scholarly journals Opioid substitution treatment uptake among people who inject drugs: The findings of two consecutive bio-behavioral surveillance surveys in Iran

2020 ◽  
Author(s):  
Mehran Nakhaeizadeh ◽  
Zahra Abdolahiniya ◽  
Hamid Sharifi ◽  
Ali Mirzazadeh ◽  
Mohammad Karamouzian ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Substitution Treatment ◽  
Urban Centers ◽  
Opioid Substitution Treatment ◽  
Behavioral Surveillance ◽  
Opioid Drugs ◽  
History Of ◽  
Opioid Substitution

Abstract Background Opioid substitution treatment (OST) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OST uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran. Methods Data were obtained from two national bio-behavioral surveillance surveys (N2010 = 1,783 and N2014 = 2,166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression model was used to determine the correlates of OST uptake for 2014 survey and adjusted odds ratios (AORs) and 95% confidence intervals (CI) were reported. Results The prevalence of OST uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P-value = 0.033). OST uptake varied across the studied cities ranging from 0.0%-69.3% in the 2010 survey and 3.2%-75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI: 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI: 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI: 1.08, 2.5) were associated with OST uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI: 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI: 0. 0.51, 0.86) were less likely to uptake OST. Conclusions Although OST uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remains significant disparities across urban centers in Iran. Importantly, the OST services appear to be serving high risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes of opioid substitution treatment across Iran.

scholarly journals Opioid agonist therapy uptake among people who inject drugs: The findings of two consecutive bio-behavioral surveillance surveys in Iran

2020 ◽  
Author(s):  
Mehran Nakhaeizadeh ◽  
Zahra Abdolahiniya ◽  
Hamid Sharifi ◽  
Ali Mirzazadeh ◽  
Mostafa Shokoohi ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
World Health ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Behavioral Surveillance ◽  
Opioid Agonist Therapy ◽  
Opioid Drugs ◽  
History Of

Abstract Background Opioid agonist therapy (OAT) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OAT uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran.Methods Data were obtained from two national bio-behavioral surveillance surveys (N2010 = 1,783 and N2014 = 2,166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression models were built to determine the correlates of OAT uptake for the 2014 survey and adjusted odds ratios (AORs) and 95% confidence intervals (CI) were reported.Results The prevalence of OAT uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P-value = 0.033). OAT uptake varied across the studied cities ranging from 0.0%-69.3% in the 2010 survey and 3.2%-75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI: 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI: 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI: 1.08, 2.5) were associated with OAT uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI: 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI: 0. 0.51, 0.86) were less likely to uptake OAT. Conclusions Although OAT uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remains significant disparities across urban settings in Iran. Importantly, the OAT services appear to be serving high-risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes of OAT across Iran.

scholarly journals The shifting roles of medical stakeholders in opioid substitution treatment: a comparison between Denmark and the UK

2015 ◽  
Vol 15 (4) ◽  
pp. 216-230 ◽  
Author(s):  
Bagga Bjerge ◽  
Karen Duke ◽  
Vibeke Asmussen Frank
Keyword(s):  
Medical Professionals ◽  
Substitution Treatment ◽  
Policy And Practice ◽  
Opioid Substitution Treatment ◽  
Content Type ◽  
Recovery Movement ◽  
Drug Policies ◽  
History Of ◽  
The Uk ◽  
Opioid Substitution

Purpose – The purpose of this paper is to examine the shifting roles of medical professionals as stakeholders in opioid substitution treatment (OST) policies and practices in Denmark and the UK within the past 15 years. Design/methodology/approach – The paper is based on literature reviews, documentary analyses and key informant interviews with a range of stakeholders involved in OST and policy in Denmark and UK. The study is part of the EU-funded project: Addictions and Lifestyles in Contemporary Europe: Reframing Addictions Project. Findings – Denmark and the UK are amongst those few European countries that have long traditions and elaborate systems for providing OST to heroin users. The UK has a history of dominance of medical professionals in drugs treatment, although this has been recently challenged by the recovery movement. In Denmark, a social problem approach has historically dominated the field, but a recent trend towards medicalisation can be traced. As in all kinds of policy changes, multiple factors are at play when shifts occur. We examine how both countries’ developments around drugs treatment policy and practice relate to broader societal, economic and political changes, how such divergent developments emerge and how medical professionals as stakeholders enhanced their roles as experts in the field through a variety of tactics, including the production and use of “evidence”, which became a key tool to promote specific stakeholder’s perspectives in these processes. Originality/value – The paper contributes to current policy and practice debates by providing comparative analyses of drug policies and examination of stakeholder influences on policy processes.

