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Tsang VWL, Wong JS, Westenberg JN, Ramadhan NH, Fadakar H, Nikoo M, Li VW, Mathew N, Azar P, Jang KL, Krausz RM. Systematic review on intentional non-medical fentanyl use among people who use drugs. Front Psychiatry 2024; 15:1347678. [PMID: 38414500 PMCID: PMC10896833 DOI: 10.3389/fpsyt.2024.1347678] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 02/29/2024] Open
Abstract
Objectives Fentanyl is a highly potent opioid and has, until recently, been considered an unwanted contaminant in the street drug supply among people who use drugs (PWUD). However, it has become a drug of choice for an increasing number of individuals. This systematic review evaluated intentional non-medical fentanyl use among PWUD, specifically by summarizing demographic variance, reasons for use, and resulting patterns of use. Methods The search strategy was developed with a combination of free text keywords and MeSH and non-MeSH keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO. Studies included were human studies with intentional use of non-medical fentanyl or analogues in individuals older than 13. Only peer-reviewed original articles available in English were included. Results The search resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. Out of 41 papers included, it was found that individuals who use fentanyl intentionally were more likely to be young, male, and White. They were also more likely to have experienced overdoses, and report injection drug use. There is evidence that fentanyl seeking behaviours are motivated by greater potency, delay of withdrawal, lower cost, and greater availability. Conclusions Among PWUD, individuals who intentionally use fentanyl have severe substance use patterns, precarious living situations, and extensive overdose history. In response to the increasing number of individuals who use fentanyl, alternative treatment approaches need to be developed for more effective management of withdrawal and opioid use disorder. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021272111.
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Affiliation(s)
- Vivian W. L. Tsang
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - James S.H. Wong
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jean N. Westenberg
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Noor H. Ramadhan
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Hasti Fadakar
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Victor W. Li
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Nick Mathew
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Burnaby, BC, Canada
| | - Pouya Azar
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Kerry L. Jang
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Reinhard M. Krausz
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Kim JJ, Nikoo M, Nikoo N, Javidanbardan S, Kazemi A, Choi F, Gholami A, Lafooraki NY, Vogel M, Rezazadeh-Azar P, Meyer M, Cabanis M, Jang K, Aknondzadeh S, Krausz M. Quality of life of patients treated with opium tincture or methadone: A randomized controlled trial. Drug Alcohol Depend 2023; 249:110874. [PMID: 37402335 DOI: 10.1016/j.drugalcdep.2023.110874] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Quality of life (QoL) is an increasingly recognized patient-centered treatment outcome in individuals with opioid use disorder. There is a gap in literature on the impact of opium tincture (OT) on patients' QoL compared to standard treatment options such as methadone. This study aimed to compare the QoL of participants with opioid use disorder receiving OAT using OT or methadone and identify the factors associated with their QoL during treatment. METHODS The opium trial was a multicenter non-inferiority randomized clinical trial in four private OAT outpatient clinics in Iran. The study assigned patients to either OT (10 mg/ml) or methadone sirup (5 mg/ml) for a follow-up of 85 days. QoL was assessed using the brief version of the World Health Organization Quality of Life instrument (WHOQOL- BREF). RESULTS A total of 83 participants, 35 (42.2%) in the OT arm and 48 (57.8%) in the methadone arm, completed the WHOQOL-BREF in full and were included in the primary analysis. The mean score of patients' QoL showed improvement compared to baseline, but differences were not statistically significant between OT and methadone arms (p = 0.786). Improvements were mainly observed within the first 30 days of receiving treatment. Being married and lower psychological distress were associated with an improved QoL. Within the social relationships domain, male gender showed significantly higher QoL compared to females. CONCLUSION OT shows promise as an OAT medication, comparable to methadone in improving patients' QoL. There is a need to incorporate psychosocial interventions to further sustain and improve the QoL in this population. Identifying other social determinants of health which affect QoL and the cultural adaptation of assessments for individuals from various ethnocultural backgrounds are critical areas of inquiry.
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Affiliation(s)
- Jane J Kim
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada.
| | - Mohammadali Nikoo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Nooshin Nikoo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Alireza Kazemi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Sari, Mazandaran, Iran
| | - Neda Y Lafooraki
- Islamic Azad University, Science and Research Branch, Mazandaran, Iran
| | - Marc Vogel
- Division of Substance Use Disorders, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Pouya Rezazadeh-Azar
- Complex Pain and Addiction Services, Vancouver General Hospital & Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Maximilian Meyer
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Maurice Cabanis
- Center for Mental Health, Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, Stuttgart, 70374, Germany
| | - Kerry Jang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Shahin Aknondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Iran
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, V6T 2A1, Canada
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Nikoo M, Kianpoor K, Nikoo N, Javidanbardan S, Kazemi A, Choi F, Vogel M, Gholami A, Tavakoli S, Wong JSH, Moazen-Zadeh E, Givaki R, Jazani M, Mohammadian F, Moghaddam NM, Schütz C, Jang K, Akhondzadeh S, Krausz M. Opium tincture versus methadone for opioid agonist treatment: a randomized controlled trial. Addiction 2023; 118:284-294. [PMID: 35971297 DOI: 10.1111/add.16030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/03/2022] [Indexed: 01/05/2023]
Abstract
AIM To test if opium tincture (OT) was non-inferior to methadone in retaining participants in opioid agonist treatment (OAT). DESIGN A Phase III, multi-centre, parallel-group, non-inferiority, double-blind randomized controlled trial with an allocation ratio of 1:1. Participants were provided treatment and followed for a period of 85 days. SETTING Four OAT clinics in Iran. PARTICIPANTS Two hundred and four participants with opioid use disorder [mean age (standard deviation) = 37.4 (9.3); female 11.3%] recruited between July 2017 and January 2018. INTERVENTIONS Participants were assigned to either OT (102) or methadone (102) using a patient-centred flexible dosing strategy. MEASUREMENTS Treatment retention over 85 days was the primary outcome. Self-reported opioid use outside treatment and occurrence of adverse events (AEs) were the secondary outcomes. FINDINGS Remaining in treatment at the end of the follow-up were 68.6% in the methadone arm and 59.8% in the OT arm. The relative retention rate of methadone to OT was 1.15 (0.97, 1.36) in both intent-to-treat and per-protocol analyses; non-inferiority was not supported statistically, as the upper bound of the confidence interval exceeded our pre-specified non-inferiority margin (1.25). Opioid use outside treatment was reported by 30.3% of OT (n = 152) and 49.4% of methadone (n = 168) patients, a difference in proportions of -19%: 90% confidence interval (-28%, -10%). The total count of AEs in the OT arm (22 among nine individuals) was significantly higher (P = 0.04) than that in the methadone arm (three among two individuals). Nausea was the most common side effect. CONCLUSION While this study could not conclude the non-inferiority of opium tincture (OT) to methadone for retaining patients in opioid agonist treatment, OT retained 60% of participants to end of follow-up (85 days) and was superior to methadone in reducing self-reported opioid use outside treatment.
