Addiction Treatment as Prison Governance: A Critical Discourse Analysis of Methadone Delivery in Kyrgyz Prisons

2021 ◽  
pp. 009145092110607 ◽  
Author(s):  
Lyu Azbel ◽  
Daniel J. Bromberg ◽  
Sergii Dvoryak ◽  
Frederick L. Altice
Keyword(s):  
Eastern Europe ◽  
Central Asia ◽  
Critical Discourse Analysis ◽  
Addiction Treatment ◽  
Methadone Treatment ◽  
Opioid Addiction ◽  
Kyrgyz Republic ◽  
Opioid Use ◽  
Informal Governance ◽  
The Government

Methadone treatment is prescribed by evidence-based medicine as the most effective tool for the treatment of opioid addiction. Its implementation into high-need prison settings worldwide has been met with challenges, particularly in Eastern Europe and Central Asia where the opioid epidemic continues to expand. To address these impasses to intervention translation, we turn to post-structural approaches to policy analysis. These approaches open space for (re)thinking the ways that translated interventions emerge locally, by treating policy texts as social practices that make interventions in specific, sometimes unexpected, ways. We leverage Carol Bacchi’s post-structuralist analytic framework to interrogate how the object of methadone is constituted in Kyrgyz prisons through an analysis of the national legislative document, the “Government Program,” which provides the legislative basis for opioid addiction treatment administration in the Kyrgyz Republic. Rather than the medicalized methadone for the treatment of opioid use disorder, contained in the distinct objectivization of methadone emerging from this policy text, is the previously unexamined assumption that methadone is a particular type of governance. We describe a methadone object tied up with the shifting social structures that govern Kyrgyz prisons, divided between formal (state-run) and informal (prisoner-run) governance. In Kyrgyz prisons, where opioid policy discourse produces a divide between formal and informal governance, methadone emerges as a tool of the formal prison administration to regain control of the prisons from the practices of prisoner subculture. Although this study takes the Kyrgyz case as an example, the enactment of methadone as formal governance is likely to resonate throughout Eastern Europe and Central Asia, where there is a strong legacy of self-governing prisons. We conclude with a call for global health policymakers to consider how opioid addiction treatment is constituted within local governing relations, in ways that may depart sharply from the evidence base.

scholarly journals A call for consensus in defining efficacy in clinical trials for opioid addiction: combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Brittany B. Dennis ◽  
Nitika Sanger ◽  
Monica Bawor ◽  
Leen Naji ◽  
Carolyn Plater ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Addiction Treatment ◽  
Treatment Effectiveness ◽  
Methadone Treatment ◽  
Population Level ◽  
Opioid Addiction ◽  
Complex Nature ◽  
Opioid Use ◽  
Structured Interviews ◽  
Patient Reported

Abstract Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g., EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient-reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g., abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n = 28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, although they also stressed goals under-reported in clinical trials. Conclusions There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. Trial registration PROSPERO, CRD42013006507.

scholarly journals Full A Call for Consensus in Defining Efficacy in Clinical Trials for Opioid Addiction: Combined Results from a Systematic Review and Qualitative Study in Patients Receiving Pharmacological Assisted Therapy for Opioid Use Disorder

2019 ◽  
Author(s):  
Brittany B. Dennis ◽  
Nitika Sanger ◽  
Monica Bawor ◽  
Leen Naji ◽  
Andrew Worster ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Addiction Treatment ◽  
Treatment Effectiveness ◽  
Methadone Treatment ◽  
Population Level ◽  
Opioid Addiction ◽  
Complex Nature ◽  
Opioid Use ◽  
Structured Interviews ◽  
Patient Reported

Abstract Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms.We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g. EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g. abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n=28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, however they also stressed goals under-reported in clinical trials. Conclusion There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. PROSPERO ID CRD42013006507

scholarly journals A Call for Consensus in Defining Efficacy in Clinical Trials for Opioid Addiction: Combined Results from a Systematic Review and Qualitative Study in Patients Receiving Pharmacological Assisted Therapy for Opioid Use Disorder

2019 ◽  
Author(s):  
Brittany B. Dennis ◽  
Nitika Sanger ◽  
Monica Bawor ◽  
Leen Naji ◽  
Andrew Worster ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Addiction Treatment ◽  
Treatment Effectiveness ◽  
Methadone Treatment ◽  
Population Level ◽  
Opioid Addiction ◽  
Complex Nature ◽  
Opioid Use ◽  
Structured Interviews ◽  
Patient Reported

Abstract Background: Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods: We searched nine commonly used databases (e.g. EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results: We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g. abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n=28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, however they also stressed goals under-reported in clinical trials. Conclusion: There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. PROSPERO ID: CRD42013006507 Key Words: opioid addiction; clinical trials; efficacy; methodology; patient important outcomes; treatment effectiveness

scholarly journals A Call for Consensus in Defining Efficacy in Clinical Trials for Opioid Addiction: Combined Results from a Systematic Review and Qualitative Study in Patients Receiving Pharmacological Assisted Therapy for Opioid Use Disorder

