scholarly journals Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

2022 ◽  
Author(s):  
Farah Tahsin ◽  
Kristen A. Morin ◽  
Frank Vojtesek ◽  
David C. Marsh
Keyword(s):  
Drug Screening ◽  
Urban Areas ◽  
Primary Objective ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Rural And Urban Areas ◽  
Urine Drug ◽  
Cascade Of Care ◽  
The Impact ◽  
Urine Drug Screening

Abstract Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for individuals who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients' location of the residence on retention in OAT. Design: A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014-2020. Study participants included all individuals who received OAT from the network of clinics during the study period. Measurements: In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to two years, and more than two years. Correlates associated with OAT retention for 90 days, 90 to 365 days, one to two years, and more than two years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 individuals were included in the study. Compared to individuals who were retained in OAT for 90 days, individuals who were retained for 90 to 365 days, one to two years, or more than two years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of engagement have the potential to improve outcomes of OAT.

scholarly journals Negative Impact of Amphetamine-Type Stimulant Use on Opioid Agonist Treatment Retention in Ontario, Canada

2021 ◽  
Vol 12 ◽  
Author(s):  
Kristen A. Morin ◽  
Frank Vojtesek ◽  
Shreedhar Acharya ◽  
David C. Marsh
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Drug Screening ◽  
Urban Areas ◽  
Logistic Regression Model ◽  
Opioid Agonist ◽  
Stimulant Use ◽  
Urine Drug ◽  
The Impact ◽  
Urine Drug Screening

Objective: The objective of this study was to evaluate epidemiological trends of co-use patterns of amphetamine-type stimulants and opioids and the impact of co-use patterns on Opioid Agonist Treatment (OAT) retention in Ontario, Canada. The secondary objective was to assess geographical variation in amphetamine-type stimulant use in Northern Rural, Northern Urban, Southern Rural and Southern Urban Areas of Ontario.Methods: A retrospective cohort study on 32,674 adults receiving OAT from ~70 clinics was conducted between January 1, 2014, and December 31, 2020, in Ontario, Canada. Patients were divided into four groups base on the proportion of positive urine drug screening results for amphetamine-type stimulants during treatment: group 1 (0–25%), group 2 (25–50%), group 3 (50–75%), and groups 4 (75–100%). A Fractional logistic regression model was used to evaluate differences over time in amphetamine-type stimulant use with urine drug screening results. A Cox Proportional Hazard Ratio model was used to calculate the impact of amphetamine-type stimulant use on retention in OAT and adjusted for sociodemographic characteristics, drug use and clinical factors. Lastly, a logistic regression model was used on a subgroup of patients to assess the impact of geography on amphetamine-type stimulant use in Northern Rural, Northern Urban, Southern Rural and Southern Urban Areas of Ontario.Results: There were significant differences in amphetamine-type stimulant positive urine drug screening results year-over-year from 2015 to 2020. Significant differences were observed between amphetamine-type stimulant groups with regards to sociodemographic, clinical and drug use factors. Compared to those with no amphetamine-type stimulant use, the number of days retained in OAT treatment for amphetamine-type stimulant users was reduced (hazard ratio 1.19; 95% confidence interval = 1.07–1.17; p < 0.001). Lastly, an adjusted logistic regression model showed a significant increase in the likelihood of amphetamine-type stimulant use in Northern Rural regions compared to Southern Urban areas.Conclusion: There was a significant increase in amphetamine-type stimulant use among individuals in OAT from 2014 to 2020, associated with decreased OAT retention. Research is required to determine if tailored strategies specific to individuals in OAT who use amphetamine-type stimulants can improve OAT outcomes.

scholarly journals Large Variation in Provincial Guidelines for Urine Drug Screening During Opioid Agonist Treatment in Canada

2018 ◽  
Vol 9 (2) ◽  
pp. 6-9 ◽  
Author(s):  
Eloise Moss ◽  
Jasmine McEachern ◽  
Lauren Adye-White ◽  
Kelsey C. Priest ◽  
Lauren Gorfinkel ◽  
...  
Keyword(s):  
Drug Screening ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Urine Drug ◽  
Urine Drug Screening

scholarly journals Impact of Urine Drug Screening on No Shows and Dropouts among Chronic Pain Patients: A Propensity-Matched Cohort Study

2016 ◽  
Vol 19 (2;2) ◽  
pp. 89-100
Author(s):  
Parthasarathy Krishnamurthy
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Propensity Score ◽  
Drug Screening ◽  
Proportional Hazards ◽  
Pain Clinic ◽  
Urine Drug ◽  
The Impact ◽  
Pain Patients ◽  
Urine Drug Screening

