Opioid overdose history and awareness of naloxone in patients seeking outpatient detoxification

Objectives: The goal of this study was to investigate whether patients were knowledgeable about naloxone, and whether they would accept overdose (OD) education and naloxone distribution (OEND), if available.Design: This is a cross-sectional study to ascertain participants knowledge about OEND. A questionnaire was designed requesting information regarding age, gender, ethnicity, previous OD experience, type of substance(s) used, availability and use of naloxone for reversal, other treatment interventions utilized if witnessed OD, ways of seeking help for OD, knowledge about OEND, and willingness to accept OEND.Setting: Study was conducted at the ambulatory detoxification clinic of a tertiary healthcare institution.Participants: Consecutive 131 patients, who presented for primary treatment of opioid detoxification during their visits to the ambulatory detoxification clinic between a predefined timeline from October 2014 through February 2015, were invited to participate, and all 131 agreed to be included in the study. A total of 124 participants returned completed questionnaires (95 percent response rate.)Results: Overall, 68 (52 percent) of the participants indicated that they would accept OEND. A logistic regression analysis showed that younger participants (95% CI: 0.9-1, p = 0.02) and those who identified as non-white (95% CI: 0-0.8, p = 0.01) had higher odds for accepting OEND. Furthermore, prior administration of naloxone was significantly associated with OEND acceptance (95% CI: 1.6-68.6, p = 0.01).Conclusions: Results indicate more than half of participants presenting for outpatient detoxification from opioids have had an OD or witnessed an OD. More than half of the participants were willing to accept OEND. This study provides evidence that patients starting their recovery are willing to accept naloxone.

A consensus protocol for the management of medication-overuse headache: Evaluation in a multicentric, multinational study

Introduction The management of medication-overuse headache (MOH) is often difficult and no specific guidelines are available as regards the most practical and effective approaches. In this study we defined and tested a consensus protocol for the management of MOH on a large population of patients distributed in different countries. Subjects and methods The protocol was based on evidence from the literature and on consolidated expertise of the members of the consensus group. The study was conducted according to a multicentric interventional design with the enrolment of 376 MOH subjects in four centres from Europe and two centres in Latin America. The majority of patients were treated according to an outpatient detoxification programme. The post-detoxification follow-up lasted six months. Results At the final evaluation, two-thirds of the subjects were no longer overusers and in 46.5% of subjects headache had reverted back to an episodic pattern of headache. When comparing the subjects who underwent out-patient detoxification vs those treated with in-patient detoxification, both regimens proved effective, although the drop-out rate was higher in the out-patient approach. Conclusions The present findings support the effectiveness and usability of the proposed consensus protocol in different countries with different health care modalities.

Effectiveness of daily outpatient alcohol detoxification by an Irish public psychiatric hospital – A pilot study

Objective: To assess the effectiveness of daily outpatient alcohol detoxification in an Irish public psychiatric hospital.Method: The outpatient records of patients presenting to the Assessment Unit of St Brendan's Hospital in one year (August 2004-July 2005) with symptoms of Alcohol Dependence Syndrome (ADS) and commencing daily outpatient detoxification were examined retrospectively for parameters relevant to the objectives of the study. The results were compiled and analysed using descriptive statistics.Results: Forty patients underwent outpatient alcohol detoxification in one year and complete records were available for 32 patients (80%). Twenty patients had fixed addresses in the hospital catchment areas, eight patients had no fixed addresses and the remaining four patients had addresses outside the catchment areas. Seven patients (22%) presented with a co-morbid psychiatric condition including depression (four patients), anxiety disorder (two patients) and personality disorder (one patient). All seven patients were known to psychiatric sector services. Of the 32 patients commencing detoxification, 28 patients (87.5%) attended on the second day whilst 22 patients (69%) attended their third day's appointment. Only 17 patients (53%) completed the outpatient detoxification. Thirteen patients (40.6%) received at least two outpatient detoxifications during the year; of whom seven patients (58%) received their second detoxification within two months of the first one. The record of 20 patients (62.5%) showed that they had received advice regarding selfreferral to counselling services.Conclusion: A high proportion of patients (47%) presenting with symptoms of ADS did not complete daily outpatient detoxifications. A high proportion of all patients (40.6%) also underwent multiple outpatient detoxifications during the year. It is possible that the separation between alcohol detoxification and alcohol counselling services in Ireland contributed to these disappointing results.