prospective cohort studies of PWUD in Vancouver, Canada. Respondents not currently receiving addiction treatment were asked about experience of care and drug use disclosure to their most commonly accessed outpatient healthcare provider in the past 6 months. We used an adjusted logistic regression model to identify client characteristics associated with disclosure. RESULTS From a total of 261 respondents (34.1% female), less than half (n = 125, 47.8%) reported disclosing drug use to their healthcare provider. Indigenous participants were less likely to disclose compared to non-Indigenous participants (adjusted OR: 0.55, 95% confidence interval: 0.30, 0.97). Disclosure was associated with lower self-reported quality of care (overall rating: disclosed 8.2 vs. did not disclose 8.8, p = 0.04). CONCLUSIONS In a sample of PWUD accessing outpatient healthcare services, we observed low rates of drug use disclosure, particularly for Indigenous respondents, and reduced quality of care for those who disclosed. These findings highlight the need for culturally safe and non-stigmatizing care to address pervasive stereotyping in the healthcare system and improved screening for substance use disorder in outpatient healthcare services.
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Affiliation(s)
- Lindsay A Pearce
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton VIC 3053, Melbourne, Australia
| | - Fahmida Homayra
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Laura M Dale
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Soroush Moallef
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Brittany Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; First Nations Research and Knowledge Exchange, First Nations Health Authority, 100 Park Royal South, West Vancouver V7T 1A2, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Alexa Norton
- First Nations Research and Knowledge Exchange, First Nations Health Authority, 100 Park Royal South, West Vancouver V7T 1A2, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Bohdan Nosyk
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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Vold JH, Aas C, Skurtveit S, Odsbu I, Chalabianloo F, Reutfors J, Halmøy A, Johansson KA, Fadnes LT. Potentially addictive drugs dispensing to patients receiving opioid agonist therapy: a register-based prospective cohort study in Norway and Sweden from 2015 to 2017. BMJ Open 2020; 10:e036860. [PMID: 32771988 PMCID: PMC7418685 DOI: 10.1136/bmjopen-2020-036860] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To compare the use of benzodiazepines, z-hypnotics, gabapentinoids, opioids and centrally acting stimulants (CAS) among patients who had received opioid agonist therapy (OAT) in Norway and Sweden during the period 2015 - 2017. DESIGN A register-based prospective cohort study using information about dispensed drugs from the Norwegian Prescription Database and Swedish Prescribed Drug Register. SETTING Patients who were dispensed OAT opioids from pharmacies. PARTICIPANTS A total of 7176 Norwegian and 3591 Swedish patients on OAT were included. OUTCOME MEASURES The number and frequency of potentially addictive drugs dispensed were calculated for the two countries. The mean daily doses of dispensed benzodiazepines and z-hypnotics were summarised by calculating benzodiazepines in diazepam equivalents and z-hypnotics in zopiclone equivalents. RESULTS In 2017, 46% of patients in Norway, and 15% in Sweden, were dispensed a benzodiazepine. Moreover, 14% in Norway and 26% in Sweden received z-hypnotics. Gabapentinoids were dispensed to 10% of patients in Norway and 19% of patients in Sweden. In Norway, 6% and 12% of the patients received strong and weak non-OAT opioids, respectively, whereas in Sweden 10% were dispensed strong non-OAT opioids and 5% weak non-OAT opioids . CAS were dispensed to 4% in Norway and 18% in Sweden. The mean daily doses of benzodiazepines were 16 and 17 mg diazepam equivalents in Norway and Sweden, respectively. For z-hypnotics, the mean daily dose was 8 mg zopiclone equivalents in both countries. 'Benzodiazepines and z-hypnotics' was the most dispensed drug combination in 2017. Similar results were found in 2015 and 2016. CONCLUSIONS Nearly half of those patients who were dispensed an OAT opioid in Norway and Sweden were dispensed potentially addictive drugs. The differences identified between Norway and Sweden might be related to differences in eligibility guidelines and restrictions with respect to OAT.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christer Aas
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Ingvild Odsbu
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Johan Reutfors
