Addiction Science & Clinical Practice最新文献

Background: This study evaluated the effectiveness and patient outcomes of a temporary switch from methadone to slow-release oral morphine (SROM) during COVID-19-related supply disruptions in Lithuania in 2022.

Methods: Data from 231 patients at the Vilnius Branch of the Republican Centre for Addictive Disorders who received SROM for at least two days were retrospectively analyzed. The key metrics included methadone and SROM dosages, withdrawal severity (Clinical Opioid Withdrawal Scale (COWS)), and retention rates at 1, 3, 6, and 12 months post-switch. The data were compared by sex, methadone dosage group (low: 10-60 mg/d, medium: 61-100 mg/d, high: 101-150 mg/d), and clinic attendance frequency. To contextualize long-term outcomes, retention rates were compared with annual program-level data from 2018 to 2024.

Results: Patients received SROM for an average of 8.4 days at an initial methadone-to-SROM ratio of 1:4, which increased to 1:5.23. Withdrawal symptoms were generally mild, peaking at a mean COWS score of 8.2. Women experienced more severe symptoms than men did. After two weeks of SROM therapy, methadone supplies were restored, and patients resumed their original treatment. The retention rates remained high at 1, 3, 6, and 12 months (97.8%, 96.1%, 93.5%, and 89.2%, respectively), with higher retention rates among patients with take-home doses, higher baseline methadone dosages, or longer treatment histories. Long-term program data confirmed that the temporary switch to SROM did not adversely affect overall treatment engagement compared with preceding and subsequent years.

Conclusions: A temporary switch to SROM effectively managed methadone supply disruptions by serving as a viable substitute for methadone, causing minimal withdrawal symptoms and maintaining long-term retention. Coordinated clinical monitoring, institutional protocols, and supportive policy measures ensure continuity of care, emphasizing the value of flexible, personalized treatment strategies during crises.

Background: How communities impact patients taking medication for opioid use disorder (MOUD) has not been well-studied. Understanding the experience of MOUD providers allows us to better understand and measure community attitudes toward MOUD and identify strategies to increase support.

Methods: We deployed an explanatory sequential mixed methods design to analyze baseline data from the SITT-MAT clinical trial. Our quantitative instrument was seven Likert-scale questions asking about community attitudes toward MOUD analyzed through means, standard deviations, and principal components. The qualitative data were semi-structured interviews coded inductively using a thematic analysis. The quantitative and qualitative results were integrated to produce the findings.

Results: We surveyed staff from 20 specialty care addiction and primary care clinics in Washington state as part of a larger clinical trial. Eleven sites were also selected to complete an interview. Participating clinics were primarily specialty addiction treatment programs (N = 14, 70%), outpatient (N = 17, 85%), and/or located in urban areas (N = 12, 81%). In the survey, participants most agreed that relationships with other clinics help provide better care and least agreed that system-level policies mandate MOUD. In interviews, some staff described how reliable relationships with other clinics improved employee morale and patient care while others added that loose collaborations had fallen apart, leaving patients without the care they need. Interviewees described how insurer and government policies have made it difficult to expand their MOUD offerings. The interview data also indicated community attitudes on MOUD have improved over time with some clinics using direct outreach to garner support for MOUD.

Conclusions: Our results suggest that building local peer networks of clinics can improve staff morale and patient care in areas where community support for MOUD is low. Though system-level barriers to MOUD have been reduced, there is still room for improvement in simplifying reimbursements and funding for clinics looking to improve care. Our findings encourage further measurement of community attitudes toward MOUD and development of implementation strategies to build networks that support patients and clinics alike.

Trial registration: The data for this study is from the Stagewise Implementation-to-Target - Medications for Addiction Treatment clinical trial registered as NCT05343793 on April 25, 2022.

Background: Human immunodeficiency virus (HIV) cases among people who inject drugs increased during the US overdose crisis. Although HIV pre-exposure prophylaxis (PrEP) decreases HIV acquisition, and medications for opioid use disorder (MOUD) reduce overdose deaths, uptake remains suboptimal. The CHORUS + study will test the efficacy of a comprehensive peer recovery coaching intervention to increase PrEP and MOUD initiation and adherence.

Methods: This two-arm RCT will enroll 284 people who inject opioids (PWIO) and are negative for HIV from two sites. Participants randomized to the CHORUS + intervention will receive a study smartphone, motivational interviewing sessions, assistance connecting to PrEP and/or MOUD, and support to access resources addressing social needs such as employment and housing. We will also incorporate adapted 'Life-Steps for PrEP' modules to increase adherence. The control arm will receive information on local organizations with access to PrEP and MOUD. Participants will complete assessments at baseline, 1-, 3-, 6-, and 12-month visits. The primary outcome is adherence to HIV PrEP, assessed by tenofovir-diphosphate drug levels at 6-months post enrollment. Secondary outcomes include PrEP adherence assessed at 3- and 12-months, measured by drug levels (3-months), prescription refills, and self-report; and MOUD receipt at 3-, 6-, and 12-months, measured by prescription refills, self-report, and urine toxicology. The primary analysis will employ intent-to-treat logistic regression to assess differences in adherence between treatment arms, adjusting for stratification factors including site, race and sex assigned at birth. We will analyze secondary outcomes using similar methods. We will use multilevel growth curve modeling to evaluate changes in adherence over time by treatment group, incorporating random intercepts and slopes to account for individual trajectories. We will use exploratory multilevel structural equation modeling to assess mediators including HIV risk perception and PrEP/MOUD knowledge to understand pathways that may influence adherence.

Discussion: The CHORUS + intervention integrates a novel, theory-based, peer-delivered, smartphone-supported approach to address HIV prevention and opioid use disorder, while tackling social and structural barriers to care. Findings will inform strategies for linking PWIO to rapid HIV prevention and substance use treatment.

Trial registration: ClinicalTrials.gov number: NCT05769218.