Background: The last 2 decades have seen a substantial increase in both the prescription of opioids for managing chronic pain, and an increase in opioid-related deaths in the US. Urine drug screening (UDS) is the de facto monitoring tool aimed at detecting and deterring opioid misuse. Objective: We study whether administering UDS on pain patients influences post-screening behavior of no-shows and dropouts. Study Design: Observational cohort study of electronic medical records. Setting: Single urban academic pain-clinic. Methods: A retrospective cohort comparison of patients receiving UDS versus those not receiving UDS was conducted on the entire sample as well as in the propensity score-matched samples in which matching was based on age, gender, pain-score, procedure-scheduled, systolic and diastolic blood pressure (BP), pulse, temperature, physician ID, year of visit, psychology referral, and opioid prescription in the first visit. In addition, we conducted within-subjects logistic-regression to study no-shows and non-proportional hazards survival modeling to study dropout. Results: Analyses of 4,448 clinic visits by 723 pain patients indicated that UDS exposure in the first visit is associated with increased risk of no-show in the second visit (OR = 2.73, P < .0001); no-show rate was 10.24% for those without UDS compared to 23.75% for those with a UDS. Among those tested, the no-show rate was higher for those testing positive for illicit substances (34.57%) than for those testing negative (21.74%). These findings were replicated in 8 different propensity-score matched subsamples aimed at addressing potential nonrandom selection, as well as in within-subject analysis accounting for individual-level no-show propensity. Non-proportional hazards survival analysis shows that risk of dropout increased by 100.3% with every additional UDS (HR 95% CI: 1.54 to 2.61). Limitations: Retrospective design, non-randomized sample, single-setting. Conclusions: The results indicate that UDS is associated with increased no-shows and dropout from clinic subject to limitations of observational studies such as selection bias and confound by unobserved variables. These results serve as a call for additional prospective randomized studies to understand the impact of UDS, and where the patients might go when they dropout from the clinic. Key words: Chronic pain, opioid monitoring, UDS, urine-drug screening, no-show, dropout, adherence, propensity-score matching

scholarly journals Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy

2019 ◽  
Vol 64 ◽  
pp. 30-33 ◽  
Author(s):  
Jasmine McEachern ◽  
Lauren Adye-White ◽  
Kelsey C. Priest ◽  
Eloise Moss ◽  
Lauren Gorfinkel ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Drug Screening ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Urine Drug ◽  
Urine Drug Screening

Urine Drug Screening

2001 ◽  
Vol 11 (3) ◽  
pp. 18???22
Author(s):  
Albert Jekelis
Keyword(s):  
Drug Screening ◽  
Urine Drug ◽  
Urine Drug Screening

Impact of Elected Women Representatives of Panchayati Raj in Physical and Financial and Business Assets Development of Rural Women: A Study among the Rural Women’s of Tiruvannamalai District, Tamil Nadu[1]

2017 ◽  
Vol 4 (24) ◽  
Author(s):  
Kalaichelvi Sivaraman ◽  
Rengasamy Stalin
Keyword(s):  
Rural Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Direct Democracy ◽  
Tamil Nadu ◽  
Local Level ◽  
Rural And Urban Areas ◽  
The Government ◽  
The Impact ◽  
Panchayati Raj

This research paper is the part of Research Project entitled “Impact of Elected Women Representatives in the Life and Livelihood of the Women in Rural Areas: With Special Reference to Tiruvannamalai District, Tamil Nadu” funded by University of Madras under UGC-UPE Scheme.The 73rd and 74th amendments of the Constitution of India were made by the government to strengthen the position of women and to create a local-level legal foundation for direct democracy for women in both rural and urban areas. The representation for women in local bodies through reservation policies amendment in Constitution of India has stimulated the political participation of women in rural areas. However, when it’s comes to the argument of whether the women reservation in Panchayati Raj helps or benefits to the life and livelihood development of women as a group? The answer is hypothetical because the studies related to the impact of women representatives of Panchayati Raj in the life and livelihood development of women was very less. Therefore, to fill the gap in existing literature, the present study was conducted among the rural women of Tiruvannamalai district to assess the impact of elected women representatives in the physical and financial and business development of the women in rural areas. The findings revealed that during the last five years because of the women representation in their village Panjayati Raj, the Physical Asset of the rural women were increased or developed moderately (55.8%) and Highly (23.4%) and the Financial and Business Asset of the rural women were increased or developed moderately (60.4%) and Highly (18.7%).

Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing

2007 ◽  
Vol 33 (1) ◽  
pp. 33-42 ◽  
Author(s):  
William B. Jaffee ◽  
Elisa Trucco ◽  
Sharon Levy ◽  
Roger D. Weiss
Keyword(s):  
Systematic Review ◽  
Drug Screening ◽  
Urine Drug ◽  
Urine Drug Screening

Urine Drug Screening in the Era of Designer Benzodiazepines: Comparison of Three Immunoassay Platforms, LC-QTOF-MS, and LC-MS/MS

2021 ◽  
Author(s):  
Andrii Puzyrenko ◽  
Dan Wang ◽  
Randy Schneider ◽  
Greg Wallace ◽  
Sara Schreiber ◽  
...  
Keyword(s):  
Drug Screening ◽  
Forensic Toxicology ◽  
Confirmatory Testing ◽  
Urine Drug ◽  
Screening Assays ◽  
Us Fda ◽  
Urine Specimens ◽  
Abbott Architect ◽  
Designer Benzodiazepines ◽  
Urine Drug Screening

ABSTRACT This study investigated the presence of designer benzodiazepines in 35 urine specimens obtained from emergency department patients undergoing urine drug screening. All specimens showed apparent false-positive benzodiazepine screening results (i.e., confirmatory testing using a 19-component LC-MS/MS panel showed no prescribed benzodiazepines at detectable levels). The primary aims were to identify the possible presence of designer benzodiazepines, characterize the reactivity of commercially available screening immunoassays with designer benzodiazepines, and evaluate the risk of inappropriately ruling out designer benzodiazepine use when utilizing common urine drug screening and confirmatory tests. Specimens were obtained from emergency departments of a single US Health system. Following clinically ordered drug screening using Abbott ARCHITECT c assays and lab-developed LC-MS/MS confirmatory testing, additional characterization was performed for investigative purposes. Specifically, urine specimens were screened using two additional assays (Roche cobas c502, Siemens Dimension Vista) and LC-QTOF-MS to identify presumptively positive species, including benzodiazepines and non-benzodiazepines. Finally, targeted, qualitative LC-MS/MS was performed to confirm the presence of 12 designer benzodiazepines. Following benzodiazepine detection using the Abbott ARCHITECT, benzodiazepines were subsequently detected in 28/35 and 35/35 urine specimens, respectively, using Siemens and Roche assays. LC-QTOF-MS showed the presumptive presence of at least one non-FDA approved benzodiazepine in 30/35 specimens: flubromazolam (12/35), flualprazolam (11/35), flubromazepam (2/35), clonazolam (4/35), etizolam (9/35), metizolam (5/35), nitrazepam (1/35), and pyrazolam (1/35). Two or three designer benzodiazepines were detected concurrently in 13/35 specimens. Qualitative LC-MS/MS confirmed the presence of at least one designer benzodiazepine or metabolite in 23/35 specimens, with 3 specimens unavailable for confirmatory testing. Urine benzodiazepine screening assays from three manufacturers were cross-reactive with multiple non-US FDA-approved benzodiazepines. Clinical and forensic toxicology laboratories using traditionally designed LC-MS/MS panels may fail to confirm the presence of non-US FDA-approved benzodiazepines detected by screening assays, risking inappropriate interpretation of screening results as false-positives.

scholarly journals IMPROVISATION AS A MEANS OF ENHANCING THE TEACHING AND LEARNING OF MATHEMATICS IN SECONDARY SCHOOLS IN ENUGU STATE

2021 ◽  
Vol 9 (04) ◽  
pp. 506-511
Author(s):  
Eunice a ◽  
◽  
N. Anumudu ◽  
Adedapo I. Yemi ◽  
◽  
...  
Keyword(s):  
Secondary School ◽  
Urban Areas ◽  
Teaching And Learning ◽  
Secondary School Students ◽  
Mathematics Learning ◽  
Primary Objective ◽  
Learning Material ◽  
School Students ◽  
Rural And Urban Areas ◽  
Enugu State

Mathematics is an essential part of the education system in Nigeria. However, it is perceived among learners as a tedious and challenging subject. The primary objective of the current study was to enhance the teaching and learning of mathematics using improvisation. The study also examined the role of students location on mathematics learning when the learning material is improvised. The population of the study included secondary school students in both rural and urban areas of Enugu State. A total of 68 secondary school students constituted the study samples. A quasi-experimental design was used. Two hypotheses were tested, and it was concluded that improvisation of learning material enhances students performance in mathematics. Also, the study found that students location does not affect performance in mathematics when instructional material is improvised. The findings and recommendations are discussed.

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