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Vold JH, Skurtveit S, Aas C, Johansson KA, Fadnes LT. Too much or too little opioids to patients receiving opioid agonist therapy in Norway (2013-2017): a prospective cohort study. BMC Health Serv Res 2020; 20:668. [PMID: 32690022 PMCID: PMC7370481 DOI: 10.1186/s12913-020-05504-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/02/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dispensations of opioid analgesics to patients on opioid agonist therapy (OAT) may increase the risk of overdoses. The current study's objectives are to investigate the dispensation rates and mean daily doses of dispensed opioid analgesics among patients who received OAT opioids in Norway during 2013-2017 and evaluate whether discontinuing OAT opioids affects the dispensed dose of opioid analgesics. METHODS Information on opioids was collected from the Norwegian Prescription Database. Dispensation rates were calculated by dividing the number of patients who were dispensed at least one opioid analgesic by the number of patients who were dispensed an OAT opioid. We calculated the mean daily dose of opioid analgesics in oral morphine equivalents. The OAT opioid dose was defined as a ratio between the dispensed doses divided by the mean recommended dose. We used logistic regression to estimate the association between the dispensation of an opioid analgesic, a dose of OAT opioids, having chronic pain, and being on palliative care. RESULTS A total of 10,371 patients were dispensed at least one OAT opioid during the study period. In 2017, 18% were dispensed an opioid analgesic with a mean daily dose of 29 mg of oral morphine equivalents. Being dispensed an opioid analgesic was associated with having chronic pain (adjusted odds ratio (aOR): 3.6, 95% confidence interval: 3.2-4.2), being on palliative care (aOR: 6.1, 4.7-7.9), and receiving an OAT opioid dose below half of the recommended OAT dose (aOR: 1.7, 1.4-2.0). Similar results were seen in 2013-2016. The discontinuation of OAT opioids could increase the dose of dispensed opioid analgesics. CONCLUSION Reducing the dispensation of opioid analgesics can be achieved by increasing the OAT opioid dose for patients on a low OAT dose, and by extending the period needed to taper off the OAT opioid dose at discontinuation.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Christer Aas
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Woods B, Legal M, Shalansky S, Mihic T, Ma W. Designing a Pharmacist Opioid Safety and Intervention Tool. Can J Hosp Pharm 2020; 73:7-12. [PMID: 32109955 PMCID: PMC7023926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Despite the recent increase in opioid overdoses across Canada, few pharmacy-led initiatives have been implemented to address issues related to opioid prescribing in the hospital setting. OBJECTIVES The primary objective of this study was to develop a clinical tool, intended for use by hospital pharmacists and informed by best practices from the literature, that would provide a structured approach to enhancing the safety of opioid prescribing. The secondary objective was to collect pharmacists' opinions about the feasibility and utility of this tool. METHODS A comprehensive literature search and pharmacist focus group analysis provided content for development of a candidate clinical tool. This tool was then piloted by clinical pharmacists working on general medical and surgical units in a single hospital. Pharmacists participating in the pilot were invited to complete an online survey concerning their perceptions of the tool. Descriptive statistics were used to analyze the survey results. RESULTS The literature search and focus group analysis led to development of a candidate clinical tool that focused on Medication review, Optimization, Reassessment, and Education (MORE). It included key risk factors relating to opioid safety, along with suggested mitigating strategies. The MORE tool was piloted for 3 weeks by 14 clinical pharmacists, 9 of whom responded to the subsequent survey. Five respondents indicated that the clinical tool increased their ability to identify risk factors. Five respondents also noted an increase in their ability to identify possible interventions. Most respondents felt that the tool was useful and that it would be feasible to integrate it into their practice; however, they noted that a more streamlined version could improve ease of use. CONCLUSIONS The MORE tool was well received by clinical pharmacists. Implementation of the tool into routine practice requires additional changes to improve ease of use. Suggestions for modifying and streamlining the tool will be incorporated into future versions.
