Buprenorphine Prevalence in DUID Cases in Southwestern Virginia: Case Studies and Observations

2020 ◽  
Author(s):  
James J Kuhlman ◽  
Chad Harris ◽  
Trista Wright
Keyword(s):  
Large Range ◽  
Opioid Use Disorder ◽  
Driving Under The Influence ◽  
Screening Tests ◽  
Opioid Use ◽  
Polysubstance Use ◽  
Common Drug ◽  
Liquid Chromatography Tandem Mass ◽  
Central Nervous System Depressant ◽  
Abused Drugs

Abstract Buprenorphine, a semisynthetic mixed agonist/antagonist opioid used primarily for the treatment of opioid use disorder, was reported in 194 driving under the influence of drugs (DUID) cases in Southwestern Virginia during the period from 2017 through 2019. Identifying and confirming buprenorphine in DUID cases is common in this region. Interpretation is complex due to the large range of concentrations of buprenorphine found in blood and frequent combinations with other therapeutic and abused drugs. Buprenorphine was identified by immunoassay and quantified by liquid chromatography–tandem mass spectrometry. A sensitive method was necessary as one-third of concentrations of buprenorphine and/or norbuprenorphine were <1.0 µg/L. Concentrations of buprenorphine ranged from <0.5 to 11 µg/L (mean 2.5 µg/L, median 1.8 µg/L) and concentrations of norbuprenorphine ranged from <0.5 to >20 µg/L (mean 3.3 µg/L, median 2.2 µg/L). Buprenorphine polysubstance use was common. Only 10% of the cases examined did not contain other drugs confirmed in routine DUID screening tests. The most common drug groups confirmed were benzodiazepines, amphetamines and cannabinoids. The DUID case histories presented represent examples of buprenorphine abuse, buprenorphine with no other drug groups, buprenorphine combined with other drug groups, cases consistent with impairment and cases with minimal impairment. Central nervous system depressant and narcotic analgesic symptoms were commonly observed; however, some cases contained stimulant symptoms. Buprenorphine-to-norbuprenorphine (B/NB) ratios had a mean and median ratio of 1.1 and 0.8, respectively. B/NB ratios >3.0 were found in 4.7% of the cases. The finding of a higher B/NB ratio may indicate a more recent buprenorphine administration and a greater potential for impairment. No relationship between the concentration of buprenorphine and/or norbuprenorphine in blood and the performance on drug recognition expert evaluation or standardized field sobriety tests could be determined.

scholarly journals Association between vaping and health outcomes in patients with opioid use disorder: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040349
Author(s):  
Nitika Sanger ◽  
Alessia D'Elia ◽  
Stephanie Sanger ◽  
Tea Rosic ◽  
M Constantine Samaan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Health Outcomes ◽  
Addiction Treatment ◽  
Data Extraction ◽  
Opioid Use Disorder ◽  
Cochrane Library ◽  
Opioid Use ◽  
Polysubstance Use ◽  
Clinical Trials Registry

IntroductionVaping behaviour has increased in popularity and is particularly important to examine how it effects health outcomes in vulnerable populations, including those with opioid use disorder (OUD). With polysubstance use including cigarette and cannabis use being highly prevalent in the OUD population and cannabis/nicotine increasingly being consumed by vaping, vaping may have an important contribution to health outcomes in these individuals. The primary objective of this review is to systematically assess the literature related to patients with OUD and the effects vaping has shown on their physical and mental health.Method and analysisA systematic search of databases including MEDLINE, Embase, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Cochrane Clinical Trials Registry, the National Institutes for Health Clinical Trials Registry and the WHO International Clinical Trials Registry Platform from inception to 31 December 2020 will be conducted. Identified citations will be screened by two reviewers to determine eligibility at the title and abstract level, and then at the full text and data extraction phases. Any disagreements in inclusion will be resolved through unblinded discussion by these reviewers, with any remaining disagreements being resolved by a third reviewer. Data collection from eligible studies will be conducted according to the data extraction form tested prior to abstraction. Included studies will be examined for quality and bias and will be meta-analysed where applicable. This protocol is reported in keeping with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines.Ethics and disseminationThe results for this review will be disseminated through publications in peer-reviewed journals, posters and presentations at scientific conferences. Additionally, we are collaborating with the Canadian Addiction Treatment Centre clinics to help disseminate the findings for this review. As this is a systematic review, no ethics approval is needed.Review registration numberCRD42020178441.

