Greater Pain Severity is Associated with Inability to Access Addiction Treatment Among a Cohort of People Who Use Drugs

Abstract Background: Medication-assisted treatment (MAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient MAT uptake. To expand MAT access and uptake, policy-makers, program-developers and health care providers should be aware of barriers to and facilitators of MAT uptake among PWID. Methods: As a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and MAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 health care providers to explore barriers to and facilitators of MAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns. Results: Despite some reported country-specific factors, PWID and health care providers at all geographic locations reported similar barriers to MAT initiation, such as complicated procedures to initiate MAT, problematic clinic access, lack of information on MAT, misconceptions about methadone, financial burden, and stigma towards PWID. However, while PWID reported fear of drug interaction (MAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and MAT. Motivation for a life change and social support were reported to be facilitators.Conclusion: These results highlight a need for support for PWID to initiate and retain in drug treatment. To expand MAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable MAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about MAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and MAT (especially methadone).

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Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine and Vietnam: HPTN 074 study

10.21203/rs.3.rs-42695/v2 ◽

2020 ◽

Author(s):

Tetiana Kiriazova ◽

Vivian F. Go ◽

Rebecca B. Hershow ◽

Erica L. Hamilton ◽

Riza Sarasvita ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Addiction Treatment ◽

Financial Burden ◽

Hiv Treatment ◽

Hiv Positive ◽

People Who Use Drugs ◽

Care Providers ◽

Opioid Agonist ◽

Opioid Agonist Treatment

Abstract Background: Opioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policy-makers, program-developers and health care providers should be aware of barriers to and facilitators of OAT uptake among PWID. Methods: As a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and OAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 health care providers to explore barriers to and facilitators of OAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns. Results: Despite some reported country-specific factors, PWID and health care providers at all geographic locations reported similar barriers to OAT initiation, such as complicated procedures to initiate OAT, problematic clinic access, lack of information on OAT, misconceptions about methadone, financial burden, and stigma towards PWID. However, while PWID reported fear of drug interaction (OAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and OAT. Motivation for a life change and social support were reported to be facilitators.Conclusion: These results highlight a need for support for PWID to initiate and retain in drug treatment. To expand OAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable OAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about OAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and OAT (especially methadone).

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Drug Abstinence Self-Efficacy Scale (DASES): psychometric properties of the Farsi version

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-020-00336-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maryam Khazaee-Pool ◽

Seyed Abolhassan Naghibi ◽

Tahereh Pashaei ◽

Mosharafeh Chaleshgar-Kordasiabi ◽

Mahbobeh Daneshnia ◽

...

Keyword(s):

Factor Analysis ◽

Psychometric Properties ◽

Self Efficacy ◽

Addiction Treatment ◽

Intraclass Correlation ◽

Therapeutic Interventions ◽

People Who Use Drugs ◽

Addictive Behaviors ◽

Drug Abstinence ◽

Farsi Version

Abstract Background Research has demonstrated that therapeutic interventions based on the self-efficacy theory produce positive outcomes for people who exhibit addictive behaviors, such as alcohol and drug use. Several questionnaires based on self-efficacy theory have been developed to evaluate the extent to which intervention programs can modify behavior. The present study describes the psychometric properties of the Farsi version of the Drug Abstinence Self-Efficacy Scale (DASES). Design and methods The forward–backward approach was employed to translate the DASES from English into Farsi. A cross-sectional study was conducted, and the psychometric properties of the Farsi version of the DASES were measured. Using a cluster sampling method, 400 male people who use drugs aged 20 years or older were selected from 10 addiction treatment clinics in Mazandaran, Iran. The internal consistency and test–retest methods were used to measure the reliability of the DASES. Face and content validity were measured, and the construct validity of the DASES was assessed through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The data were analyzed using SPSS and AMOS. Results The results of the EFA indicated a four-factor solution for the DASES that accounted for 64.72% of the observed variance. The results obtained from the CFA demonstrated that the data fitted the model: the relative chi square (× 2/df) equaled 1.99 (p < 0.001), and the root mean square error of approximation equaled 0.071 (90% CI = 0.059–0.082). All the comparative indices of the model were equal to or greater than 0.90 (0.91, 0.93, 0.94, 0.93, and 0.90, respectively). The Cronbach’s alpha ranged from 0.90 to 0.93, proving a satisfactory reliability. Additionally, the intraclass correlation coefficient ranged from 0.75 to 0.98, which is an acceptable result. Conclusions This study’s results show that the Iranian version of the DASES has good psychometric properties and is appropriate for assessing substance use behaviors among Iranian addicted persons.

