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Naren T, Cook J, MacCartney P. Direct induction onto high-dose long-acting injectable buprenorphine: A case series. Australas Psychiatry 2024; 32:238-241. [PMID: 38444394 DOI: 10.1177/10398562241237655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
INTRODUCTION This case series reports on five patients with opioid use disorder (OUD) who were commenced directly onto high-dose long-acting injectable buprenorphine (LAIB). METHOD A retrospective audit and manual review of the electronic medical record at cohealth Innerspace was conducted for patients who had been directly inducted onto high-dose LAIB. RESULTS Five cases were identified on retrospective manual file review. All patients identified were males aged between 33 and 60 years old and were treated with either high-dose Buvidal Weekly and Monthly preparations. No immediate significant adverse effects were noticed and 4 out of 5 remain engaged with treatment. CONCLUSION This case series shows it is possible to directly induct patients with OUD onto high-dose LAIB preparations without significant side effects or harm to the patient and could be considered a viable option in the treatment of patients with OUD.
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Affiliation(s)
- Thileepan Naren
- Drug Health Services, Western Health, Footscray, AU-VIC, Australia; and
- Monash University, Clayton, VIC, Australia
| | - Jon Cook
- Drug Health Services, Western Health, Footscray, AU-VIC, Australia; and
- Monash University, Clayton, VIC, Australia
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2
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FitzGerald G, MacCartney P, Cook J, Crawford S, Naren T. Time for Australia to increase take away doses in opioid agonist treatment. Int J Drug Policy 2024; 127:104420. [PMID: 38614016 DOI: 10.1016/j.drugpo.2024.104420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
Opioid Agonist Treatment is the cornerstone of minimising harms related to opioid use, however its uptake is limited by a tightly regulated and stigmatising treatment environment. The COVID-19 pandemic necessitated relaxation of some treatment restrictions, with global evidence pointing to more patient-centred care in this time. In light of local evidence to support the safety of increased access to takeaway doses and a precedent set by the Substance Abuse and Mental Health Administration, we recommend adoption of the Australian Interim Medication Assisted Treatment of Opioid Dependence guidance in Australia.
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Affiliation(s)
- Grace FitzGerald
- Drug Health Services, Western Health, 3-7 Eleanor St, Footscray, VIC 3031, Australia.
| | - Paul MacCartney
- Cohealth Innerspace, 4-6 Johnston St, Collingwood, VIC 3066, Australia
| | - Jon Cook
- Drug Health Services, Western Health, 3-7 Eleanor St, Footscray, VIC 3031, Australia
| | - Sione Crawford
- Harm Reduction Victoria, 299-305 Victoria St, Brunswick, VIC 3056, Australia
| | - Thileepan Naren
- Drug Health Services, Western Health, 3-7 Eleanor St, Footscray, VIC 3031, Australia; Monash University, Wellington Road, Clayton, VIC 3800, Australia
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Naren T, Cook J, MacCartney P, Membrey D. Buprenorphine microdosing regimen using transdermal buprenorphine patches to transition from methadone to buprenorphine. Drug Alcohol Rev 2024. [PMID: 38408741 DOI: 10.1111/dar.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION This case series records a cohort of patients treated with transdermal buprenorphine patches as part of a buprenorphine microdose induction protocol to transition from methadone to buprenorphine in a community setting. This has historically been a difficult process to manage in community settings and this case series explored a method to gradually manage this in an outpatient setting. METHOD A retrospective file audit was conducted of the electronic medical records of cohealth Innerspace patients who had undergone buprenorphine microdose induction using transdermal patches. A total of 32 patients were identified. RESULTS In this case series 23 of the 32 patients successfully transitioned from methadone to sublingual or long-acting injectable depot buprenorphine preparations utilising the transdermal buprenorphine microdosing technique. All patients in this case series regardless of the success of the transition were retained in treatment. DISCUSSION AND CONCLUSIONS A fixed-dose transdermal buprenorphine patch regimen enabled 23 of 32 patients in this case series transition from methadone to buprenorphine in an outpatient setting. Given the small sample size further research is required to demonstrate the effectiveness of this technique.
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Affiliation(s)
- Thileepan Naren
- Drug Health Services, Western Health, Melbourne, Australia
- cohealth Innerspace, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Jon Cook
- Drug Health Services, Western Health, Melbourne, Australia
| | - Paul MacCartney
- Drug Health Services, Western Health, Melbourne, Australia
- cohealth Innerspace, Melbourne, Australia
| | - Dean Membrey
- Drug Health Services, Western Health, Melbourne, Australia
- cohealth Innerspace, Melbourne, Australia
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Kirby J, Naren T. Cannabinoid hyperemesis syndrome in pregnancy: Challenges and opportunities. Aust N Z J Obstet Gynaecol 2023; 63:746-752. [PMID: 37259610 DOI: 10.1111/ajo.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
Antenatal cannabis consumption is common and associated with adverse perinatal outcomes, including low birthweight, pre-term birth and increased rates of admission to neonatal intensive care. Cannabinoid hyperemesis syndrome (CHS) comprises severe, cyclical episodes of vomiting, intractable nausea and abdominal pain observed in chronic cannabis users. CHS, particularly during pregnancy, poses a diagnostic dilemma with a tendency to be ineffectively managed secondary to reduced clinician awareness and a scarcity of available therapies. This clinical perspective explores the current literature on CHS in pregnancy, available pharmacotherapeutics, and recognises the current barriers to improving clinical care.