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Affiliation(s)
- Brendan Woods
- , BScPharm, ACPR, is a Clinical Pharmacist with Royal University Hospital, Saskatchewan Health Authority, Saskatoon, Saskatchewan
| | - Michael Legal
- , BScPharm, PharmD, ACPR, FCSHP, is Clinical Pharmacy Manager with Lower Mainland Pharmacy Services, Vancouver, British Columbia
| | - Stephen Shalansky
- , BScPharm, PharmD, ACPR, FCSHP, is a Pharmacy Clinical Coordinator with Providence Health Care, Lower Mainland Pharmacy Services, Vancouver, British Columbia
| | - Tamara Mihic
- , BScPharm, PharmD, ACPR, is a Clinical Pharmacy Specialist with Providence Health Care, Lower Mainland Pharmacy Services, Vancouver, British Columbia
| | - Winnie Ma
- , BScPharm, ACPR, is a Pharmacy Clinical Supervisor with Providence Health Care, Lower Mainland Pharmacy Services, Vancouver, British Columbia
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Prevalence and factors associated with continual opioid use among patients attending methadone clinic at Mwananyamala Hospital, Dar Es Salaam, Tanzania. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2019. [DOI: 10.1016/j.fsir.2019.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Mahu I, Conrod P, Barrett S, Sako A, Swansburg J, Lawrence M, Laroque F, Morin J, Chinneck A, Nogueira-Arjona R, Stewart S. Specificity of personality relationships to particular forms of concurrent substance use among methadone maintenance therapy clients. Addict Behav 2019; 98:106056. [PMID: 31351326 DOI: 10.1016/j.addbeh.2019.106056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/18/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A mainstay treatment for opioid addiction in North America is methadone maintenance therapy (MMT) - a form of opiate agonist therapy (OAT). While efficacious for treating opioid addiction, MMT fails to address the concurrent polysubstance use that is common among opioid dependent clients. Moreover, psychosocial approaches for addressing polysubstance use during MMT are lacking. Our study's goals were to validate the use of the four-factor personality model of substance use vulnerability in MMT clients, and to demonstrate theoretically-relevant relationships of personality to concurrent substance use while receiving MMT. METHOD Respondents included 138 daily-witnessed MMT clients (65.9% male, 79.7% Caucasian), mean age (SD) 40.18 (11.56), recruited across four Canadian MMT clinics. Bayesian confirmatory factor analysis was used to establish the structural validity of the four-factor personality model of substance use vulnerability (operationalized with the Substance Use Risk Profile Scale [SURPS]) in MMT clients. SURPS personality scores were then used as predictors for specific forms of recent (past 30-day) substance use. RESULTS Using a latent hierarchal model, hopelessness was associated with recent opioid use; anxiety sensitivity with recent tranquilizer use; and sensation seeking with recent alcohol, cannabis, and stimulant use. CONCLUSION Personality is associated with substance use patterns and may be an appropriate target for intervention for those undergoing MMT to reduce opioid use, and potentially dangerous concurrent use of other drugs, while receiving methadone.
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13
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Kim B, Nolan S, Beaulieu T, Shalansky S, Ti L. Inappropriate opioid prescribing practices: A narrative review. Am J Health Syst Pharm 2019; 76:1231-1237. [DOI: 10.1093/ajhp/zxz092] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Purpose
Results of a literature review to identify indicators of inappropriate opioid prescribing are presented.
Summary
While prescription opioids can be effective for the treatment of acute pain, inappropriate prescribing practices can increase the risk of opioid-related harms, including overdose and mortality. To date, little research has been conducted to determine how best to define inappropriate opioid prescribing. Five electronic databases were searched to identify studies (published from database inception to January 2017) that defined inappropriate opioid prescribing practices. Search terms varied slightly across databases but included opioid, analgesics, inappropriate prescribing, practice patterns, and prescription drug misuse. Gray literature and references of published literature reviews were manually searched to identify additional relevant articles. From among the 4,665 identified articles, 41 studies were selected for data extraction and analysis. Fourteen studies identified high-daily-dose opioid prescriptions, 14 studies identified coadministration of benzodiazepines and opioids, 10 studies identified inappropriate opioid prescribing in geriatric populations, 8 studies identified other patient-specific factors, 4 studies identified opioid prescribing for the wrong indication, and 4 studies identified factors such as initiation of long-acting opioids in opioid-naive patients as indicators of inappropriate opioid prescribing.
Conclusion
A literature review identified various indicators of inappropriate opioid prescribing, including the prescribing of high daily doses of opioids, concurrent benzodiazepine administration, and geriatric-related indicators. Given the significant contribution of inappropriate opioid prescribing to opioid-related harms, identification of these criteria is important to inform and improve opioid prescribing practices among healthcare providers.
