scholarly journals Long term pre-treatment opioid use trajectories in relation to opioid agonist therapy outcomes among people who use drugs in a Canadian setting

2021 ◽  
Vol 112 ◽  
pp. 106655
Author(s):  
Huiru Dong ◽  
Kanna Hayashi ◽  
Nadia Fairbairn ◽  
M-J Milloy ◽  
Kora DeBeck ◽  
...  
Keyword(s):  
People Who Use Drugs ◽  
Opioid Use ◽  
Therapy Outcomes ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Canadian Setting ◽  
Pre Treatment

The duration dilemma in opioid agonist therapy

2021 ◽  
Vol 17 (4) ◽  
pp. 353-358
Author(s):  
Anjali Dhanda, MD ◽  
Edwin A. Salsitz, MD, DFASAM
Keyword(s):  
Maintenance Treatment ◽  
A Priori ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Short Term ◽  
Opioid Agonist ◽  
Adequate Treatment ◽  
Opioid Agonist Therapy ◽  
Optimal Outcomes

Objective: Studies dating back to 1964 consistently support the effectiveness of methadone as a maintenance treatment for opioid use disorder (OUD), and since 2003, the effectiveness of buprenorphine. Short-term detoxification has not proven to be an effective treatment, as it results in high relapse rates when compared with maintenance treatment with an opioid agonist therapy (OAT). The question about the duration of maintenance treatment for OUD has been debated with recommendations ranging from a minimum of 1 year, 2 years, to indefinitely. Other factors such as misconceptions, regulations, and insurance barriers also have an impact on the duration dilemma of OAT.Design: There were no a priori criteria for article inclusion and this is not a structured literature review. It is a review of articles of convenience from 1964 to 2018.Main outcome measure: This paper aims to address the dilemma of the ideal duration of OAT and to discuss the factors that could affect this decision.Results: Sustained OAT has had significantly better long-term outcomes than short-term detoxification or time limited maintenance. Optimal outcomes are dependent on adequate treatment duration.Conclusions: Addiction is a chronic brain disease and its treatment should be similar to the treatment of other chronic medical and psychiatric diseases. Long-term, sometimes lifetime, continuation of OAT for the treatment of OUD results in optimal outcomes when measuring morbidity and mortality. The accumulated evidence does not support any arbitrary limitation to the duration of OAT. 

scholarly journals Changes in substance use in relation to opioid agonist therapy among people who use drugs in a Canadian setting

2020 ◽  
Vol 212 ◽  
pp. 108005 ◽  
Author(s):  
Huiru Dong ◽  
Kanna Hayashi ◽  
M-J Milloy ◽  
Kora DeBeck ◽  
Joel Singer ◽  
...  
Keyword(s):  
Substance Use ◽  
People Who Use Drugs ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Canadian Setting

scholarly journals 2897. Collocated Buprenorphine Is Associated with Improved HCV Visit Adherence in People Who Inject Drugs (PWID): Data From the ANCHOR Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S82-S82
Author(s):  
Elana S Rosenthal ◽  
Rachel Silk ◽  
Poonam Mathur ◽  
Rahwa Eyasu ◽  
Laura Nussdorf ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
People Who Use Drugs ◽  
High Risk Population ◽  
Opioid Use ◽  
Hcv Treatment ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Visit Adherence ◽  
Chronic Hcv

Abstract Background Engaging PWID in HCV treatment and monitoring for reinfection is critical to eliminate HCV and improve health in people who use drugs. However, PWID are often marginalized and can be difficult to engage and retain in care. The collocation of HCV treatment with buprenorphine to treat opioid use disorder (OUD) may improve visit adherence in this population. Methods ANCHOR is a single-center study evaluating treatment of HCV in PWID with chronic HCV, OUD, and IDU. Participants receive sofosbuvir/velpatasvir x12 weeks and are offered collocated buprenorphine. HCV visits occur at weeks 4, 12, 24, 48, 72 and 96. Results At screening, the 100 enrolled patients were predominantly male (76%), black (93%), middle-aged (median 57years), injected opioids daily or more (58%), and were not on OAT (67%). Fifty-five (55%) patients were initiated on collocated buprenorphine at some point after day 0. Being on collocated buprenorphine at the time of HCV visit was associated with increased likelihood of visit attendance at weeks 12 (P = 0.002), 24 (P = 0.01), 48 (P = 0.02), 72 (P = 0.003), and 96 (P = 0.04). For patients who attended study visits, being on collocated buprenorphine was associated with a shorter time between planned visit and actual visit at weeks 12 (P = 0.03), 24 (P = 0.04), and 48 (P = 0.04). When looking at patients not on collocated buprenorphine, being on noncollocated opioid agonist therapy vs. not being on OUD treatment did not impact visit adherence. Conclusion Evidence-based treatment of HCV and OUD are critical to improving health in PWID. The collocation of HCV treatment with office-based buprenorphine may improve adherence to visits and visit timing, especially in long-term follow-up. Infectious disease providers should offer collocated buprenorphine as a tool to improve long-term outcomes and engagement in this high-risk population. Disclosures All Authors: No reported Disclosures.

scholarly journals Optimizing Hepatitis C Virus (HCV) Treatment in a US Colocated HCV/Opioid Agonist Therapy Program

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Jackie Habchi ◽  
Aurielle M Thomas ◽  
Sophie Sprecht-Walsh ◽  
Elenita Arias ◽  
Jeffrey Bratberg ◽  
...  
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Methadone Maintenance ◽  
The United States ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy

