1
|
Kathiresan P, Patel V, Jangra J, Chattopadhyay A, Abdus S, Jadhav M, Rao R, Arya A, Bansal PD, Chinggouman C, Bhad R, Ambekar A, Agrawal A, Chatterjee B, Yadav D. Experience of patients on methadone maintenance treatment receiving take-home methadone doses during COVID-19 pandemic: A multi-site study from India. Asian J Psychiatr 2024; 95:103979. [PMID: 38442535 DOI: 10.1016/j.ajp.2024.103979] [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] [Received: 12/18/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Methadone take-home doses for opioid dependence treatment are strictly regulated due to diversion and overdose concerns, so patients must visit the clinic daily for dispensing. This was also done in India until the COVID-19 pandemic, when lockdown restriction compelled take- home dispensing of methadone. This study examined experience of patients who received take- home methadone during COVID-19 pandemic in India. METHODS Observational, cross-sectional design. We contacted all consenting methadone centres in India during the lockdown and selected those that provided take-home doses for the study. Patients who received daily methadone before the lockdown and take-home doses after were interviewed using a study-specific questionnaire. RESULTS The study had 210 participants. Take-home methadone was dispensed for 2.5 days on average in each dispensing. When taking methadone at home, 3.3% split their dose 25% took less than the prescribed dose to save it for a rainy days, and 3.3% reported an overdose episode. Adherence improved in 58.6% participants after take-home methadone. Participants perceived many benefits from take-home methadone such as reduced hospital visits and travel time to collect methadone, improvement in work, and financial savings. About 54.3% participants reported storing their take-home doses safely, and 1.9% reported that their family consumed methadone by mistake. CONCLUSIONS Take-home methadone was found to be beneficial to most participants in terms of time saved and improved productivity. Preconceived concerns of providing take-home methadone in terms of its overdose, diversion, or accidental ingestion by others are not commonly seen when individuals are provided take-home doses of methadone.
Collapse
Affiliation(s)
| | - Vinit Patel
- All India Institute of Medical Sciences, New Delhi, India
| | - Jaswant Jangra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sabir Abdus
- Medical Officer, Manipur Health Services, Government of Manipur, India
| | - Monali Jadhav
- All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Rao
- All India Institute of Medical Sciences, New Delhi, India.
| | - Amit Arya
- Nodal Officer, Drug Treatment Clinic, King George Medical University, Lucknow, India
| | - Pir Dutt Bansal
- Nodal Officer, Drug Treatment Clinic, Civil Hospital, Bathinda, India
| | | | - Roshan Bhad
- All India Institute of Medical Sciences, New Delhi, India
| | - Atul Ambekar
- All India Institute of Medical Sciences, New Delhi, India
| | - Alok Agrawal
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Deepak Yadav
- All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Sason A, Adelson M, Schreiber S, Peles E. Fentanyl abuse proportion in methadone maintenance treatment, and patients' knowledge about its risks. J Psychiatr Res 2024; 173:254-259. [PMID: 38554621 DOI: 10.1016/j.jpsychires.2024.03.047] [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] [Received: 12/27/2023] [Revised: 02/12/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Fentanyl is not yet routinely monitored among methadone maintenance treatment (MMT) patients in Israel. We aimed 1. to evaluate urine fentanyl proportion changes over 3 years and characterize patients' characteristics 2. To study patients' self-report on fentanyl usage, and compare knowledge about fentanyl risk, before and following brief educational intervention. METHODS Fentanyl in the urine of all current MMT patients was tested every 3 months year between 2021 and 2023, and patients with positive urine fentanyl were characterized. Current patients were interviewed using a fentanyl knowledge questionnaire (effects, indications, and risks) before and following an explanation session. RESULTS Proportion of fentanyl ranged between 9.8 and 15.1%, and patients with urine positive for fentanyl (September 2023) were characterized as having positive urine for pregabalin, cocaine, and benzodiazepine (logistic regression). Of the current 260 patients (87% compliance), 78(30%) self-reported of fentanyl lifetime use ("Ever"), and 182 "never" use. The "Ever" group had higher Knowledge scores than the "Never", both groups improved following the explanatory session (repeated measure). The "Ever" group patients were found with urine positive for cannabis and benzodiazepine on admission to MMT, they were younger, did not manage to gain take-home dose privileges and had a higher fentanyl knowledge score (logistic regression). CONCLUSIONS In the absence of routine fentanyl tests, a high knowledge score, shorter duration in MMT, benzodiazepine usage on admission, and current cannabis usage, may hint of the possibility of fentanyl abuse.
Collapse
Affiliation(s)
- Anat Sason
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Schreiber
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University Faculty of Medical and Health Sciences, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University Faculty of Medical and Health Sciences, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
3
|
Zorani S, Peles E. Is pain empathy associated with pain indices and trauma history? A comparison between patients receiving methadone maintenance treatment and healthy controls. J Psychiatr Res 2024; 171:286-295. [PMID: 38335639 DOI: 10.1016/j.jpsychires.2024.02.007] [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] [Received: 12/13/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND To study whether pain empathy and theory of mind (ToM) are related to pain indices and trauma experience, we studied opioid users receiving methadone maintenance treatment (MMT), a population with a history of traumas and a high prevalence of chronic pain. METHODS MMT patients (n = 53), substance abuse-free, with no impaired cognition (Montreal Cognitive Assessment (MoCA) ≥24), were compared to healthy controls (HC) matched by age and gender (n = 66). All participants were assessed using Reading the Mind in the Eyes (RMET) for ToM, empathy (Interpersonal Reactivity Index [IRI], Empathy Quotient Scale for Adults [EQ60]), and Pain Empathy [PE task]). An algometer was used for pain pressure threshold, and supra-pain threshold was rated using a visual analog scale (VAS). Catastrophizing, McGill pain, Negative life events (NLE), and MoCA questionnaires were administered. Substance abuse was tested in the urine of MMT patients and self-reported by HC. RESULTS MMT, compared to HC, were less educated with more NLE and a lower RMET (logistic regression). Groups had comparable empathy and pain indices, except for higher supra-threshold VAS rating and catastrophizing in univariate analyses. Pain empathy (PE) correlated with NLE in HC, and in MMT, with catastrophizing, which correlated with NLE, perceived stress, and pain intensity. Higher empathy was observed in 18 participants with a history of sexual abuse (83.3 % belong to the MMT group). CONCLUSIONS Pain Empathy was found to be associated with personal suffering experience in both groups, as reflected by correlations with NLE in HC and with catastrophizing, which correlates with NLE, stress, and pain intensity, in MMT.
Collapse
Affiliation(s)
- Shlomit Zorani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; D Miriam and Sheldon G. Adelson Clinic for Drug Use, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Einat Peles
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; D Miriam and Sheldon G. Adelson Clinic for Drug Use, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Chung YCE, Tung YC, Wang SC, Huang CL, Chen LY, Chen WJ. Assessing the impact of public funding in alleviating participant reduction and improving the retention rate in methadone maintenance treatment clinics in Taiwan: an interrupted time series analysis. Implement Sci 2024; 19:18. [PMID: 38389082 PMCID: PMC10885479 DOI: 10.1186/s13012-024-01351-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Given the steady decline in patient numbers at methadone maintenance treatment (MMT) clinics in Taiwan since 2013, the government initiated Patients' Medical Expenditure Supplements (PMES) in January 2019 and the MMT Clinics Accessibility Maintenance Program (MCAM) in September 2019. This study aims to evaluate the impact of the PMES and MCAM on the enrollment and retention of patients attending MMT clinics and whether there are differential impacts on MMT clinics with different capacities. METHODS The monthly average number of daily participants and 3-month retention rate from 2013 to 2019 were extracted from MMT databases and subjected to single interrupted time series analysis. Pre-PMES (from February 2013 to December 2018) was contrasted with post-PMES, either from January 2019 to December 2019 for clinics funded solely by the PMES or from January 2019 to August 2019 for clinics with additional MCAM. Pre-MCAM (from January 2019 to August 2019) was contrasted with post-MCAM (from September 2019 to December 2019). Based on the monthly average number of daily patients in 2018, each MMT clinic was categorized as tiny (1-50), small (51-100), medium (101-150), or large (151-700) for subsequent stratification analysis. RESULTS In terms of participant numbers after the PMES intervention, a level elevation and slope increase were detected in the clinics at every scale except medium in MMT clinics funded solely by PMES. In MMT clinics with subsequent MCAM, a level elevation was only detected in small-scale clinics, and a slope increase in the participant numbers was detected in tiny- and small-scale clinics. The slope decrease was also detected in medium-scale clinics. In terms of the 3-month retention rate, a post-PMES level elevation was detected at almost every scale of the clinics, and a slope decrease was detected in the overall and tiny-scale clinics for both types of clinics. CONCLUSIONS Supplementing the cost of a broad treatment repertoire enhances the enrollment of people with heroin use in MMTs. Further funding of human resources is vital for MMT clinics to keep up with the increasing numbers of participants and their retention.
Collapse
Affiliation(s)
- Yu-Chu Ella Chung
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chieh-Liang Huang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Lian-Yu Chen
- Department of Mental Health, Ministry of Health and Welfare, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei J Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
5
|
Tang X, Xiong W, Chen W, Wang C, Wang H, Li B, Zhang Z, Ling L. Benefits and challenges experienced by participants on long-term methadone maintenance treatment in China: a qualitative study. BMC Med 2024; 22:18. [PMID: 38185665 PMCID: PMC10773040 DOI: 10.1186/s12916-023-03203-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Methadone maintenance treatment (MMT) has been implemented in China for nearly two decades, with a significant decrease in the number of participants in recent years. However, there is a lack of comprehensive research focusing on the long-term effectiveness in the context of this decline, especially from the perspectives of MMT participants themselves. This study aims to address this gap by examining the benefits and challenges experienced by long-term MMT participants in China, to uncover potential causes of the decrease in participant numbers and to improve the effectiveness of the program. METHODS We conducted semi-structured interviews with 21 long-term MMT participants (treatment duration ≥ 5 years) recruited through purposive sampling from 6 MMT clinics in the Guangdong Province, China, between December 2021 and August 2022. Thematic analysis was employed to analyze the transcribed interviews. Two analysts independently coded the data, and a third researcher double-coded 20% of transcripts to ensure intercoder reliability. RESULTS Overall, participants corroborated the notable decline in MMT participants during their long-term MMT, citing death, arrest, and self-perceived abstinence from heroin, as their perceived driving factors. They reported positive changes in their health, family relationships, and social functioning. However, they identified economic hardship as their greatest challenge associated with MMT, further exacerbated by other barriers including the conflict of clinic opening hours and working schedules, discrimination from employers, and COVID-19-related restrictions. Additionally, participants identified issues with dose adjustment and emergency treatment continuation. CONCLUSIONS This study outlines the overall improvement in the quality of life of long-term MMT participants. However, it highlights the need for official guidelines for dose adjustment and emergency treatment continuation as well as the provision of health education, job referrals, and flexibility of clinic opening times to facilitate the return to society receiving participants. Establishing a follow-up mechanism for those receiving MMT is also recommended to prevent relapses to heroin and other illicit substances.
Collapse
Affiliation(s)
- Xijia Tang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2Nd Road, Yuexiu District, Guangzhou, Guangdong, PR China, 510080
| | - Wenxue Xiong
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2Nd Road, Yuexiu District, Guangzhou, Guangdong, PR China, 510080
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2Nd Road, Yuexiu District, Guangzhou, Guangdong, PR China, 510080
| | - Chijie Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2Nd Road, Yuexiu District, Guangzhou, Guangdong, PR China, 510080
| | - Hexuan Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2Nd Road, Yuexiu District, Guangzhou, Guangdong, PR China, 510080
| | - Boyu Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2Nd Road, Yuexiu District, Guangzhou, Guangdong, PR China, 510080
| | - Zirong Zhang
- School of Mathematics, Sun Yat-Sen University, Guangzhou, Guangdong, PR China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2Nd Road, Yuexiu District, Guangzhou, Guangdong, PR China, 510080.
- Clinical Research Design Division, Clinical Research Center, Sun-Yat Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China, 510120.
| |
Collapse
|
6
|
Lv Q, Zhang M, Jiang H, Liu Y, Zhao S, Xu X, Zhang W, Chen T, Su H, Zhang J, Wang H, Zhang J, Feng Y, Li Y, Li B, Zhao M, Wang Z. Metabolic and functional substrates of impulsive decision-making in individuals with heroin addiction after prolonged methadone maintenance treatment. Neuroimage 2023; 283:120421. [PMID: 37879424 DOI: 10.1016/j.neuroimage.2023.120421] [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: 04/20/2023] [Revised: 10/08/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
Elevated impulsivity has been frequently reported in individuals with opioid addiction receiving methadone maintenance therapy (MMT), but the underlying neural mechanisms and cognitive subprocesses are not fully understood. We acquired functional magnetic resonance imaging (fMRI) data from 37 subjects with heroin addiction receiving long-term MMT and 33 healthy controls who performed a probabilistic reversal learning task, and measured their resting-state brain glucose using fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET). Subjects receiving MMT exhibited significantly elevated self-reported impulsivity, and computational modeling revealed a marked impulsive decision bias manifested as switching more frequently without available evidence. Moreover, this impulsive decision bias was associated with the dose and duration of methadone use, irrelevant to the duration of heroin use. During the task, the switch-related hypoactivation in the left rostral middle frontal gyrus was correlated with the impulsive decision bias while the function of reward sensitivity was intact in subjects receiving MMT. Using prior brain-wide receptor density data, we found that the highest variance of regional metabolic abnormalities was explained by the spatial distribution of μ-opioid receptors among 10 types of neurotransmitter receptors. Heightened impulsivity in individuals receiving prolonged MMT is manifested as atypical choice bias and noise in decision-making processes, which is further driven by deficits in top-down cognitive control, other than reward sensitivity. Our findings uncover multifaceted mechanisms underlying elevated impulsivity in subjects receiving MMT, which might provide insights for developing complementary therapies to improve retention during MMT.
