scholarly journals Comparing views on civil commitment for drug misuse and for mental illness among persons with opioid use disorder

2020 ◽  
Vol 113 ◽  
pp. 107998
Author(s):  
Paul P. Christopher ◽  
Bradley Anderson ◽  
Michael D. Stein
Keyword(s):  
Mental Illness ◽  
Civil Commitment ◽  
Opioid Use Disorder ◽  
Drug Misuse ◽  
Opioid Use

Perceived Benefits and Harms of Involuntary Civil Commitment for Opioid Use Disorder

2020 ◽  
Vol 48 (4) ◽  
pp. 718-734
Author(s):  
Elizabeth A. Evans ◽  
Calla Harrington ◽  
Robert Roose ◽  
Susan Lemere ◽  
David Buchanan
Keyword(s):  
Civil Commitment ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Treatment Access ◽  
Evidence Based Treatment ◽  
Ethics Framework ◽  
Vulnerable Patients ◽  
Underserved Patients ◽  
Legal Consequences

Involuntary civil commitment (ICC) to treatment for opioid use disorder (OUD) prevents imminent overdose, but also restricts autonomy and raises other ethical concerns. Using the Kass Public Health Ethics Framework, we identified ICC benefits and harms. Benefits include: protection of vulnerable, underserved patients; reduced legal consequences; resources for families; and “on-demand” treatment access. Harms include: stigmatizing and punitive experiences; heightened family conflict and social isolation; eroded patient self-determination; limited or no provision of OUD medications; and long-term overdose risk. To use ICC ethically, it should be recognized as comprising vulnerable patients worthy of added protections; be a last resort option; utilize consensual, humanizing processes; provide medications and other evidence-based-treatment; integrate with existing healthcare systems; and demonstrate effective outcomes before diffusion. ICC to OUD treatment carries significant potential harms that, if unaddressed, may outweigh its benefits. Findings can inform innovations for ensuring that ICC is used in an ethically responsible way.

Civil commitment for opioid misuse: do short-term benefits outweigh long-term harms?

2021 ◽  
pp. medethics-2020-107160
Author(s):  
John C Messinger ◽  
Daniel J Ikeda ◽  
Ameet Sarpatwari
Keyword(s):  
Civil Commitment ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Short Term ◽  
Community Based ◽  
Loss Of Life ◽  
Severe Withdrawal ◽  
The Usa ◽  
Overdose Deaths

In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment—the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalise proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.

scholarly journals Neuropharmacological and Neurogenetic Correlates of Opioid Use Disorder (OUD) As a Function of Ethnicity: Relevance to Precision Addiction Medicine

2020 ◽  
Vol 18 (7) ◽  
pp. 578-595 ◽  
Author(s):  
Tomilowo Abijo ◽  
Kenneth Blum ◽  
Marjorie C. Gondré-Lewis
Keyword(s):  
African American ◽  
Association Studies ◽  
Deficiency Syndrome ◽  
Opioid Use Disorder ◽  
Drug Misuse ◽  
Opioid Overdose ◽  
Genome Wide Association Studies ◽  
Addictive Behaviors ◽  
Opioid Use ◽  
Addiction Medicine

Background: Over 100 people die daily from opioid overdose and $78.5B per year is spent on treatment efforts, however, the real societal cost is multifold greater. Alternative strategies to eradicate/manage drug misuse and addiction need consideration. The perception of opioid addiction as a social/criminal problem has evolved to evidence-based considerations of them as clinical disorders with a genetic basis. We present evaluations of the genetics of addiction with ancestryspecific risk profiles for consideration. Objective: Studies of gene variants associated with predisposition to substance use disorders (SUDs) are monolithic, and exclude many ethnic groups, especially Hispanics and African Americans. We evaluate gene polymorphisms that impact brain reward and predispose individuals to opioid addictions, with a focus on the disparity of research which includes individuals of African and Hispanic descent. Methodology: PubMed and Google Scholar were searched for: Opioid Use Disorder (OUD), Genome- wide association studies (GWAS); genetic variants; polymorphisms, restriction fragment length polymorphisms (RFLP); genomics, epigenetics, race, ethnic group, ethnicity, ancestry, Caucasian/ White, African American/Black, Hispanic, Asian, addictive behaviors, reward deficiency syndrome (RDS), mutation, insertion/deletion, and promotor region. Results: Many studies exclude non-White individuals. Studies that include diverse populations report ethnicity-specific frequencies of risk genes, with certain polymorphisms specifically associated with Caucasian and not African-American or Hispanic susceptibility to OUD or SUDs, and vice versa. Conclusion: To adapt precision medicine-based addiction management in a blended society, we propose that ethnicity/ancestry-informed genetic variations must be analyzed to provide real precision- guided therapeutics with the intent to attenuate this uncontrollable fatal epidemic.