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The effect of depressive symptoms on pain in a substance-using population with persistent pain: a cross-sectional cohort study

BMC Psychiatry ◽

10.1186/s12888-021-03424-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pauline Voon ◽

Jin Cheol Choi ◽

Kanna Hayashi ◽

M-J Milloy ◽

Jane Buxton ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Depressive Symptoms ◽

Brief Pain Inventory ◽

Pain Severity ◽

People Who Use Drugs ◽

Opioid Overdose ◽

Cross Sectional ◽

Heroin Use ◽

Functional Interference

Abstract Background In light of the ongoing opioid overdose crisis, there is an urgent need for research on the impacts of mental health among people presenting with concurrent pain and substance use. This study examined the effect of depressive symptoms on pain severity and functional interference among people who use drugs (PWUD) during a community-wide overdose crisis. Methods From December 1st 2016 to December 31st 2018, 288 participants in two cohort studies of PWUD in Vancouver, Canada completed interviewer-administered questionnaires that included the Brief Pain Inventory and PROMIS Emotional Distress–Depression instruments. Generalized linear regression modelling (GLM) was used to examine the cross-sectional effect of depressive symptoms and other confounding factors on pain severity and interference. Results Moderate to severe depressive symptoms were significantly associated with greater pain-related functional interference (adjusted β = 1.24, 95% confidence interval [CI] = 0.33–2.15), but not significantly associated with greater average pain severity (adjusted β = 0.22, 95% CI = − 0.3 – 0.82), when controlling for confounding variables. Reported daily heroin use (adjusted β = 1.26, 95% CI = 0.47–2.05) and non-fatal overdose (adjusted β = 1.02, 95% CI = 0.08–1.96) were also significantly associated with greater pain-related functional interference. Conclusions In a substance-using population, greater pain-related functional interference was positively associated with depressive symptoms as well as overdose and daily heroin use. These findings emphasize the need to address the functional impact of pain, mental health comorbidity, and high-risk substance use that may contribute to overdose and other harms.

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Mandatory addiction treatment for people who use drugs: global health and human rights analysis: Table

BMJ ◽

10.1136/bmj.i2943 ◽

2016 ◽

pp. i2943 ◽

Cited By ~ 4

Author(s):

Karsten Lunze ◽

Bulat Idrisov ◽

Mikhail Golichenko ◽

Adeeba Kamarulzaman

Keyword(s):

Human Rights ◽

Global Health ◽

Addiction Treatment ◽

People Who Use Drugs ◽

Health And Human Rights

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The Perfect Storm

10.1093/med/9780199374847.003.0008 ◽

2018 ◽

Author(s):

Haider A. Al-Darraji ◽

Frederick L. Altice

Keyword(s):

Addiction Treatment ◽

World Health ◽

People Who Use Drugs ◽

People Living With Hiv ◽

Drug Resistant ◽

Treatment Services ◽

Treatment Interruptions ◽

Prison Systems ◽

Poor Ventilation ◽

Living With Hiv

Globally, tuberculosis (TB) is a major cause of morbidity and mortality among people who use drugs (PWUD), particularly those co-infected with HIV. This chapter describes how TB is prevalent in several prison systems by virtue of the concentration of PWUD and people living with HIV. TB is further amplified within this system through overcrowding, poor ventilation, and delayed access to quality prevention and treatment services. In many countries, individuals cycling through prisons are inadequately screened and treated for TB, and affected individuals may have frequent treatment interruptions. For PWUD, relapse to drug use immediately after release from custody can impede continuity of care, which may contribute to the development of drug-resistant TB. Particularly in countries with high incarceration rates, prisons act as amplifiers of TB and drug-resistant TB in the community. The World Health Organization’s recommendations for integration of TB, HIV, and addiction treatment are seldom achieved, especially within prisons. Other factors contributing to poor TB outcomes among PWUD interfacing with prisons include insufficient support to promote medication adherence and co-morbidities, like viral hepatitis that potentiate hepatic toxicity, both of which are prevalent among PWUD.