Collapse
Affiliation(s)
- Qian Lv
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Miao Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yilin Liu
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, China
| | - Shaoling Zhao
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, China
| | - Xiaomin Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenlei Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hang Su
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiangtao Zhang
- Tongde Hospital of Zhejiang Province (Zhejiang Mental Health Center), Zhejiang Office of Mental Health, Hangzhou, China
| | - Heqiu Wang
- Tongde Hospital of Zhejiang Province (Zhejiang Mental Health Center), Zhejiang Office of Mental Health, Hangzhou, China
| | - Jianmin Zhang
- Tongde Hospital of Zhejiang Province (Zhejiang Mental Health Center), Zhejiang Office of Mental Health, Hangzhou, China
| | - Yuanjing Feng
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Yongqiang Li
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Zheng Wang
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China.
| |
Collapse
|
7
|
Nguyen HTT, Dinh DX. Opioid relapse and its predictors among methadone maintenance patients: a multicenter, cross-sectional study in Vietnam. Harm Reduct J 2023; 20:136. [PMID: 37717002 PMCID: PMC10505306 DOI: 10.1186/s12954-023-00872-0] [Citation(s) in RCA: 1] [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: 04/16/2023] [Accepted: 09/14/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Opioid relapse, one of the common and severe problems during methadone maintenance treatment, can give rise to poor treatment outcomes. This study measured the opioid relapse rate and its associated factors among methadone maintenance patients in Vietnam. METHODS Information about the demographic characteristics and social support of 655 patients was collected through direct interviews. Medical records were used to gather data on treatment characteristics. Relapse was determined via urine opioid test results. RESULTS The overall relapse rate of patients during treatment was 13.1%. According to the multivariate logistic regression model, living in mountainous areas (adjusted odds ratio (aOR) = 3.63, 95% CI 1.90-7.46) and long duration of drug use in the past (aOR = 1.06, 95% CI 1.03-1.09) were associated with an increase in the odds of opioid relapse. By contrast, living with many family members (aOR = 0.69, 95% CI 0.55-0.85), having longer treatment time (aOR = 0.80, 95% CI 0.73-0.87), and completely adhering to treatment (aOR = 0.38, 95% CI 0.23-0.64) were protective for opioid relapse. As per the univariate analyses, the odds of opioid relapse declined by 25% for each increase of one close friend or relative (OR = 0.75, 95% CI 0.66-0.86). Regarding social support (range score: 0-100), each additional increase of one score was associated with a 1% decrease in the odds of opioid relapse (OR = 0.99, 95% CI 0.98-0.99). Patient sex, education level, occupation type, patient's monthly income, family's monthly income, the number of previous treatments, daily methadone dose, comorbidity, and received antiretroviral therapy were not associated with opioid relapse among patients (p > 0.05). CONCLUSIONS Residence, the role of family and social support, and treatment adherence should be paid more attention to guarantee and enhance the success of methadone maintenance treatment.
Collapse
Affiliation(s)
- Huong Thi Thanh Nguyen
- Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi City, 111000, Vietnam
| | - Dai Xuan Dinh
- Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi City, 111000, Vietnam.
| |
Collapse
|
8
|
Wu LT, Mannelli P, John WS, Anderson A, Schwartz RP. Pharmacy-based methadone treatment in the US: views of pharmacists and opioid treatment program staff. Subst Abuse Treat Prev Policy 2023; 18:55. [PMID: 37697326 PMCID: PMC10496162 DOI: 10.1186/s13011-023-00563-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The US federal regulations allow pharmacy administration and dispensing of methadone for opioid use disorder (PADMOUD) to increase the capability of opioid treatment programs (OTPs) in providing methadone maintenance treatment (MMT) for opioid use disorder (OUD) as part of a medication unit. However, there is a lack of research data from both pharmacy and OTP staff to inform the implementation of PADMOUD. METHODS Staff of a pharmacy (n = 8) and an OTP (n = 9) that participated in the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were recruited to participate in this qualitative interview study to explore implementation-related factors for PADMOUD. Each interview was recorded and transcribed verbatim. NVivo was used to help identify themes of qualitative interview data. The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to guide the coding and interpretation of data. RESULTS Six pharmacy staff and eight OTP staff (n = 14) completed the interview. Results based on PARIHS domains were summarized, including evidence, context, and facilitation domains. Participants perceived benefits of PADMOUD for patients, pharmacies, OTPs, and payers. PADMOUD was considered to increase access for stable patients, provide additional patient service opportunities and revenues for pharmacies/pharmacists, enhance the capability of OTPs to treat more new patients, and reduce patients' cost when receiving medication at a pharmacy relative to an OTP. Both pharmacy and OTP staff were perceived to be supportive of the implementation of PADMOUD. Pharmacy staff/pharmacists were perceived to need proper training on addiction and methadone as well as a protocol of PADMOUD to conduct PADMOUD. Facilitators include having thought leaders to guide the operation, a certification program to ensure proper training of pharmacy staff/pharmacist, having updated pharmacy service software or technology to streamline the workflow of delivering PADMOUD and inventory management, and reimbursement for pharmacists. CONCLUSION This study presents the first findings on perspectives of PADMOUD from both staff of a community pharmacy and an OTP in the US. Finding on barriers and facilitators are useful data to guide the development of strategies to implement PADMOUD to help address the US opioid crisis.
Collapse
Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
- Duke Institute For Brain Sciences, Duke University, Durham, NC, USA.
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | | |
Collapse
|
9
|
Peles E, Kim Y, Sason A, Adelson M, Levran O. Predictors of treatment retention and survival among methadone-maintained patients: A possible role for a functional delta opioid receptor gene variant. Drug Alcohol Depend 2023; 250:110903. [PMID: 37531661 PMCID: PMC11015812 DOI: 10.1016/j.drugalcdep.2023.110903] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/08/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Variants in the delta opioid receptor gene, OPRD1, were associated with opioid use disorder and response to treatment. The study goal was to assess whether OPRD1 variants predict survival and retention in methadone maintenance treatment (MMT). METHODS Retention and survival time since admission (June 1993 - June 2022) until leaving treatment (for retention), or at the end of follow-up (Dec 2022) (for retention and survival) were analyzed in 488 patients. Vital data was taken from a national registry. Predictors were estimated using Kaplan-Meier and Cox regression models. RESULTS Longer retention and survival were found for carriers of the T allele of SNP rs204076. This SNP is associated with OPRD1 expression in cortex (GTEx). Carriers of the T allele (n = 251) survived longer compared to non-carriers (24.7 vs. 20.2 years, p = 0.005) and had longer retention (11.2 vs. 8.8 years, p = 0.04). Multivariate analysis identified the T allele as an independent predictor of longer survival time (p = 0.003) and retention (p = 0.009). Additional predictors for survival were no benzodiazepine use after one year in MMT, no hepatitis C, <20 years of opioid usage, and admission at age < 30. Additional predictors for longer retention were no use of other drugs except opioids on admission, and no drugs at one year, as well as methadone dose ≥ 100mg/d at one year and axis I & II DSM-5 psychiatric diagnosis. CONCLUSIONS The OPRD1 SNP rs204076 and non-genetic predictors contribute to survival time and retention in MMT patients.
Collapse
Affiliation(s)
- Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment, and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Yuli Kim
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY, United States
| | - Anat Sason
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment, and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment, and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orna Levran
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY, United States
| |
Collapse
|
10
|
Wu LT, John WS, Mannelli P, Morse ED, Anderson A, Schwartz RP. Patient perspectives on community pharmacy administered and dispensing of methadone treatment for opioid use disorder: a qualitative study in the U.S. Addict Sci Clin Pract 2023; 18:45. [PMID: 37533071 PMCID: PMC10398989 DOI: 10.1186/s13722-023-00399-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Pharmacy administration and dispensing of methadone treatment for opioid use disorder (PADMOUD) may address inadequate capability of opioid treatment programs (OTPs) in the US by expanding access to methadone at community pharmacies nationally. PADMOUD is vastly underutilized in the US. There is no published US study on OUD patients' perspectives on PADMOUD. Data are timely and needed to inform the implementation of PADMOUD in the US to address its serious opioid overdose crisis. METHODS Patient participants of the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were interviewed to explore implementation-related factors for PADMOUD. All 20 participants of the parent study were invited to participate in this interview study. Each interview was recorded and transcribed verbatim. Thematic analysis was conducted to identify emergent themes. RESULTS Seventeen participants completed the interview. Patients' perspectives on PADMOUD were grouped into five areas. Participants reported feasibility of taking the tablet formulation of methadone at the pharmacy and identified benefits from PADMOUD (e.g., better access, efficiency, convenience) compared with usual care at the OTP. Participants perceived support for PADMOUD from their family/friends, OTP staff, and pharmacy staff. PADMOUD was perceived to be a great option for stable patients with take-home doses and those with transportation barriers. The distance (convenience), office hours, and the cost were considered factors most influencing their decision to receive methadone from a pharmacy. Nonjudgmental communication, pharmacists' training on methadone treatment, selection of patients (stable status), workflow of PADMOUD, and protection of privacy were considered key factors for improving operations of PADMOUD. CONCLUSION This study presents the first findings on patient perspectives on PADMOUD. Participants considered pharmacies more accessible than OTPs, which could encourage more people to receive methadone treatment earlier and help transition stable patients from an OTP into a local pharmacy. The findings have timely implications for informing implementation strategies of PADMOUD that consider patients' views and needs.
Collapse
Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
- Duke Institute For Brain Sciences, Duke University, Durham, NC, USA.
| | | | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | | |
Collapse
|
11
|
Cui Z, Hayashi K, Bach P, Milloy MJ, Kerr T. Crystal methamphetamine use and methadone maintenance treatment dissatisfaction: A prospective cohort study in Vancouver, Canada. J Subst Use Addict Treat 2023; 151:208956. [PMID: 36804867 PMCID: PMC10810610 DOI: 10.1016/j.josat.2023.208956] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/01/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patient satisfaction is key to the success of methadone maintenance treatment (MMT), and yet how MMT satisfaction is affected by the increasingly common use of crystal methamphetamine among people receiving opioid treatment remains poorly understood. We aimed to assess the association between crystal methamphetamine use and MMT dissatisfaction. METHODS We employed generalized estimating equations to examine the relationship between crystal methamphetamine use and MMT dissatisfaction among patients receiving MMT within two prospective cohorts in Vancouver, Canada, between December 2016 and March 2020. RESULTS Of the 836 participants receiving MMT, the median age was 47 years, and 55.3 % self-identified as male at baseline. In a multivariable model, those reporting more than weekly crystal methamphetamine use were more likely to report MMT dissatisfaction (Odds ratio: 1.40, 95 % confidence interval: 1.05-1.86) compared to those reporting less than monthly crystal methamphetamine use. CONCLUSIONS Among our sample of people receiving MMT, we noted a positive association of frequent crystal methamphetamine use with MMT dissatisfaction. Our study suggests a need for novel strategies to better understand and address frequent methamphetamine use among those receiving MMT, particularly given recent shifts in substance use patterns involving the rising co-use of methamphetamines and opioids.
Collapse
Affiliation(s)
- Zishan Cui
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver V6Z 2A9, BC, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver V6Z 2A9, BC, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver V6Z 2A9, BC, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - M J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver V6Z 2A9, BC, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver V6Z 2A9, BC, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
| |
Collapse
|
12
|
Meyer M, Gygli F, Westenberg JN, Schmid O, Strasser J, Lang UE, Dürsteler KM, Vogel M. Benzodiazepine use, quality of life and psychiatric symptom burden in oral and injectable opioid agonist treatment: a cross-sectional study. Addict Sci Clin Pract 2023; 18:43. [PMID: 37464432 PMCID: PMC10354905 DOI: 10.1186/s13722-023-00397-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Use of benzodiazepines (BZD) in patients receiving opioid agonist treatment (OAT) is common and associated with a variety of negative health and social outcomes. This cross-sectional study investigates the impact of BZD use in OAT patients on their quality of life (QoL). METHODS A convenience sample of patients receiving oral OAT or heroin-assisted treatment in two outpatient centres in Basel, Switzerland was investigated. Participants (n = 141) completed self-report questionnaires on psychiatric symptoms and psychological distress (The Symptom Checklist 27, SCL-27), depressive state (German version of the Center for Epidemiological Studies Depression Scale), quality of life (Lancashire Quality of Life Profile, LQOLP) and use of BZD and other drugs (self-report questionnaire). Substance use was assessed by urine toxicology testing. RESULTS In bivariate analysis, total QoL scores were significantly lower for lifetime, current, and prolonged BZD users compared to participants without the respective use patterns. There was no significant relationship between BZD dose and QoL. In multivariable linear regression models controlling for psychiatric symptom load and depressive state, only lifetime use predicted lower QoL, whereas other BZD use patterns were not significantly associated. CONCLUSIONS The association of lower QoL and BZD use in OAT patients is strongly confounded by co-occurring depressive state and psychiatric symptoms. Careful diagnosis and treatment of co-occurring mental disorders in OAT is paramount to improve QoL in this patient population and may also help reduce BZD use.