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Affiliation(s)
- Brian Kim
- Department of Medicine, University of British Columbia, Vancouver, Canada, and St. Paul’s Hospital, Vancouver, Canada
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, Vancouver, Canada, and British Columbia Centre on Substance Use, St. Paul’s Hospital, Vancouver, Canada
| | - Tara Beaulieu
- British Columbia Centre on Substance Use, Vancouver, Canada, and Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Stephen Shalansky
- Pharmacy Department, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada, and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, Canada, and Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Developing a patient-reported experience questionnaire with and for people who use drugs: A community engagement process in Vancouver's Downtown Eastside. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:16-23. [PMID: 29966804 DOI: 10.1016/j.drugpo.2018.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 11/23/2022]
Abstract
People who use drugs (PWUD) frequently have complex health care needs, yet face multiple barriers to accessing services. Involving PWUD in health service design and evaluation can enhance the quality of data collected and ensure policy and practice improvements reflect the expressed needs of the population. However, PWUD remain largely excluded from the evaluation of health services that directly affect their lives, including development of patient-reported experience measures (PREMS) that have gained prominence in health services research and clinical practice. Detailed descriptions of PWUD participation in survey design are notably absent in the literature. In this commentary, we present a case that demonstrates how PWUD can contribute meaningfully to the development of questionnaires that assess patient-reported health care experiences. We describe the development, implementation and outcomes of a process to engage local drug user organizations in the evaluation of a redesign and reorientation of health service delivery in the Downtown Eastside (DTES) neighborhood of Vancouver, Canada. Through this process, participants contributed critical elements to the design of a patient-reported experience measure, including: (1) identifying unmet service needs in the neighborhood; (2) identifying local barriers and facilitators to care; (3) formulating questions on cultural safety; and (4) improving structure, language and clarity of the questionnaire. We highlight lessons learned from the process, reflecting on the strengths, challenges and ethical considerations associated with community-based approaches to questionnaire development. The workshop model presented here illustrates one flexible and promising approach to enabling meaningful participation of PWUD in questionnaire development.
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15
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Delorme J, Chenaf C, Bertin C, Riquelme M, Eschalier A, Ardid D, Authier N. Chronic Pain Opioid-Maintained Patients Receive Less Analgesic Opioid Prescriptions. Front Psychiatry 2018; 9:335. [PMID: 30083113 PMCID: PMC6065119 DOI: 10.3389/fpsyt.2018.00335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/02/2018] [Indexed: 12/29/2022] Open
Abstract
Treating pain and opioid use disorder represents a clinical challenge. While most studies that have assessed opioid analgesic use in opioid substitution treatment (OST) patients primarily address opioid analgesic misuse (1, 2), only few studies focused on OST patients assessed the prescription of analgesic opioids for chronic pain. We sought to compare the prevalence of analgesic opioid prescription (AOP) in two groups of chronic non-cancer pain (CNCP) patients: OST patients vs. the general population. This was a population-based cross-sectional study based on the French national healthcare claims database SNIIRAM (Système National d'Informations Inter-Régimes de l'Assurance Maladie) covering over 66 million people (98.8% of the French population). Overall, 67,173 participants ≥15 years old undergoing continuous OST in 2015 ("OST patients" group) were included and age- and gender-matched by means of a 1:1 ratio with 67,173 patients without OST ("control" group). In each group, patients with cancer conditions were excluded and those having received opioid and non-opioid analgesics for at least 3 months were identified (CNCP patients). Compared to control patients, CNCP OST patients received less AOP (47.8 vs. 68.0%, p < 0.0001) and more often non-opioid prescription (52.2 vs. 32.0%, p < 0.0001). In multivariate analysis, CNCP OST patients were 2.7 times less likely to be prescribed analgesic opioids (adjusted odds ratio [OR] = 2.7 [2.42-3.01], p < 0.0001) than control patients. AOP correlated in CNCP OST patients with: age ≤ 40 years old, female gender, low-income status, methadone-maintained treatment, mental health disorder, hepatitis C virus (HCV) infection, and alcohol abuse disorder. Opioid analgesics were less often prescribed in CNCP OST patients. AOP prevalence was 2.7-fold lower than in the general population. Chronic pain management in OST patients needs to be reinforced through additional physician training and a multidisciplinary approach.
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Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Celian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie Riquelme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
| | - Denis Ardid
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
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16
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Dawson-Rose C, Draughon JE, Zepf R, Cuca YP, Huang E, Freeborn K, Lum PJ. Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for Screening. J Assoc Nurses AIDS Care 2017; 28:238-249. [PMID: 26763795 PMCID: PMC4903083 DOI: 10.1016/j.jana.2015.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022]
Abstract
Substance use complicates HIV care and prevention. Primary care clinics are an ideal setting to screen for and offer interventions for unhealthy alcohol and drug use; however, few HIV clinics routinely screen for substance use. We enrolled 208 clinic patients at an urban underserved HIV primary care clinic. We screened the patients for substance use with the Alcohol, Smoking, and Substance Involvement Score Test and measured urine toxicology. Of the 168 participants who completed screening, the majority reported tobacco or nonprescribed substance use in the previous 3 months. More African American participants reported low or no risk amphetamine use compared to Hispanic, White, or Other race participants (p < .001). Implementing standard clinic practice for screening and assessing substance use in HIV primary care clinics is needed.
