Pub Date : 2020-11-02eCollection Date: 2020-01-01DOI: 10.2147/SAR.S266838
Graham Parsons, Cindy Ragbir, Oscar D'Agnone, Ayana Gibbs, Richard Littlewood, Bernadette Hard
Introduction: Prolonged-release buprenorphine (PRB), administered by weekly or monthly injection, for opioid dependence (OD) treatment offers the potential to address some limitations of oral therapy including stigma, difficulty in achieving consistent appropriate dosing, risk of diversion of medications, risk of overdose, and continuing use of other drugs. Patient-reported outcomes (PRO) and experiences are important in the evaluation of OD therapy success. This work aimed to document PRO during PRB therapy to guide future treatment decision-making.
Methods: Qualitative interviews were completed with people on PRB OD treatment. Twenty individuals from four treatment services in England and Wales were asked to participate. A structured interview was developed guided by a person with OD lived experience. Interviews were transcribed, coded and analyzed using iterative categorization.
Results: Fifteen of 20 individuals approached agreed to participate, and 14 completed interviews. The average age of participants was 42 (range 33-54) years, 13 males and 1 woman, the history of problematic opioid use was 14 years (3-25 years), time in treatment was 7 years (1-20 years), and duration on treatment with PRB was 4 months (range 1-8 months). Participants reported treatment experiences leading to coding of 277 unique comments: therapy effectiveness (77% indicated a benefit of, or satisfaction with, PRB therapy, 7% neutral/general, 16% indicated concern or questions about PRB therapy), convenience (81% benefit, 7% neutral/general, 12% concern), and overall satisfaction (81% benefit, 3% neutral/general, 16% concern). Reported benefits include cravings reduction of 10 (71%), self-care improvement of 10 (71%), relationships improvement of 9 (64%), resources management of 6 (43%), positive outlook on life of 12 (86%). Participants reported a range of positive personal experiences; challenges reported included temporary injection discomfort at treatment initiation.
Discussion: In this small, focused population, there was generally a positive level of treatment satisfaction with PRB. These experiences provide insights to explain potential treatment benefit to others and are useful in guiding therapy choices for others in the future.
{"title":"Patient-Reported Outcomes, Experiences and Satisfaction with Weekly and Monthly Injectable Prolonged-Release Buprenorphine.","authors":"Graham Parsons, Cindy Ragbir, Oscar D'Agnone, Ayana Gibbs, Richard Littlewood, Bernadette Hard","doi":"10.2147/SAR.S266838","DOIUrl":"https://doi.org/10.2147/SAR.S266838","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged-release buprenorphine (PRB), administered by weekly or monthly injection, for opioid dependence (OD) treatment offers the potential to address some limitations of oral therapy including stigma, difficulty in achieving consistent appropriate dosing, risk of diversion of medications, risk of overdose, and continuing use of other drugs. Patient-reported outcomes (PRO) and experiences are important in the evaluation of OD therapy success. This work aimed to document PRO during PRB therapy to guide future treatment decision-making.</p><p><strong>Methods: </strong>Qualitative interviews were completed with people on PRB OD treatment. Twenty individuals from four treatment services in England and Wales were asked to participate. A structured interview was developed guided by a person with OD lived experience. Interviews were transcribed, coded and analyzed using iterative categorization.</p><p><strong>Results: </strong>Fifteen of 20 individuals approached agreed to participate, and 14 completed interviews. The average age of participants was 42 (range 33-54) years, 13 males and 1 woman, the history of problematic opioid use was 14 years (3-25 years), time in treatment was 7 years (1-20 years), and duration on treatment with PRB was 4 months (range 1-8 months). Participants reported treatment experiences leading to coding of 277 unique comments: therapy effectiveness (77% indicated a benefit of, or satisfaction with, PRB therapy, 7% neutral/general, 16% indicated concern or questions about PRB therapy), convenience (81% benefit, 7% neutral/general, 12% concern), and overall satisfaction (81% benefit, 3% neutral/general, 16% concern). Reported benefits include cravings reduction of 10 (71%), self-care improvement of 10 (71%), relationships improvement of 9 (64%), resources management of 6 (43%), positive outlook on life of 12 (86%). Participants reported a range of positive personal experiences; challenges reported included temporary injection discomfort at treatment initiation.</p><p><strong>Discussion: </strong>In this small, focused population, there was generally a positive level of treatment satisfaction with PRB. These experiences provide insights to explain potential treatment benefit to others and are useful in guiding therapy choices for others in the future.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"11 ","pages":"41-47"},"PeriodicalIF":1.8,"publicationDate":"2020-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S266838","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38595619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-19eCollection Date: 2020-01-01DOI: 10.2147/SAR.S253960
Mohammad Reza Karimirad, Sima Afrashteh, Ali Gholami, Saeid Hossein Oghli, Abbas Abbasi-Ghahramanloo, Leila Bordbar, Mostafa Salari
Purpose: High-risk behaviors are the main causes of death and disability among youth and adults. Entering university might cause students to go through their first-hand experience of using substances.