Collapse
Affiliation(s)
- Maximilian Meyer
- University of Basel Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
| | - Ferdinand Gygli
- University of Basel Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
- Cantonal Hospital Baden, Baden, Switzerland
| | - Jean N Westenberg
- University of Basel Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Otto Schmid
- University of Basel Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Johannes Strasser
- University of Basel Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Undine E Lang
- University of Basel Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Kenneth M Dürsteler
- University of Basel Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
- Department for Psychiatry, Psychotherapy and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Marc Vogel
- University of Basel Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| |
Collapse
|
13
|
Nong T, Hodgkin D, Trang NT, Shoptaw SJ, Li MJ, Hai Van HT, Le G. A review of factors associated with methadone maintenance treatment adherence and retention in Vietnam. Drug Alcohol Depend 2023; 243:109699. [PMID: 36603363 PMCID: PMC9851667 DOI: 10.1016/j.drugalcdep.2022.109699] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Starting in 2008, Vietnam's national MMT program expanded quickly, but it is struggling with increasing attrition rates and poor adherence among patients. Several studies have reported on MMT retention and adherence, but no overview has yet been published. The objective of this study is to fill that gap and to review factors associated with retention and adherence in MMT in Vietnam. METHODS A systematic search was conducted using databases of literature - Pubmed, Cochrane, Scopus, Academic search premiere, and SoINDEX. Peer-reviewed empirical studies with full text in English discussing retention attrition and adherence regarding MMT in Vietnam were selected. The results were synthesized using qualitative methods. RESULTS Adherence and retention rates varied among the 11 included studies. In general, patients in mountainous provinces had lower adherence and retention rates than those in big cities. Retention rates decreased with the studies' follow-up period and had a downward trend over time. Factors associated with adherence and retention can be classified into three groups: individual, community, and institutional factors. Important individual factors areage, education, awareness of MMT and HIV, and co-occurring disorders and comorbidities. Stigma is the major community risk factor, and methadone daily dose, the distance between home and clinic, and clinic's service hours are the three most important institutional factors. CONCLUSIONS The literature reviewed identifies important factors associated with MMT adherence and retention in Vietnam. The findings suggest further research exploring both subjective and objective factors and more policies to remove social and structural barriers to enhance treatment outcomes.
Collapse
Affiliation(s)
- Thuong Nong
- The Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453, the United States of America.
| | - Dominic Hodgkin
- The Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453, the United States of America
| | - Nguyen Thu Trang
- Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Viet Nam
| | - Steven J Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, the United States of America
| | - Michael J Li
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, the United States of America
| | | | - Giang Le
- Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Viet Nam
| |
Collapse
|
14
|
Chen Z, Tang X, Xu C, Wang C, Ling L. Exploring factors jointly associated with recurrent relapse and dropout of methadone maintenance treatment clients in Guangdong, China: A retrospective cohort study. Drug Alcohol Depend 2023; 243:109739. [PMID: 36535097 DOI: 10.1016/j.drugalcdep.2022.109739] [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] [Received: 06/30/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Clients receiving methadone maintenance treatment (MMT) may experience multiple relapses, which may lead to dropout. However, previous studies mostly only explored the influencing factors of relapse or dropout separately. In this study, we investigated the influencing factors jointly associated with both recurrent relapse and dropout. METHODS This study was conducted in 16 MMT clinics in Guangdong, China. Data on the clients' demographic characteristics; drug-related behavior; HIV, HCV, and urine morphine test results; and daily methadone doses were collected. The outcomes were time to recurrent relapse and time to dropout. A joint frailty model was used to explore factors jointly associated with recurrent relapse and dropout. The hazard ratios (HRs) of the covariates in the multivariable model were adjusted, with HR > 1 indicating a faster time to recurrent relapse and dropout. RESULTS Among 1539 clients, 39.5% had ≥ 2 relapse events, and 90.8% of the clients dropped out. A high attendance rate was protective for recurrent relapse (HR50-80%=0.63, 95% CI: 0.51, 0.79; HR>80%=0.35, 95% CI: 0.28, 0.44) and dropout (HR50-80%=0.56, 95% CI: 0.47, 0.68; HR>80%=0.27, 95% CI: 0.23, 0.33). Being married (HR=0.80, 95% CI: 0.67, 0.96), having a fair relationship with family (HR=0.79, 95% CI: 0.67, 0.93) and drug injection (HR=0.80, 95% CI: 0.67, 0.96) were also protective for recurrent relapse. Female (HR=0.64, 95% CI: 0.50, 0.82) and a high methadone dose (≥60 ml/day; HR=0.79, 95% CI: 0.65, 0.96) were protective for dropout, and a longer traveling time to the clinic (>60 min; HR=1.59, 95% CI: 1.20, 2.10) was associated with an increased risk of dropout. CONCLUSIONS It is common for clients to experience recurrent relapse and dropout. The findings suggest that MMT clinics should provide holistic interventions and appropriate methadone doses for clients to improve treatment compliance.
Collapse
Affiliation(s)
- Zouxiang Chen
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Xijia Tang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Chaofan Xu
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Chijie Wang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Li Ling
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China; Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
| |
Collapse
|
15
|
Amini Z, HeidariFarsani E. Investigating the effect of zinc supplementation on probability of relapse and mental health in patients with opioid use disorder undergoing methadone maintenance treatment. Subst Abuse Treat Prev Policy 2023; 18:1. [PMID: 36609286 PMCID: PMC9817328 DOI: 10.1186/s13011-023-00514-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Considering different factors, such as high withdrawal rates in methadone maintenance treatment (MMT) programs alongside mental health (MH) problems appearing in patients with opioid use disorder and the lack of prior research on the effect of zinc supplementation in this respect, the present study aimed to investigate the effect of zinc supplementation on the probability of relapse (PoR) and MH problems in patients with opioid use disorder undergoing MMT. METHODS For this purpose, a randomized controlled trial with a clinical basis was fulfilled on a total of 68 patients with opioid use disorder receiving MMT, allocated to two groups, viz. intervention, and control (each one consisting of 34 individuals). Then, the participants in the intervention group were given zinc supplements combined with methadone for three months, and the controls only took methadone, according to the treatment plan. The data were collected using the Relapse Prediction Scale (RPS) and the Depression, Anxiety, and Stress Scale 21 (DASS-21) before, one month after, and at the end of the intervention program. FINDINGS Compared to the control group, the likelihood of drug use (p = 0.01), drug craving (p = 0.002), and the RPS total score (p = 0.002) in the intervention group was significantly lower. Moreover, the results revealed a significant decreasing trend in depression (p = 0.01), anxiety (p < 0.001), stress (p = 0.001), and the DASS-21 total score (p = 0.001) in the intervention. Compared to the control group, the DASS-21 total score (p < 0.001) in the intervention group was significantly lower. CONCLUSION Accordingly, it was concluded that zinc supplementation could reduce the PoR and improve MH problems in patients with opioid use disorder experiencing MMT. However, further research is recommended to fill the gaps. TRIAL REGISTRATION The research protocol has also been listed on the Iranian Registry of Clinical Trials (IRCT) with code no. IRCT2020050904736N1.
Collapse
Affiliation(s)
- Zahra Amini
- grid.411036.10000 0001 1498 685XDepartment of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, 8174673461 Isfahan Province Iran ,grid.411036.10000 0001 1498 685XDepartment of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ebrahim HeidariFarsani
- Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, 8174673461, Isfahan Province, Iran. .,Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
16
|
Tran HV, Filipowicz TR, Landrum KR, Nong HTT, Tran TTT, Pence BW, Go VF, Le GM, Nguyen MX, Verhey R, Chibanda D, Ho HT, Gaynes BN. Stigma experienced by people living with HIV who are on methadone maintenance treatment and have symptoms of common mental disorders in Hanoi, Vietnam: a qualitative study. AIDS Res Ther 2022; 19:63. [PMID: 36517849 PMCID: PMC9753276 DOI: 10.1186/s12981-022-00491-y] [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: 09/06/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stigma around human immunodeficiency virus (HIV), injection drug use (IDU), and mental health disorders can be co-occurring and have different impacts on the well-being of people living with HIV (PWH) who use drugs and have mental health disorders. This stigma can come from society, health professionals, and internalized stigma. A person who has more than one health condition can experience overlapping health-related stigma and levels of stigma which can prevent them from receiving necessary support and healthcare, serving to intensify their experience with stigma. This study investigates HIV, drug use, and mental health stigmas in three dimensions (social, internalized, and professional) around PWH on methadone maintenance treatment (MMT) who have common mental disorders (CMDs) including depression, anxiety, and stress-related disorders in Hanoi, Vietnam.Please check and confirm whether corresponding author's email id is correctly identified.The cooresponding author's email is correct METHODS: We conducted semi-structured, in-depth interviews (IDIs) (n = 21) and two focus group discussions (FGDs) (n = 10) with PWH receiving MMT who have CMD symptoms, their family members, clinic health care providers, and clinic directors. We applied thematic analysis using NVIVO software version 12.0, with themes based on IDI and FGD guides and emergent themes from interview transcripts. RESULTS The study found evidence of different stigmas towards HIV, IDU, and CMDs from the community, family, health care providers, and participants themselves. Community and family members were physically and emotionally distant from patients due to societal stigma around illicit drug use and fears of acquiring HIV. Participants often conflated stigmas around drug use and HIV, referring to these stigmas interchangeably. The internalized stigma around having HIV and injecting drugs made PWH on MMT hesitant to seek support for CMDs. These stigmas compounded to negatively impact participants' health. CONCLUSIONS Strategies to reduce stigma affecting PWH on MMT should concurrently address stigmas around HIV, drug addiction, and mental health. Future studies could explore approaches to address internalized stigma to improve self-esteem, mental health, and capacities to cope with stigma for PWH on MMT. TRIAL REGISTRATION NCT04790201, available at clinicaltrials.gov.
Collapse
Affiliation(s)
- Ha V. Tran
- The University of North Carolina-Vietnam Office, Hanoi, Vietnam
| | - Teresa R. Filipowicz
- grid.410711.20000 0001 1034 1720Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - Kelsey R. Landrum
- grid.448980.90000 0004 0444 7651Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ha T. T. Nong
- The University of North Carolina-Vietnam Office, Hanoi, Vietnam
| | - Thuy T. T. Tran
- grid.448980.90000 0004 0444 7651Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Brian W. Pence
- grid.448980.90000 0004 0444 7651Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Vivian F. Go
- grid.410711.20000 0001 1034 1720Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Giang M. Le
- grid.56046.310000 0004 0642 8489Center for Research and Training in HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
| | - Minh X. Nguyen
- grid.56046.310000 0004 0642 8489Epidemiology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Ruth Verhey
- grid.56046.310000 0004 0642 8489Epidemiology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Dixon Chibanda
- grid.13001.330000 0004 0572 0760Department of Psychiatry & Research Support Centre, University of Zimbabwe, Harare, Zimbabwe ,grid.8991.90000 0004 0425 469XLondon School of Hygiene & Tropical Medicine, London, UK
| | - Hien T. Ho
- grid.448980.90000 0004 0444 7651Faculty of Clinical Medicine, Hanoi University of Public Health, Hanoi, Vietnam
| | - Bradley N. Gaynes
- grid.448980.90000 0004 0444 7651Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam ,grid.410711.20000 0001 1034 1720Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| |
Collapse
|
17
|
Chen J, Wang S, Li Z, Li Y, Huang P, Zhu J, Wang F, Li Y, Liu W, Xue J, Shi H, Li W, Liang Z, Wang W, Li Q. The effect of long-term methadone maintenance treatment on coupling among three large-scale brain networks in male heroin-dependent individuals: A resting-state fMRI study. Drug Alcohol Depend 2022; 238:109549. [PMID: 35810622 DOI: 10.1016/j.drugalcdep.2022.109549] [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: 01/05/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Methadone maintenance treatment (MMT) is considered as an effective and mainstream therapy for heroin dependence. However, whether long-term MMT would improve the coupling among the three core large-scale brain networks (salience, default mode, and executive control) and its relationship with the craving for heroin is unknown. METHODS Forty-four male heroin-dependent individuals during long-term MMT, 27 male heroin-dependent individuals after short-term detoxification/abstinence (SA), and 26 demographically matched healthy controls (HC) underwent resting-state functional magnetic resonance imaging. We analyzed the difference in coupling among the salience, default mode, and executive control networks among the three groups and examined how the coupling among these large-scale networks was associated with craving before and after drug-cue exposure. RESULTS Compared with the SA group, the MMT group showed lower craving before and after cue exposure and stronger connectivity between the dorsal anterior cingulate cortex (a key node of the salience network) and key regions of the bilateral executive control network, including the bilateral dorsolateral prefrontal cortex, posterior parietal cortex, and dorsomedial prefrontal cortex. Among the heroin-dependent individuals, the functional connectivity was negatively correlated with the craving before and after heroin-cue exposure. CONCLUSION Our findings suggest that long-term MMT could increase the coupling between the salience and bilateral executive control networks and decrease craving for heroin. These findings contribute to the understanding of the neural mechanism of MMT, from the perspective of large-scale brain networks.
Collapse
Affiliation(s)
- Jiajie Chen
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Shu Wang
- Biomedical Engineering, School of Life Science and Technology, Xi'an Jiao Tong University, Xi'an 710038, Shaanxi, China
| | - Zhe Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Yiyao Li
- School of basic medicine, Air Force Military Medical University, Xi 'an 710038, Shaanxi, China
| | - Peng Huang
- School of basic medicine, Air Force Military Medical University, Xi 'an 710038, Shaanxi, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Fan Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Yongbin Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Wei Liu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Jiuhua Xue
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Hong Shi
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China
| | - Zifei Liang
- Center for Biomedical Imaging, Radiology, New York University School of Medicine, New York 10012, USA
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China.
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, Shaanxi, China.
| |
Collapse
|
18
|
Wang C, Fan C, Lu Q, Chen W, Liu Y, Xu C, Tang X, Zhou W, Ling L. Exploration of dose tapering strategies for methadone maintenance treatment based on relapse risks: A subpopulation treatment effect pattern plot (STEPP) analysis. Drug Alcohol Depend 2022; 238:109581. [PMID: 35901533 DOI: 10.1016/j.drugalcdep.2022.109581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/03/2021] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Half of methadone maintenance treatment (MMT) participants experience a tapering phase, however, the guidelines vary from country to country and lack individualized strategies based on relapse risk. A detailed and individualized tapering strategy is needed in China. This study aims to explore dose tapering strategies for Chinese individuals with different relapse risks. METHODS A retrospective study was conducted from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 549 participants. The end point was the first relapse within 12 months of the start of tapering. Relapse risks before tapering for each participant were determined from a Cox model. RESULTS Out of 549 participants, 173 (31.5 %) relapsed within 12 months after tapering. Findings indicated that a taper dose of less than 5 mg/week is better than other taper doses. Subpopulation treatment effect pattern plot (STEPP) methodology revealed different tapering strategies benefit participants according to relapse risk before tapering. Overall, findings indicated that a less than 5 mg/week reduction in MMT dose is better than reductions of other amounts. For participants with a low relapse risk before tapering, a reduction of less than 2.5 mg/week in MMT dose is better than a 2.5-5 mg/week reduction. CONCLUSIONS A taper dose of less than 5 mg/week appears to be the best dose tapering strategy for Chinese participants. Furthermore, for participants with a low relapse risk, a more gradual taper dose (less than 2.5 mg/week) works better than 2.5-5 mg/week. This benefit was not seen in participants with a high relapse risk before tapering.
