HIV Treatment Initiation and Retention Among Individuals Initiated on Injectable Opioid Agonist Therapy for Severe Opioid Use Disorder

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.

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

BMJ Case Reports ◽

10.1136/bcr-2019-233715 ◽

2020 ◽

Vol 13 (3) ◽

pp. e233715 ◽

Cited By ~ 1

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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Punitive discontinuation of opioid agonist therapy during incarceration

International Journal of Prisoner Health ◽

10.1108/ijph-02-2020-0012 ◽

2020 ◽

Vol 16 (4) ◽

pp. 337-342

Author(s):

Allison Marmel ◽

Nikki Bozinoff

Keyword(s):

Case Report ◽

Significant Risk ◽

Opioid Use Disorder ◽

Considerable Proportion ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Content Type ◽

Opioid Agonist Therapy ◽

Increased Risk

Purpose The prevalence of substance use disorders among incarcerated individuals in Canada is substantially higher than in the general population. Many incarcerated individuals with opioid use disorder remain untreated due to inadequate access to opioid agonist therapy (OAT). A considerable proportion of overdose-related deaths in the province of Ontario are individuals who have recently been released from prison. The purpose of this paper is to highlight that discontinuation of OAT as a disciplinary measure remains an active concern within prisons in Canada and places individuals with opioid use disorder at increased risk of relapse and resultant overdose death. Design/methodology/approach This case report describes an incarcerated client with opioid use disorder who was initially stable on OAT, but was forcibly tapered off OAT as a disciplinary measure and subsequently relapsed to illicit opioid use while in custody. Findings This case calls attention to concerns regarding treatment of opioid use disorder during incarceration, as forcible detoxification from OAT as a disciplinary measure is a highly dangerous practice. The authors discuss concerns regarding diversion and ways in which prison-based OAT programs can be improved to increase their safety and acceptability among correctional staff. Ongoing advocacy is required on the part of health-care workers and policymakers to ensure that individuals are able to appropriately access this life-saving therapy while incarcerated. Originality/value To the best of the authors’ knowledge, this is the first case report to describe forcible tapering of OAT as a disciplinary measure during incarceration. Despite existing evidence emphasizing the significant risk of overdose associated with detoxification from opioids, this case highlights the need for further research into the causes and prevalence of this practice.

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A pilot study assessing acceptability and feasibility of hatha yoga for chronic pain in people receiving opioid agonist therapy for opioid use disorder

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2019.07.015 ◽

2019 ◽

Vol 105 ◽

pp. 19-27 ◽

Cited By ~ 2

Author(s):

Lisa A. Uebelacker ◽

Donnell Van Noppen ◽

Geoffrey Tremont ◽

Genie Bailey ◽

Ana Abrantes ◽

...

Keyword(s):

Chronic Pain ◽

Pilot Study ◽

Opioid Use Disorder ◽

Hatha Yoga ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy

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The Affordable Care Act and Opioid Agonist Therapy for Opioid Use Disorder

Psychiatric Services ◽

10.1176/appi.ps.201900025 ◽

2019 ◽

Vol 70 (7) ◽

pp. 617-620 ◽

Cited By ~ 12

Author(s):

Ramin Mojtabai ◽

Christine Mauro ◽

Melanie M. Wall ◽

Colleen L. Barry ◽

Mark Olfson

Keyword(s):

Affordable Care Act ◽

Opioid Use Disorder ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

The Affordable Care Act

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Corrigendum to “Predictors of enrollment in opioid agonist therapy after opioid overdose or diagnosis with opioid use disorder: A cohort study” [Drug and Alcohol Dependence 219 (2021) 108435]

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2021.108889 ◽

2021 ◽

pp. 108889

Author(s):

Alexandria Macmadu ◽

Kimberly Paull ◽

Rouba Youssef ◽

Sivakumar Batthala ◽

Kevin H. Wilson ◽

...

Keyword(s):

Cohort Study ◽

Alcohol Dependence ◽

Study Drug ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Drug And Alcohol

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Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses

PLoS ONE ◽

10.1371/journal.pone.0244401 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244401

Author(s):

Danielle Rice ◽

Kimberly Corace ◽

Dianna Wolfe ◽

Leila Esmaeilisaraji ◽

Alan Michaud ◽

...