Aim: This study aimed to detect the subgroups of students based on substance use and assess the effects of religiosity and parental support as well as other related factors on the membership of students in each latent class.
Methods: Using a multistage sampling method, this cross-sectional study was conducted in 2016 in Hormozgan University of Medical Sciences (n=524). All students completed a self-report questionnaire. This questionnaire contained questions about substance use, religious beliefs and familial support. The questions of substance use were prepared using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). To analyze the data, PROC LCA statistical method was run in SAS9.2.
Results: Three latent classes were identified: 1) nonuser (87.5%), 2) tobacco and illicit drug user (8.7%) and 3) polydrug user (3.8%). Having extramarital sex in the last month (OR=28.29, 95% CI; 8.45-94.76), living alone (OR=4.29, 95% CI; 1.01-18.35) and having a higher score of familial support (OR=0.94, 95% CI; 0.89-0.98) were associated with the polydrug user class. Hookah smoking had the highest (11.1%) and non-medical methylphenidate use had the lowest (2.3%) prevalence among the participants of the study.
Conclusion: This study revealed that 12.5% of the students were either tobacco and illicit drug users or polydrug users. Thus, focusing on the religiosity and familial support may help design some preventive programs for this stratum of young adults.
{"title":"Subgrouping University Students Based on Substance Use Pattern: A Latent Class Analysis.","authors":"Mohammad Reza Karimirad, Sima Afrashteh, Ali Gholami, Saeid Hossein Oghli, Abbas Abbasi-Ghahramanloo, Leila Bordbar, Mostafa Salari","doi":"10.2147/SAR.S253960","DOIUrl":"https://doi.org/10.2147/SAR.S253960","url":null,"abstract":"<p><strong>Purpose: </strong>High-risk behaviors are the main causes of death and disability among youth and adults. Entering university might cause students to go through their first-hand experience of using substances.</p><p><strong>Aim: </strong>This study aimed to detect the subgroups of students based on substance use and assess the effects of religiosity and parental support as well as other related factors on the membership of students in each latent class.</p><p><strong>Methods: </strong>Using a multistage sampling method, this cross-sectional study was conducted in 2016 in Hormozgan University of Medical Sciences (n=524). All students completed a self-report questionnaire. This questionnaire contained questions about substance use, religious beliefs and familial support. The questions of substance use were prepared using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). To analyze the data, PROC LCA statistical method was run in SAS9.2.</p><p><strong>Results: </strong>Three latent classes were identified: 1) nonuser (87.5%), 2) tobacco and illicit drug user (8.7%) and 3) polydrug user (3.8%). Having extramarital sex in the last month (OR=28.29, 95% CI; 8.45-94.76), living alone (OR=4.29, 95% CI; 1.01-18.35) and having a higher score of familial support (OR=0.94, 95% CI; 0.89-0.98) were associated with the polydrug user class. Hookah smoking had the highest (11.1%) and non-medical methylphenidate use had the lowest (2.3%) prevalence among the participants of the study.</p><p><strong>Conclusion: </strong>This study revealed that 12.5% of the students were either tobacco and illicit drug users or polydrug users. Thus, focusing on the religiosity and familial support may help design some preventive programs for this stratum of young adults.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"11 ","pages":"33-39"},"PeriodicalIF":1.8,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S253960","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38546067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-29eCollection Date: 2020-01-01DOI: 10.2147/SAR.S263165
Gillian A Beauchamp, Jennifer L Carey, Mikayla B Hurwitz, Briana N Tully, Matthew D Cook, Robert D Cannon, Kenneth D Katz, Andrew L Koons, Hope Kincaid, Marna Rayl Greenberg
Background: Variations between male and female populations are previously reported in classes of harmfully used/misused drugs, severity of substance use disorder and risk of relapse. The aim of this study was to provide a review of bedside medical toxicologist managed, sex-specific poisonings in adults that present with harmful drug use/misuse.