Collapse
Affiliation(s)
- Chijie Wang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Chaonan Fan
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Qian Lu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Wen Chen
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Yin Liu
- Department of Cancer Epidemiology, Henan Office for Cancer Control and Research, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, PR China
| | - Chaofan Xu
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Xijia Tang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Wensu Zhou
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Li Ling
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| |
Collapse
|
19
|
Bonifonte A, Garcia E. Improving geographic access to methadone clinics. J Subst Abuse Treat 2022; 141:108836. [PMID: 35870438 DOI: 10.1016/j.jsat.2022.108836] [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: 08/19/2021] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Opioid misuse is a nationwide public health crisis. Methadone treatment is proven to be highly successful in preventing opioid use disorder, reducing the use of illicit drugs, and preventing overdoses. Clients acquire methadone daily from clinics, making geographic access crucial for the initiation of and adherence to treatment. METHODS This work estimates unsatisfied methadone demand due to lack of geographic access at a census tract level and models the problem of identifying optimal locations to open new methadone clinics. The objective function of the model is a weighted combination of providing access to individuals with unmet methadone demand and improving the travel time of individuals currently attending a clinic. Data on existing methadone clinics and statewide methadone demand is acquired from Substance Abuse and Mental Health Services Administration (SAMHSA) surveys from 2019. Unsatisfied demand is estimated through a linear regression model after aggregating the population, heroin use, and satisfied methadone demand at the state level. RESULTS Nationwide, we find 18.2 % of the United States population does not have geographic access to a methadone clinic and estimate 77,973 individuals in these areas would attend a clinic if geographic access barriers were removed (95 % CI: 67,413-88,532). In a case study of six Midwestern states, we find that geography significantly contributes to the value of opening additional clinics and we see large differences in expected gains between states sharing similar characteristics such as population and satisfied methadone demand. The number of additional clients served by opening one new clinic ranges from 180 to 804 across these six states, representing between 8.4 % and 16.2 % of state unmet demand. Between 1.2 % and 14.1 % of existing clients were reassigned with a single newly opened clinic, with a one-way average travel distance improvement between 6.3 and 11.9 miles / person / day for these clients. CONCLUSIONS The results demonstrate the large unserved methadone demand in the United States, the significant improvement in methadone access for new and existing clients that can be achieved by opening new clinics, and the important role state-specific geography plays in these decisions.
Collapse
Affiliation(s)
- Anthony Bonifonte
- Data Analytics Department, Denison University, Granville, OH, United States of America.
| | - Erin Garcia
- Department of Industrial and Systems Engineering, Auburn University, Auburn, AL, United States of America.
| |
Collapse
|
20
|
Xue J, Chen J, Wang S, Li W, Zhu J, Wang F, Li Z, Wang W, Li Q. Assessing brain activity in male heroin-dependent individuals under methadone maintenance treatment: A resting-state fMRI study. Psychiatry Res Neuroimaging 2022; 320:111431. [PMID: 35007942 DOI: 10.1016/j.pscychresns.2021.111431] [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] [Received: 07/11/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Abstract
Methadone maintenance treatment (MMT) is recognized as an effective and mainstream alternative treatment for heroin addiction. However, the effect of long-term MMT on the local and global brain activity of heroin-dependent individuals during resting state remains unknown. Twenty-five heroin-dependent individuals under MMT, 26 heroin-dependent individuals after short-term abstinence (HA) and 42 healthy controls (HC) were included in the resting-state functional magnetic resonance imaging study. The craving before and after heroin cue exposure were evaluated among HA and MMT subjects. The difference in craving, regional homogeneity (ReHo) and related functional connectivity were analyzed among the three groups. We found that the craving before and after heroin cue exposure of MMT group was significantly lower than that of HA group. Compared with HA group, the MMT group showed higher ReHo value in the right orbitofrontal cortex and bilateral posterior central cortex. No significant difference in global brain connectivity based on differential ReHo regions was found among the three groups. This study demonstrated the long-term MMT could improve the local activity of executive control and somatosensory brain regions in heroin-dependent individuals. It suggested that MMT might be beneficial to restoring executive control and somatosensory function in the direction towards that of healthy controls.
Collapse
Affiliation(s)
- Jiuhua Xue
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China; Department of Radiology, xian NO.1 hospital, Xi'an, Shaanxi, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shu Wang
- Canon Medical Systems (China) Co., LTD, MR Division, Xi'an, Shaanxi, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhe Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
| |
Collapse
|
21
|
Giang LM, Li MJ, Okafor CN, Diep NB, Shoptaw SJ. Correlates of methamphetamine use severity among patients receiving methadone maintenance treatment for opioid use disorder in Vietnam. J Subst Abuse Treat 2022; 132:108461. [PMID: 34098204 PMCID: PMC8572314 DOI: 10.1016/j.jsat.2021.108461] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess the severity of methamphetamine use among methadone maintenance treatment (MMT) patients in Vietnam with opioid use disorder and concurrent methamphetamine use, and to identify risk factors associated with higher severity of methamphetamine use. METHODS We used survey data and medical record abstractions from 428 people with opioid use disorder who also use methamphetamine while partaking in methadone treatment in five clinics in Hanoi, Vietnam. We used multinomial logistic regression to assess other risk factors and problems associated with high methamphetamine use severity. RESULTS Those who reported injecting heroin in the past 3 months (AOR = 4.05, 95% CI [1.30, 12.55], p = 0.02), having a longer history of lifetime heroin use (AOR = 1.13, 95% CI [1.03, 1.24], p < 0.01), and having higher cravings (AOR = 1.97, 95% CI [1.31, 2.98], p < 0.01) and fatigue (AOR = 1.25, 95% CI [0.96, 1.61], p = 0.09) related to methamphetamine withdrawal had greater odds of high methamphetamine use severity. One of five clinics had a significantly higher percentage of methamphetamine use severity than others. CONCLUSION Successful MMT in patients with opioid use disorder in Vietnam may additionally require methamphetamine-focused screening and intervention.
Collapse
Affiliation(s)
- Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Michael J. Li
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco Texas
| | - Nguyen Bich Diep
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Steven J. Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles
| |
Collapse
|
22
|
Zhang J, Fan Y, Zhou J, Ma T, Gao K, Xu M, Xiao Y, Zhu Y. Methylation quantitative trait locus rs5326 is associated with susceptibility and effective dosage of methadone maintenance treatment for heroin use disorder. Psychopharmacology (Berl) 2021; 238:3511-3518. [PMID: 34476566 DOI: 10.1007/s00213-021-05968-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 05/24/2021] [Accepted: 08/18/2021] [Indexed: 01/01/2023]
Abstract
RATIONALE Opioid use disorder is a complicated brain disease with high heritability. The underlying mechanisms of the genetic underpinnings in the susceptibility and treatment response of opioid use disorder remain elusive. OBJECTIVES To reveal the potential associations of genotypes and gene methylations of dopaminergic system genes, as well as roles of them in opioid use disorder. In the present study, we detected the DNA methylation in the promoter regions of five representative dopaminergic system genes (DRD1, DRD2, SLC6A3, TH, and COMT) between 120 patients with heroin use disorder in methadone maintenance treatment (MMT) program and 111 healthy controls. The associations of 25 SNPs in the above genes and methylation of 237 CpG sites, known as methylation quantitative trait loci (mQTLs), were determined. Then, the correlations of the above mQTLs and traits of heroin use disorder were analyzed in a sample set of 801 patients with heroin use disorder and 930 healthy controls. RESULTS Our results demonstrated that several mQTLs in the DRD1 and DRD2 genes were identified both in the heroin use disorder and healthy control groups. Interestingly, rs4867798-CpG_174872884 and rs5326-CpG_174872884 in the DRD1 gene were the unique SNP-CpG pairs in the patients with heroin use disorder. Furthermore, mQTL rs5326 was associated with the susceptibility and effective dosage of MMT for heroin use disorder, and demonstrated allele-specific correlation with the expression of the DRD1 gene in the human caudate. CONCLUSIONS Our findings suggest that some mQTLs may be associated with traits of opioid use disorder by implicating the DNA methylation and gene expression.
Collapse
Affiliation(s)
- Jianbo Zhang
- Key Laboratory of National Health Commission for Forensic Science, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.,Bio-evidence Sciences Academy, Xi'an Jiaotong University, Xi'an, 712000, Shaanxi, China
| | - Yajuan Fan
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jinting Zhou
- Key Laboratory of National Health Commission for Forensic Science, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.,Bio-evidence Sciences Academy, Xi'an Jiaotong University, Xi'an, 712000, Shaanxi, China
| | - Tengfei Ma
- School of Pharmacy, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Keqiang Gao
- School of Pharmacy, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Min Xu
- School of Pharmacy, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Yifan Xiao
- Key Laboratory of National Health Commission for Forensic Science, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.,Bio-evidence Sciences Academy, Xi'an Jiaotong University, Xi'an, 712000, Shaanxi, China
| | - Yongsheng Zhu
- Key Laboratory of National Health Commission for Forensic Science, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. .,Bio-evidence Sciences Academy, Xi'an Jiaotong University, Xi'an, 712000, Shaanxi, China.
| |
Collapse
|
23
|
Madden EF, Christian BT, Lagisetty PA, Ray BR, Sulzer SH. Treatment provider perceptions of take-home methadone regulation before and during COVID-19. Drug Alcohol Depend 2021; 228:109100. [PMID: 34600251 PMCID: PMC8459541 DOI: 10.1016/j.drugalcdep.2021.109100] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The loosening of U.S. methadone regulations during the COVID-19 pandemic expanded calls for methadone reform. This study examines professional perceptions of methadone take-home dose regulation before and during the COVID-19 pandemic to understand responses to varied methadone distribution policies. METHODS Fifty-nine substance use disorder treatment professionals were interviewed between 2017 and 2020 in-person or over video call. An inductive iterative coding process was used to analyze the data. Constructivist grounded theory guided the collection and analysis of in-depth interviews. RESULTS Treatment professionals expressed mixed views toward methadone take-home regulations. Participants justified regulation using several arguments: 1) patient care benefitting from supervision, 2) attributing improved patient safety to take-home regulation, 3) fearing liability for methadone-related harms, and 4) relying on buprenorphine as an "escape hatch" for patients who cannot manage MMT policies. Other professionals suggested partial deregulation, while others strongly opposed pre-pandemic take-home regulation, explaining such regulations impede medication access and hinder patient-centered care. Some professionals supported the COVID-19 policy changes and saw these as a test run for broader deregulation, while others framed the changes as temporary and cautiously applied deregulation to their services, at times revoking looser rules for patients they perceived as nonadherent. CONCLUSION Treatment professionals working in a range of modalities, including opioid treatment programs, expressed hesitation toward expanded take-home methadone access. While some participants also supported forms of deregulation, post-pandemic efforts to extend looser methadone distribution policies will have to address apprehensive professionals if such policy changes are to be meaningfully adopted in community services.
Collapse
Affiliation(s)
- Erin Fanning Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 3939 Woodward Ave., Detroit, MI 48201, USA.
| | | | - Pooja A. Lagisetty
- Division of General Medicine, University of Michigan Medical School, 7300 Medical Science Building I, 1301 Catherine St., Ann Arbor, MI 48109, USA
| | - Bradley R. Ray
- School of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI 48202, USA
| | - Sandra H. Sulzer
- Office of Health Equity & Community Engagement, Utah State University, 7000 Old Main Hill, Logan, UT 84322, USA
| |
Collapse
|
24
|
Zhou X, Altice FL, Chandra D, Didomizio E, Copenhaver MM, Shrestha R. Use of Pre-exposure Prophylaxis Among People Who Inject Drugs: Exploratory Findings of the Interaction Between Race, Homelessness, and Trust. AIDS Behav 2021; 25:3743-3753. [PMID: 33751313 DOI: 10.1007/s10461-021-03227-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Scale-up of pre-exposure prophylaxis (PrEP) in people who inject drugs (PWID) remains suboptimal. Patient-level factors are often complex and may contribute to scale-up. Using cross-sectional data from 234 opioid-dependent patients on methadone who met eligibility criteria for PrEP, we conducted logistic regression analyses to assess potential moderators associated with being on PrEP (n = 60). Mean provider trust was significantly higher among Blacks vs Whites (39.4 vs 34.9; p = 0.002) and non-homeless vs homeless participants (37.5 vs 34.8; p = 0.008). Though race/ethnicity was not a significant moderator on provider trust and PrEP use, increased provider trust was marginally associated with increased PrEP use among Blacks (p = 0.058). Additionally, homelessness significantly moderated provider trust and PrEP use (p = 0.024). Provider trust among non-homeless participants was positively correlated with PrEP use (p = 0.013) but not among homeless participants. Strategies that promote provider trust in Blacks and non-homeless PWID on methadone may improve PrEP scale-up.