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Affiliation(s)
- Carol Dawson-Rose
- A Professor, University of California San Francisco (UCSF), Center for AIDS Prevention Studies, School of Nursing, San Francisco, California, USA ()
| | - Jessica E. Draughon
- A Postdoctoral Scholar, University of California San Francisco, School of Nursing, San Francisco, California, USA
| | - Roland Zepf
- A Doctoral Student, University of California San Francisco, San Francisco, California, USA
| | - Yvette P. Cuca
- A Sociologist/Project Director, University of California San Francisco, School of Nursing, San Francisco, California, USA
| | - Emily Huang
- A Project Coordinator, University of California San Francisco, School of Nursing, San Francisco, California, USA
| | - Kellie Freeborn
- A Predoctoral Scholar, University of California San Francisco, School of Nursing, San Francisco, California, USA
| | - Paula J. Lum
- A Professor of Clinical Medicine, University of California San Francisco, School of Medicine, San Francisco, California, USA
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17
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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18
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Wang L, Panagiotoglou D, Min JE, DeBeck K, Milloy MJ, Kerr T, Hayashi K, Nosyk B. Inability to access health and social services associated with mental health among people who inject drugs in a Canadian setting. Drug Alcohol Depend 2016; 168:22-29. [PMID: 27610937 PMCID: PMC5086265 DOI: 10.1016/j.drugalcdep.2016.08.631] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND People who inject drugs (PWID) face barriers to healthcare due to reasons including comorbidity. We evaluated access to health and social services by three of the most prevalent comorbid conditions among PWID: HIV, hepatitis C (HCV), and mental health, in an urban setting in Canada. METHODS Data were derived from prospective cohorts of community-recruited PWID between 2005 and 2015. HIV and HCV serostatuses were based on antibody tests, while mental health conditions and inability to access health and social services (barriers to access) were determined by participants' self-report. We employed generalized linear mixed models controlling for confounders to examine associations between health conditions and barriers to access. RESULTS Among 2494 participants, 1632 (65.4%) reported barriers to access at least once over a median of seven (IQR: 3, 12) semi-annual assessments. Mental health conditions were independently associated with increased odds of reporting barriers (adjusted Odds Ratio (aOR): 1.45, 95% Confidence Interval (CI): 1.32, 1.58), while HIV was not (aOR: 0.96, 95% CI: 0.85, 1.08), and HCV was associated with decreased odds (aOR: 0.80, 95% CI: 0.69, 0.93). The associations between mental health conditions and barriers to access were consistent among PWID without HIV/HCV (aOR: 1.35, 95% CI: 1.10, 1.65), with HCV mono-infection (aOR: 1.55, 95% CI: 1.37, 1.75), and HCV/HIV co-infection (aOR: 1.36, 95% CI: 1.15, 1.60). CONCLUSIONS Targeted strategies to seek and treat mental health conditions in settings that serve PWID, and assist PWID with mental health conditions in navigating healthcare system may improve the publicly-funded health and social services.