Methods: ToxIC Registry cases ≥19 and ≤65 years old, with harmful drug use or misuse during the timeframe June 2010-December 2016, were studied. Demographics, primary agents of toxic exposure, administration route and complications were analyzed. Descriptive methods were used in the analysis.
Results: The database included 51,440 cases. Of these, 3426 cases were analyzed in which the primary reason for the encounter was harmful substance use/misuse. Females were found to harmfully use/misuse pharmaceutical drugs (N=806, 65.6%) more than nonpharmaceutical drugs (N=423, 34.4%). Males more frequently used nonpharmaceutical drugs (N=1189, 54.1%) than pharmaceutical drugs (1008, 45.9%). Analgesics were used by females (N= 215, 18.2%) and males (N=137, 6.6%). Sedative hypnotics were used by females (N=165, 14%) and males (N=160, 7.8%). Psychoactive agents were used by males (N=325, 15.8%) and females (N=67, 5.7%). Sympathomimetics were used by males (N=381, 18.5%) and females (N=151, 12.8%). The majority of both male and female participants, 1712 (57.9%), utilized an oral route of administration. However, 312 (16.5%) of males utilized inhalation vs 73 (6.8%) of females inhaled their substance.
Conclusion: There were sex-specific differences among patients evaluated for harmful substance use/misuse by toxicologists. Considering these differences in regards to management and preventive approaches may be indicated.
{"title":"Sex Differences in Substance Use and Misuse: A Toxicology Investigators' Consortium (ToxIC) Registry Analysis.","authors":"Gillian A Beauchamp, Jennifer L Carey, Mikayla B Hurwitz, Briana N Tully, Matthew D Cook, Robert D Cannon, Kenneth D Katz, Andrew L Koons, Hope Kincaid, Marna Rayl Greenberg","doi":"10.2147/SAR.S263165","DOIUrl":"https://doi.org/10.2147/SAR.S263165","url":null,"abstract":"<p><strong>Background: </strong>Variations between male and female populations are previously reported in classes of harmfully used/misused drugs, severity of substance use disorder and risk of relapse. The aim of this study was to provide a review of bedside medical toxicologist managed, sex-specific poisonings in adults that present with harmful drug use/misuse.</p><p><strong>Methods: </strong>ToxIC Registry cases ≥19 and ≤65 years old, with harmful drug use or misuse during the timeframe June 2010-December 2016, were studied. Demographics, primary agents of toxic exposure, administration route and complications were analyzed. Descriptive methods were used in the analysis.</p><p><strong>Results: </strong>The database included 51,440 cases. Of these, 3426 cases were analyzed in which the primary reason for the encounter was harmful substance use/misuse. Females were found to harmfully use/misuse pharmaceutical drugs (N=806, 65.6%) more than nonpharmaceutical drugs (N=423, 34.4%). Males more frequently used nonpharmaceutical drugs (N=1189, 54.1%) than pharmaceutical drugs (1008, 45.9%). Analgesics were used by females (N= 215, 18.2%) and males (N=137, 6.6%). Sedative hypnotics were used by females (N=165, 14%) and males (N=160, 7.8%). Psychoactive agents were used by males (N=325, 15.8%) and females (N=67, 5.7%). Sympathomimetics were used by males (N=381, 18.5%) and females (N=151, 12.8%). The majority of both male and female participants, 1712 (57.9%), utilized an oral route of administration. However, 312 (16.5%) of males utilized inhalation vs 73 (6.8%) of females inhaled their substance.</p><p><strong>Conclusion: </strong>There were sex-specific differences among patients evaluated for harmful substance use/misuse by toxicologists. Considering these differences in regards to management and preventive approaches may be indicated.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"11 ","pages":"23-31"},"PeriodicalIF":1.8,"publicationDate":"2020-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/aa/sar-11-23.PMC7532888.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38498530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-17eCollection Date: 2020-01-01DOI: 10.2147/SAR.S239507
Walter Ling, David Farabee, Vijay R Nadipelli, Brian Perrochet
{"title":"An Updated Version of the Treatment Effectiveness Assessment (TEA) [Letter].","authors":"Walter Ling, David Farabee, Vijay R Nadipelli, Brian Perrochet","doi":"10.2147/SAR.S239507","DOIUrl":"https://doi.org/10.2147/SAR.S239507","url":null,"abstract":"","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"11 ","pages":"21-22"},"PeriodicalIF":1.8,"publicationDate":"2020-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S239507","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37686341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-31eCollection Date: 2020-01-01DOI: 10.2147/SAR.S247083
[This corrects the article DOI: 10.2147/SAR.S155843.].