Collapse
|
25
|
Huang S, Yang C, Xin J, Xie R, Yang X, Zhang R, Li X, Zhang B, Lei S, Hong L, Dong X, Li H. Outcomes of Methadone Maintenance Therapy Combined with Rilpivirine/Efavirenz in Treatment-Naive HIV-Infected Patients. Curr HIV Res 2021; 19:368-376. [PMID: 33902415 DOI: 10.2174/1570162x19666210423123958] [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: 10/10/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Injecting drugs is associated with a high risk of HIV infection, alongside the risk of a drug overdose and mental health problems. OBJECTIVE To evaluate the effect of methadone maintenance treatment (MMT) combined with rilpivirine (RPV)-based regimens on drug use of HIV individuals. METHODS This study was a prospective, open-label, controlled, drug-drug interaction trial at a single center for 24 weeks. Participants on stable MMT were randomly divided into two groups administered RPV/TDF/3TC (RPV group) and EFV/TDF/3TC (EFV group), respectively. Adjustment doses of methadone were monitored for 12 weeks. HIV-1 RNA was used to evaluate the effects of antiretroviral therapy at week 24. Acute opioid withdrawal-, drug craving questionnaire- and MOSHIV scales were used to assess study outcomes. RESULTS 22 and 18 cases of HIV-infected drug users were recruited in the RPV and EFV groups, respectively. Thirty-one cases had completed monitoring and clinical evaluation at week 24. In the RPV and EFV groups, 32% and 56% of the participants had methadone dose adjustment, respectively, indicating a significantly lower rate in the RPV group. The rates of individuals with HIV RNA levels from 50-500 copies/ml were 94% (RPV group) and 90% (EFV group). The drug craving questionnaire scale scores decreased in both groups. After one week of treatments, acute opioid withdrawal scale scores increased in both groups, with no significant difference between them. CONCLUSION Concomitant administration of RPV does not significantly affect methadone and could decrease withdrawal symptoms. An RPV-based regimen may be used as first-line treatment in IDUs with HIV infection.
Collapse
Affiliation(s)
- Shizhen Huang
- Antiviral Clinic Department, Yunnan Infectious Disease Hospital, Kunming, China
| | - Cuixian Yang
- Clinical Laboratory, Yunnan Infectious Disease Hospital, Kunming, China
| | - Jiaying Xin
- Antiviral Clinic Department, Yunnan Infectious Disease Hospital, Kunming, China
| | - Ronghui Xie
- Antiviral Clinic Department, Yunnan Infectious Disease Hospital, Kunming, China
| | - Xinping Yang
- Infectious Department, Yunnan Infectious Disease Hospital, Kunming, China
| | - Ruimin Zhang
- Social Service Department, Yunnan Institute for Drug Abuse, Kunming, China
| | - Xia Li
- Infectious Department, Yunnan Infectious Disease Hospital, Kunming, China
| | - Bo Zhang
- Social Service Department, Yunnan Institute for Drug Abuse, Kunming, China
| | - Suyun Lei
- Science research and Education Department, Yunnan Institute for Drug Abuse, Kunming, China
| | - Lizhu Hong
- Science research and Education Department, Yunnan Institute for Drug Abuse, Kunming, China
| | - Xingqi Dong
- Clinical Laboratory, Yunnan Infectious Disease Hospital, Kunming, China
| | - Huiqin Li
- Antiviral Clinic Department, Yunnan Infectious Disease Hospital, Kunming, China
| |
Collapse
|
26
|
Sason A, Adelson M, Schreiber S, Peles E. The prevalence of constipation and its relation to sweet taste preference among patients receiving methadone maintenance treatment. Drug Alcohol Depend 2021; 225:108836. [PMID: 34182372 DOI: 10.1016/j.drugalcdep.2021.108836] [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: 04/06/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preference for sweet-tasting foods, weight gain, and constipation characterize patients receiving methadone maintenance treatment (MMT). The prevalence of constipation in MMT and its relation to preference for sweet taste and body mass index (BMI) are undetermined. METHODS A random sample of 83 patients was interviewed for constipation with the Patient Assessment Constipation Quality of Life (PAC-QOL) questionnaire. They rated taste intensity and reward of sweet, salty, and sour solutions by means of a nine-point Likert scale. Data on their BMI, drugs in urine, methadone dose, and serum levels were analyzed. RESULTS Forty-two patients reported minimum to severe constipation. They characterized as having longer durations of opioid usage before MMT and worse sleep quality than non-constipated patients (logistic regression). Constipation intensity was inversely correlated with duration in MMT and linearly correlated with the Patient Assessment Constipation Quality of Life score. Patients with constipation rated reward to sweet taste significantly higher with no differences in taste intensity compared to non-constipated patients. Patients with high methadone serum levels (≥750 ng/mL) rated taste intensity significantly lower compared to those with normal methadone serum levels (<750 ng/mL), and the lowest rates were reported among patients with no constipation and high methadone serum levels. CONCLUSIONS Constipation was highly prevalent among MMT patients and associated with poor sleep and lower quality of life. The relation to preference for sweets, as reflected by higher reward rating, strongly supports the need for nutritional intervention to alleviate constipation symptoms and improve quality of life and sleep.
Collapse
Affiliation(s)
- Anat Sason
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Schreiber
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
27
|
Rezapour T, Hatami J, Farhoudian A, Noroozi A, Daneshmand R, Sofuoglu M, Baldacchino A, Ekhtiari H. Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder. J Subst Abuse Treat 2021; 131:108558. [PMID: 34366202 DOI: 10.1016/j.jsat.2021.108558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/10/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impaired cognitive functions, particularly executive function, predicts poor treatment success in people with substance use disorders. The current study investigated the effect of receiving adjunct cognitive rehabilitation and baseline executive function (EF) measures on treatment response among people with opioid use disorder (OUD). METHOD The analysis sample consisted of 113 participants with OUD who were discharged from a compulsory court-mandated methadone maintenance treatment (MMT) and followed for 3 months. We used the Backward digit span/Auditory verbal learning, Stroop, and Trail making tests to assess the three measures of EF, including working memory, inhibition, and shifting, respectively. Treatment response was operationalized as (1) treatment retention and (2) the number of positive urine tests for morphine during 3-month follow-up periods. The study used Cox's proportional hazards model and linear mixed model to identify predictive factors. RESULTS Lower Stroop interference scores predicted increased length of stay in treatment (χ2 = 33.15, P < 0.001). The linear mixed model showed that scores on auditory verbal learning test and group intervention predicted the number of positive urine tests during a 3-month follow-up. CONCLUSION Working memory and inhibitory control, as well as receiving cognitive rehabilitation, could be potentially considered as predictors of treatment response for newly MMT admitted patients with OUD. Assessment of EF before treatment initiation may inform treatment providers about patient's cognitive deficits that may interfere with therapeutic interventions.
Collapse
Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Javad Hatami
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Daneshmand
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Alex Baldacchino
- University of St Andrews, School of Medicine, Division of Population and Behavioral Sciences, St Andrews, Scotland, UK
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA.
| |
Collapse
|
28
|
Chalabianloo F, Fadnes LT, Høiseth G, Ohldieck C, Vold JH, Aas C, Løberg EM, Johansson KA, Bramness JG. Subjective symptoms and serum methadone concentrations: what should guide dose adjustments in methadone maintenance treatment? A naturalistic cohort study from Norway. Subst Abuse Treat Prev Policy 2021; 16:39. [PMID: 33941217 PMCID: PMC8091668 DOI: 10.1186/s13011-021-00367-w] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND There is little evidence-based guidance on how to optimize methadone dosages among patients with opioid addiction undergoing methadone maintenance treatment (MMT). This study aims to investigate whether self-perceived opioid withdrawal symptoms, adverse effects, and self-reported substance use in patients on MMT are related to serum methadone concentrations and the role that these variables could play in clinical decisions on dose adjustments. METHODS This naturalistic prospective cohort study included clinical and laboratory measurements from 83 patients undergoing MMT in outpatient clinics in Bergen, Norway, from May 2017 to January 2020. Information on age, gender, methadone daily doses and serum concentrations, subjective opioid withdrawal symptoms using 16 items Subjective Opioid Withdrawal Scale (SOWS) questionnaire, self-reported adverse effects, and substance use was obtained. Linear mixed modelling was used for analyzing the data. RESULTS The mean age of the participants was 45 years, and 33% were women. Almost half reported mild to moderate subjective opioid withdrawal symptoms, and all had experienced at least one subjective adverse effect. The use of at least one substance was reported by 88% of the participants. Serum concentration-to-dose ratios were lower among those who had reported subjective opioid withdrawal symptoms (p) = 0.039). The total SOWS score (p < 0.001); the specific subjective withdrawal symptoms of anxiety (p = 0.004), bone and muscle aches (p = 0.003), restlessness (p = 0.017), and (slightly) shaking (p = 0.046), also use of heroin (p = 0.015) and alcohol (p = 0.011) were associated with lower methadone concentrations. Cannabis use was slightly related to higher methadone concentrations (p = 0.049). CONCLUSIONS The findings suggest that the patient's self-perceived symptoms and current clinical condition are related to the serum concentrations of methadone. This interpretation supports dose adjustments based on patient-reported symptoms. In some aberrant cases, measurement of serum concentrations together with other individual assessments may be considered to support the clinical decision.
Collapse
Affiliation(s)
- Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gudrun Høiseth
- Department of Forensic Medicine, Oslo University Hospital, Oslo, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.,Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
| | - Christian Ohldieck
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christer Aas
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jørgen G Bramness
- Institute of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
29
|
Lamhoot T, Adelson M, Sason A, Schreiber S, Peles E. Post-traumatic stress disorder due to sexual abuse and its relation to pain sensitivity among patients in methadone maintenance treatment. Psychiatry Res 2021; 298:113828. [PMID: 33652250 DOI: 10.1016/j.psychres.2021.113828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 02/21/2021] [Indexed: 11/24/2022]
Abstract
We studied whether post-traumatic stress disorder (PTSD) due to sexual abuse is related to pain indices among methadone maintenance treatment (MMT) patients. Pain threshold was determined, and suprathreshold pain levels were rated among 18 patients with PTSD and sexual abuse, and 38 patients without PTSD (20 with and 18 without sexual abuse). Patients with PTSD had higher proportion of chronic pain and high-perceived stress, and lower pain threshold, with similar supra-threshold ratings. Patients with benzodiazepine in urine had higher pain thresholds and they rated supra-threshold stimuli lower. However, the analgesic effect was not observed among PTSD patients.
Collapse
|
30
|
Mistler CB, Chandra DK, Copenhaver MM, Wickersham JA, Shrestha R. Engagement in Harm Reduction Strategies After Suspected Fentanyl Contamination Among Opioid-Dependent Individuals. J Community Health 2021; 46:349-357. [PMID: 32997253 PMCID: PMC7920905 DOI: 10.1007/s10900-020-00928-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 11/26/2022]
Abstract
The evolving opioid epidemic in the United States has increased drug-related overdose rates exponentially (Centers for Disease Control and Prevention in Opioid overdose, 2020c, https://www.cdc.gov/drugoverdose/data/otherdrugs.html#:~:text=Polysubstance%20drug%20use%20occurs%20with,or%20other%20non%2Dopioid%20substances ). Fentanyl, a synthetic opioid, has recently fueled the epidemic, increasing overdose death rates (Centers for Disease Control and Prevention in Drug overdose deaths involving fentanyl, 2011-2016, 2019a, https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_03-508.pdf ). Harm reduction strategies (drug checking, naloxone administration, etc.) are at the forefront of preventing opioid-related overdoses in high-risk populations (Kennedy et al. in Drug Alcohol Depend 185:248-252, 2018, https://doi.org/10.1016/j.drugalcdep.2017.12.026 ; Laing et al. in Int J Drug Policy 62:59-66, 2018, https://doi.org/10.1016/j.drugpo.2018.10.001 ). Little is known, however, about how people who inject drugs (PWID) may modify their drug use behaviors after suspected fentanyl contamination in their drugs. We conducted a cross-sectional survey among 105 opioid-dependent PWID enrolled in a methadone maintenance program. We assessed their willingness to engage in various harm reduction methods (i.e., slowing down drug use, not using drugs, carrying naloxone, using with someone who has naloxone) after suspected fentanyl contamination of their drugs. In a multivariable analysis, participants who were white, low-income, polysubstance users, and had previously experienced an overdose or had previously administered naloxone were more likely to report a willingness to engage in harm reduction measures. These findings provide an evidence-based understanding of PWID's engagement in harm reduction behaviors after suspecting potential fentanyl exposure as well as a basis for tailoring intervention strategies in the context of fentanyl-adulterated markets.
Collapse
Affiliation(s)
- Colleen B Mistler
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269-1101, USA.
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
| | - Divya K Chandra
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael M Copenhaver
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269-1101, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Jeffrey A Wickersham
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Roman Shrestha
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
31
|
Wei X, Chen J, Zhu J, Li Q, Li W, Wang W. Functional connectivity of posterior cingulate gyrus in heroin dependents treated by methadone maintenance and protracted abstinence measures: an event-related fMRI study. Brain Imaging Behav 2021; 15:2472-2480. [PMID: 33502720 DOI: 10.1007/s11682-020-00447-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
Protracted abstinence (PA) and Methadone maintenance treatment (MMT) are two main types of heroin addiction treatment, however, the effects of both measures on the functional connectivity (FC) of the brain in heroin dependents in the drug cue event-related response are unclear. Functional magnetic resonance imaging (fMRI) based drug cue-reactivity task has been widely used in addiction research, which may provide a new way to understand the change of brain function during a certain period of treatment. The default function network (DMN) with posterior cingulate cortex (PCC) as the core is generally involved in the process of addiction. The aim of the present study was to explore the brain response of FC in patients with heroin-dependent during PA, MMT treatment under task-fMRI. Twenty-two heroin-dependent patients during PA, 18 heroin-dependent patients during MMT and 16 healthy control (HC) individuals were included to conduct the heroin cue-reactivity task during fMRI. The MMT and PA patients' subjective craving for heroin was evaluated. The psychophysiological interaction (PPI) analysis of SPM12 was used to get FC during the task state. There was a significant difference on FC between PCC and the right medial Prefrontal Cortex (mPFC) in three groups. The post-hoc analysis showed that there was a significant difference of brain regions between the MMT and the PA group. The FC of PCC-mPFC in the MMT group was significantly stronger than that in the PA group. Compared with the PA group, the FC of the DMN in the MMT group was significantly increased under drug cue response. Therefore, PA is more beneficial for the heroin-dependent patients to lower the salience value of drug related cues, in turn to reduce relapse risks. It also reflected the important role of PCC-mPFC pathway in heroin dependents induced by heroin cues.