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Affiliation(s)
- Linwei Wang
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Dimitra Panagiotoglou
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Jeong Eun Min
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Kora DeBeck
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; School of Public Policy, Simon Fraser University, Simon Fraser University at Harbour Centre, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| | - M J Milloy
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Kanna Hayashi
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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19
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Kennedy MC, Kerr T, DeBeck K, Dong H, Milloy MJ, Wood E, Hayashi K. Seeking prescription opioids from physicians for nonmedical use among people who inject drugs in a Canadian setting. Am J Addict 2016; 25:275-82. [PMID: 27143485 DOI: 10.1111/ajad.12380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 03/12/2016] [Accepted: 04/19/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the high prevalence of prescription opioid (PO) misuse, little is known about the phenomenon of seeking POs for nonmedical use among high-risk populations, such as people who inject drugs (PWID). We therefore sought to examine the prevalence and correlates of seeking POs from a physician for nonmedical use among PWID in Vancouver, Canada. METHODS Cross-sectional data from two open prospective cohort studies of PWID in Vancouver were collected between June 2013 and May 2014 (n = 1252). Multivariable logistic regression was used to identify factors associated with seeking POs from physicians for nonmedical use. RESULTS Of 1252 participants, 458 individuals (36.6%) reported ever trying to get a PO prescription from a physician for nonmedical use and, of these, 343 (74.9%, comprising 27.4% of the total sample) reported ever being successful. Variables independently and positively associated with PO-seeking behavior included older age (adjusted odds ratio [AOR] = 1.02), Caucasian ethnicity (AOR = 1.38), having ever overdosed (AOR = 1.32), having ever participated in methadone maintenance therapy (AOR = 1.90), having ever dealt drugs (AOR = 1.65), and having ever been refused a prescription for pain medication (AOR = 2.02) (all p < .05). DISCUSSION AND CONCLUSIONS We observed that PO-seeking behavior was common among this sample of PWID and associated with several markers of higher intensity drug use. SCIENTIFIC SIGNIFICANCE Our findings highlight the need to identify evidence-based public health and clinical strategies to mitigate PO misuse among PWID without compromising care for PWID with legitimate medical concerns. (Am J Addict 2016;25:275-282).
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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20
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Glenn MC, Sohler NL, Starrels JL, Maradiaga J, Jost JJ, Arnsten JH, Cunningham CO. Characteristics of methadone maintenance treatment patients prescribed opioid analgesics. Subst Abus 2016; 37:387-391. [PMID: 26731299 DOI: 10.1080/08897077.2015.1135225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Opioid analgesic use and disorders have dramatically increased among the general American population and those receiving methadone maintenance treatment (MMT). Most research among MMT patients focuses on opioid analgesics misuse or disorders; few studies focus on MMT patients prescribed opioid analgesics. We describe demographic, clinical, and substance use characteristics of MMT patients prescribed opioid analgesics and compare them with MMT patients not prescribed opioid analgesics. METHODS We conducted a cross-sectional secondary data analysis using screening interviews from a parent study. From 2012 to 2015, we recruited adults from 3 MMT Bronx clinics. Questionnaire data included patterns of opioid analgesic use, substance use, comorbid illnesses, and demographic characteristics. Our main dependent variable was patients' report of currently taking prescribed opioid analgesics. To compare characteristics between MMT patients prescribed and not prescribed opioid analgesics, we conducted chi-square tests, t tests, and Mann-Whitney U tests. RESULTS Of 611 MMT patients, most reported chronic pain (62.0%), hepatitis C virus (HCV) infection (52.1%), and current use of illicit substances (64.2%). Of the 29.8% who reported currently taking prescribed opioid analgesics, most misused their opioid analgesics (57.5%). Patients prescribed (versus not prescribed) opioid analgesics were more likely to report human immunodeficiency virus (HIV) infection (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1-2.3) and chronic pain (aOR = 7.6, 95% CI: 4.6-12.6). CONCLUSION Among MMT patients primarily in 3 Bronx clinics, nearly one third reported taking prescribed opioid analgesics. Compared with patients not prescribed opioid analgesics, those prescribed opioid analgesics were more likely to report chronic pain and HIV infection. However, between these patients, there was no difference in illicit substance use. These findings highlight the complexity of addressing chronic pain in MMT patients.