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Affiliation(s)
- Mohammadali Nikoo
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kiana Kianpoor
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nooshin Nikoo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Alireza Kazemi
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Fiona Choi
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marc Vogel
- Division of Substance Use Disorders, Psychiatric Services of Thurgovia, Münsterlingen, Switzerland.,Division of Substance Use Disorders, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Private Practice, Sari, Mazandaran, Iran
| | - Saeed Tavakoli
- Rooz-e-No, Methadone Maintenance Treatment Clinic (Private Practice), Shiraz, Fars, Iran
| | - James S H Wong
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Complex Pain and Addiction Consult Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Ehsan Moazen-Zadeh
- Addiction Institute of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Reza Givaki
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Jazani
- Sales, Marketing, Export and Medical Department, Darou Pakhsh Pharmaceutical Manufacturing Company, Tehran, Iran
| | - Fatemeh Mohammadian
- Sales, Marketing, Export and Medical Department, Darou Pakhsh Pharmaceutical Manufacturing Company, Tehran, Iran
| | - Nader Markazi Moghaddam
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Christian Schütz
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry Jang
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Iran
| | - Michael Krausz
- Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Song MJ, Westenberg JN, Kianpoor K, Nikoo M, Kazemi A, Schuetz C, Jang K, Gholami A, Akhondzadeh S, Krausz M. Substance of choice, impact of heroin or opium on treatment retention in a multicentre randomised controlled trial in Iran. Drug Alcohol Rev 2022; 41:895-901. [PMID: 35170124 DOI: 10.1111/dar.13445] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In the Middle East and Asia, illicit opioid use exists across a spectrum between heroin and opium. The impact of primary opioid of choice on opioid agonist treatment retention has not been well evaluated previously, especially for opium tincture, an increasingly popular form of opioid agonist treatment in Iran. This study investigates the relationship between primary opioid of choice, namely heroin or opium, and retention in opium tincture and methadone treatment. METHODS Participants with opioid use disorder (n = 204) were randomised to receive opium tincture or methadone. All participants were categorised as mainly using opium or heroin. Bivariate analyses between treatment retention and primary opioid of choice (P < 0.05) and logistic regression were conducted. RESULTS Among the 191 participants included in this analysis, heroin was the primary substance of choice for 135 participants (70.7%) and opium for 56 (29.3%). Bivariate analysis showed that the opium group was more likely to be satisfied with family situation, employed and retained in treatment than the heroin group while less likely to experience incarceration and use multiple substances. When adjusting for covariates, primary opioid of choice was not significantly associated with retention in either methadone or opium tincture treatment arm. DISCUSSION AND CONCLUSIONS Positive factors, such as employment, housing and family support, seem to collectively explain the higher retention in treatment among those who primarily use opium compared to those who use heroin. To optimise retention in opioid agonist treatment, biopsychosocial care models should be further evaluated to improve psychosocial functioning.
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Affiliation(s)
- Michael Jae Song
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Kiana Kianpoor
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alireza Kazemi
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Christian Schuetz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kerry Jang
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Private Practice and Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Vogel M, Choi F, Westenberg JN, Cabanis M, Nikoo N, Nikoo M, Hwang SW, Somers J, Schütz CG, Krausz M. Chronic Pain among Individuals Experiencing Homelessness and Its Interdependence with Opioid and Other Substance Use and Mental Illness. Int J Environ Res Public Health 2021; 19:ijerph19010005. [PMID: 35010263 PMCID: PMC8751035 DOI: 10.3390/ijerph19010005] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 05/14/2023]
Abstract
Chronic pain and substance use disorders are serious conditions that are prevalent among homeless populations. The aim of this study was to examine the association between chronic pain and substance use among individuals experiencing homelessness and mental illness. We analyzed cross-sectional data from two sites of the At Home/Chez Soi study (Vancouver and Toronto) using bivariate statistics and multivariate logistic regression. Substance use and chronic pain parameters were assessed with the Maudsley Addiction Profile and purpose-designed short instruments. The sample comprised 828 participants. Mean age was 42.4 years and 54% reported chronic pain. In bivariate analysis, chronic pain was significantly associated with use of opioids and stimulants, daily substance use, polysubstance use and injecting as route of administration. In multivariate analysis, only daily substance use (OR: 1.46, 95% CI: 1.02-2.09) and injecting (OR: 1.81, 95% CI: 1.08-3.05) remained as significant associated factors, whereas neither use of opioids nor use of stimulants specifically were significantly associated with chronic pain. Among participants with chronic pain, daily substance users (50% vs. 22%, p < 0.001) and injectors (66% vs. 24%, p < 0.001) were more likely to use non-prescribed medication for pain. Participants with daily substance use were less likely to receive professional treatment (52% vs. 64%, p = 0.017) and prescribed pain medication (42% vs. 54%, p = 0.023). Our findings suggest an association of chronic pain with patterns related to severity of substance use rather than to specific substance use in homeless persons with mental illness. Interventions aiming at prevention and treatment of chronic pain in this population should consider severity of substance use and associated risk behavior over use of specific substances.
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Affiliation(s)
- Marc Vogel
- Psychiatric Services Thurgovia, Division of Substance Use Disorders, 8596 Münsterlingen, Switzerland
- Center for Addiction Disorder, University of Basel Psychiatric Clinics, 4002 Basel, Switzerland
- Correspondence: ; Tel.: +41-71-686-41-41
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
| | - Jean N. Westenberg
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
- Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Maurice Cabanis
- Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Nooshin Nikoo
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
| | - Mohammadali Nikoo
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada;
| | - Julian Somers
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC V5A 1S6, Canada;
| | - Christian G. Schütz
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
- Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, BC V6Z IY6, Canada
- BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Agency, Vancouver, BC V5Z 4H4, Canada
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 2A1, Canada; (F.C.); (J.N.W.); (N.N.); (M.N.); (C.G.S.); (M.K.)
- Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, BC V6Z IY6, Canada
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Nikoo M, Kianpoor K, Nikoo N, Javidanbardan S, Kazemi A, Choi F, Vogel M, Gholami A, Tavakoli S, Wong J, Moazen‐Zadeh E, Givaki R, Jazani M, Mohammadian F, Moghaddam NM, Schütz C, Jang K, Akhondzadeh S. Opium tincture for opioid substitution treatment. Eur Psychiatry 2021. [PMCID: PMC9471765 DOI: 10.1192/j.eurpsy.2021.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Opium tincture (OT) is widely used for opioid substitution treatment (OST) in Iran. Objectives To determine if OT is a safe and effective medication for OST. Methods Opium Trial was a multicenter, double‐blind, noninferiority randomized controlled trial, with 204 participants with opioid dependence in Iran. Participants were then randomized to OT or methadone arms with an allocation ratio of 1:1 and were followed for 12 weeks. The primary outcome was retention in treatment, compared between the two groups using both intention-To-Treat (ITT) and Per-Protocol (PP) analyses. Results A total of 70 participants (IT: 68.6%, PP: 69.3%) in methadone arm and 61 participants (ITT: 59.8%, PP: 60.4%) in OT arm remained in the treatment. The relative retention rate was 1.15 (0.97, 1.36) in both analyses in favour of methadone. A total of 46 out of 152 (30.3%) participants in OT arm and 83 out of 168 (49.4%) participants in methadone arm reported opioid use outside the treatment. The difference in these two proportions (OT - methadone) was 19%: (10%, 28%) in favour of OT. The proportion of patients with adverse events were not different between the two arms (P = 0.06). There was no serious AE in OT arm. Conclusions Opium tincture is a clinically effective and safe medication, but this study could not conclude if it was as equally effective as methadone in retaining participants in treatment, but it showed that OT was superior to methadone in reducing opioid use outside the treatment. Disclosure No significant relationships.
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Wong JSH, Nikoo M, Westenberg JN, Suen JG, Wong JYC, Krausz RM, Schütz CG, Vogel M, Sidhu JA, Moe J, Arishenkoff S, Griesdale D, Mathew N, Azar P. Comparing rapid micro-induction and standard induction of buprenorphine/naloxone for treatment of opioid use disorder: protocol for an open-label, parallel-group, superiority, randomized controlled trial. Addict Sci Clin Pract 2021; 16:11. [PMID: 33579359 PMCID: PMC7881636 DOI: 10.1186/s13722-021-00220-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Buprenorphine/naloxone (Suboxone) is a current first-line treatment for opioid use disorder (OUD). The standard induction method of buprenorphine/naloxone requires patients to be abstinent from opioids and therefore experience withdrawal symptoms prior to induction, which can be a barrier in starting treatment. Rapid micro-induction (micro-dosing) involves the administration of small, frequent does of buprenorphine/naloxone and removes the need for a period of withdrawal prior to the start of treatment. This study aims to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone in patients with OUD. METHODS This is a randomized, open-label, two-arm, superiority, controlled trial comparing the safety and effectiveness of rapid micro-induction versus standard induction of buprenorphine/naloxone for the treatment of OUD. A total of 50 participants with OUD will be randomized at one Canadian hospital. The primary outcome is the completion of buprenorphine/naloxone induction with low levels of withdrawal. Secondary outcomes are treatment retention, illicit drug use, self-reported drug use behaviour, craving, pain, physical health, safety, and client satisfaction. DISCUSSION This is the first randomized controlled trial to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone. This study will thereby generate evidence for a novel induction method which eliminates substantial barriers to the use of buprenorphine/naloxone in the midst of the ongoing opioid crisis. Trial registration ClinicalTrials.gov, NCT04234191; date of registration: January 21, 2020; https://clinicaltrials.gov/ct2/show/NCT04234191.
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Affiliation(s)
- James S H Wong
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada.
| | - Mohammadali Nikoo
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Jean N Westenberg
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Janet G Suen
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Y C Wong
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Reinhard M Krausz
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Christian G Schütz
- Behavioral Reward Affect + Impulsivity Neuroscience Lab, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Marc Vogel
- Division of Addictive Disorders, University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jesse A Sidhu
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Nickie Mathew
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Pouya Azar
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
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Wong JS, Nikoo M, Kianpoor K, Gholami A, Jazani M, Mohammadian F, Lafooraki NY, Jang KL, Schütz CG, Akhondzadeh S, Krausz MR. The effects of opium tincture and methadone on the cognitive function of patients with opioid use disorder. Personality and Individual Differences 2021. [DOI: 10.1016/j.paid.2020.110091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Shams F, Wong JSH, Nikoo M, Outadi A, Moazen-Zadeh E, Kamel MM, Song MJ, Jang KL, Krausz RM. Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review. J Med Internet Res 2021; 23:e20557. [PMID: 33475520 PMCID: PMC7861997 DOI: 10.2196/20557] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/10/2020] [Accepted: 12/05/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context. OBJECTIVE We conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: "How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?" METHODS A literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work. RESULTS A total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor. CONCLUSIONS Five strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts.
