Intranasal Oxytocin for Stimulant Use Disorder Among Male Veterans Enrolled in an Opioid Treatment Program: A Randomized Controlled Trial

The increasing prevalence of illicit stimulant use among those in opioid treatment programs poses a significant risk to public health, stimulant users have the lowest rate of retention and poorest outcomes among those in addiction treatment, and current treatment options are limited. Oxytocin administration has shown promise in reducing addiction-related behavior and enhancing salience to social cues. We conducted a randomized, double-blind, placebo-controlled clinical trial of intranasal oxytocin administered twice daily for 6 weeks to male Veterans with stimulant use disorder who were also receiving opioid agonist therapy and counseling (n = 42). There was no significant effect of oxytocin on stimulant use, stimulant craving, or therapeutic alliance over 6 weeks. However, participants receiving oxytocin (vs. placebo) attended significantly more daily opioid agonist therapy dispensing visits. This replicated previous work suggesting that oxytocin may enhance treatment engagement among individuals with stimulant and opioid use disorders, which would address a significant barrier to effective care.

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Low Hepatitis C Reinfection Following Direct-acting Antiviral Therapy Among People Who Inject Drugs on Opioid Agonist Therapy

Clinical Infectious Diseases ◽

10.1093/cid/ciz693 ◽

2019 ◽

Vol 70 (12) ◽

pp. 2695-2702 ◽

Cited By ~ 14

Author(s):

Matthew J Akiyama ◽

Daniel Lipsey ◽

Moonseong Heo ◽

Linda Agyemang ◽

Brianna L Norton ◽

...

Keyword(s):

Hepatitis C ◽

People Who Inject Drugs ◽

Controlled Trial ◽

Extension Study ◽

Agonist Therapy ◽

Opioid Agonist ◽

Direct Acting Antiviral ◽

Opioid Agonist Therapy ◽

Direct Acting

Abstract Background Direct-acting antiviral (DAA) therapy is highly effective in people who inject drugs (PWID); however, rates, specific injection behaviors, and social determinants associated with hepatitis C virus (HCV) reinfection following DAA therapy among PWID on opioid agonist therapy (OAT) are poorly understood. Methods PREVAIL was a randomized controlled trial that assessed models of HCV care for 150 PWID on OAT. Those who achieved sustained virologic response (SVR) (n = 141; 94%) were eligible for this extension study. Interviews and assessments of recurrent HCV viremia occurred at 6-month intervals for up to 24 months following PREVAIL. We used survival analysis to analyze variables associated with time to reinfection. Results Of 141 who achieved SVR, 114 had a least 1 visit in the extension study (62% male; mean age, 52 years). Injection drug use (IDU) was reported by 19% (n = 22) in the extension study. HCV reinfection was observed in 3 participants. Over 246 person-years of follow-up, the incidence of reinfection was 1.22/100 person-years (95% CI, 0.25–3.57). All reinfections occurred among participants reporting ongoing IDU. The incidence of reinfection in participants reporting ongoing IDU (41 person-years of follow-up) was 7.4/100 person-years (95% CI, 1.5–21.6). Reinfection was associated with reporting ongoing IDU in the follow-up period (P < .001), a lack confidence in the ability to avoid contracting HCV (P < .001), homelessness (P = .002), and living with a PWID (P = .007). Conclusions HCV reinfection was low overall, but more common among people with ongoing IDU following DAA therapy on OAT, as well as those who were not confident in the ability to avoid contracting HCV, homeless, or living with a PWID. Interventions to mediate these risk factors following HCV therapy are warranted.

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Effectiveness and Cost-Effectiveness of Adjunctive Personalised Psychosocial Intervention in Treatment-Resistant Opioid Agonist Therapy: A Pragmatic, Open-Label, Randomised Controlled Trial

SSRN Electronic Journal ◽

10.2139/ssrn.3223117 ◽

2018 ◽

Author(s):

John Marsden ◽

Garry Stillwell ◽

Kirsty James ◽

James Shearer ◽

Sarah Byford ◽

...

Keyword(s):

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Psychosocial Intervention ◽

Controlled Trial ◽

Treatment Resistant ◽

Agonist Therapy ◽

Open Label ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Randomised Controlled

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Punitive discontinuation of opioid agonist therapy during incarceration

International Journal of Prisoner Health ◽

10.1108/ijph-02-2020-0012 ◽

2020 ◽

Vol 16 (4) ◽

pp. 337-342

Author(s):

Allison Marmel ◽

Nikki Bozinoff

Keyword(s):

Case Report ◽

Significant Risk ◽

Opioid Use Disorder ◽

Considerable Proportion ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Content Type ◽

Opioid Agonist Therapy ◽

Increased Risk

Purpose The prevalence of substance use disorders among incarcerated individuals in Canada is substantially higher than in the general population. Many incarcerated individuals with opioid use disorder remain untreated due to inadequate access to opioid agonist therapy (OAT). A considerable proportion of overdose-related deaths in the province of Ontario are individuals who have recently been released from prison. The purpose of this paper is to highlight that discontinuation of OAT as a disciplinary measure remains an active concern within prisons in Canada and places individuals with opioid use disorder at increased risk of relapse and resultant overdose death. Design/methodology/approach This case report describes an incarcerated client with opioid use disorder who was initially stable on OAT, but was forcibly tapered off OAT as a disciplinary measure and subsequently relapsed to illicit opioid use while in custody. Findings This case calls attention to concerns regarding treatment of opioid use disorder during incarceration, as forcible detoxification from OAT as a disciplinary measure is a highly dangerous practice. The authors discuss concerns regarding diversion and ways in which prison-based OAT programs can be improved to increase their safety and acceptability among correctional staff. Ongoing advocacy is required on the part of health-care workers and policymakers to ensure that individuals are able to appropriately access this life-saving therapy while incarcerated. Originality/value To the best of the authors’ knowledge, this is the first case report to describe forcible tapering of OAT as a disciplinary measure during incarceration. Despite existing evidence emphasizing the significant risk of overdose associated with detoxification from opioids, this case highlights the need for further research into the causes and prevalence of this practice.

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