How do people who use drugs receiving Opioid Medication Therapy perceive their treatment ? A multicentre study

Predictors of concurrent heroin use among patients on opioid maintenance treatment in France: a multilevel study over 11 years

BACKGROUND

Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal epidemiological assessment on the matter.

METHODS

We use a yearly updated compendium retrieving information on patients admitted in treatment centres in France between 2010 and 2020. Given the hierarchical nature of the data collection, we conduct 2-level modified Poisson regressions to estimate the risks of past month heroin use among patients on OMT.

RESULTS

Despite an overall decreasing trend over time, heroin use among patients on OMT is indeed common, with half of patients declaring concurrent use. Our study unveils differentiated risks of heroin use vary according to the type of OMT, with patients on methadone more likely to use heroin compared to those on buprenorphine. The use of multilevel-related measures also uncovers high heterogeneity among patients' profiles, reflecting different stages in the treatment process, as well as differentiated practices across treatment centres.

CONCLUSION

Opioid maintenance treatment is associated with heroin use, in particular when methadone is involved. The heterogeneity among patients on OMT should be given particular attention, as it underscores the need for tailored interventions.

Pharmacist Opioid Dispensing Confidence in an Evolving Practice Landscape

Pharmacists are increasingly called upon to make dispensing decisions when presented with prescriptions for opioids. Risk mitigation strategies have been implemented to assist pharmacists in making these decisions, but they have also increased the complexity of decision-making. The primary objective of this study was to describe change in pharmacist comfort levels with opioid prescription dispensing over the previous year. This was a cross-sectional, multi-state, 16-item survey disseminated to the general membership of 2 state-level professional pharmacy organizations in November 2018. Of 274 pharmacists who opened the questionnaire, 195 (n = 195) completed at least 80% of the survey and were included. Three-fourths (74.6%) of the respondents noted community/retail as their practice site. When asked about change in comfort with dispensing opioids, 19.6% reported an increase in comfort level, 42.5% reported a decrease in comfort level, and 38.0% reported no change. When asked about information that may increase comfort in dispensing opioids, respondents noted diagnosis, morphine milligram equivalent, prior treatments, past medical history, drug monitoring program verification, and previous treatment trials with opioids. Comfort with dispensing opioids decreased over a 12-month period among pharmacists surveyed. Improved communication between prescriber and pharmacist, as well as enhanced access to patient health information, is critical to reduce barriers to care for patients.