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Affiliation(s)
- Matthew C Glenn
- a Albert Einstein College of Medicine , Bronx , New York , USA
| | - Nancy L Sohler
- b The City College of New York, Sophie Davis School of Biomedical Education , New York , New York , USA
| | - Joanna L Starrels
- a Albert Einstein College of Medicine , Bronx , New York , USA.,c Montefiore Medical Center, Division of General Internal Medicine , Bronx , New York , USA
| | | | - John J Jost
- a Albert Einstein College of Medicine , Bronx , New York , USA
| | - Julia H Arnsten
- a Albert Einstein College of Medicine , Bronx , New York , USA.,c Montefiore Medical Center, Division of General Internal Medicine , Bronx , New York , USA
| | - Chinazo O Cunningham
- a Albert Einstein College of Medicine , Bronx , New York , USA.,c Montefiore Medical Center, Division of General Internal Medicine , Bronx , New York , USA
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21
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Dunn KE, Finan PH, Tompkins DA, Fingerhood M, Strain EC. Characterizing pain and associated coping strategies in methadone and buprenorphine-maintained patients. Drug Alcohol Depend 2015; 157:143-9. [PMID: 26518253 PMCID: PMC4663104 DOI: 10.1016/j.drugalcdep.2015.10.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic pain is common among patients receiving opioid maintenance treatment (OMT) for opioid use disorder. To aid development of treatment recommendations for coexisting pain and opioid use disorder, it is necessary to characterize pain treatment needs and assess whether needs differ as a function of OMT medication. METHODS A point-prevalence survey assessing pain and engagement in coping strategies was administered to 179 methadone and buprenorphine-maintained patients. RESULTS Forty-two percent of participants were categorized as having chronic pain. Methadone patients had greater severity of pain relative to buprenorphine patients, though both groups reported high levels of interference with daily activities, and participants with pain attended the emergency room more frequently relative to participants without pain. Only 2 coping strategies were being utilized by more than 50% of participants (over-the-counter medication, prayer). CONCLUSIONS Results indicate that pain among OMT patients is common, severe, and of significant impairment. Methadone patients reported greater severity pain, particularly worse pain in the past 24h, though interference from pain in daily activities did not vary as a function of OMT. Most participants with pain were utilizing few evidenced-based pain coping strategies. Increasing OMT patient access to additional pain treatment strategies is an opportunity for immediate intervention, and similarities across OMT type suggest interventions do not need to be customized to methadone vs. buprenorphine patients.
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Affiliation(s)
- Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - D Andrew Tompkins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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22
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Nosyk B, Krebs E, Min JE, Ahamad K, Buxton J, Goldsmith C, Hull M, Joe R, Krajden M, Lima VD, Olding M, Wood E, Montaner JSG. The 'Expanded HIV care in opioid substitution treatment' (EHOST) cluster-randomized, stepped-wedge trial: A study protocol. Contemp Clin Trials 2015; 45:201-209. [PMID: 26342295 DOI: 10.1016/j.cct.2015.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/28/2015] [Accepted: 08/30/2015] [Indexed: 11/18/2022]
Abstract
The public health response to HIV/AIDS has turned its focus onto optimizing health care system delivery to maximize case identification, access and sustained engagement in antiretroviral treatment (ART). Opioid Agonist Treatment (OAT) provides a critical opportunity for HIV testing and linkage to ART. The EHOST study is a cluster-randomized, stepped-wedge trial to evaluate a prescriber-focused intervention to increase HIV testing rates, and optimize ART engagement and retention outcomes among individuals engaged in OAT. The study will encompass all drug treatment clinics currently admitting patients for the treatment of opioid use disorder across the province of British Columbia, encompassing an estimated 90% of the OAT caseload. The trial will be executed over a 24-month period, with groups of clinics receiving the intervention in 6-month intervals. Evaluation of the proposed intervention's effectiveness will focus on three primary outcomes: (i) the HIV testing rate among those not known to be HIV positive; (ii) the rate of ART initiation among those not on ART; and (iii) the rate of ART continuation among those on ART. A difference-in-differences analytical framework will be applied to estimate the intervention's effect. This approach will assess site-specific changes in primary outcomes across clusters while adjusting for potential residual heterogeneity in patient case mix, volume, and quality of care across clinics. Statistical analysis of outcomes will be conducted entirely with linked population-level administrative health datasets. Facilitated by established collaborations between key stakeholders across the province, the EHOST intervention promises to optimize HIV testing and care within a marginalized and hard-to-reach population.
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Affiliation(s)
- B Nosyk
- BC Centre for Excellence in HIV/AIDS, Canada; Faculty of Health Sciences, Simon Fraser University, Canada.
| | - E Krebs
- BC Centre for Excellence in HIV/AIDS, Canada
| | - J E Min
- BC Centre for Excellence in HIV/AIDS, Canada
| | - K Ahamad
- BC Centre for Excellence in HIV/AIDS, Canada
| | - J Buxton
- BC Centre for Disease Control and Prevention, Canada; School of Population and Public Health, University of British Columbia, Canada
| | - C Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Canada
| | - M Hull
- BC Centre for Excellence in HIV/AIDS, Canada; Vancouver Coastal Health Authority, Canada
| | - R Joe
- Vancouver Coastal Health Authority, Canada
| | - M Krajden
- BC Centre for Disease Control and Prevention, Canada
| | - V D Lima
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
| | - M Olding
- BC Centre for Excellence in HIV/AIDS, Canada
| | - E Wood
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
| | - J S G Montaner
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
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