2019 ◽  
Author(s):  
Brittany B. Dennis ◽  
Nitika Sanger ◽  
Monica Bawor ◽  
Leen Naji ◽  
Andrew Worster ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Addiction Treatment ◽  
Treatment Effectiveness ◽  
Methadone Treatment ◽  
Population Level ◽  
Opioid Addiction ◽  
Complex Nature ◽  
Opioid Use ◽  
Structured Interviews ◽  
Patient Reported

Abstract Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms.We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g. EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g. abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n=28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, however they also stressed goals under-reported in clinical trials. Conclusion There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. PROSPERO ID CRD42013006507

scholarly journals Nature Use and Environmental Matters in Statements made by the EECCA Countries at the UN General Assembly Debates

2021 ◽  
pp. 86-107
Author(s):  
Keyword(s):  
Water Management ◽  
Eastern Europe ◽  
Central Asia ◽  
Russian Federation ◽  
General Assembly ◽  
Preliminary Results ◽  
Un General Assembly ◽  
The Russian Federation ◽  
The Government

The article presents some preliminary results of the research that reviewed the statements made at the general debate of the UN General Assembly from 1992 to 2020 by the countries of Eastern Europe, Caucuses and Central Asia focusing on the environmental matters. These findings demonstrate the key environment related priorities of the countries across the years, the ways countries frame them as well as the initiatives and proposals put forward. General trends by countries and regions have been identified and new priority issues for future statements have been proposed. The study was carried out within the framework of the UNECE project “Support to the Network of Russian-Speaking Water Management Organizations”, funded by the Government of the Russian Federation.

Methadone for Opioid Use Disorder

2020 ◽  
pp. 139-154
Author(s):  
Dennis J. Hand
Keyword(s):  
Addiction Treatment ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Long Term Treatment ◽  
Long Acting ◽  
Practical Factors

Methadone is a long-acting full opioid agonist that has a long history in the treatment of opioid use disorder (OUD). It was the first opioid agonist with OUD as an indication for use. Methadone was developed for OUD during a time of prohibition and criminalization of both addiction and the use of opioid agonists for addiction treatment, which resulted in methadone being heavily regulated at multiple levels. Methadone is frequently used in short-term withdrawal management (i.e., detoxification) and in long-term treatment, with the latter producing better treatment outcomes. This chapter explores the basic pharmacology of methadone and the development of methadone for OUD and its accompanying regulations, discusses the place of methadone in treatment for OUD, reviews the effectiveness of methadone treatment, and visits some practical factors related to methadone as part of treatment for OUD.

scholarly journals Current status of opioid addiction treatment and related preclinical research

2019 ◽  
Vol 5 (10) ◽  
pp. eaax9140 ◽  
Author(s):  
M. J. Kreek ◽  
B. Reed ◽  
E. R. Butelman
Keyword(s):  
Addiction Treatment ◽  
Prolonged Exposure ◽  
Standard Of Care ◽  
Positive Influence ◽  
Opioid Addiction ◽  
Current Status ◽  
Opioid Use ◽  
Preclinical Research ◽  
Access To Treatment ◽  
Environment Stress

Opioid use disorders (OUDs) are diseases of the brain with behavioral, psychological, neurobiological, and medical manifestations. Vulnerability to OUDs can be affected by factors such as genetic background, environment, stress, and prolonged exposure to μ-opioid agonists for analgesia. Two standard-of-care maintenance medications, methadone and buprenorphine-naloxone, have a long-term positive influence on health of persons with opioid addiction. Buprenorphine and another medication, naltrexone, have also been approved for administration as monthly depot injections. However, neither medication is used as widely as needed, due largely to stigma, insufficient medical education or training, inadequate resources, and inadequate access to treatment. Ongoing directions in the field include (i) personalized approaches leveraging genetic factors for prediction of OUD vulnerability and prognosis, or for targeted pharmacotherapy, and (ii) development of novel analgesic medicines with new neurobiological targets with reduced abuse potential, reduced toxicity, and improved effectiveness, especially for chronic pain states other than cancer pain.

scholarly journals Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers

2021 ◽  
Vol 19 (1) ◽  
pp. 239
Author(s):  
Matthew Taing ◽  
Vijay Nitturi ◽  
Tzuan A. Chen ◽  
Bryce Kyburz ◽  
Isabel Martinez Leal ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Tobacco Cessation ◽  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Opioid Addiction ◽  
Evidence Based ◽  
Opioid Use ◽  
Opioid Treatment ◽  
Tobacco Education ◽  
Treatment Settings