Collapse
Affiliation(s)
- Xuan Wei
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China.,Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No.95, Yong An Road, Xicheng District, Beijing, 100050, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China.
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China.
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China
| |
Collapse
|
32
|
Cao P, Zhang Z, Zhong J, Xu S, Huang Q, Fan N. Effects of treatment status and life quality on anxiety in MMT patients. Subst Abuse Treat Prev Policy 2021; 16:9. [PMID: 33441176 PMCID: PMC7805232 DOI: 10.1186/s13011-021-00343-4] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/17/2022]
Abstract
Background Anxiety, an important factor that affects the therapeutic effect and preservation rate of methadone maintenance treatment, has a high prevalence among MMT patients. This study aims to investigate the effects of treatment status and life quality on anxiety in MMT patients. Methods One hundred and Seventy-seven methadone maintenance treatment users in Guangzhou, China were evaluated. The socio-demographic, duration and MMT-related characteristics were documented. Anxiety level and quality of life were evaluated by Beck Anxiety inventory (BAI) and the Quality of Life-Drug Addiction (QOL-DA) respectively. The correlation between different factors and BAI score was also analyzed. Results The BAI total score and the QOL-DA score were 7.1±8.2, 163.5±21.4 respectively. 30.5% of the subjects showed mild to severe anxiety. Treatment interruption and QOL-DA score had strong correlations with the score of BAI, with correlation coefficients of 0.17 and − 0.08 respectively. Conclusions Anxiety symptoms were commonly presented in MMT patients. Treatment interruption and quality of life are two major factors affecting anxiety of MMT patients.
Collapse
Affiliation(s)
- Penghui Cao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Zhaohua Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Jun Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Shichao Xu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Qiaofang Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China
| | - Ni Fan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong Province, China.
| |
Collapse
|
33
|
Peles E, Levran O, Randesi M, Ott J, Kreek MJ, Adelson M. Polymorphisms in Stress-Related Genes Are Associated with Reduced Cocaine Abuse and Longer Retention in Methadone Maintenance Treatment for Opioid Use Disorder. Eur Addict Res 2021; 27:198-205. [PMID: 33242852 DOI: 10.1159/000511898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/04/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND As CRH-binding protein (CRHBP) SNP rs1500 was associated with reduced cocaine abuse after 1 year in methadone maintenance treatment (MMT) for heroin addiction, we evaluated the association of additional 28 selected SNPs, in 17 stress-related genes, with MMT outcome. METHODS The distribution of genotypes of each SNP by cocaine abuse after 1 year in MMT was assessed under the dominant and recessive models using χ2. Cumulative retention (up to 26.5 years) was studied using Kaplan-Meier analyses. Logistic regression and Cox model were used for multivariate analyses. RESULTS Of a nonselective sample of 404 patients, 25 patients with <50% Europeans/Middle Eastern ancestry were excluded. Of the remaining 379 patients, 330 (87.1%) stayed at least 1 year in treatment. Four SNPs were associated with cocaine abuse after 1 year in MMT. A lower proportion of cocaine abusers was found in the groups of subjects with the following genotypes: arginine vasopressin (AVP) SNP rs2282018 CC, CRHBP rs7728378 TT, galanin rs3136541 TT/TC, and neuropeptide Y receptor Y1 (NPY1R) rs4518200 AA. The following independent variables were associated with lack of cocaine in urine after 1 year (multivariate analyses): CRHBP rs7728378 TT, NPY1R rs4518200 AA, no cocaine in urine on admission, as well as opiate and benzodiazepine use after 1 year in MMT. Cumulative retention (n = 379) was longer in carriers of AVP rs2282018 CC (13.7 years, 95% CI 11.1-16.2) versus TT/TC genotypes (10.5, 95% CI 9.4-11.5) (p = 0.0230) Conclusions: The study suggests that a reduction in cocaine abuse and longer retention among MMT patients is mediated in part by variants in stress-related genes and is a step toward precision medicine.
Collapse
Affiliation(s)
- Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, .,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel,
| | - Orna Levran
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, New York, USA
| | - Matthew Randesi
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, New York, USA
| | - Jurg Ott
- The Laboratory of Statistical Genetics, The Rockefeller University, New York, New York, USA
| | - Mary Jeanne Kreek
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, New York, USA
| | - Miriam Adelson
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, New York, USA.,Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Las Vegas, Nevada, USA
| |
Collapse
|
34
|
Trujols J, Larrabeiti A, Sànchez O, Madrid M, De Andrés S, Duran-Sindreu S. Increased flexibility in methadone take-home scheduling during the COVID-19 pandemic: Should this practice be incorporated into routine clinical care? J Subst Abuse Treat 2020; 119:108154. [PMID: 33032860 PMCID: PMC7532346 DOI: 10.1016/j.jsat.2020.108154] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/12/2020] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
Abstract
In the context of the COVID-19 pandemic and the state of emergency that the government of Spain declared, the rapid adaptation of health services is of paramount importance to preserve access to and continuity of service delivery. This research note underscores the importance of ensuring a sufficient quantity of methadone take-home doses for patients on methadone maintenance treatment (MMT) to maximize their adherence to government-imposed lockdown restrictions and social distancing measures designed to curtail the spread of SARS-CoV-2. We evaluate the impact of COVID-19 on take-home medication (number of days provided) in a methadone clinic in Barcelona (Catalonia, Spain). This work conveys that we should consider maintaining the take-home practices that we adopted in response to the pandemic, even after the pandemic has abated.
Collapse
Affiliation(s)
- Joan Trujols
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Antonio Larrabeiti
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Oriol Sànchez
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Maite Madrid
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Sandra De Andrés
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Santiago Duran-Sindreu
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| |
Collapse
|
35
|
Abstract
The current overdose crisis in the United States emphasizes the importance of providing substance use treatment programs that are not only effective but tailored to meet the specific needs of the populations they serve. While Methadone Maintenance Treatment (MMT) is considered to be among the best strategies for reducing rates of opioid-involved overdose, its ability to attract and maintain patients may be hindered by a recent focus on policing the non-opioid substance use of people on the program. This paper uses interview data from treatment providers to examine how clinicians conceptualize and organize MMT in regards to patients' use of non-opioid drugs. Responses demonstrate that some treatment providers are increasingly monitoring their patients' use of non-opioid substances and punishing them for infractions, up to and including discharge from treatment. This approach will likely result in increasing rates of patient dropout and a lack of new admissions among people who use non-opioid substances. This article argues that including non-opioid substances in MMT's mandate restricts its ability to improve public health, including by preventing overdoses, and recommends instead that MMT adopt a more individualized approach, shaped by the needs and goals of the patient rather than those of the clinician.
Collapse
Affiliation(s)
- David Frank
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| |
Collapse
|
36
|
Gong H, Zhang Y, Ren Q, Zhou Z, Zhou H, Sun X, Zhang C, Voon V, Zhao M, Yu S. The Chinese version of obsessive compulsive drug use scale: validation in outpatient methadone maintenance treatment program. BMC Psychiatry 2020; 20:465. [PMID: 32977774 PMCID: PMC7517618 DOI: 10.1186/s12888-020-02843-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/10/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Obsessive Compulsive Drug Use Scale (OCDUS) measures the overall craving level within a period from a multidimensional perspective. However, no studies have addressed the validity of the new OCDUS factor structure, presented in 2016, in China. Additionally, there is lack of evidence on the interaction among risk factors for relapse. We aimed to assess the psychometric properties of the scores of the Chinese version of the OCDUS in patients with heroin dependence receiving methadone maintenance treatment (MMT). Further, we aimed to assess the correlations of the OCDUS scores with withdrawal symptoms, depression, anxiety, and nicotine dependence. METHODS We enrolled 113 adults (age 32-64 years) and administered them with the OCDUS, Subjective Opioid Withdrawal Scale (SOWS), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), and Fagerstrom Test for Nicotine Dependence (FTND). RESULTS Exploratory factor analysis identified a 3-dimensional component that included "Frequency of craving," "Inference of heroin," and "Control of heroin." These factors showed acceptable internal consistency, adequate item-total correlations, and significant item-subscale correlations. There was no correlation between the OCUDS scores and age, education, duration of receiving MMT, and MMT dosages. However, there was a significant correlation between the OCDUS total scores and the SOWS, STAI, BDI-II, and FTND scores. The scores of all the subscales were associated with the SOWS scores; further, the scores of the first two subscales were associated with BDI-II scores while only the scores of the first subscale were associated with the FTND scores. CONCLUSIONS Our findings support the reliability and structure validity of the OCDUS scores. Heroin craving, withdrawal symptoms, negative emotions, and nicotine dependence, which are considered as risk factors for heroin relapse, might interact with each other. There is a need for further studies on the underlying mechanism of these clinical phenomena.
Collapse
Affiliation(s)
- Hengfen Gong
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.24516.340000000123704535Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Yingying Zhang
- grid.16821.3c0000 0004 0368 8293Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qihuan Ren
- grid.415630.50000 0004 1782 6212Department of Clinical Psychology, Shanghai Hongkou Mental Health Center, Shanghai, China
| | - Zhirong Zhou
- Department of Functional Clinic of the Community Based Methadone Maintenance Therapy, Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Huijing Zhou
- Department of Drug Dependence, Shanghai Yangpu Mental Health Center, Shanghai, China
| | - Xirong Sun
- grid.24516.340000000123704535Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- grid.16821.3c0000 0004 0368 8293Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- grid.5335.00000000121885934Department of Psychiatry and Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, UK
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China. .,Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
| | - Shunying Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
37
|
Peles E, Malik E, Altman Y, Baharav A, Schreiber S, Sason A, Adelson M. Stress indices in methadone maintenance treatment - Cross sectional and follow up study. Psychiatry Res 2020; 291:113218. [PMID: 32544714 DOI: 10.1016/j.psychres.2020.113218] [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: 03/20/2020] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
To study the prevalence of perceived high stress among methadone maintenance treatment (MMT) patients, and whether stress can predict outcome, and whether stress may improve during treatment, we studied a sample of 107 MMT patients using Perceived Stress Scale (PSS) questionnaires. We studied if PSS scores on admission predict long-term retention, and we monitored stress indices (PSS, heart rate variability, saliva cortisol) on admission, 6 and 12 months later, to measure changes. Variables included demographic data, history of adverse events, and urine test. A sample of 79 (73.8%) males and 28 (26.2%) females whose age at opioid use onset was 22.1±7.2 years and age at study onset 50.5±10.8 years was studied for PSS. Both high and very-high PSS patients characterized (logistic regression) as abusing benzodiazepine, and with history of depressive symptoms. The very-high PSS group on admission (n=29) had shorter cumulative retention (1.8 years, 95%%CI 1.2-2.4) compared with 50 others (2.8 years, 95%%CI 2.3-3.3, p=0.03). Monitoring stress indices among 25 patients found that no-benzodiazepine and cocaine use on admission, opioid discontinuation after 6 months, and any substance discontinuation after a year were associated with stress reduction. Conclusion: stress level appears to normalize among MMT patients if no other substance is abused.
Collapse
Affiliation(s)
- Einat Peles
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research Tel Aviv, Sourasky Medical Center, 1 Henrietta Szold St., Tel Aviv 64924, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Elad Malik
- Department of Psychiatry, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Shaul Schreiber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research Tel Aviv, Sourasky Medical Center, 1 Henrietta Szold St., Tel Aviv 64924, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Psychiatry, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Sason
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Adelson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
38
|
Chao E, Hung CC, Lin CP, Ku YCJ, Ain QU, Metzger DS, Lee TSH. Adherence among HIV-positive injection drug users undergoing methadone treatment in Taiwan. BMC Psychiatry 2020; 20:346. [PMID: 32616019 PMCID: PMC7331024 DOI: 10.1186/s12888-020-02764-0] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS The study aims were to investigate adherence to methadone maintenance treatment (MMT) and to identify associated clinical factors in patients who inject drugs diagnosed with human immunodeficiency virus (HIV) infection in Taiwan. METHODS Data were from the National Health Surveillance System on HIV and the National Drug Treatment System on MMT. HIV-positive people who inject drugs (HIVPWID) were defined as the study population. Information obtained included age, sex, education, marital status, employment, methadone dose, and date of diagnosis of HIV infection. Adherence was defined as taking methadone for the past 90, 180 and 365 days, then categorized as high (> 90%), moderate (51 to 90%), or low (<=50%) adherent respectively. RESULTS Of 1641 HIVPWID registered in the datasets from 2007 to 2012, 961 (58.56%) had received MMT. For HIVPWID evaluated at 90 days (n = 951), 271 (28.5%), 382 (40.2%), and 298 (31.3%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 180 days (n = 936), 190 (20.3%), 349 (37.3%), and 397 (42.4%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 365 days (n = 919), 133 (14.5%), 271 (29.5%), and 515 (56.0%) were classified as high, moderate, and low adherent respectively. After controlling for sociodemographics, results showed that methadone dose, location of MMT clinic, and date of HIV diagnosis were significantly associated with MMT adherence. CONCLUSIONS Study findings underscore the importance to MMT adherence of methadone dosage, early diagnosis of patient's HIV infection, and area of patient residence.