[这更正了文章DOI: 10.2147/SAR.S155843.]。
{"title":"Erratum: Depot Buprenorphine Injection in the Management of Opioid Use Disorder: From Development to Implementation [Corrigendum].","authors":"","doi":"10.2147/SAR.S247083","DOIUrl":"https://doi.org/10.2147/SAR.S247083","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2147/SAR.S155843.].</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"11 ","pages":"19-20"},"PeriodicalIF":1.8,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S247083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37678627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Opioid maintenance treatment reduces a person's use of heroin. However, frequent substance use in treatment is a problem.
Aim: To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment.
Patients and methods: Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants' social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life.
Results: There was a significant negative association between time in treatment and use of opioids, b =-0.89, SE = 0.19, p = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, b =-0.40, SE =0.19, p = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, b = -0.62, SE = 0.23, p = < 0.01. Social dimensions, participants' adverse experiences, and social resources were not associated with polydrug or opioid use.
Conclusion: Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients' opioid use.
目的:阿片类药物维持治疗减少一个人对海洛因的使用。然而,在治疗中频繁使用药物是一个问题。目的:探讨阿片类药物维持治疗与阿片类/多种药物使用之间的关系,以及治疗前12个月的社会因素、不良经历、社会资源和生活质量是否与阿片类/多种药物使用有关。患者和方法:来自挪威卑尔根治疗单位的47名参与者参与了五波数据收集。每三个月进行一次结构化的面对面访谈,收集有关社会人口学特征、阿片类药物/多种药物使用、参与者的社会资源或不良经历以及生活质量的自我报告数据。数据是作为KVARUS(国家药物滥用治疗质量登记)的一部分收集的。采用多水平二元logistic回归分析来检验当前治疗中阿片类药物/多种药物使用与时间的关系。分析包括阿片类药物/多种药物使用对时不变基线不良经历和社会资源的回归,以及时变生活质量报告。结果:治疗时间与阿片类药物使用呈显著负相关,b =-0.89, SE =0.19, p = b =-0.40, SE =0.19, p = 0.03。在阿片类药物维持治疗期间,较高的总体生活质量与较低的阿片类药物使用几率显著相关,b = -0.62, SE = 0.23, p = < 0.01。社会维度、参与者的不良经历和社会资源与多种药物或阿片类药物的使用无关。结论:阿片类药物维持治疗与阿片类药物使用减少有关,但与多种药物使用的程度较低。我们的研究结果增加了生活质量作为一个重要因素,应该给予特别关注,因为它可以提供对可能影响患者阿片类药物使用的方面的见解。
{"title":"Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment.","authors":"Siv-Elin Leirvaag Carlsen, Linn-Heidi Lunde, Torbjørn Torsheim","doi":"10.2147/SAR.S221618","DOIUrl":"https://doi.org/10.2147/SAR.S221618","url":null,"abstract":"<p><strong>Purpose: </strong>Opioid maintenance treatment reduces a person's use of heroin. However, frequent substance use in treatment is a problem.</p><p><strong>Aim: </strong>To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment.</p><p><strong>Patients and methods: </strong>Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants' social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life.</p><p><strong>Results: </strong>There was a significant negative association between time in treatment and use of opioids, <i>b</i> =-0.89, <i>SE</i> = 0.19, <i>p</i> = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, <i>b</i> =-0.40, <i>SE</i> =0.19, <i>p</i> = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, <i>b</i> = -0.62, <i>SE</i> = 0.23, <i>p</i> = < 0.01. Social dimensions, participants' adverse experiences, and social resources were not associated with polydrug or opioid use.</p><p><strong>Conclusion: </strong>Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients' opioid use.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"11 ","pages":"9-18"},"PeriodicalIF":1.8,"publicationDate":"2020-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S221618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37678728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-08eCollection Date: 2020-01-01DOI: 10.2147/SAR.S228224
Nirvana Morgan, William Daniels, Ugasvaree Subramaney
Background: Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use.
