scholarly journals Comparative effectiveness of buprenorphine-naloxone versus methadone for treatment of opioid use disorder: a population-based observational study protocol in British Columbia, Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036102
Author(s):  
Micah Piske ◽  
Trevor Thomson ◽  
Emanuel Krebs ◽  
Natt Hongdilokkul ◽  
Julie Bruneau ◽  
...  
Keyword(s):  
British Columbia ◽  
Comparative Effectiveness ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
Sensitivity Analyses ◽  
Administrative Databases ◽  
Treatment Modalities ◽  
Ethical Review ◽  
Opioid Use ◽  
Opioid Agonist

IntroductionDespite a recent meta-analysis including 31 randomised controlled trials comparing methadone and buprenorphine for the treatment of opioid use disorder, important knowledge gaps remain regarding the long-term effectiveness of different treatment modalities across individuals, including rigorously collected data on retention rates and other treatment outcomes. Evidence from real-world data represents a valuable opportunity to improve personalised treatment and patient-centred guidelines for vulnerable populations and inform strategies to reduce opioid-related mortality. Our objective is to determine the comparative effectiveness of methadone versus buprenorphine/naloxone, both overall and within key populations, in a setting where both medications are simultaneously available in office-based practices and specialised clinics.Methods and analysisWe propose a retrospective cohort study of all adults living in British Columbia receiving opioid agonist treatment (OAT) with methadone or buprenorphine/naloxone between 1 January 2008 and 30 September 2018. The study will draw on seven linked population-level administrative databases. The primary outcomes include retention in OAT and all-cause mortality. We will determine the effectiveness of buprenorphine/naloxone vs methadone using intention-to-treat and per-protocol analyses—the former emulating flexible-dose trials and the latter focusing on the comparison of the two medication regimens offered at the optimal dose. Sensitivity analyses will be used to assess the robustness of results to heterogeneity in the patient population and threats to internal validity.Ethics and disseminationThe protocol, cohort creation and analysis plan have been approved and classified as a quality improvement initiative exempt from ethical review (Providence Health Care Research Institute and the Simon Fraser University Office of Research Ethics). Dissemination is planned via conferences and publications, and through direct engagement and collaboration with entities that issue clinical guidelines, such as professional medical societies and public health organisations.

scholarly journals Implementing a Low-threshold Audio-only Telehealth Model for Medication-assisted Treatment of Opioid Use Disorder at a Community-based Non-profit Organization in Washington, D.C.

2021 ◽  
Author(s):  
Ellis Jaewon Yeo ◽  
Hannah Kralles ◽  
David Sternberg ◽  
Dana McCullough ◽  
Ajetha Nadanasabesan ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
People Who Use Drugs ◽  
Opioid Use ◽  
Treatment Access ◽  
Community Based ◽  
Medication Assisted Treatment ◽  
Low Threshold

Abstract BackgroundThe COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the United States, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Case PresentationThis case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. ConclusionsLow-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.

Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 784-792 ◽  
Author(s):  
Patrick McLane ◽  
Ken Scott ◽  
Zainab Suleman ◽  
Karen Yee ◽  
Brian R. Holroyd ◽  
...  
Keyword(s):  
Emergency Department ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Emergency Department Care ◽  
Improvement Project ◽  
Health Crisis ◽  
Opioid Agonist Treatment ◽  
Before And After ◽  
Disorder Treatment

ABSTRACTBackgroundOpioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.MethodsThe intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.ResultsThe intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.ConclusionsEmergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.

scholarly journals Opioid agonist treatment and fatal overdose risk in a state‐wide US population receiving opioid use disorder services

Addiction ◽  
2020 ◽  
Vol 115 (9) ◽  
pp. 1683-1694 ◽  
Author(s):  
Noa Krawczyk ◽  
Ramin Mojtabai ◽  
Elizabeth A. Stuart ◽  
Michael Fingerhood ◽  
Deborah Agus ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Fatal Overdose

scholarly journals The effects of opioid-agonist treatments on HIV risk and social stability: A mixed methods study of women with opioid use disorder in Ukraine

2017 ◽  
Vol 83 ◽  
pp. 36-44 ◽  
Author(s):  
Emily Hoff ◽  
Ruthanne Marcus ◽  
Martha J. Bojko ◽  
Iuliia Makarenko ◽  
Alyona Mazhnaya ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hiv Risk ◽  
Opioid Use Disorder ◽  
Mixed Methods Study ◽  
Social Stability ◽  
Opioid Use ◽  
Opioid Agonist

scholarly journals Readiness to try extended-released buprenorphine and related factors of interest: comparison between incarcerated and non-incarcerated subjects with opioid use disorder.