Keyword(s):

Contingency Management ◽

Psychosocial Interventions ◽

Opioid Use Disorder ◽

Treatment Retention ◽

Controlled Trials ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Meta Analyses

Background Guidelines recommend that individuals with opioid use disorder (OUD) receive pharmacological and psychosocial interventions; however, the most appropriate psychosocial intervention is not known. In collaboration with people with lived experience, clinicians, and policy makers, we sought to assess the relative benefits of psychosocial interventions as an adjunct to opioid agonist therapy (OAT) among persons with OUD. Methods A review protocol was registered a priori (CRD42018090761), and a comprehensive search for randomized controlled trials (RCT) was conducted from database inception to June 2020 in MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials. Established methods for study selection and data extraction were used. Primary outcomes were treatment retention and opioid use (measured by urinalysis for opioid use and opioid abstinence outcomes). Odds ratios were estimated using network meta-analyses (NMA) as appropriate based on available evidence, and in remaining cases alternative approaches to synthesis were used. Results Seventy-two RCTs met the inclusion criteria. Risk of bias evaluations commonly identified study limitations and poor reporting with regard to methods used for allocation concealment and selective outcome reporting. Due to inconsistency in reporting of outcome measures, only 48 RCTs (20 unique interventions, 5,404 participants) were included for NMA of treatment retention, where statistically significant differences were found when psychosocial interventions were used as an adjunct to OAT as compared to OAT-only. The addition of rewards-based interventions such as contingency management (alone or with community reinforcement approach) to OAT was superior to OAT-only. Few statistically significant differences between psychosocial interventions were identified among any other pairwise comparisons. Heterogeneity in reporting formats precluded an NMA for opioid use. A structured synthesis was undertaken for the remaining outcomes which included opioid use (n = 18 studies) and opioid abstinence (n = 35 studies), where the majority of studies found no significant difference between OAT plus psychosocial interventions as compared to OAT-only. Conclusions This systematic review offers a comprehensive synthesis of the available evidence and the limitations of current trials of psychosocial interventions applied as an adjunct to OAT for OUD. Clinicians and health services may wish to consider integrating contingency management in addition to OAT for OUD in their settings to improve treatment retention. Aside from treatment retention, few differences were consistently found between psychosocial interventions adjunctive to OAT and OAT-only. There is a need for high-quality RCTs to establish more definitive conclusions. Trial registration PROSPERO registration CRD42018090761.

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Predictors of enrollment in opioid agonist therapy after opioid overdose or diagnosis with opioid use disorder: A cohort study

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2020.108435 ◽

2021 ◽

Vol 219 ◽

pp. 108435

Author(s):

Alexandria Macmadu ◽

Kimberly Paull ◽

Rouba Youssef ◽

Sivakumar Batthala ◽

Kevin H. Wilson ◽

...

Keyword(s):

Cohort Study ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy

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Predictors of enrollment in opioid agonist therapy after opioid overdose or diagnosis with opioid use disorder: A cohort study

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2021.108890 ◽

2021 ◽

pp. 108890

Author(s):

Alexandria Macmadu ◽

Kimberly Paull ◽

Rouba Youssef ◽

Sivakumar Batthala ◽

Kevin H. Wilson ◽

...

Keyword(s):

Cohort Study ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy

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Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs

Clinical Infectious Diseases ◽

10.1093/cid/ciaa105 ◽

2020 ◽

Vol 71 (7) ◽

pp. 1715-1722 ◽

Cited By ~ 5

Author(s):

Elana S Rosenthal ◽

Rachel Silk ◽

Poonam Mathur ◽

Chloe Gross ◽

Rahwa Eyasu ◽

...

Keyword(s):

Hepatitis C ◽

Drug Use ◽

People Who Inject Drugs ◽

Opioid Use Disorder ◽

Opioid Use ◽

Agonist Therapy ◽

Hcv Treatment ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

The Impact

Abstract Background People who inject drugs have a high prevalence of hepatitis C virus (HCV) and significant disease associated with drug use; however, HCV treatment often occurs in absence of interventions to address opioid use disorder and drug use–related harms. The impact of concurrent initiation of opioid agonist therapy (OAT) on HCV treatment and drug use outcomes is unknown. Methods In this prospective, open-label, observational trial at a harm reduction organization’s drop-in center in Washington, DC, 100 patients with chronic HCV infection, opioid use disorder, and ongoing injection drug use were treated with sofosbuvir-velpatasvir for 12-weeks and offered buprenorphine initiation. The primary end point was sustained virologic response (SVR), and secondary end points included uptake of and retention in OAT, change in risk behavior, and determinants of SVR. Results Eighty-two patients (82%) achieved SVR, which was not associated with baseline OAT status (P = .33), on-treatment drug use (P >.99), or imperfect daily adherence (P = .35) but was significantly associated with completing 2 or more 28-pill bottles of sofosbuvir-velpatasvir (P < .001) and receiving OAT at week 24 (P = .01). Of 67 patients not already receiving OAT at baseline, 53 (79%) started OAT. At week 24, 68 (68%) patients were receiving OAT. Receipt of OAT was associated with fewer opiate-positive urine drug screens (P = .003), lower human immunodeficiency virus risk-taking behavior scores (P < .001), and lower rates of opioid overdose (P = .04). Conclusions The Novel Model of Hepatitis C Treatment as an Anchor to Prevent HIV, Initiate Opioid Agonist Therapy, and Reduce Risky Behavior study demonstrates high uptake of buprenorphine collocated with HCV treatment, and it shows that concurrent initiation of OAT with HCV treatment can result in high rates of SVR while reducing risks associated with drug use. Clinical Trials Registration NCT03221309.

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