Methods: 300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints.
Results: Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased.
Conclusion: After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.
{"title":"An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification.","authors":"Nirvana Morgan, William Daniels, Ugasvaree Subramaney","doi":"10.2147/SAR.S228224","DOIUrl":"https://doi.org/10.2147/SAR.S228224","url":null,"abstract":"<p><strong>Background: </strong>Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use.</p><p><strong>Methods: </strong>300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints.</p><p><strong>Results: </strong>Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased.</p><p><strong>Conclusion: </strong>After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"11 ","pages":"1-8"},"PeriodicalIF":1.8,"publicationDate":"2020-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S228224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37613197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Buprenorphine has pharmacologic advantages over methadone, especially buprenorphine’s better safety profile. The true significance of buprenorphine’s introduction lies in returning the care of those suffering from opioid use disorder (OUD) to the hands of the physician. The clinical success of buprenorphine has been meager, in part because most physicians have not been exposed to treating these patients. For physicians inclined to treat OUD, the barriers to buprenorphine’s implementation have been onerous and largely counter to the norms of medical practice. Some notable concerns pertain to buprenorphine’s clinical pharmacology like street diversion, unintended use and accidental poisoning. Recently, injectable buprenorphine preparations have been introduced to mitigate these latter shortcomings. Yet, the injectable preparations’ clinical and commercial success has fallen far short of expectation. Here, we review the clinical pharmacology of these products and their expected clinical advantages for the manufacturers, clinicians, policy makers and patients, and offer our perspective, as clinicians and researchers, on how things can improve. Questions remain whether clinicians are willing to overcome barriers to treat OUD using these medications.
{"title":"Depot Buprenorphine Injection In The Management Of Opioid Use Disorder: From Development To Implementation","authors":"W. Ling, S. Shoptaw, D. Goodman-Meza","doi":"10.2147/SAR.S155843","DOIUrl":"https://doi.org/10.2147/SAR.S155843","url":null,"abstract":"Abstract Buprenorphine has pharmacologic advantages over methadone, especially buprenorphine’s better safety profile. The true significance of buprenorphine’s introduction lies in returning the care of those suffering from opioid use disorder (OUD) to the hands of the physician. The clinical success of buprenorphine has been meager, in part because most physicians have not been exposed to treating these patients. For physicians inclined to treat OUD, the barriers to buprenorphine’s implementation have been onerous and largely counter to the norms of medical practice. Some notable concerns pertain to buprenorphine’s clinical pharmacology like street diversion, unintended use and accidental poisoning. Recently, injectable buprenorphine preparations have been introduced to mitigate these latter shortcomings. Yet, the injectable preparations’ clinical and commercial success has fallen far short of expectation. Here, we review the clinical pharmacology of these products and their expected clinical advantages for the manufacturers, clinicians, policy makers and patients, and offer our perspective, as clinicians and researchers, on how things can improve. Questions remain whether clinicians are willing to overcome barriers to treat OUD using these medications.","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"10 1","pages":"69 - 78"},"PeriodicalIF":1.8,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S155843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46004996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-22eCollection Date: 2019-01-01DOI: 10.2147/SAR.S192045
Caleb J Banta-Green, Anthony S Floyd, Kristin Vick, Jen Arthur, Theresa J Hoeft, Judith I Tsui
Purpose: Opioid use disorder (OUD) is a medical condition that is effectively treated with medications. A major challenge in breaking the cycle of OUD and related illegal activity is seamlessly introducing medications for opioid use disorder (MOUD) as individuals leave jail or prison. We examined the feasibility of a pilot intervention to link participants to ongoing MOUD and psychosocial supports following release from custody.