scholarly journals Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Veer Vekaria ◽  
Budhaditya Bose ◽  
Sean M. Murphy ◽  
Jonathan Avery ◽  
George Alexopoulos ◽  
...  
Keyword(s):  
New York ◽  
Mental Illness ◽  
Substance Use ◽  
Healthcare Utilization ◽  
Substance Use Disorders ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Related Services ◽  
Comparison Groups ◽  
Utilization Patterns

AbstractSubstance use disorders (SUDs) commonly co-occur with mental illness. However, the ongoing addiction crisis raises the question of how opioid use disorder (OUD) impacts healthcare utilization relative to other SUDs. This study examines the utilization patterns of patients with major depressive disorder (MDD) and: (1) co-occurring OUD (MDD-OUD); (2) a co-occurring SUD other than OUD (MDD-NOUD); and (3) no co-occurring SUD (MDD-NSUD). We analyzed electronic health records (EHRs) derived from multiple health systems across the New York City (NYC) metropolitan area between January 2008 and December 2017. 11,275 patients aged ≥18 years with a gap of 30–180 days between 2 consecutive MDD diagnoses and an antidepressant prescribed 0–180 days after any MDD diagnosis were selected, and prevalence of any SUD was 24%. Individuals were stratified into comparison groups and matched on age, gender, and select underlying comorbidities. Prevalence rates and encounter frequencies were measured and compared across outpatient, inpatient, and emergency department (ED) settings. Our key findings showed that relative to other co-occurring SUDs, OUD was associated with larger increases in the rates and odds of using substance-use-related services in all settings, as well as services that integrate mental health and substance abuse treatments in inpatient and ED settings. OUD was also associated with larger increases in total encounters across all settings. These findings and our proposed policy recommendations could inform efforts towards targeted OUD interventions, particularly for individuals with underlying mental illness whose treatment and recovery are often more challenging.

Isomorphic Pressures on Jail Diversion: From Serious Mental Illness to Opioid Use Disorder

2021 ◽  
pp. 003288552199109
Author(s):  
Monte D. Staton ◽  
Barbara Andraka-Christou ◽  
Dennis P. Watson
Keyword(s):  
Mental Illness ◽  
Serious Mental Illness ◽  
Qualitative Interview ◽  
Opioid Use Disorder ◽  
Institutional Isomorphism ◽  
Jail Diversion ◽  
Opioid Use ◽  
Program Data ◽  
Over Time ◽  
Isomorphic Pressures

This article explains how jail diversion introduced in one Midwestern county changed its focus over time from persons with serious mental illness (PSMI) to persons with opioid use disorder (POUD). Applying the theory of institutional isomorphism, the authors use both qualitative interview and quantitative program data to explore the isomorphic pressures that caused programming change resulting from an opioid addiction crisis at the expense of arrested PSMI not appropriate for treatment with Vivitrol®.

L'esperienza clinica con Levometadone nel trattamento del disturbo da uso di oppiacei

MISSION ◽  
2019 ◽  
pp. 54-57
Author(s):  
Marco Riglietta ◽  
Paolo Donadoni ◽  
Grazia Carbone ◽  
Caterina Pisoni ◽  
Franca Colombi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Real Life ◽  
Opioid Use Disorder ◽  
Racemic Mixture ◽  
Opioid Use ◽  
The Real ◽  
New Formulation

In Italy, at the end of the 1970s, methadone hydrochloride was introduced for the treatment of opioid use disorder, in the form of a racemic mixture consisting of levomethadone and dextromethadone.In 2015 Levometadone was introduced, a new formulation marketed in Italy for the treatment of opioid use disorder in 2015.The article aims to bring the experience of an Italian Addiction Centre back to the use of this new formulation in the "real life" analyzing the efficacy, the trend of adverse events and pharmacological iterations in a context in which the treated population often uses besides the opiates, cocaine and alcohol, are burdened by a relevant physical and psychic comorbidity and frequently have a prescribed polypharmacy.

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