Collapse
Affiliation(s)
- En Chao
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.416121.10000 0004 0573 0539Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Chia-Chun Hung
- grid.260770.40000 0001 0425 5914Institute of Brain Science, National Yang Ming University, Taipei, Taiwan ,grid.454740.6Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ching-Po Lin
- grid.260770.40000 0001 0425 5914Institute of Brain Science, National Yang Ming University, Taipei, Taiwan
| | - Yi-Chien Jacob Ku
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.25879.310000 0004 1936 8972Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Qurat Ul Ain
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.440552.20000 0000 9296 8318Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | - David S. Metzger
- grid.454740.6Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan. .,CTBC Center for Addiction Prevention and Policy Research, National Taiwan Normal University, No 162 Sec. 1 He-Ping East Road, Taipei, 10610, Taiwan.
| |
Collapse
|
39
|
Gimelfarb Y, Shamir EZ, Ness Dabush K, Ben Tzarfati M. Methadone maintenance treatment and survival of schizophrenic patients with a lifetime comorbid substance use disorders: a long-term follow-up study. J Addict Dis 2020; 38:458-464. [PMID: 32608328 DOI: 10.1080/10550887.2020.1782558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background Methadone maintenance treatment (MMT) remains the most widely used effective therapeutic approach for opioid use disorders. However, there is paucity of empirical data regarding the relationship between the MMT and survival of subjects with schizophrenia. Aim The aim of this study was to examine the effect of MMT on the long-term survival of subjects with schizophrenia and a lifetime comorbid substance use disorders. Methods The charts of 277 consecutive subjects admitted in our center during a period from January 1, 2002 to February 1, 2007 were assessed. Psychiatric diagnoses have been established according to international classification of diseases and health related problems-10th edition (ICD-10). The risk of all-cause mortality was assessed by Cox proportional-hazards regression models, including time-dependent covariates. Results Out of MMT subjects, 31 (11.2%) had mental and behavioral disorders due to multiple psychoactive substance use, 5 (1.8%) had mental and behavioral disorders due to use of opioids. All of 13 (4.7%) subjects with opioid use disorders were treated. MMT has been found to be predictive of lower long-term survival, in time-independent (hazard ration [HR] = 1.88; 95%CI: 1.06-3.37; p<.05) and in time-dependent adjusted models (HR = 2.01; 95%CI: 1.21-3.60; p<.05). MMT daily dose of <120 mg (adjusted HR = 1.83; 95%CI: .95-3.54) and MMT daily dose of ≥120 mg (adjusted HR = 2.70; 95%CI: .97-7.54) were associated with less long-term survival, all compared with no lifetime MMT (p<.046). Conclusions Among subjects with schizophrenia and a lifetime comorbid substance use disorders, overall mortality was higher in those who received lifetime MMT, then in patients without MMT.
Collapse
Affiliation(s)
- Yuri Gimelfarb
- AMHC, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Bat Yam, Israel
| | - Eyal Zvi Shamir
- AMHC, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Bat Yam, Israel
| | - Keren Ness Dabush
- Assuta Medical Center, affiliated to the Faculty of Medicine, Ariel University, Ashdod, Israel
| | - Mashit Ben Tzarfati
- AMHC, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Bat Yam, Israel
| |
Collapse
|
40
|
Shao ZH, Shi J, Yao T, Feng D, Dong S, Shi S, Feng YL, Zhang YW, Wang SP. [Characteristics of methadone maintenance treatment clinic patients and influencing factors for HBsAg positivity based on Bayesian network model]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:331-336. [PMID: 32294830 DOI: 10.3760/cma.j.issn.0254-6450.2020.03.010] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To understand the characteristics and explore the influencing factors of HBsAg positivity in methadone maintenance treatment (MMT) clinic patients. Methods: A face to face interview and medical record review were conducted in 1 040 patients at three MMT clinics in Guangxi from September to November in 2014. The questionnaire information included general demographic characteristics, drug use history, MMT status, sexual behaviors, and health status, etc. Blood samples were collected from the patients at the same time for the detections of the level of HBsAg, anti-HBs and anti-HCV. By using χ(2) test, unconditional logistic regression model and Bayesian network model the influencing factors for HBsAg positivity in MMT clinic patients and the complex network relationship among these factors were explored. Results: A total of 1 031 MMT clinic patients were surveyed, the HBsAg positive rate was 11.35% (117/1 031). The anti-HCV positive rate was 71.77% (740/1 031), among the anti-HCV positive patients, the HBsAg positive rate was 10.27% (76/740). After adjusting for the confounding factors, anti-HBs positive persons might not be HBsAg positive (OR=0.05, 95%CI: 0.03-0.09), and anti-HCV positive persons might not be HBsAg positive too (OR=0.30, 95%CI: 0.17-0.52) compared with anti-HBs negative and anti-HCV negative persons, respectively. The persons with family history of hepatitis B virus infection were more likely to be HBsAg positive compared those with no such family history (OR=5.30, 95%CI: 2.68-10.52). Bayesian network model analysis results showed that family history of hepatitis B virus infection and anti-HBs were directly related with HBsAg positivity. Anti-HCV, intravenous drug use in the past three months and other drug using during treatment were indirectly related with HBsAg positivity. Conclusions: Anti-HBs, family history of hepatitis B virus infection, anti-HCV, intravenous drug use in past three months and other drug use during treatment were related with the HBsAg positivity in MMT clinic patients. So, it is necessary to enhance health education, improve health awareness and decrease high risk behaviors to reduce the rate of HBV infection.
Collapse
Affiliation(s)
- Z H Shao
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - J Shi
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - T Yao
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - D Feng
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - S Dong
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - S Shi
- Methadone Maintenance Treatment Clinic, Nanning Red Cross Hospital, Nanning 530012, China
| | - Y L Feng
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Y W Zhang
- Division of Environment Health Sciences, School of Public Health, Yale University, New Haven, Connecticut 06520, USA
| | - S P Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| |
Collapse
|
41
|
Dennis BB, Akhtar D, Cholankeril G, Kim D, Sanger N, Hillmer A, Chawar C, D'Elia A, Panesar B, Worster A, Marsh DC, Thabane L, Samaan Z, Ahmed A. The impact of chronic liver disease in patients receiving active pharmacological therapy for opioid use disorder: One-year findings from a prospective cohort study. Drug Alcohol Depend 2020; 209:107917. [PMID: 32088589 DOI: 10.1016/j.drugalcdep.2020.107917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/19/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite the demonstrated benefit of methadone, the incidence opioid-related overdose, and its associated mortality continues to rise at an alarming rate. The impact of high prevalence comorbid features such as chronic liver disease (CLD) on methadone treatment response remain unclear. AIM To determine whether CLD is associated with poor response to methadone treatment. METHODS Using a well-established multi-center cohort from the Genetics of Opioid Addiction Study (GENOA), we evaluated if presence of CLD among 1234 eligible patients with opioid use disorder receiving methadone treatment impacted health and behavioural responses to treatment. CLD was classified as any liver disorder/dysfunction present for a minimum period of six months. Serial urine toxicology assessments were used to determine treatment response. The effect of CLD was determined using a multi-variable logistic regression model. RESULTS CLD was present in 25 % (n = 314) of the population. On average, patients with CLD were found to be older (mean age 44 vs 36 years, p < 0.0001), unemployed (81.8 % vs 61 %, p < 0.0001), and receiving government disability benefits at significantly higher rates (21.9 % vs 11 %, p < 0.0001). Increased levels of physical craving, emotional stress, as well as health risk behaviors were noted in CLD patients. Findings from the multi-variable model demonstrate a 68 % increased risk for dangerous opioid consumption behaviors (Odds Ration [OR]: 1.68, 95 % Confidence Interval [CI] 1.22, 2.31, p = 0.001) among patients with CLD. Methadone dose (OR: 0.76, 95 % CI 0.70, 0.81, p < 0.0001) was shown to be protective with a significant risk reduction of 24 % per 20 mg increase in methadone. Duration in treatment was also found to be protective (OR: 0.99, 95 % CI 0.97, 0.99, p < 0.0001). CONCLUSION CLD poses a distinct risk for patients with opioid addiction. Closer drug monitoring, and substance use contingency management should be considered to reduce mortality risk in these patients.
Collapse
Affiliation(s)
- Brittany B Dennis
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton ON L8S4L8, Canada; Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Daud Akhtar
- Department of Medicine, University of British Columbia, Vancouver Costal Health, Vancouver Canada.
| | - George Cholankeril
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Nitika Sanger
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON L8S4L8, Canada; McMaser Neuroscience Graduate Program, McMaster University, Hamilton ON, L8S4L8, Canada.
| | - Alannah Hillmer
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON L8S4L8, Canada; McMaser Neuroscience Graduate Program, McMaster University, Hamilton ON, L8S4L8, Canada.
| | - Caroul Chawar
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON L8S4L8, Canada; McMaser Neuroscience Graduate Program, McMaster University, Hamilton ON, L8S4L8, Canada.
| | - Alessia D'Elia
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON L8S4L8, Canada; McMaser Neuroscience Graduate Program, McMaster University, Hamilton ON, L8S4L8, Canada.
| | - Balpreet Panesar
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON L8S4L8, Canada; McMaser Neuroscience Graduate Program, McMaster University, Hamilton ON, L8S4L8, Canada.
| | - Andrew Worster
- Department of Health Research Evaluation and Impact (Formerly Department of Clinical Epidemiology and Biostatistics), McMaster University, Hamilton ON L8S4L8, Canada.
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury ON P3E2C6, Canada; Canadian Addiction Treatment Centres, Markham ON L3T 7P6, Canada.
| | - Lehana Thabane
- Department of Health Research Evaluation and Impact (Formerly Department of Clinical Epidemiology and Biostatistics), McMaster University, Hamilton ON L8S4L8, Canada; Centre for Evaluation of Medicine, Hamilton ON L8S4L8, Canada.
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON L8S4L8, Canada; McMaser Neuroscience Graduate Program, McMaster University, Hamilton ON, L8S4L8, Canada; Department of Health Research Evaluation and Impact (Formerly Department of Clinical Epidemiology and Biostatistics), McMaster University, Hamilton ON L8S4L8, Canada; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton ON L8S4L8, Canada.
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA.
| |
Collapse
|
42
|
Kriegler J, Wegener S, Richter F, Scherbaum N, Brand M, Wegmann E. Decision making of individuals with heroin addiction receiving opioid maintenance treatment compared to early abstinent users. Drug Alcohol Depend 2019; 205:107593. [PMID: 31634665 DOI: 10.1016/j.drugalcdep.2019.107593] [Citation(s) in RCA: 15] [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: 04/04/2019] [Revised: 07/18/2019] [Accepted: 07/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Individuals with heroin addiction are prone to dysfunctional decision-making. They frequently choose the short-term rewarding option of drug intake despite experiencing long-term negative consequences. Opioid maintenance treatment (OMT) is the most common treatment of heroin addiction. METHODS In this study, 38 individuals in an early stage of abstinence from heroin addiction (ESA-HA individuals) at the end of inpatient detoxification treatment and 41 individuals in long-term OMT were examined. Decision-making was assessed by (I) a modified version of the Iowa Gambling Task (IGT) with drug-related stimuli focusing on decision-making under ambiguity and (II) the Game of Dice Task (GDT) assessing decision-making under objective risk. RESULTS OMT-individuals showed significantly better performance in the IGT than the ESA-HA-individuals. They also showed significantly less craving under exposure of drug-related pictures. In the GDT, OMT-individuals showed significantly less risky decision-making than ESA-HA-individuals. CONCLUSION The results suggest that patients receiving OMT show better functional decision-making and lower craving reactions. It could be assumed that the effectiveness of OMT in preventing relapse is linked to better decision-making and lower craving among these patients.
Collapse
Affiliation(s)
- Julia Kriegler
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Virchowstraße 174, 45147 Essen, Germany.
| | - Sophia Wegener
- Berufsförderungswerk Stralsund GmbH, Große Parower Straße 133, 18435 Stralsund, Germany.
| | - Francois Richter
- Suchthilfe direkt Essen GmbH, Hoffnungstraße 24, 45127 Essen, Germany.
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Virchowstraße 174, 45147 Essen, Germany.
| | - Matthias Brand
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Forsthausweg 2, 47057 Duisburg, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany.
| | - Elisa Wegmann
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Forsthausweg 2, 47057 Duisburg, Germany.
| |
Collapse
|
43
|
Abstract
Objective: Comorbidity of depression among individuals with opioid addiction is highly prevalent, but their outcome in methadone maintenance treatment (MMT) is not well determined.Methods: Characteristics and outcomes (retention until December 2017) of newly admitted and already (5.5 ± 4 years) in MMT patients with available Hamilton Depression Rating Scale (HAM-D) scores on admission were studied.Results: During psychiatric intake on admission, 70 (21.2%) of 330 patients were diagnosed with high depressive symptoms beyond the cutoff (HAM-D scores ≥ 18). Depressed and nondepressed groups had a similar proportion of females (20% and 23.8%) and age at admission (43.0 ± 10.5 and 43.7 ± 10.4 years), but the depressed group had higher Brief Psychiatric Rating Scale (BPRS) scores (21.4 ± 8.6 vs. 7.0 ± 7.3, respectively; p < .0005), a higher proportion of minority (non-Jewish faith; 28.6% vs.15.4%; p =.02), and a higher proportion of positive urine screening results for cocaine (55.7% vs. 34.4%; p = .001) and for benzodiazepines on admission (74.3% vs. 57.5%; p = .01). Retention after 1 year was similar (79% and 80.7%), but depressed patients had higher rates of cocaine (40.8% vs. 25.5%; p = .05) and benzodiazepine use (59.2% vs. 41.8%; p = .04) and a shorter cumulative retention (5.6 years, 95% confidence interval [CI; 4.3, 7.0]) than the nondepressed patients (6.8 years, 95% CI [6.1, 7.5]; p = .05). Of the 263 evaluated while already in MMT, 23.5% were depressed, characterized with more females (43.5% vs. 23.4%) and with a history of rape (34.5% vs. 7.6%).Conclusions: Newly admitted depressed and nondepressed patients succeeded similarly in the first year retention in treatment, despite their cocaine and benzodiazepine co-abuse. The depression was characterized with females and with rape history in those who were already in MMT. Adequate intervention is recommended for both depressed groups to improve long-term retention and outcome.