Methods: The study enrolled adults with a history of OUD released from Washington State prisons to Department of Corrections (DOC) community supervision. Participants were randomized to the study intervention or comparison group. The intervention consisted of education on OUD and available treatments, support with individualized treatment decision making, and continued care navigation for 6 months to facilitate linkage to chosen treatments. Participants randomized to the control condition received referral to services in the community from their community corrections officers. A care navigation activity log documented intervention participants' intervention engagement, service utilization, and needs. Follow-up interviews were conducted at 1 and 6 months to assess satisfaction with the intervention.
Results: Fifteen participants were enrolled. All were male, most were white (86.6%) and the average age was 36.9 years. The majority (14 of 15 participants) were near-daily heroin users with severe OUD prior to incarceration. Of the seven intervention participants, two wished to start medications immediately. Three participants reported starting buprenorphine or methadone in the subsequent follow-up period, with or without social support and/or outpatient counseling, and three reported enrolling in social support and/or outpatient counseling without medications. Participants who received the intervention reported high satisfaction. We discuss barriers and facilitators to study implementation.
Conclusion: An intervention to link participants to ongoing MOUD and psychosocial supports following release from prison had broad acceptability among participants and was feasible to implement among those recruited; however, enrollment was much lower than anticipated and the study intervention did not demonstrate the intended effect to facilitate use of MOUD immediately post-release in this small sample of participants. Given recent research showing benefits of pre-release medication initiation, the potential added benefits of this two-part intervention should be studied in systems that initiate MOUD prior to release.
{"title":"Opioid Use Disorder Treatment Decision Making And Care Navigation Upon Release From Prison: A Feasibility Study.","authors":"Caleb J Banta-Green, Anthony S Floyd, Kristin Vick, Jen Arthur, Theresa J Hoeft, Judith I Tsui","doi":"10.2147/SAR.S192045","DOIUrl":"https://doi.org/10.2147/SAR.S192045","url":null,"abstract":"<p><strong>Purpose: </strong>Opioid use disorder (OUD) is a medical condition that is effectively treated with medications. A major challenge in breaking the cycle of OUD and related illegal activity is seamlessly introducing medications for opioid use disorder (MOUD) as individuals leave jail or prison. We examined the feasibility of a pilot intervention to link participants to ongoing MOUD and psychosocial supports following release from custody.</p><p><strong>Methods: </strong>The study enrolled adults with a history of OUD released from Washington State prisons to Department of Corrections (DOC) community supervision. Participants were randomized to the study intervention or comparison group. The intervention consisted of education on OUD and available treatments, support with individualized treatment decision making, and continued care navigation for 6 months to facilitate linkage to chosen treatments. Participants randomized to the control condition received referral to services in the community from their community corrections officers. A care navigation activity log documented intervention participants' intervention engagement, service utilization, and needs. Follow-up interviews were conducted at 1 and 6 months to assess satisfaction with the intervention.</p><p><strong>Results: </strong>Fifteen participants were enrolled. All were male, most were white (86.6%) and the average age was 36.9 years. The majority (14 of 15 participants) were near-daily heroin users with severe OUD prior to incarceration. Of the seven intervention participants, two wished to start medications immediately. Three participants reported starting buprenorphine or methadone in the subsequent follow-up period, with or without social support and/or outpatient counseling, and three reported enrolling in social support and/or outpatient counseling without medications. Participants who received the intervention reported high satisfaction. We discuss barriers and facilitators to study implementation.</p><p><strong>Conclusion: </strong>An intervention to link participants to ongoing MOUD and psychosocial supports following release from prison had broad acceptability among participants and was feasible to implement among those recruited; however, enrollment was much lower than anticipated and the study intervention did not demonstrate the intended effect to facilitate use of MOUD immediately post-release in this small sample of participants. Given recent research showing benefits of pre-release medication initiation, the potential added benefits of this two-part intervention should be studied in systems that initiate MOUD prior to release.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"10 ","pages":"57-67"},"PeriodicalIF":1.8,"publicationDate":"2019-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S192045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Walker, L. Weatherby, M. Cepeda, Daniel C Bradford