scholarly journals Use of methamphetamine and alcohol among people with opioid use disorder and HIV in Vietnam: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrew Edsall ◽  
Kim A. Hoffman ◽  
Dinh Thanh Thuy ◽  
Pham Phuong Mai ◽  
Nguyen Thu Hang ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Social Life ◽  
Hiv Transmission ◽  
Qualitative Interviews ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Heroin Use ◽  
Methamphetamine Use ◽  
Polysubstance Use ◽  
History Of

Abstract Background Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. Methods We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants’ experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach. Results Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV. Conclusions Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally. Trial registration BRAVO - NCT01936857, September 2013.

scholarly journals Associations Between Polysubstance Use Patterns and Receipt of Medications for Opioid Use Disorder Among Adults in Treatment for Opioid Use Disorder

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Becky R. Ford ◽  
Gavin Bart ◽  
Brian Grahan ◽  
Riley D. Shearer ◽  
Tyler N.A. Winkelman
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Use Patterns ◽  
Polysubstance Use

scholarly journals The impact of methamphetamine/amphetamine use on receipt and outcomes of medications for opioid use disorder: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Madeline C. Frost ◽  
Hannah Lampert ◽  
Judith I. Tsui ◽  
Matthew D. Iles-Shih ◽  
Emily C. Williams
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Data Extraction ◽  
Opioid Use Disorder ◽  
Small Samples ◽  
Future Research ◽  
Opioid Use ◽  
Polysubstance Use ◽  
Amphetamine Use ◽  
The Impact

Abstract Background Methamphetamine/amphetamine use has sharply increased among people with opioid use disorder (OUD). It is therefore important to understand whether and how use of these substances may impact receipt of, and outcomes associated with, medications for OUD (MOUD). This systematic review identified studies that examined associations between methamphetamine/amphetamine use or use disorder and 3 classes of outcomes: (1) receipt of MOUD, (2) retention in MOUD, and (3) opioid abstinence during MOUD. Methods We searched 3 databases (PubMed/MEDLINE, PsycINFO, CINAHL Complete) from 1/1/2000 to 7/28/2020 using key words and subject headings, and hand-searched reference lists of included articles. English-language studies of people with documented OUD/opioid use that reported a quantitative association between methamphetamine/amphetamine use or use disorder and an outcome of interest were included. Study data were extracted using a standardized template, and risk of bias was assessed for each study. Screening, inclusion, data extraction and bias assessment were conducted independently by 2 authors. Study characteristics and findings were summarized for each class of outcomes. Results Thirty-nine studies met inclusion criteria. Studies generally found that methamphetamine/amphetamine use or use disorder was negatively associated with receiving methadone and buprenorphine; 2 studies suggested positive associations with receiving naltrexone. Studies generally found negative associations with retention; most studies finding no association had small samples, and these studies tended to examine shorter retention timeframes and describe provision of adjunctive services to address substance use. Studies generally found negative associations with opioid abstinence during treatment among patients receiving methadone or sustained-release naltrexone implants, though observed associations may have been confounded by other polysubstance use. Most studies examining opioid abstinence during other types of MOUD treatment had small samples. Conclusions Overall, existing research suggests people who use methamphetamine/amphetamines may have lower receipt of MOUD, retention in MOUD, and opioid abstinence during MOUD. Future research should examine how specific policies and treatment models impact MOUD outcomes for these patients, and seek to understand the perspectives of MOUD providers and people who use both opioids and methamphetamine/amphetamines. Efforts to improve MOUD care and overdose prevention strategies are needed for this population.

scholarly journals Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis

2020 ◽  
Vol 110 (2) ◽  
pp. 244-250 ◽  
Author(s):  
Theodore J. Cicero ◽  
Matthew S. Ellis ◽  
Zachary A. Kasper
Keyword(s):  
Substance Use ◽  
Supply And Demand ◽  
The United States ◽  
National Sample ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Polysubstance Use ◽  
Drug Classes ◽  
Global Nature ◽  
Illicit Opioid Use

Objectives. To understand important changes in co-occurring opioid and nonopioid drug use (i.e., polysubstance use) within the opioid epidemic in the United States. Methods. We analyzed survey data on the past month co-use of prescription and illicit opioids and 12 nonopioid psychoactive drug classes from a national sample of 15 741 persons entering treatment of opioid use disorder. Results. Past-month illicit opioid use increased from 44.8% in 2011 to 70.1% in 2018, while the use of prescription opioids alone dropped from 55.2% to 29.9%, yet overall remained high (94.5% to 85.2%). Past-month use of at least 1 nonopioid drug occurred in nearly all participants (> 90%), with significant increases in methamphetamine (+85%) and decreases across nonopioid prescription drug classes (range: −40% to –68%). Conclusions. Viewing opioid trends in a “silo” ignores the fact not only that polysubstance use is ubiquitous among those with opioid use disorder but also that significant changes in polysubstance use should be monitored alongside opioid trends. Public Health Implications. Treatment, prevention, and policymaking must address not only the supply and demand of a singular drug class but also the global nature of substance use overall.