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Affiliation(s)
- Jordan Kirby
- Obstetrics & Gynaecology Resident, Department of Obstetrics & Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Thileepan Naren
- Addiction Medicine Advanced Trainee, Drug Health Services, Western Health, Melbourne, Victoria, Australia
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Naren T, MacCartney P, Crawford S, Cook J. People who use drugs in hospital settings: 'Moving towards a person-centred harm reduction model'. Drug Alcohol Rev 2023; 42:1529-1533. [PMID: 37232049 DOI: 10.1111/dar.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
People who use drugs often continue to use drugs while in hospital. However, health-care systems often expect abstinence from drugs as a condition of engagement in various services. This commentary piece proposes that this approach is inconsistent with the principles of person-centred care. A harm reduction-based approach in conjunction with collaboration of people who use drugs is proposed as a model for providing person-centred care to people who use drugs during hospital-based treatment.
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Affiliation(s)
| | | | | | - Jon Cook
- Drug Health Services, Western Health, Melbourne, Australia
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Naren T, Cook J. Kamini: an underappreciated cause of opioid dependence. Med J Aust 2023; 218:284. [PMID: 36889735 DOI: 10.5694/mja2.51879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 03/10/2023]
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Brickley B, Burzacott J, Naren T. Enhancing person-centred care and access to primary care for Aboriginal and Torres Strait Islander peoples. AUST HEALTH REV 2023; 47:13-15. [PMID: 36423653 DOI: 10.1071/ah22190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/09/2022] [Indexed: 11/26/2022]
Abstract
The pandemic has amplified the health needs of Aboriginal and Torres Strait Islander peoples and influenced the way primary care services are delivered. The purpose of this critical perspective is to explore the research on person-centred care (PCC) that has been conducted during the pandemic, with a contextual focus on care delivered by general practitioners (GPs) to Aboriginal and Torres Strait Islander communities. The pandemic has shown that primary care needs to be flexible, adaptive and innovative to maintain PCC. During the pandemic, general practice teams maintained their focus on the delivery of PCC and adapted routine services. National health care policy and modifications to the Medicare Benefits Schedule supported the delivery of PCC. Evaluation research has shown that funding extensions made during the pandemic increased patient engagement and the delivery of routine services, which supported primary care clinic sustainability. However, the delivery of PCC by GPs in the clinical setting requires time. Adequately funded, longer primary care consultations are needed to enhance PCC and access to services for Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Bryce Brickley
- Healthy Primary Care, Menzies Health Institute Queensland, G40 Griffith Health Centre, Level 8.86, Gold Coast Campus, Griffith University, Gold Coast, Qld 4222, Australia
| | - Jaydene Burzacott
- Bendigo & District Aboriginal Co-operative, 119 Prouses Road, North Bendigo, Vic. 3550, Australia
| | - Thileepan Naren
- Drug Health Services, Western Health, 3¿7 Eleanor Street, Footscray, Vic. 3011, Australia
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Naren T, Silkoff D, Forsythe M, Cook J. Case series on treatment of dependence to Kamini Vidrawan Ras with opioid substitution therapy. Drug Alcohol Rev 2022; 41:1408-1411. [PMID: 35711156 DOI: 10.1111/dar.13505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION A cohort of clients was recognised attending an addiction medicine clinic with similar presentations of opioid dependence from use of a rarely known Ayurvedic medication in a specific ethnic community. This retrospective case series was completed to promote wider recognition and further understanding of dependence on Kamini Vidrawan Ras (Kamini). METHODS A retrospective file audit of the electronic medical record for clients of an addiction medicine outpatient clinic with a history of dependent use of Kamini identified 12 clients meeting inclusion criteria. RESULTS All 12 clients were male, aged 27-41 years, all but one of north Indian origin, predominantly employed and predominantly (but not exclusively) without significant other substance use history. All 12 clients were treated with opioid substitution therapy. DISCUSSION AND CONCLUSIONS This case series highlights an opioid dependence syndrome resulting from use of an Ayurvedic medicine by men from a specific area of India, highlighting a potential adverse effect of traditional medicines in ongoing use by migrant and ethnic populations that have emigrated to Australia.