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Affiliation(s)
- Farhud Shams
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - James S H Wong
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ava Outadi
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Ehsan Moazen-Zadeh
- Addiction Institute of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Mostafa M Kamel
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, Tanta University, Tanta, Egypt
| | - Michael Jae Song
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Reinhard Michael Krausz
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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10
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Krausz RM, Nikoo M, Jang K, Choi F. The North American Overdose Crisis and the European-American "Fentanyl and Treatment Gap". Eur Addict Res 2021; 27:304-310. [PMID: 33735869 DOI: 10.1159/000508128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Reinhard M Krausz
- Department of Psychiatry, Institute of Mental Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,
| | - Mohammadali Nikoo
- Department of Psychiatry, Institute of Mental Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry Jang
- Department of Psychiatry, Institute of Mental Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fiona Choi
- Department of Psychiatry, Institute of Mental Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Yazdani K, Nikoo M, Sayre EC, Choi F, Jang K, Krausz RM. The impact of employment on recovery among individuals who are homeless with severe mental illness in the Vancouver At Home/Chez Soi trial. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1619-1627. [PMID: 32476057 DOI: 10.1007/s00127-020-01887-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess impact of employment on recovery in a sample of adults from Vancouver At Home (VAH) study, who were homeless and were diagnosed with severe mental disorders. METHODS The VAH included two randomized controlled trials investigating the effect of housing first with support intervention in vulnerable population. Employment was assessed at baseline and during the follow-up using Demographics, Housing, Vocational, and Service Use History (DSHH), and Vocational Timeline Follow-Back (VTLFB) self-report questionnaires, respectively. Recovery was examined using Recovery Assessment Scale (RAS) at baseline and at 24-month follow-up visit. Multivariable regression models were built to examine: (1) the effect of current employment at baseline on RAS score at baseline, and RAS score at 24-month follow-up visit; and (2) and to examine the cumulative effect of recent employment over 8 follow-up visits on RAS score at 24-month visit. Cumulative effect of employment over the follow-up visits was weighted by recency using a pre-specified weighting function. RESULTS Employment at baseline was associated with an increase in recovery score at baseline [8.06 (95% CI 1.21, 14.91); p = 0.02], but not with recovery score at 24-month follow-up visit [3.78 (-4.67, 12.24); p = 0.37]. Weighted cumulative effect of employment over 8 follow-up visits was associated with increase in RAS score at 24-month follow-up visit [8.33 (1.68, 14.99) p = 0.01]. CONCLUSION Employment is associated with an increase in recovery. Our result suggests a dual effect of employment on recovery, an immediate effect through current employment, and a long-term effect of cumulative employment.
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Affiliation(s)
- Kiana Yazdani
- Addiction and Concurrent Disorders Group, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada. .,Arthritis Research Canada, Richmond, BC, Canada. .,Experimental Medicine Program, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Mohammadali Nikoo
- Addiction and Concurrent Disorders Group, Centre for Health Evaluation Outcome Sciences, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
| | | | - Fiona Choi
- Addiction and Concurrent Disorders Group, Centre for Health Evaluation Outcome Sciences, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
| | - Kerry Jang
- Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
| | - Reinhard Michael Krausz
- Addiction and Concurrent Disorders Group, Centre for Health Evaluation Outcome Sciences, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
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12
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Lee DS, Hann JE, Klaire SS, Nikoo M, Negraeff MD, Rezazadeh-Azar P. Rapid Induction of Buprenorphine/Naloxone for Chronic Pain Using a Microdosing Regimen: A Case Report. A A Pract 2020; 14:44-47. [PMID: 31770128 DOI: 10.1213/xaa.0000000000001138] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Buprenorphine is an effective treatment for chronic pain and may reduce opioid-induced hyperalgesia. However, its pharmacological properties make its induction challenging, time-consuming, and can precipitate opioid withdrawal. We present the case of a 66-year-old woman with inadequately controlled postoperative pain despite escalating doses of oxycodone and methadone, who was successfully transitioned to buprenorphine/naloxone using a rapid microinduction technique without precipitating opioid withdrawal. Rapid induction provides an alternative method for transitioning patients from other opioids to buprenorphine/naloxone and facilitates transition of patients with chronic pain to buprenorphine therapy within a shorter window compared to currently existing protocols.
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Affiliation(s)
- Danny S Lee
- From the British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica E Hann
- From the British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sukhpreet S Klaire
- From the British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Mohammadali Nikoo
- Addictions and Concurrent Disorders Group, Institute of Mental Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael D Negraeff
- Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Pouya Rezazadeh-Azar
- From the British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Foundry, Providence Health Care, Vancouver, British Columbia, Canada.,Inner City Youth Program, Providence Health Care, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
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13
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Azar P, Wong JS, Jassemi S, Moore E, Vo DX, Nikoo M, Young S. A Case Report: Rapid Micro‐Induction of Buprenorphine/Naloxone to Administer Buprenorphine Extended‐Release in an Adolescent With Severe Opioid Use Disorder. Am J Addict 2020; 29:531-535. [DOI: 10.1111/ajad.13050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Pouya Azar
- Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada
| | - James S.H. Wong
- Addictions and Concurrent Disorders Research Group, Department of Psychiatry Institute of Mental Health University of British Columbia Vancouver British Columbia Canada
| | - Sara Jassemi
- Department of Pediatrics, Division of Adolescent Health and Medicine B.C. Children’s Hospital University of British Columbia Vancouver British Columbia Canada
| | - Eva Moore
- Department of Pediatrics, Division of Adolescent Health and Medicine B.C. Children’s Hospital University of British Columbia Vancouver British Columbia Canada
| | - Dzung X. Vo
- Department of Pediatrics, Division of Adolescent Health and Medicine B.C. Children’s Hospital University of British Columbia Vancouver British Columbia Canada
| | - Mohammadali Nikoo
- Addictions and Concurrent Disorders Research Group, Department of Psychiatry Institute of Mental Health University of British Columbia Vancouver British Columbia Canada
| | - Samantha Young
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence, St. Paul’s Hospital Vancouver British Columbia Canada
- Department of Medicine, Interdepartmental Division of Addiction Medicine St. Paul’s Hospital Vancouver British Columbia Canada
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14
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Rozylo J, Mitchell K, Nikoo M, Durante SE, Barbic SP, Lin D, Mathias S, Azar P. Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach. Addict Sci Clin Pract 2020; 15:2. [PMID: 31941547 PMCID: PMC6964069 DOI: 10.1186/s13722-020-0177-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/04/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The requirement for moderate withdrawal prior to initiation can be a barrier to buprenorphine/naloxone induction. CASE PRESENTATION We aimed to use a microdosing regimen to initiate regular dosing of buprenorphine/naloxone in a high-risk patient with a history of failed initiations due, in part, to withdrawal symptoms. Using an assertive outreach model and a buprenorphine/naloxone microdosing schedule, we initiated treatment of an individual's opioid use disorder. There was a successful buprenorphine/naloxone microdosing induction as the team reached a therapeutic dose of buprenorphine/naloxone. Including the induction period, the medication was used consistently for 4 weeks. CONCLUSIONS A microdosing schedule can be used to induce a patient onto buprenorphine/naloxone with no apparent withdrawal; gradually reducing illicit substance use. This case report builds on previous literature, highlighting ways to minimize barriers to induction of buprenorphine/naloxone, using a microdosing schedule and assertive outreach. Given the safety profile of buprenorphine and its potential to be a lifesaving intervention, a larger study of microdosing is indicated.