Abstract Background A minority of patients with opioid use disorder are treated for hepatitis C virus infection (HCV). While colocated HCV and opioid agonist therapy (OAT) along with harm reduction can facilitate prevention and cascade to cure, there are few real-world examples of such embedded care models in the United States in the direct-acting antiviral (DAA) era. Methods We conducted a retrospective chart review to determine sustained virologic response (SVR) and reinfection rates during the first 5-year period of DAA availability among individuals tested and treated on-site at Rhode Island’s only nonprofit methadone maintenance program. Results Of 275 who initiated DAAs, the mean age (range) was 43 (22–71) years, 34.5% were female, 57.5% had genotype 1a, 23.3% had cirrhosis, and 92% were Medicaid recipients. SVR was 85.0% (232/273), while modified intent-to-treat SVR was 93.2% (232/249); 17 patients did not achieve SVR, 2 awaited SVR 12 weeks post-end-of-treatment, and 24 were lost to follow-up. Thirty reinfections were identified over 375.5 person-years of follow-up (rate, 7.99/100 person-years). The median time to first reinfection (interquartile range) was 128 (85.25–202.5) days. Before July 1, 2018, 72 patients accessed DAAs over 3.7 years; after Medicaid DAA restrictions were lifted, 109 patients accessed DAAs over 1.3 years. The Prior Authorization (PA) process requires many steps, differing across 11 RI insurers, taking 45–120 minutes per patient. Conclusions DAA treatment was effective among a marginalized population in an urban colocated OAT/HCV program. Removing DAA restrictions facilitates treatment initiation. The PA process remains a modifiable barrier to expanding capacity in the United States.

scholarly journals Chronic pain, craving, and illicit opioid use among patients receiving opioid agonist therapy

2016 ◽  
Vol 166 ◽  
pp. 26-31 ◽  
Author(s):  
Judith I. Tsui ◽  
Marlene C. Lira ◽  
Debbie M. Cheng ◽  
Michael R. Winter ◽  
Daniel P. Alford ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Illicit Opioid Use

scholarly journals Evaluating comparative effectiveness of psychosocial interventions for persons receiving opioid agonist therapy for opioid use disorder: protocol for a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023902 ◽  
Author(s):  
Danielle B Rice ◽  
Brian Hutton ◽  
Patricia Poulin ◽  
Beth A Sproule ◽  
Dianna Wolfe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Transmitted Disease ◽  
Psychosocial Interventions ◽  
Opioid Use Disorder ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy

IntroductionThe opioid crisis has resulted in increasing rates of death caused by problematic opioid use. Current clinical guidelines recommend that individuals with persons with opioid use disorder (OUD) receive pharmacological (eg, opioid agonist therapy) and psychosocial (eg, cognitive behavioural therapy) therapy; however, the best combination of pharmacologic and psychosocial components is not known. Our objective of the planned study is to conduct a comprehensive systematic review to assess the relative benefits of psychosocial interventions as an adjunct to opioid agonist therapy among persons with OUD.Methods and analysisA comprehensive search for randomised controlled trials published in English or French will be conducted from database inception to March 2018. The search will be conducted in MEDLINE and translated for Embase, PsycINFO and the Cochrane Central Register of Controlled Trials. Two independent reviewers will screen, extract and assess risk of bias of eligible articles. Primary outcomes of interest will be treatment retention and opioid use (based on urinalysis results). Secondary outcomes will include self-reported opioid use, abstinence from illicit drugs, adherence to psychosocial therapy and opioid agonist therapy, risk for sexually transmitted disease, risk for blood borne pathogens, changes in mental health symptoms (eg, depression), measures of craving and changes in patients’ quality of life and relevant adverse events. If sufficient data and adequate homogeneity exists, network meta-analyses (NMA) will be performed.Ethics and disseminationThis will be the first systematic review to incorporate NMA to compare psychosocial treatments used as an adjunct to opioid agonist therapy for OUD. Results of this review will inform clinical management of persons with OUD.Trial registration numberCRD42018090761.

Transitioning a patient from injectable opioid agonist therapy to sublingual buprenorphine/naloxone for the treatment of opioid use disorder using a microdosing approach

2020 ◽  
Vol 13 (3) ◽  
pp. e233715 ◽  
Author(s):  
Mackenzie Duncan Gregory Caulfield ◽  
Rupinder Brar ◽  
Christy Sutherland ◽  
Seonaid Nolan
Keyword(s):  
Slow Release ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Evidence Based ◽  
Opioid Use ◽  
First Line ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Evidence Based Treatment ◽  
Opioid Agonist Therapy

In the wake of North America’s opioid crisis, access to evidence-based treatment for opioid use disorder (OUD) is of critical importance. While buprenorphine/naloxone and methadone are currently indicated as first-line medications for the treatment of OUD, there are a proportion of individuals who do not benefit from these therapies. Recent Canadian guidelines suggest the use of alternate therapies, including slow-release oral morphine or injectable opioid agonist therapy (iOAT) for individuals unsuccessful with either methadone or buprenorphine/naloxone. While the guidelines highlight the need to intensify OUD treatment as disease severity increases, equally important is the consideration for deintensification of treatment (eg, from iOAT to an oral opioid agonist treatment (OAT) option) following successful stabilisation. Literature addressing how best to accomplish this, however, is currently lacking. Accordingly, the case presented here describes a patient that successfully transitions from iOAT to oral buprenorphine/naloxone using a novel induction approach termed microdosing.

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