2020 ◽  
Author(s):  
Mathieu CHAPPUY ◽  
Fadi MEROUEH ◽  
Benoit TROJAK ◽  
Jérôme BACHELLIER ◽  
Patrick BENDIMERAD ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Pharmaceutical Products ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Related Factors ◽  
Medical Centers ◽  
Efficacious Treatment ◽  
The Individual ◽  
Opioid Users

Abstract Background: Extended-release buprenorphine (XR-BUP) are new pharmaceutical products that offer a one-week-, one-month- or six-months-long buprenorphine treatment for subjects with opioid use disorder (OUD). OUD is frequent in incarcerated populations, and XR-BUP has been suggested to be an interesting treatment option in prison. However, some opioid users have deemed that XR-BUP could constitute a threat to the individual freedom of occasionally using drugs, and was also at risk to be coercively used in some situations. It was thus needed to explore whether incarcerated people with OUD were ready to try XR-BUP formulations, and which reasons could warrant their possible interest or apprehension.Methods: This is a secondary analysis of a survey performed between 12/02/2018 and 05/31/2019 among 366 patients with OUD. Participants were recruited in 68 addiction French settings, among which six were prison medical centers. Bivariable and multivariable comparisons between incarcerated and non-incarcerated interviewees with respect to their readiness to try XR-BUP and the reasons of interest in this new option. Odds ratios and their 95% confidence intervals (aORs; 95%CI) were adjusted for gender, age category, level of education, and type of opioid agonist treatment.Results: The data of 317 participants were included in the analyses. While 108 (48.9%) of the 221 non-incarcerated interviewees declared being ready to try XR-BUP, they were 63.5% (61 out of 96) among those incarcerated (p =0.016). Adjusted comparisons found that incarcerated were significantly less attracted by the potential of XR-BUP to reduce withdrawal symptoms (aOR= 0.54; 95%CI= 0.29 – 0.99), and to reduce misuse of buprenorphine (aOR= 0.56; 95%CI= 0.34 – 0.94), but more attracted by receiving a constantly efficacious treatment for a week or month (aOR= 2.91; 95%CI= 1.21 – 6.98), and have a more discreet treatment (aOR= 1.76; 95%CI= 1.01 – 3.10).Conclusions: Relative to non-incarcerated subjects with OUD, those in prison were readier to try XR-BUP and they seemed more attracted by practicability and discretion features.

scholarly journals Novel treatment of opioid use disorder using ibogaine and iboga in two adults

2020 ◽  
Author(s):  
Claire Wilson ◽  
Trevor Millar ◽  
Zak Matieschyn
Keyword(s):  
Addiction Treatment ◽  
Case Series ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Safety Risks ◽  
Short Period ◽  
Multiple Treatments

AbstractIbogaine is a naturally occurring psychedelic medicine with anti-addictive properties. While research on ibogaine is limited, several observational studies have shown ibogaine can mitigate opioid withdrawal, as seen with reductions in clinical and subjective opioid withdrawal scores and reduced drug use severity (Noller, Frampton, & Yazar-Klosinski, 2018; Brown & Alper 2018). Furthermore, the psychoactive experience may help individuals to realign their values, purpose and sense of connection, as seen with post treatment reductions in depression scores (Noller et al., 2018; Mash et al., 2000).Case seriesThis case series describes two cases of individuals accessing ibogaine through private unregulated clinics in the Vancouver area to treat their opioid use disorder.ConclusionsIn case 1, the client achieved total abstinence from all opioids within 5–6 days of starting ibogaine treatment, did not experience any opioid withdrawal symptoms after ibogaine treatment and maintained abstinence from opioids for 3 years. In case 2, the patient took ibogaine/iboga in multiple treatments over a short period of time (<4 months). The patient stopped all non-medical opioids after the first iboga treatment and then used ibogaine to aid with further dose reductions of her opioid agonist therapy (OAT) and has maintained abstinence from opioids for 2 years. Ibogaine offers a unique and novel therapeutic approach to treating opioid use disorder. Further studies are needed to establish the safety, risks and potential role for ibogaine as a mainstream, evidence-based addiction treatment.

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