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Affiliation(s)
| | - Keren Mitchell
- University of British Columbia, Vancouver, BC, Canada
- Inner City Youth Program, Providence Health Care, Vancouver, BC, Canada
- Foundry, Providence Health Care, Vancouver, BC, Canada
- St Paul's Hospital, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- University of British Columbia, Vancouver, BC, Canada
- Addiction and Concurrent Disorders Group, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - S Elise Durante
- Inner City Youth Program, Providence Health Care, Vancouver, BC, Canada
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Skye P Barbic
- University of British Columbia, Vancouver, BC, Canada
- Inner City Youth Program, Providence Health Care, Vancouver, BC, Canada
- Foundry, Providence Health Care, Vancouver, BC, Canada
- St Paul's Hospital, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Lin
- University of British Columbia, Vancouver, BC, Canada
- Inner City Youth Program, Providence Health Care, Vancouver, BC, Canada
- Foundry, Providence Health Care, Vancouver, BC, Canada
- St Paul's Hospital, Vancouver, BC, Canada
| | - Steve Mathias
- University of British Columbia, Vancouver, BC, Canada
- Inner City Youth Program, Providence Health Care, Vancouver, BC, Canada
- Foundry, Providence Health Care, Vancouver, BC, Canada
- St Paul's Hospital, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Pouya Azar
- University of British Columbia, Vancouver, BC, Canada.
- Inner City Youth Program, Providence Health Care, Vancouver, BC, Canada.
- Foundry, Providence Health Care, Vancouver, BC, Canada.
- St Paul's Hospital, Vancouver, BC, Canada.
- Vancouver General Hospital, DHCC, Floor 8-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
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15
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Tabi K, Choi F, Mithani Z, Nikoo M, Jang K, Krausz M. History of parenting instability and lifetime suicidal behavior in people who inject drugs. Psychiatry Res 2019; 280:112493. [PMID: 31376790 DOI: 10.1016/j.psychres.2019.112493] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 11/26/2022]
Abstract
Despite high rates of suicide in people who inject drugs, little is known about the risk factors for suicide related to childhood and family history in this population. We aimed to explore the relationship between the history of out-of-home care (OHC) and lifetime suicide attempts among people who inject opioids. Participants (N = 202) were current injection opioid users with at least one previous episode of opioid maintenance treatment. They were recruited into a double-blind randomized controlled trial for opioid substitution treatment. Secondary analysis of baseline data was conducted from the European Addiction Severity Index and basic demographics questionnaires. A total of 81 (40%) participants reported a history of living in OHC and 27% reported attempting suicide. Participants who reported living in OHC were more likely to report lifetime suicide attempts compared to those who did not live in OHC. History of OHC and suicidal ideation were significant risk factors for suicide attempts adjusting for depression and anxiety. Highest rates of lifetime attempts were among participants who lived in a group home, foster care, and/or psychiatric facility. Living in OHC during childhood was significantly associated with higher rates of suicide attempts in our sample. Greater efforts should be made to provide children from vulnerable families with environments where stable one-to-one relationships can be cultivated.
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Affiliation(s)
- Katarina Tabi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Pharmacology, Masaryk University, Brno, Czech Republic.
| | - Fiona Choi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Zamina Mithani
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kerry Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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16
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Tabi K, Randhawa AS, Choi F, Mithani Z, Albers F, Schnieder M, Nikoo M, Vigo D, Jang K, Demlova R, Krausz M. Mobile Apps for Medication Management: Review and Analysis. JMIR Mhealth Uhealth 2019; 7:e13608. [PMID: 31512580 PMCID: PMC6786858 DOI: 10.2196/13608] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/31/2019] [Accepted: 06/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background Pharmacotherapy remains one of the major interventional strategies in medicine. However, patients from all age groups and conditions face challenges when taking medications, such as integrating them into the daily routine, understanding their effects and side effects, and monitoring outcomes. In this context, a reliable medication management tool adaptable to the patient’s needs becomes critical. As most people have a mobile phone, mobile apps offer a platform for such a personalized support tool available on the go. Objective This study aimed to provide an overview of available mobile apps, focusing on those that help patients understand and take their medications. We reviewed the existing apps and provided suggestions for future development based on the concept understand and manage, instead of the conventional adhere to medication. This concept aims to engage and empower patients to be in charge of their health, as well as see medication as part of a broader clinical approach, working simultaneously with other types of interventions or lifestyle changes, to achieve optimal outcomes. Methods We performed a Web search in the iOS Apple App Store and Android Google Play Store, using 4 search terms: medication management, pill reminder, medication health monitor, and medication helper. We extracted information from the app store descriptions for each eligible app and categorized into the following characteristics: features, author affiliation, specialty, user interface, cost, and user rating. In addition, we conducted Google searches to obtain more information about the author affiliation. Results A total of 328 apps (175 Android and 153 iOS) were categorized. The majority of the apps were developed by the software industry (73%, 11/15), a minority of them were codeveloped by health care professionals (15%, 3/20) or academia (2.1%; 7/328). The most prevalent specialty was diabetes (23 apps). Only 7 apps focused on mental health, but their content was highly comprehensive in terms of features and had the highest prevalence of the education component. The most prevalent features were reminder, symptom tracker, and ability to share data with a family member or doctor. In addition, we highlighted the features considered innovative and listed practical suggestions for future development and innovations. Conclusions We identified detailed characteristics of the existing apps, with the aim of informing future app development. Ultimately, the goal was to provide users with effective mobile health solutions, which can be expected to improve their engagement in the treatment process and long-term well-being. This study also highlighted the need for improved standards for reporting on app stores. Furthermore, it underlined the need for a platform to offer health app users an ongoing evaluation of apps by health professionals in addition to other users and to provide them with tools to easily select an appropriate and trustworthy app.
