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

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.

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Treatment of the opioid use disorder in the primary health care in The City of Zagreb

European Journal of Public Health ◽

10.1093/eurpub/ckz187.163 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Margreitner ◽

D Stimac Grbic ◽

O Santini Manzin ◽

V Bralic Lang

Keyword(s):

Treatment Plan ◽

Opioid Use Disorder ◽

Integrated Treatment ◽

Opioid Use ◽

Duration Of Treatment ◽

Opioid Agonist ◽

Physician Practices ◽

Treatment Choices ◽

The Individual ◽

Epidemiological Characteristics

Abstract Issue/problem Management of patients with opioid use disorder commonly includes opioid agonist therapy as a part of an integrated treatment plan. These interventions are associated with proven benefits to the individual and society. Treatment choices in opioid use disorder pharmacotherapy should be based on the needs of the individual and characteristics of medications. Description of the problem The aim was to present the use of pharmacotherapy in the treatment of opioid use disorder in family medicine practice in Zagreb. We collected data from 30 family physician practices, on patients treated for opioid use disorder. We analyzed the epidemiological characteristics of the patient, the diagnosis according to ICD X rev., as well as the frequency of the medication use and the duration of the treatment. Results Data about 100 patients treated for opioid use disorder were obtained, (88% men and 12% women). The average age of the patients was 37.9 years. From all patients, 31% had dg. F.60, 22% had dg. F19, 15% had dg. F32, 3% had dg. F29. 19% of patients was HCV positive. 62%of patients were treated with buprenorphine and 38% with methadone. In 5% of patients buprenorphine was only medication in therapy. 53% of patients with buprenorphine use diazepam, 30% use buprenorphine with antidepressant, and 12% use diazepam and antidepressant with buprenorphine. All patients who are on methadone therapy are using some other medication in therapy. Methadone is commonly prescribed in combination with diazepam and antidepressant (55%). The following combination is methadone and diazepam (34%), a combination of methadone, antipsychotics and pregabalin (7%) and a combination of methadone, antidepressants and antipsychotics (4%). The average duration of treatment for opiate addicts is 11.9 years. Lessons Patients who use buprenorphine in the treatment of opioid use disorder have less need for additional medication in therapy than patients who use methadone. Key messages Patients who use buprenorphine in the treatment of opioid use disorder have less need for additional medication in therapy than patients who use methadone. Treatment choices in opioid use disorder pharmacotherapy should be based on the needs of the individual and characteristics of medications.

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Syringe service program-based telemedicine linkage to opioid use disorder treatment: protocol for the STAMINA randomized control trial

BMC Public Health ◽

10.1186/s12889-021-10669-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dennis P. Watson ◽

James A. Swartz ◽

Lisa Robison-Taylor ◽

Mary Ellen Mackesy-Amiti ◽

Kim Erwin ◽

...

Keyword(s):

Study Protocol ◽

Randomized Control Trial ◽

Treatment Protocol ◽

Opioid Use Disorder ◽

Additional Treatment ◽

Initial Assessment ◽

Opioid Use ◽

Structured Interviews ◽

Randomized Control ◽

Opioid Users

Abstract Background A key strategy for mitigating the current opioid epidemic is expanded access to medications for treating opioid use disorder (MOUD). However, interventions developed to expand MOUD access have limited ability to engage opioid users at higher levels of overdose risk, such as those who inject opioids. This paper describes the study protocol for testing STAMINA (Syringe Service Telemedicine Access for Medication-assisted Intervention through NAvigation), an intervention that engages high-risk opioid users at community-based syringe service programs (SSP) and quickly links them to MOUD using a telemedicine platform. Methods This randomized control trial will be conducted at three SSP sites in Chicago. All participants will complete an initial assessment with a provider from a Federally Qualified Health Center who can prescribe or refer MOUD services as appropriate. The control arm will receive standard referral to treatment and the intervention arm will receive immediate telemedicine linkage to the provider and (depending on the type of MOUD prescribed) provided transportation to pick up their induction prescription (for buprenorphine or naltrexone) or attend their intake appointment (for methadone). We aim to recruit a total of 273 participants over two years to provide enough power to detect a difference in our primary outcome of MOUD treatment linkage. Secondary outcomes include treatment engagement, treatment retention, and non-MOUD opioid use. Data will be collected using structured interviews and saliva drug tests delivered at baseline, three months, and six months. Fixed and mixed effects generalized linear regression analyses and survival analysis will be conducted to compare the probabilities of a successful treatment linkage between the two arms, days retained in treatment, and post-baseline opioid and other drug use. Discussion If successful, STAMINA’s telemedicine approach will significantly reduce the amount of time between SSP clients’ initial indication of interest in the medication and treatment initiation. Facilitating this process will likely lead to stronger additional treatment- and recovery-oriented outcomes. This study is also timely given the need for more rigorous testing of telemedicine interventions in light of temporary regulatory changes that have occurred during the COVID-19 pandemic. Trial registration ClinicalTrials.gov (Clinical Trials ID: NCT04575324 and Protocol Number: 1138–0420). Registered 29 September 2020. The study protocol is also registered on the Open Science Framework (DOI 10.17605/OSF.IO/4853 M).