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Treating patients with multiple substance use in accordance with their personal treatment goals: a new paradigm for addiction treatment

Drugs and Alcohol Today ◽

10.1108/dat-10-2020-0065 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Joachim Körkel

Keyword(s):

Substance Use ◽

Addiction Treatment ◽

Readiness To Change ◽

Theory And Practice ◽

Future Research ◽

People Who Use Drugs ◽

Psychoactive Substances ◽

New Paradigm ◽

Adequate Treatment ◽

Content Type

Purpose This paper aims to present the theoretical foundation and practical approach of “open-target addiction treatment” (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently. Design/methodology/approach The theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed). Findings The systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities. Research limitations/implications Future research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes. Practical implications To implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development. Social implications OTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way. Originality/value The OTAT approach has not been described in the addiction treatment literature so far.

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Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine, and Vietnam: HPTN 074 study

Harm Reduction Journal ◽

10.1186/s12954-020-00415-x ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Tetiana Kiriazova ◽

Vivian F. Go ◽

Rebecca B. Hershow ◽

Erica L. Hamilton ◽

Riza Sarasvita ◽

...

Keyword(s):

Addiction Treatment ◽

Financial Burden ◽

Healthcare Providers ◽

Hiv Treatment ◽

Hiv Positive ◽

People Who Use Drugs ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

Lack Of Information ◽

Living With Hiv

Abstract Background Opioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID. Methods As a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and OAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 healthcare providers to explore barriers to and facilitators of OAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns. Results Despite some reported country-specific factors, PWID and healthcare providers at all geographic locations reported similar barriers to OAT initiation, such as complicated procedures to initiate OAT, problematic clinic access, lack of information on OAT, misconceptions about methadone, financial burden, and stigma toward PWID. However, while PWID reported fear of drug interaction (OAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and OAT. Motivation for a life change and social support were reported to be facilitators. Conclusion These results highlight a need for support for PWID to initiate and retain in drug treatment. To expand OAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable OAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about OAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and OAT (especially methadone).

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Police discretion in encounters with people who use drugs: operationalizing the theory of planned behavior

Harm Reduction Journal ◽

10.1186/s12954-021-00583-4 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Brandon del Pozo ◽

Emily Sightes ◽

Jeremiah Goulka ◽

Brad Ray ◽

Claire A. Wood ◽

...

Keyword(s):

Theory Of Planned Behavior ◽

Planned Behavior ◽

Perceived Control ◽

Mental Health Treatment ◽

Addiction Treatment ◽

Situational Factor ◽

People Who Use Drugs ◽

Instrument Measuring ◽

Police Encounters ◽

On Line

Abstract Background Policing shapes the health risks of people who use drugs (PWUD), but little is understood about interventions that can align officer practices with PWUD health. This study deploys the Theory of Planned Behavior (TPB) to understand what influences police intentions to make discretionary referrals to treatment and harm reduction resources rather than arrest on less serious charges. Methods On-line surveys integrating TPB constructs and adapting an instrument measuring police intentions to make mental health treatment referrals were completed by police employees in Indiana, Massachusetts, and Missouri. They also included items about stigma towards PWUD and attitudes and beliefs about opioid addiction, treatment, and recovery. Findings Across the sites, 259 respondents perceived control over their decision to arrest for misdemeanors (69%) and confiscate items such as syringes (56%). Beliefs about others’ approval of referrals to treatment, its ability to reduce future arrests, and to increase trust in police were associated with stated practices of nonarrest for drug and possession and making referrals (p ≤ .001), and nonarrest for syringe possession (p ≤ .05). Stigma a towards PWUD was negatively associated with stated practices of nonarrest (p ≤ .05). Respondents identified supervisors as having the most influence over use of discretion, seriousness of the offense as the most influential value, and attitude of the suspect as the most important situational factor. The 17 Likert scale items analyzed had a Cronbach’s alpha of 0.81. Conclusion The TPB offers untapped potential to better understand and modify police practices. In designing interventions to improve the health outcomes of police encounters with PWUD, further research should validate instruments that measure the relationship between these variables and discretionary intentions, and that measure role-relevant police stigma towards PWUD.

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