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Affiliation(s)
- Katarina Tabi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Pharmacology, Masaryk University, Brno, Czech Republic
| | | | - Fiona Choi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Zamina Mithani
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Friederike Albers
- Center of Human Movement Sciences, University of Groningen, Groningen, Netherlands
| | - Maren Schnieder
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
| | - Mohammadali Nikoo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Kerry Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Regina Demlova
- Department of Pharmacology, Masaryk University, Brno, Czech Republic
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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17
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Sandhu R, Zivanovic R, Klaire S, Nikoo M, Rozylo J, Azar P. Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report. Canadian Journal of Pain 2019; 3:79-84. [PMID: 35005396 PMCID: PMC8730552 DOI: 10.1080/24740527.2019.1599279] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Due to its unique pharmacologic properties, efficacy as an analgesic, and role as a first-line medication for the treatment of opioid use disorder, sublingual buprenorphine has emerged as a treatment for patients with concurrent chronic pain and opioid use disorders. One challenge to utilizing buprenorphine is that precipitated opioid withdrawal can result if this medication is initiated in the presence of other opiates with lesser binding affinities. Micro-dosing induction regimens utilize a slower titration to avoid the need for a period of abstinence from other opiates and decrease the risk of precipitated withdrawal. Aims: The aim of this article is to present a case where a standardized micro-dosing induction regimen was used to transition a patient from other opiate analgesia to a sublingual formulation of buprenorphine/naloxone. Methods: This case took place on an inpatient neurosurgical unit of a Canadian tertiary-care city hospital. Written informed consent was collected prior to a detailed chart review. Results: Here we present a case of a postoperative neurosurgical inpatient who was referred to our team for pain management in the context of chronic pain and a past history of opioid use disorder. She was successfully transitioned to buprenorphine/naloxone, replacing all other opioid analgesia, without a period of opioid withdrawal using a micro-dosing induction regimen. Conclusions: Sublingual buprenorphine/naloxone can be safe and effective for treatment of chronic pain, particularly for those with past or current opioid use disorder. Micro-dosing provides a preferable induction strategy for patients who are not able to tolerate the requirement for moderate opioid withdrawal prior to initiation with existing regimens.
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Affiliation(s)
- Raman Sandhu
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sukhpreet Klaire
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Mohammadali Nikoo
- Addiction and Concurrent Disorders Group, Institute of Mental Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Rozylo
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Pouya Azar
- University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver General Hospital, DHCC, Vancouver, British Columbia, Canada
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18
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Nikoo M, Moazen-Zadeh E, Nikoo N, Javidanbardan S, Kazemi A, Choi F, Vogel M, Gholami A, Tavakoli S, Givaki R, Jazani M, Mohammadian F, Markazi Moghaddam N, Goudarzi N, Schutz C, Jang K, Akhondzadeh S, Krausz M. Comparing opium tincture and methadone for medication-assisted treatment of patients with opioid use disorder: Protocol for a multicenter parallel group noninferiority double-blind randomized controlled trial. Int J Methods Psychiatr Res 2019; 28:e1768. [PMID: 30714249 PMCID: PMC6877259 DOI: 10.1002/mpr.1768] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This is the first study to compare the safety and efficacy of opium tincture (OT) with methadone for treatment of opioid use disorder. METHODS In this multicenter, double-blind, noninferiority controlled trial, a stratified sample of 204 participants with opioid use disorder were recruited from community outreach, drop-in centers, and triangular clinics. Participants were excluded in case of active participation in another treatment program for opioid use disorder, hypersensitivity to trial medications, pregnancy, and certain serious medical conditions. They were randomized to receive either OT or methadone with an allocation ratio of 1:1 using a patient-centered flexible dosing strategy. Eligible participants were followed for a period of 12 weeks. Primary outcome is the difference in percentage of patients retained in the treatment. Secondary outcomes are craving, withdrawal symptoms, physical health, mental health, quality of life, and severity of substance use problems, cognitive function, safety profile, cost-effectiveness, and participants' satisfaction. Both intention-to-treat and per-protocol analyses will be conducted. The Ethics Board of the University of British Columbia and Tehran University of Medical Sciences approved the study. (clinicaltrials.gov; NCT02502175). RESULTS To be reported after final analysis. CONCLUSIONS If shown to be effective, OT will diversify the options for medication-assisted treatment of opioid use disorder.
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Affiliation(s)
- Mohammadali Nikoo
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Ehsan Moazen-Zadeh
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, University of British Columbia, Vancouver, Canada.,Psychiatric Research Center, Roozbeh Hospital, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Nikoo
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Sanam Javidanbardan
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alireza Kazemi
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, Canada.,Health Information Management and Technology Group, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fiona Choi
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Marc Vogel
- Department of Psychiatry (UPK), Division of Addictive Disorders, University of Basel, Basel, Switzerland
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Private Practice and Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Saeed Tavakoli
- Rooz-e-No Methadone Maintenance Treatment Clinic, Private Practice and Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Reza Givaki
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Jazani
- Sales, Marketing, Export, and Medical Department, Darou Pakhsh Pharmaceutical Mfg.Co., Tehran, Iran
| | - Fatemeh Mohammadian
- Pharmacovigilance & Clinical Trial Manager, Darou Pakhsh Pharmaceutical Mfg Co., Tehran, Iran
| | - Nader Markazi Moghaddam
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Nasser Goudarzi
- Department of Psychology, AJA University of Medical Sciences, Tehran, Iran
| | - Christian Schutz
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kerry Jang
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Krausz
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Azar P, Nikoo M, Miles I. Methadone to buprenorphine/naloxone induction without withdrawal utilizing transdermal fentanyl bridge in an inpatient setting-Azar method. Am J Addict 2018; 27:601-604. [DOI: 10.1111/ajad.12809] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pouya Azar
- St Paul's Hospital; Vancouver British Columbia Canada
- Vancouver General Hospital; Vancouver British Columbia Canada
- Inner City Youth; Vancouver British Columbia Canada
| | - Mohammadali Nikoo
- Addiction and Concurrent Disorders Group, Institute of Mental Health; University of British Columbia; Vancouver British Columbia Canada
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Song MJ, Ward J, Choi F, Nikoo M, Frank A, Shams F, Tabi K, Vigo D, Krausz M. A Process Evaluation of a Web-Based Mental Health Portal (WalkAlong) Using Google Analytics. JMIR Ment Health 2018; 5:e50. [PMID: 30126832 PMCID: PMC6121139 DOI: 10.2196/mental.8594] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/26/2018] [Accepted: 05/19/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite the increasing amount of research on Web-based mental health interventions with proven efficacy, high attrition rates decrease their effectiveness. Continued process evaluations should be performed to maximize the target population's engagement. Google Analytics has been used to evaluate various health-related Web-based programs and may also be useful for Web-based mental health programs. OBJECTIVE The objective of our study was to evaluate WalkAlong.ca, a youth-oriented mental health web-portal, using Google Analytics to inform the improvement strategy for the platform and to demonstrate the use of Google Analytics as a tool for process evaluation of Web-based mental health interventions. METHODS Google Analytics was used to monitor user activity during WalkAlong's first year of operation (Nov 13, 2013-Nov 13, 2014). Selected Google Analytic variables were overall website engagement including pages visited per session, utilization rate of specific features, and user access mode and location. RESULTS The results included data from 3076 users viewing 29,299 pages. Users spent less average time on Mindsteps (0 minute 35 seconds) and self-exercises (1 minute 08 seconds), which are important self-help tools, compared with that on the Screener tool (3 minutes 4 seconds). Of all visitors, 82.3% (4378/5318) were desktop users, followed by 12.7 % (677/5318) mobile phone and 5.0% (263/5318) tablet users. Both direct traffic (access via URL) and referrals by email had more than 7 pages viewed per session and longer than average time of 6 minutes per session. The majority of users (67%) accessed the platform from Canada. CONCLUSIONS Engagement and feature utilization rates are higher among people who receive personal invitations to visit the site. Low utilization rates with specific features offer a starting place for further exploration of users in order to identify the root cause. The data provided by Google Analytics, although informative, can be supplemented by other evaluation methods (ie, qualitative methods) in order to better determine the modifications required to improve user engagement. Google Analytics can play a vital role in highlighting the preferences of those using Web-based mental health tools.