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Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards

Psychological Medicine ◽

10.1017/s0033291721003834 ◽

2021 ◽

pp. 1-10

Author(s):

Eric L. Garland ◽

Spencer T. Fix ◽

Justin P. Hudak ◽

Edward M. Bernat ◽

Yoshio Nakamura ◽

...

Keyword(s):

Chronic Pain ◽

Skin Conductance Level ◽

Opioid Therapy ◽

Opioid Use Disorder ◽

Opioid Use ◽

Natural Reward ◽

Before And After ◽

Natural Rewards ◽

Chronic Opioid Use ◽

Opioid Users

Abstract Background Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Methods Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Results Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. Conclusions MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

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Latent Class Analysis of DSM-5 Criteria for Opioid Use Disorders: Results from the Iranian National Survey on Mental Health

European Addiction Research ◽

10.1159/000369338 ◽

2015 ◽

Vol 21 (3) ◽

pp. 144-152 ◽

Cited By ~ 7

Author(s):

Mohammad Javad Tarrahi ◽

Afarin Rahimi-Movaghar ◽

Hojjat Zeraati ◽

Seyed Abbas Motevalian ◽

Masoumeh Amin-Esmaeili ◽

...

Keyword(s):

Mental Health ◽

Latent Class ◽

Composite International Diagnostic Interview ◽

Opioid Use Disorder ◽

Diagnostic Interview ◽

Opioid Use ◽

Dsm 5 ◽

Legal Problems ◽

Dsm Iv ◽

Opioid Users

Background: Assessments of DSM-IV and DSM-5 criteria with sample populations of opioid users are limited. This study aimed to determine the number of latent classes in opioid users and assessment of the proposed revisions to the DSM-5 opioid use disorder (OUD) criteria. Methods: Data came from the 2011 Iranian National Mental Health Survey (IranMHS) on 7,886 participants aged 15-64 years living in Iran. We used the Composite International Diagnostic Interview (CIDI) version 2.1 in all respondents who indicated using opioids at least 5 times in the previous 12 months (n = 236). Results: A three-class model provided the best fit of all the models tested. Classes showed a spectrum of severity that was compatible with the DSM-5 classification. ‘Legal problems' and ‘desire to cut down' showed poor discrimination between classes. The weighted prevalence of OUD using DSM-5 was 20.7% higher than with DSM-IV. Conclusions: Results support the grouping based on severity of symptoms, combining abuse and dependence into a single diagnosis, omitting legal problems, and addition of craving as a new criterion.

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Differences in receipt of opioid agonist treatment and time to enter treatment for opioid use disorder among specialty addiction programs in the United States, 2014-17

PLoS ONE ◽

10.1371/journal.pone.0226349 ◽

2019 ◽

Vol 14 (12) ◽

pp. e0226349 ◽

Cited By ~ 1

Author(s):

Justin C. Yang ◽

Andres Roman-Urrestarazu ◽

Carol Brayne

Keyword(s):

United States ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Use ◽

Opioid Agonist ◽

Opioid Agonist Treatment

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

CJEM ◽

10.1017/cem.2020.438 ◽

2020 ◽

Vol 22 (6) ◽

pp. 784-792 ◽

Cited By ~ 1

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.

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