Tobacco use is exceedingly high among individuals receiving care for opioid addiction, but not commonly addressed by clinicians in treatment settings. Taking Texas Tobacco Free (TTTF) is a comprehensive tobacco-free workplace (TFW) program that builds treatment centers’ capacity to address tobacco use with evidence-based tobacco cessation policies and practices. Here, we examine the process and outcomes of TTTF’s implementation within 7 opioid addiction centers. Program goals were structured according to the RE-AIM framework. Pre- and post-implementation data were collected from client facing and non-client facing employees to assess changes in education, training receipt, knowledge, and intervention behaviors, relative to program goals. Centers reported tobacco screenings conducted and nicotine replacement therapy (NRT) delivered through 6 months post-implementation. Overall, 64.56% of employees participated in TTTF-delivered tobacco education, with a 54.9% gain in tobacco control and treatment knowledge (p < 0.0001), and significant increases in exposure to education about tobacco use and harms among individuals with opioid use disorder (p = 0.0401). There were significant gains in clinicians’ receipt of training in 9/9 tobacco education areas (ps ≤ 0.0118). From pre- to post-implementation, there were mean increases in the use of the 5A’s (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with statistically significant gains seen in NRT provision/referral (p < 0.0001). Several program goals were achieved or exceeded; however, 100% center participation in specialized clinical trainings was among notable exceptions. One program withdrew due to competing pandemic concerns; all others implemented comprehensive TFW policies. Overall, TTTF may have improved participating opioid treatment centers’ capacity to address tobacco use, although study limitations, including lower post-implementation evaluation response rates, suggest that results require replication in other opioid addiction treatment settings.

scholarly journals The Fight against the Forced Labor and the Human Trafficking in Central Asia

2015 ◽  
pp. 204-210
Author(s):  
L. Yu. Gusev
Keyword(s):  
Central Asia ◽  
Human Trafficking ◽  
Action Plan ◽  
Forced Labor ◽  
Kyrgyz Republic ◽  
Human Beings ◽  
Criminal Proceedings ◽  
The Law ◽  
The Government ◽  
Interdepartmental Commission

The article deals with the combat of forced labor and human trafficking in Central Asia. It is noted that this problem has emerged since the early 90s, when these countries got the independence, due to the difficult economic situation, activity of extremist organizations. It is pointed out that the victims of trafficking may be men, women and children, but in most cases they are young women and girls who are sexually exploited. It is shown by the examples of each of the countries of the region, what is being done to counter this terrible phenomenon. The Government of the Republic of Tajikistan established the Interdepartmental Commission to Combat Human Trafficking. The commission, in cooperation with international organizations doing some work to inform the public, the search for victims of sexual business, return and rehabilitation of these persons. In Kazakhstan, according to the new law it has become easier to initiate criminal proceedings concerning labor slavery. In addition, a temporary accommodation center for victims of human trafficking «Komek» was created. In Kyrgyzstan, a working group on the development of 3 of the National Action Plan to Combat Trafficking in Human Beings (2011-2015) under the auspices of the Ministry of Labour, Employment and Migration of the Kyrgyz Republic was created. In Uzbekistan, the law «on combating human trafficking» came into force. In addition, a Republican Interdepartmental Commission to Combat Human Trafficking was created. The law defines the powers of public authorities directly involved in the activities in this direction. In Turkmenistan, the government prohibits all forms of trafficking of persons in accordance with Article 129 of the Criminal Code, adopted in May 2010 and entered into force in July 2010. It provides for penalties ranging from 4 to 25 years in prison. These penalties sufficiently stringent and commensurate with penalties prescribed for other serious crimes, such as rape. At the end of the article conclusions and recommendations are made.

New Approach for Comparison of Countries’ Achievements in Science Olympiads

2018 ◽  
Vol 12 ◽  
pp. 53-68
Author(s):  
Mile JOVANOV ◽  
Marija MIHOVA ◽  
Bojan KOSTADINOV ◽  
Emil STANKOV
Keyword(s):  
Secondary School ◽  
Eastern Europe ◽  
Computer Science ◽  
Secondary School Students ◽  
School Students ◽  
New Approach ◽  
Government Institutions ◽  
South Eastern Europe ◽  
The Government ◽  
Valuable Content

There are several International Olympiads for secondary school students (for example, mathematics, physics, chemistry, biology and informatics). These Olympiads are not just a science competition, but a means to care for talent in the particular science. The goal of this paper is to identify the necessary topics important for good results at these international contests, and to compare the contest systems for the countries in South Eastern Europe, in the field of Informatics (Computer Science), as a region that is one of the prominent world regions in the context of high results in the international competitions. Here, we provide comparison through detailed analysis of several countries, and further we present a new approach that may be used to compare the achievements of the countries based on the results that students achieved at these competitions. Finally, we present an application of this approach on the results of some of the discussed countries compared to Macedonia. We strongly believe that the paper will provide a valuable content and approach for the entities involved in the organization of the contests, to measure their results compared to other countries, to use the information for improvement, and to use their achievements to raise awareness among the government institutions and companies in order to get support from them.

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