Background Doctor and pharmacy shopping (“Shopping”) for opioids is related to opioid abuse and is associated with opioid overdose and death. Lacking identifiers for prescribers and pharmacies, many data resources (notably the US FDA’s Sentinel System) cannot evaluate Shopping. We used data in which presumptive Shopping could be identified. We investigated whether US health insurance claims data could perform as well as Shopping to identify people with evidence for opioid abuse. Methods In this cross-sectional study, we examined health insurance claims from 164,923 persons with at least two dispensing of opioids in 18 months, the first occurring in 2012. Evidence for the presence of a possible opioid abuse disorder was drawn from predictive patterns of drug fills, diagnoses and care-seeking identified in a companion research project, and Shopping was determined using a published index. The prevalence of presumptive opioid abuse was examined across levels of Shopping. The comparison between Shopping and insurance-claims-derived covariates in the detection of apparent opioid abuse was examined in multiple regression analyses. Results Despite a strong correlation between presumptive opioid abuse and Shopping, most persons with extensive Shopping did not manifest presumptive opioid abuse, and half of the population with presumptive opioid abuse did not exhibit Shopping. As Shopping ranged from “None” to “Extensive,” the prevalence of presumptive opioid abuse increased from 0.28 to 5.0 per 100. The discriminating power of Shopping for identifying opioid abuse could be replaced using insurance claims data. Conclusion The results suggest that patient characteristics that can be inferred from insurance claims data provide as complete discrimination of persons with presumptive opioid abuse as does a full assessment of doctor and pharmacy shopping. The inference rests on patterns of health services and drug dispensing that are indicative of doctor–pharmacy shopping and of opioid abuse. There was no direct evaluation of patients. The extent to which the conclusions are generalizable beyond the study population – Americans with health insurance coverage in the early part of this decade – is uncertain in a quantitative sense. The qualitative conclusion is that diagnostic data in health insurance databases can be predictive of behaviors consistent with opioid abuse and that more elaborate indices such as doctor and pharmacy shopping may add little. Registration: ClinicalTrials.gov study number: NCT02668549.
{"title":"Information on doctor and pharmacy shopping for opioids adds little to the identification of presumptive opioid abuse disorders in health insurance claims data","authors":"A. Walker, L. Weatherby, M. Cepeda, Daniel C Bradford","doi":"10.2147/SAR.S201725","DOIUrl":"https://doi.org/10.2147/SAR.S201725","url":null,"abstract":"Background Doctor and pharmacy shopping (“Shopping”) for opioids is related to opioid abuse and is associated with opioid overdose and death. Lacking identifiers for prescribers and pharmacies, many data resources (notably the US FDA’s Sentinel System) cannot evaluate Shopping. We used data in which presumptive Shopping could be identified. We investigated whether US health insurance claims data could perform as well as Shopping to identify people with evidence for opioid abuse. Methods In this cross-sectional study, we examined health insurance claims from 164,923 persons with at least two dispensing of opioids in 18 months, the first occurring in 2012. Evidence for the presence of a possible opioid abuse disorder was drawn from predictive patterns of drug fills, diagnoses and care-seeking identified in a companion research project, and Shopping was determined using a published index. The prevalence of presumptive opioid abuse was examined across levels of Shopping. The comparison between Shopping and insurance-claims-derived covariates in the detection of apparent opioid abuse was examined in multiple regression analyses. Results Despite a strong correlation between presumptive opioid abuse and Shopping, most persons with extensive Shopping did not manifest presumptive opioid abuse, and half of the population with presumptive opioid abuse did not exhibit Shopping. As Shopping ranged from “None” to “Extensive,” the prevalence of presumptive opioid abuse increased from 0.28 to 5.0 per 100. The discriminating power of Shopping for identifying opioid abuse could be replaced using insurance claims data. Conclusion The results suggest that patient characteristics that can be inferred from insurance claims data provide as complete discrimination of persons with presumptive opioid abuse as does a full assessment of doctor and pharmacy shopping. The inference rests on patterns of health services and drug dispensing that are indicative of doctor–pharmacy shopping and of opioid abuse. There was no direct evaluation of patients. The extent to which the conclusions are generalizable beyond the study population – Americans with health insurance coverage in the early part of this decade – is uncertain in a quantitative sense. The qualitative conclusion is that diagnostic data in health insurance databases can be predictive of behaviors consistent with opioid abuse and that more elaborate indices such as doctor and pharmacy shopping may add little. Registration: ClinicalTrials.gov study number: NCT02668549.","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":"10 1","pages":"47 - 55"},"PeriodicalIF":1.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S201725","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47896799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}