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Affiliation(s)
- Michael Jae Song
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John Ward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Fiona Choi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Anastasia Frank
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Farhud Shams
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Katarina Tabi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniel Vigo
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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21
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Nikoo N, Javidanbardan S, Akm M, Hakobyan S, Nikoo M, Kwan C, Song M, Vogel M, Somers J, Krausz M. Hepatitis C prevalence and associated risk factors among individuals who are homeless and diagnosed with mental illness: At Home/Chez Soi Study, Vancouver, BC. Eur J Public Health 2018; 29:242-247. [DOI: 10.1093/eurpub/cky142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nooshin Nikoo
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Department of Family Medicine, University of British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | - Sanam Javidanbardan
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | | | - Syune Hakobyan
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada
| | - Celia Kwan
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | - Michael Song
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | - Marc Vogel
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Psychiatric University Clinics, Basel, Switzerland
| | | | - Michael Krausz
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada
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22
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Vogel M, Frank A, Choi F, Strehlau V, Nikoo N, Nikoo M, Hwang SW, Somers J, Krausz MR, Schütz CG. Chronic Pain Among Homeless Persons with Mental Illness. Pain Med 2018; 18:2280-2288. [PMID: 28177481 DOI: 10.1093/pm/pnw324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Chronic pain is an important public health issue. However, characteristics and needs of marginalized populations have received limited attention. Studies on prevalence and correlates of chronic pain among homeless persons are lacking. We assessed chronic pain among homeless persons with mental illness in the At Home/Chez Soi study. Design Cross-sectional data from a randomized controlled trial on homelessness and mental health. Setting Data collected between 2009 and 2013 in three Canadian cities. Subjects One thousand two hundred eighty-seven homeless persons with mental illness. Methods Data on chronic pain and utilization of prescribed and nonprescribed interventions was assessed using a chronic pain screening instrument. Mental illness was diagnosed with the Mini-International Neuropsychiatric Interview. Results Forty-three percent reported moderate to severe chronic pain, interfering with general daily activities (80%), sleep (78%), and social interactions (61%). Multivariate analysis indicated that increasing age and diagnoses of major depressive disorder, mood disorder with psychotic features, panic disorder, and post-traumatic stress disorder (PTSD) were independent predictors of chronic pain. Chronic pain was further associated with increased suicidality. Among participants reporting chronic pain, 64% had sought medical treatment and 56% treated pain with prescribed drugs, while 38% used illicit drugs for pain relief. Conclusions Chronic pain is very common among homeless persons with mental illness and affects activities of daily living. Clinicians treating this population should be aware of the common connections between chronic pain, depression, panic disorder, PTSD, and substance use. While the data indicate the contribution of chronic pain to complex treatment needs, they also indicate a clear treatment gap.
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Affiliation(s)
- Marc Vogel
- University of Basel, Department of Psychiatry, Basel, Switzerland.,Department of Psychiatry, Institute of Mental Health
| | | | - Fiona Choi
- Department of Psychiatry, Institute of Mental Health
| | - Verena Strehlau
- Department of Psychiatry, Institute of Mental Health.,Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nooshin Nikoo
- Department of Psychiatry, Institute of Mental Health
| | | | - Stephen W Hwang
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Julian Somers
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Michael R Krausz
- Department of Psychiatry, Institute of Mental Health.,Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian G Schütz
- Department of Psychiatry, Institute of Mental Health.,Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, British Columbia, Canada
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Nikoo M, Vogel M, Choi F, Song MJ, Burghardt J, Zafari Z, Tabi K, Frank A, Barbic S, Schütz C, Jang K, Krausz M. Employment and paid work among participants in a randomized controlled trial comparing diacetylmorphine and hydromorphone. International Journal of Drug Policy 2018; 57:18-24. [DOI: 10.1016/j.drugpo.2018.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/12/2018] [Accepted: 03/17/2018] [Indexed: 11/17/2022]
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Maremmani AGI, Bacciardi S, Somers JM, Nikoo M, Schütz C, Jang KL, Krausz M. Substance Dependence Among Bipolar, Unipolar Depression and Psychotic Homeless: A Canadian National Study. Front Psychiatry 2018; 9:701. [PMID: 30618874 PMCID: PMC6305348 DOI: 10.3389/fpsyt.2018.00701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/03/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction: Homeless individuals are often mischaracterized as members of a homogeneous population that suffers from a wide mental health and addiction issues, with little consideration of potentially important differences within or between samples. The aim of the present study was to investigate the comorbidy of alcohol and/or substance dependence (ASD) and major psychiatric diagnoses (bipolar disorder, unipolar depression, and psychotic disorder) in a large Canadian sample of homeless individuals, and to examine potential sources of variability including location and ethnicity. Materials and Methods: A sample of 1,585 homeless individuals were assessed for alcohol and/or substance dependence and bipolar disorder, unipolar depression and psychotic disorder with the Mini-International Neuropsychiatric Interview (version 6.0). Regional and ethnic differences in major psychiatric diagnoses between homeless with and without ASD were examined using univariate (i.e., chi-square) and multivariate (i.e., logistic regression) statistics. Results: Members of the sample with ASD were found to be younger, Aboriginal, less well-educated, and born in the Americas. They were more significantly more prevalent in Western Canada and less prevalent in Central and Eastern Canada. The odds of having ASD were higher among people affected by bipolar disorder and (to a less extent) unipolar depression. Limitations: Data collected were self-reported and no urinalyses were performed. We considered diagnosis of ASD according to the previous 12 months only. Conclusions: Homeless people with major mental illness are at high risk for concurrent ASD, however the prevalence of ASD varies significantly between cities, and based on ethnicity and specific psychiatric diagnosis (with greater prevalence in individuals affected by bipolar disorder and, to a less extent, unipolar depression). Clinicians, administrators and policy makers should develop and deliver services based on careful assessment of the local population.