Collapse
Affiliation(s)
- Elad Malik
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Sason
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Schreiber
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
44
|
Ahmadian Moghaddam S, Mazyaki A, Razaghi EM. Public policy, attitudes and willingness to pay for treatment of substance dependence in Iran. Int J Drug Policy 2019; 74:84-89. [PMID: 31585318 DOI: 10.1016/j.drugpo.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/08/2019] [Revised: 07/11/2019] [Accepted: 08/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evaluation of costs and benefits of substance use treatment programs through a standard economic framework is necessary for optimal policy making. However, drug policy making is seldom supported by economic justification. Measurement of willingness to pay is a tool to provide better understanding of intangible substance use treatment outcomes and to help a balanced policy in treatment of substance use between maintenance treatment and abstinence-based approach. AIM To assess the reciprocal association between economic indexes and attitudes about substance use and its treatment as indicators of tendency toward the two different treatment. METHOD Willingness to pay for treatment was measured by contingency valuation method among 109 treatment cost payers of which 78 subjects were from outpatient methadone maintenance clinics and 31 were from abstinence-based residential facilities. To analyze predictors of willingness to pay, we used income to capture heterogeneity of purchasing power among subjects. Further, we checked bivariate correlation of different attitudes of cost payers with willingness to pay. In the next step using backward regression equation we tried to reach the best specification of the model. Selected variables include cost payers' attitudes toward substance use and its treatment, effectiveness of treatment, social attitude toward the condition of substance use in Iran, fairness of treatment prices, and government financial support for addiction treatment. RESULTS In methadone maintenance clinics the payers' income had a pivotal role in determining willingness to pay for substance use treatment by 50% (p<0.001 ). On the other hand, in abstinence-based residential facilities positive attitude toward substance use (61%, p<0.01) was the major direct determinant of willingness to pay for treatment. Attitude to public financial support for substance use treatment (55%, p<0.01 ) and consumption experience (45%, p<0.01 ) showed an inverse association with WTP in regression equation. CONCLUSION This study expanded the understanding of the nature of payment in different substance use treatment modalities. The suggestion to policy makers is that before taking position on different types of treatment services, it is necessary to pay attention to factors that determine values cost payers put on treatment. In other words, economic indexes, payers' views about substance use and its treatment, and their opinion about effectiveness of substance use treatment programs may jeopardize the success of the policy.
Collapse
Affiliation(s)
- Samaneh Ahmadian Moghaddam
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Iran
| | - Ali Mazyaki
- Department of Economics, Allameh Tabataba'i University, Shahid Beheshti, Tehran, Iran.
| | - Emran M Razaghi
- Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Iran.
| |
Collapse
|
45
|
Luo S, Lin C, Feng N, Wu Z, Li L. Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China. Int J Drug Policy 2019; 71:73-77. [PMID: 31233972 DOI: 10.1016/j.drugpo.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/06/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Drug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors. METHODS The cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers. RESULTS The Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=-1.79; 95% CI: -3.13, -0.45; p-value = 0.009). CONCLUSION The findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.
Collapse
Affiliation(s)
- Sitong Luo
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Nan Feng
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| |
Collapse
|
46
|
Lam JA, Lee HIS, Truong AQ, Macmadu A, Clarke JG, Rich J, Brockmann B. Brief video intervention to improve attitudes throughout medications for opioid use disorder in a correctional setting. J Subst Abuse Treat 2019; 104:28-33. [PMID: 31370982 DOI: 10.1016/j.jsat.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/12/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Medications for opioid use disorder (MOUD) in the criminal justice setting is an effective way to address opioid use disorder and prevent associated deaths in the community. The Rhode Island Department of Corrections (RIDOC) is the first statewide correctional system in the United States to offer comprehensive MOUD services to incarcerated individuals.However, due to stigma, eligible individuals may be reluctant to engage with MOUD. This study aims to 1) evaluate the efficacy of an educational video intervention about MOUD and 2) characterize MOUD-related attitudes in a general incarcerated population. METHODS Participants were recruited from eight elective classes offered to soon-to-be-released incarcerated individuals at RIDOC. Participants viewed an eight-minute video featuring incarcerated individuals speaking about their experiences using MOUD, designed to reduce MOUD-related stigma. Participants were administered surveys prior to and after watching the video to assess changes in MOUD knowledge (MOUD-K) and MOUD attitudes (MOUD-A). RESULTS This evaluation of the intervention included 80 incarcerated participants (median age = 35, 93% male, 36% non-Hispanic White, and 26% non-Hispanic Black). Forty percent indicated non-medical opioid use within six months prior to incarceration; 13% had previously used MOUD. Significant improvements in MOUD-K scores (t(65) = -7.0, p < 0.0001) and MOUD-A scores (t(69) = -5.8, p < 0.0001) were detected after participants viewed the video. The intervention yielded greater ΔMOUD-A scores among those identifying as non-Hispanic Black, compared to non-Hispanic Whites (β = 2.6, CI = 0.4, 4.8). CONCLUSION The educational video improved both knowledge and positive attitudes towards MOUD, with changes in MOUD attitudes being influenced by race. These findings may inform future MOUD educational programs, thereby helping to reduce opioid use disorder-related morbidity and mortality.
Collapse
Affiliation(s)
- Jeffrey A Lam
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America.
| | - Hye In Sarah Lee
- Harvard Department of Psychology, Harvard University, Cambridge, MA, United States of America
| | - Ashley Q Truong
- Center for Prisoner Health and Human Rights, Providence, RI, United States of America
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, Providence, RI, United States of America; Brown University School of Public Health, Brown University, Providence, RI, United States of America
| | - Jennifer G Clarke
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America; Rhode Island Department of Corrections, Cranston, RI, United States of America
| | - Josiah Rich
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America; Center for Prisoner Health and Human Rights, Providence, RI, United States of America; Brown University School of Public Health, Brown University, Providence, RI, United States of America
| | - Brad Brockmann
- Brown University School of Public Health, Brown University, Providence, RI, United States of America
| |
Collapse
|
47
|
Javdan NS, Ghoreishi FS, Sehat M, Ghaderi A, Banafshe HR. Mental health and cognitive function responses to quetiapine in patients with methamphetamine abuse under methadone maintenance treatment. J Affect Disord 2019; 251:235-41. [PMID: 30928863 DOI: 10.1016/j.jad.2019.03.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with methamphetamine (MA) abuse under methadone maintenance treatment (MMT) are susceptible to several complications including cognitive disturbance and mental health disorder. This trial was designed to determine the impacts of quetiapine administration on cognitive function and mental health scale in patients with MA abuse under MMT. METHODS This study was carried out in 60 MA abusers under MMT. Patients were randomly allocated to receive either 100 mg quetiapine (n = 30) or control (n = 30) daily for 8 weeks. Cognitive function and mental health scale were taken at baseline and post-treatment to evaluate relevant variables. RESULTS Quetiapine significantly decreased depression (b -3.94; 95% CI, -7.73, -0.16; P = 0.04) and sleep disorder (b -2.18; 95% CI, -2.89, -1.47; P < 0.001). Also, quetiapine administration resulted in a significant reduction in Iowa Gambling Task (b -2.70; 95% CI, -4.69, -0.71; P = 0.009), and significant increases in Verbal Fluency Test (b 3.04; 95% CI, 1.24, 4.85; P = 0.001), Reverse Digit Span (b 2.80; 95% CI, 2.13, 3.47; P = 0.001) compared with the placebo. CONCLUSION Overall, taking 100 mg quetiapine daily for 8 weeks by patients MA abuse in MMT had favorable effects on some of cognitive functions and mental health parameters.
Collapse
|
48
|
Ledgerwood DM, Lister JJ, LaLiberte B, Lundahl LH, Greenwald MK. Injection opioid use as a predictor of treatment outcomes among methadone-maintained opioid-dependent patients. Addict Behav 2019; 90:191-195. [PMID: 30412910 DOI: 10.1016/j.addbeh.2018.10.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/29/2018] [Revised: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Injection opioid use is associated with more severe health and psychosocial consequences relative to non-injection use, but few studies have examined whether injection use is associated with methadone maintenance treatment outcomes. The present study examined differential MMT outcomes among opioid injectors and non-injectors. METHODS Data were extracted from the clinic charts of opioid-dependent MMT patients (N = 290; n = 115 injectors) enrolled in a university-affiliated, urban MMT clinic. Injection status was examined as a predictor of short- (3-month opioid, cocaine, benzodiazepine and cannabis urine drug screens) and long- (days retained in treatment) term MMT outcomes. RESULTS Bivariate analyses revealed injection users were less likely to be African American and to have completed high school, were more likely to have started heroin use before age 21, to report having hepatitis C, to report a baseline cocaine use disorder, and had higher methadone doses at 3-months into treatment. Injection status significantly predicted a greater proportion of cocaine-positive urine drug screens in the first 3 months of treatment, but did not significantly predict opioid, benzodiazepine or cannabis drug screens, or length of treatment retention. CONCLUSION This is one of a handful of studies to examine injection status as a predictor of MMT outcomes. Injection status is associated with cocaine use early in treatment, which has implications for the focus of treatment.
Collapse
Affiliation(s)
- David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA.
| | - Jamey J Lister
- School of Social Work, Wayne State University, Detroit, MI 48201, USA
| | - Benjamin LaLiberte
- Department of Psychology, Wayne State University, Detroit, MI 48201, USA
| | - Leslie H Lundahl
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Mark K Greenwald
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA; Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| |
Collapse
|
49
|
Abstract
OBJECTIVES To confirm our previous findings of less cognitive impairments (based on cognitive screening tools) among methadone maintenance treatment (MMT) patients who achieved take-home dose (THD) privileges. METHODS a random sample of 65 Israeli MMT patients were studied using computerised, age and education standardised, cognitive domains (attention, executive function, memory, motor skills), and non-computerised phonetic and semantic verbal fluency. RESULTS Cognitive scores were within ±1 standard deviation (SD) of average for most domains, including non-verbal IQ, attention and motor skills. Verbal fluency and memory were >1 SD below average (mean = 84; z = -1.1 for both). Females were younger than the males and had poorer motor skills (P = 0.005) but better verbal memory (P < 0.0005). Opiate usage duration correlated with reaction time (P = 0.05) and inversely with verbal memory (P = 0.01). Overall cognitive function was poorest among 25 (38.5%) current drug users, and 6 (9.2%) lifetime schizophrenia patients. Cognitive domains were comparable between THD privileges subgroups. CONCLUSIONS Despite heterogeneity in MMT duration, abuse duration, substance use and psychiatric comorbidity, all performed within ±1 SD of average for age and education in most cognitive domains. Our findings challenge the notion of MMT as being synonymous with compromised cognition and may lead to reduced bias regarding cognitive function of MMT patients.
Collapse
Affiliation(s)
- Odelia Elkana
- a Behavioral Sciences , Academic College of Tel Aviv-Yaffo , Tel Aviv , Israel
| | - Miriam Adelson
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Glen M Doniger
- c Department of Clinical Research , NeuroTrax Corporation , Modiin , Israel.,d Sagol Neuroscience Center & Center of Advanced Technologies in Rehabilitation , Sheba Medical Center , Ramat-Gan , Israel
| | - Anat Sason
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Einat Peles
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,e Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,f Sagol School of Neuroscience , Tel Aviv University , Tel Aviv , Israel
| |
Collapse
|
50
|
Khalatbari-Mohseni A, Banafshe HR, Mirhosseini N, Asemi Z, Ghaderi A, Omidi A. The effects of crocin on psychological parameters in patients under methadone maintenance treatment: a randomized clinical trial. Subst Abuse Treat Prev Policy 2019; 14:9. [PMID: 30795785 PMCID: PMC6387551 DOI: 10.1186/s13011-019-0198-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/11/2019] [Indexed: 12/31/2022]
Abstract
Background Methadone maintenance treatment (MMT) might be associated with the symptoms of depression and anxiety, sleep disturbances and sexual dysfunctions. This study was designed to determine the effects of crocin on psychological parameters in patients under MMT. Methods Patients under MMT were randomly allocated into two groups to receive either 30 mg/day crocin (2 plus crocin tablet, 15 mg BID) (n = 25) or placebo (2 tablets per day, 15 mg BID) (n = 25), one hour after taking food, for 8 weeks. Psychological parameters were evaluated at baseline and end of the trial to determine related associations between crocin and patients’ mental health status. Results After 8-week intervention, crocin significantly decreased Beck Depression Inventory (b − 6.66; 95% CI, − 9.88, − 3.45; P < 0.0001), Beck Anxiety Inventory (b − 4.35; 95% CI, − 5.94, − 2.75; P < 0.0001), general health questionnaire (b − 4.45; 95% CI, − 7.68, − 1.22; P = 0.008) and Pittsburgh Sleep Quality Index (b − 2.73; 95% CI, − 3.74, − 1.73; P < 0.0001) in patients under MMT, compared with the placebo. Crocin also significantly improved International Index of Erectile Functions (b 4.98; 95% CI, 2.08, 7.88; P = 0.001) rather than placebo. Conclusion Our findings indicated that taking crocin for 8 weeks by patients under MMT had beneficial effects on their mental health status. Crocin can be recommended as an adjunct to methadone in opioid withdrawal protocols because of the ability to improve the quality of life and decrease opioids side effects in these patients. This trial was registered in the Iranian website for clinical trials registry as http://www.irct.ir: IRCT2017110537243N1. Clinical trial registration number www.irct.ir: http://www.irct.ir: IRCT2017110537243N1.
Collapse
Affiliation(s)
| | - Hamid Reza Banafshe
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pharmacology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R., Iran
| | - Amir Ghaderi
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
| | - Abdollah Omidi
- Department of clinical psychology, School of Medicine, Kashan University of Medical Science, Kashan, Iran.
| |
Collapse
|