scholarly journals Patient Dropout from Opioid Substitution Treatment

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Opioid Dependence ◽  
Dropout Rate ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Exact Test ◽  
Factors Associated ◽  
Patient Dropout ◽  
Key Indicator ◽  
History Of ◽  
Opioid Substitution

Opioid Substitution Treatment (OST) is an established treatment for opioid dependence. In New Zealand, OST programs are regulated by the Ministry of Health (2014) and Methadone and Buprenorphine/Naloxone (Suboxone) are the primary medications. Retention on OST is a key indicator for stabilisation of patients with opioid dependence. The purpose of the present research was to study dropout rates and identify factors associated with the dropout of patients from OST at the Community Alcohol and Drug Service (CADS), Hamilton, from 1st January 2013 to 30th April 2014. A retrospective clinical audit of patients on OST was conducted. There were 150 patients on OST in Hamilton under the CADS team during the period of study. Nine patients dropped out during the study period. Sixty-four patients were randomly selected from the remaining 141 patients who remained on treatment as a comparison group and for the study sample to be approximately half of the overall population of 150 patients. File review was conducted and potential predictors of dropout were identified. Thirty-five independent variables were selected and dropout was the dependent variable. The statistical programme SPSS22 was used to analyse the data. Fisher’s exact test was used and four variables were identified as being associated with dropout: history of intravenous drug use; (Fisher’s exact p = 0.05); history of lifetime imprisonment (Fisher’s exact p =0.05); other medications prescribed, (Fisher’s exact p = 0.04); and opioid type prescribed during the study, i.e. methadone or Suboxone. Patients on Suboxone dropped out more than those on methadone, (Fisher’s exact p = 0.00). The overall dropout rate was 6%, which was less than the rates of 15-85% found in previous studies. The limitations of the study were that it was retrospective and the number of dropouts was small. Furthermore, only patient factors associated with dropout were included in the study and service factors were not included.

Opioid substitution treatment in Spain: 20 years of experience in harm reduction programs

2015 ◽  
Vol 156 ◽  
pp. e223
Author(s):  
Marta Torrens ◽  
Francina Fonseca ◽  
Claudio Castillo ◽  
Antònia Domingo Salvany
Keyword(s):  
Harm Reduction ◽  
Substitution Treatment ◽  
Years Of Experience ◽  
Opioid Substitution Treatment ◽  
Opioid Substitution

scholarly journals The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Heino Stöver ◽  
Anna Tarján ◽  
Gergely Horváth ◽  
Linda Montanari
Keyword(s):  
Infectious Diseases ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Policy Framework ◽  
Opioid Substitution Treatment ◽  
Monitoring Centre ◽  
Immunodeficiency Virus ◽  
Needle And Syringe Programmes ◽  
Addiction Care ◽  
Opioid Substitution

Abstract Background People who inject drugs are often imprisoned, which is associated with increased levels of health risks including overdose and infectious diseases transmission, affecting not only people in prison but also the communities to which they return. This paper aims to give an up-to-date overview on availability, coverage and policy framework of prison-based harm reduction interventions in Europe. Methods Available data on selected harm reduction responses in prisons were compiled from international standardised data sources and combined with a questionnaire survey among 30 National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction to determine the level of availability, estimated coverage and policy framework of the interventions. Results Information about responses to health harms in prisons is limited and heterogeneous. Cross-country comparability is hampered by diverging national data collection methods. Opioid substitution treatment (OST) is available in 29 countries, but coverage remains low (below 30% of people in need) in half of the responding countries. Needle and syringe programmes, lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available. Testing for infectious diseases is offered but mostly upon prison entry, and uptake remains low in about half of the countries. While treatment of infections is mostly available and coverage is high for human immunodeficiency virus (HIV) and tuberculosis, hepatitis B and C treatment are less often provided. Health education as well as condom distribution is usually available, but provision remains low in nearly half of the countries. Post-release linkage to addiction care as well as to treatment of infections is available in a majority of countries, but implementation is often partial. Interventions recommended to be provided upon release, such as OST initiation, take-home naloxone and testing of infections, are rarely provided. While 21 countries address harm reduction in prison in national strategic documents, upon-release interventions appear only in 12. Conclusions Availability and coverage of harm reduction interventions in European prisons are limited, compared to the community. There is a gap between international recommendations and ‘on-paper’ availability of interventions and their actual implementation. Scaling up harm reduction in prison and throughcare can achieve important individual and public-health benefits.

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