Polysubstance Use, Mood Disorders, and Chronic Conditions With Anxiety in Opioid Patients

2021 ◽  
pp. 019394592110319
Author(s):  
Sophia Liu ◽  
Christian Nwabueze ◽  
Yue Pan ◽  
Suzy Mascaro Walter ◽  
Brenda Su ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Mood Disorders ◽  
Chronic Conditions ◽  
Multidisciplinary Treatment ◽  
Secondary Analysis ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Polysubstance Use ◽  
Physical Health Problems ◽  
History Of

This study examined the associations of polysubstance use, mood disorders, and chronic conditions with the history of anxiety disorder among patients with opioid use disorder (OUD). We performed a secondary analysis of the baseline data from a clinical trial including 1,645 individuals with OUD, of which 513 had anxiety disorder. Substance use disorders (SUDs) included alcohol, amphetamines, cannabis, cocaine, and sedative use disorders. Mood disorders included major depressive disorder (MDD) and bipolar disorder (BD). Chronic conditions were allergies, gastrointestinal problem(s), skin problem(s), and hypertension. Sedative use disorder, MDD, BD, skin problems, and hypertension were significantly associated with anxiety disorder ( p < 0.05). Additionally, more than two SUDs, two mood disorders, and more than two chronic conditions were significantly associated with anxiety disorder ( p < 0.05). These findings highlight the comorbid mental health and physical health problems in individuals with OUD, as well as the need for integrated multidisciplinary treatment plans.

scholarly journals Shifting Pathways of Stimulant Use Among Individuals With Opioid Use Disorder: A Retrospective Analysis of the Last Thirty Years

2021 ◽  
Vol 12 ◽  
Author(s):  
Matthew S. Ellis ◽  
Zachary A. Kasper ◽  
Stephen Scroggins
Keyword(s):  
Drug Exposure ◽  
Crack Cocaine ◽  
Drug Distribution ◽  
Opioid Use Disorder ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Stimulant Use ◽  
Polysubstance Use ◽  
Demographic Shifts

Background: Stimulant use among individuals with opioid use disorder has recently increased, driven by changes in drug distribution channels. However, our understanding of polysubstance use is often limited by a need to provide targeted treatment to a primary drug of addiction. Yet there is a crucial need to better understand pathways to addiction, and how the use of multiple substances may differ between populations, as well as time periods.Methods: Using a national opioid surveillance system, we analyzed survey data from new entrants to 124 opioid use disorder treatment centers from 2017 to 2020. Age of first use was collected for prescription opioids, illicit opioids, prescription stimulants, crack/cocaine, and methamphetamines. Year of initial use of an opioid or stimulant was calculated and grouped by 5 year blocs, inclusive of initial use starting from 1991 and ending in 2020 (n = 6,048).Results: Lifetime exposure to stimulants was 82.5% among individuals with opioid use disorder. Mean age of initiation increased for all drugs in 2016–2020, in particular prescription opioids (22.3 to 31.8). Stimulants were initiating drugs for a substantial proportion of individuals with opioid use throughout the analyzed time period. Those initiating opioid/stimulant use from 1991 to 1995 had a mean average of 6.8 years between first and second drug exposure, which steadily decreased to 1.5 years between exposures in 2016–2020. Sankey plots depict significantly more drug transitions in those initiating use from 1991 to 2000 (65.1% had at least two drug transitions) compared to 2010–2020 (16.0%). Opioid-stimulant use increased over time among racial/ethnic minorities, sexual minorities, and those with an educational attainment of high school or less.Conclusion: These data highlight not only the substantial prevalence of stimulant use among individuals who develop opioid use disorder, but also the variability through which pathways of use occur. Prevention and intervention efforts need to take into account increasing ages of initial drug exposures, demographic shifts in stimulant-using populations, and more rapid drug transitions between opioid and stimulants. But at a broader level, prevention, harm reduction ideology, and addiction medicine needs to take into account the ubiquity of polysubstance use among individuals with substance use disorders.

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