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Affiliation(s)
- Angelo G I Maremmani
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy.,Local Health Unit (Versilia Zone), Department of Psychiatry, North-Western Tuscany Region, Viareggio, Italy
| | - Silvia Bacciardi
- "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Julian M Somers
- Somers Research Group, Faculty of Health Science, Simon Fraser University, Barnaby, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Christian Schütz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael Krausz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Nikoo M, Nikoo N, Anbardan SJ, Amiri A, Vogel M, Choi F, Sepehry AA, Bagheri Valoojerdi AH, Jang K, Schütz C, Akhondzadeh S, Krausz M. Tincture of opium for treating opioid dependence: a systematic review of safety and efficacy. Addiction 2017; 112:415-429. [PMID: 27740713 DOI: 10.1111/add.13628] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/15/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Recently, there has been a growing interest in using opium tincture (OT) for treating opioid dependence in certain regions. We aimed to assess the evidence on its safety and efficacy for this indication. METHODS We searched several databases (CENTRAL, Medline, EMBASE, Web of Science, PsychINFO, ProQuest Dissertation and Theses Database, Iran Medex, clinicaltrials.gov and who.int/trialsearch) with no language or publication date limitations. Two reviewers selected randomized controlled trials (RCT), cohort/case-control/cross-sectional studies and case-series on safety or efficacy of OT for treating opioid dependence and then extracted reported measures of mentioned outcomes from selected studies. We used the Effective Public Health Practice Project (EPHPP) Quality Assessment tool for appraisal. RESULTS From nine selected studies; in three RCTs and one cohort analytical analysis on detoxification, 110 patients were treated with 15-140 morphine equivalents/day (mEq/d) of OT; in four prospective and one retrospective uncontrolled case-series on long-term/maintenance treatment, 570 patients were treated with 100-400 mEq/d of OT. Only two studies on detoxification included a comparison: one concluded equal efficacy of OT and methadone in suppressing withdrawal symptoms (P = 0.32) and the other concluded OT to be less efficacious than buprenorphine/naloxone in suppressing withdrawal [OT = 12.20, 95% confidence interval (CI) = 11.00, 13.40]; control: 5.20 (95% CI = 4.69, 5.71) and craving (OT = 303.0, 95% CI = -144.664, 750.664; control: 0.0) but not significantly different (P = 0.26) in retaining participants in treatment. No major adverse events were reported. CONCLUSIONS Conclusive recommendations about the safety and efficacy of opium tincture for treating opioid dependence are not possible at this time.
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Affiliation(s)
- Mohammadali Nikoo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada
| | - Nooshin Nikoo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sanam Javid Anbardan
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshar Amiri
- Roozbeh substance use treatment clinic, Tehran, Iran
| | - Marc Vogel
- Psychiatric University Hospital, Basel, Switzerland
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada
| | - Amir Ali Sepehry
- Department of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Kerry Jang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada
| | - Christian Schütz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada
| | - Shahin Akhondzadeh
- Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada
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Assareh M, Davari Ashtiani R, Khademi M, Jazayeri S, Rai A, Nikoo M. Efficacy of Polyunsaturated Fatty Acids (PUFA) in the Treatment of Attention Deficit Hyperactivity Disorder. J Atten Disord 2017; 21:78-85. [PMID: 23160488 DOI: 10.1177/1087054712463962] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to investigate the efficacy of polyunsaturated fatty acids (PUFAs) as an adjuvant treatment in patients with ADHD receiving methylphenidate as well as its side effects. METHOD This randomized clinical trial was conducted on 40 ADHD patients aged between 6 and 12 years. Both treatment and placebo groups received methylphenidate. Treatment arm also received omega-6 once daily. The Parent ADHD Rating Scale was used to evaluate disease improvement. RESULTS The Parent ADHD Rating Scale scores of the two groups were similar at baseline. Although total score and scores of three categories decreased significantly in both groups, total score and scores of inattention, hyperactivity, and impulsivity were not significantly different between the groups. CONCLUSION The results did not support the efficacy of PUFA in the treatment of ADHD, and adding PUFAs to the therapeutic regimen of ADHD is not recommended at the moment.
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Affiliation(s)
- Marzieh Assareh
- 1 Alborz University of Medical Sciences, Karaj, Iran.,6 Department of Psychiatry, Imam Hossein Hospital and Behavioral Sciences Research Center Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rozita Davari Ashtiani
- 2 Shahid Beheshti University of Medical Sciences, Tehran, Iran.,6 Department of Psychiatry, Imam Hossein Hospital and Behavioral Sciences Research Center Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Khademi
- 2 Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Alireza Rai
- 4 Kermanshah University of Medical Sciences, Iran
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Bolea I, Ordorica-Garcia G, Nikoo M, Carbo M. Techno-economics of CCS in Oil Sands Thermal Bitumen Extraction: Comparison of CO2 Capture Integration Options. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.egypro.2013.06.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Metastases to the skin from carcinoma arising in other organs are uncommon, yet they may be the first presentation of neoplastic disease. They usually originate from primary tumours in the breast, lung or colon. Skin metastases from esophageal adenocarcinoma are extremely rare. A unique case of an otherwise healthy patient who presented with a small, painless, mobile, clinically localized facial skin nodule is reported. A biopsy revealed metastatic adenocarcinoma, and subsequent investigations detected the primary tumour in the esophagus, despite no symptoms.
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Affiliation(s)
- F Fereidooni
- Pathology Department, Cancer Institute, Tehran University of Medical Sciences and Shahriar Hospital, Tehran, Iran.
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