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Affiliation(s)
| | - David Silkoff
- Drug Health Services, Western Health, Melbourne, Australia
| | | | - Jon Cook
- Drug Health Services, Western Health, Melbourne, Australia
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Naren T, Cook J, Armstrong F, Manger S. Lifestyle interventions in the management of substance use disorder. Aust J Gen Pract 2022; 51:560-564. [DOI: 10.31128/ajgp-02-22-6331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Naren T, Widdicombe D. Aboriginal communities need to be at the forefront of the COVID-19 vaccination campaign. Aust J Gen Pract 2022; 51. [PMID: 35393606 DOI: 10.31128/ajgp-covid-51-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To ensure that Aboriginal and Torres Strait Islander people are vaccinated it is essential to engage, work and consult with and listen to Aboriginal and Torres Strait Islander communities.
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Affiliation(s)
- Thileepan Naren
- MBBS, MHM, MPH, FACRRM, FRACGP, GAICD, General Practitioner, Bendigo & District Aboriginal Co-operative, Bendigo, Vic
| | - Dallas Widdicombe
- BSW, Executive Director, Bendigo @ District Aboriginal Co-operative, Bendigo, Vic
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Couch D, Doherty Z, Panozzo L, Naren T, Burzacott J, Ward B, Kippen R, Widdicombe D. The impact of telehealth on patient attendance and revenue within an Aboriginal Community Controlled Health Organisation during COVID-19. Aust J Gen Pract 2021; 50:851-855. [PMID: 34713288 DOI: 10.31128/ajgp-07-21-6060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Aboriginal Community Controlled Health Organisations (ACCHOs) provide culturally appropriate medical services to Aboriginal and/or Torres Strait Islander people. The aim of this study was to examine the impact of telehealth on patient attendance and revenue within an ACCHO during COVID-19. METHOD This is a time-series study of general practitioner attendances at a regional Victorian ACCHO in two periods: March-June 2019 (pre-COVID-19) and March-June 2020 (during COVID-19). RESULTS After adjusting for the number of available appointments, there was a 27% increased rate of attendances per appointment slot during the COVID-19 period when compared with the pre-COVID-19 period, and a 59% increase in Medicare Benefits Schedule items claimed during the COVID-19 period, compared with the pre-COVID-19 period. DISCUSSION The findings indicate that the provision of services via telehealth increased the number of people able to access the medical clinic, and that this had a positive financial impact for the organisation.
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Affiliation(s)
- Danielle Couch
- PhD, Strategic Projects/Policy Adviser, Bendigo @ District Aboriginal Co-operative, Bendigo, Vic; Adjunct Research Fellow, School of Rural Health, Monash University, Bendigo, Vic
| | - Zakary Doherty
- BMedSc (Hons), MD, Research Fellow, School of Rural Health, Monash University, Bendigo, Vic
| | - Laura Panozzo
- BMedSc (Hons), MD, Research Fellow, School of Rural Health, Monash University, Bendigo, Vic
| | - Thileepan Naren
- MBBS, MHM, MPH, FACRRM, FRACGP, GAICD, General Practitioner, Bendigo & District Aboriginal Co-operative, Bendigo, Vic
| | - Jaydene Burzacott
- Aboriginal Health Practitioner/Clinical Team Leader, Bendigo & District Aboriginal Co-operative, Bendigo, Vic
| | - Bernadette Ward
- PhD, Associate Professor, School of Rural Health, Monash University, Bendigo, Vic
| | - Rebecca Kippen
- PhD, GradDip (Demography), BBus, Associate Professor of Demography, Rural Health, Monash University, Bendigo, Vic
| | - Dallas Widdicombe
- BSW, Executive Director, Bendigo @ District Aboriginal Co-operative, Bendigo, Vic
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Naren T, Burzacott J, West C, Widdicombe D. Role of Aboriginal Health Practitioners in administering and increasing COVID-19 vaccination rates in a Victorian Aboriginal Community Controlled Health Organisation. Rural Remote Health 2021; 21:7043. [PMID: 34619974 DOI: 10.22605/rrh7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The COVID-19 pandemic has devastated communities throughout the world and has required rapid paradigm changes in the manner in which health care is administered. Previous health models and practices have been modified and changed at a rapid pace. This commentary provides the experiences of a regional Victorian Aboriginal Community Controlled Organisation in a COVID-19 vaccination program led and managed by Aboriginal Health Practitioners.
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Affiliation(s)
- Thileepan Naren
- Bendigo & District Aboriginal Co-operative, North Bendigo, Vic. 3550, Australia
| | - Jaydene Burzacott
- Bendigo & District Aboriginal Co-operative, North Bendigo, Vic. 3550, Australia
| | - Crystal West
- Bendigo & District Aboriginal Co-operative, North Bendigo, Vic. 3550, Australia
| | - Dallas Widdicombe
- Bendigo & District Aboriginal Co-operative, North Bendigo, Vic. 3550, Australia
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