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Bassiony MM, Abdelfattah NR, Elshabrawy A, Adly MM. A comparative study of the efficacy of venlafaxine and naltrexone for relapse prevention in patients with opioid use disorder attributed to tramadol. Int Clin Psychopharmacol 2023:00004850-990000000-00091. [PMID: 37729663 DOI: 10.1097/yic.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Tramadol and venlafaxine share similar pharmacological characteristics that may allow for overlapping therapeutic indications for them. The objective of this study was to compare the efficacy of venlafaxine and naltrexone in the treatment of tramadol abuse. This comparative trial included 95 patients with tramadol abuse who were detoxified for 2 weeks. Twenty-eight participants underwent the maintenance phase, while the remaining participants (n = 67) dropped out. The patients were randomized to use 50 mg/day of naltrexone or 225 mg/day of venlafaxine for 8 weeks. All participants were interviewed using SCID-I (DSM-IV-TR) criteria for diagnosing substance use and other psychiatric disorders. The proportion of relapsed patients was comparable between the naltrexone and venlafaxine groups (29.4% vs. 30.4%, P = 0.9). However, participants in the venlafaxine group stayed in treatment longer than participants in the naltrexone group, and the difference was significant (22.9 ± 7.89 days vs. 16.9 ± 3.4 days, P = 0.01). Only psychiatric comorbidity was found to be significantly associated with retention in treatment (80% vs. 22%, P = 0.005). Venlafaxine is as effective as naltrexone in preventing relapse in patients with tramadol abuse. Venlafaxine was more effective than naltrexone in treatment retention.
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Affiliation(s)
- Medhat M Bassiony
- Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
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Kinsella M, Capel Y, Nelson SM, Kearns RJ. Opioid substitution in pregnancy a narrative review: contemporary evidence for use of methadone and buprenorphine in pregnancy. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2106600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- M. Kinsella
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Y. Capel
- Foundation Programme, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - R. J. Kearns
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Zhang P, Li Z, Yang Q, Zhou J, Ma X. Effects of Taijiquan and Qigong exercises on depression and anxiety levels in patients with substance use disorders: A systematic review and meta-analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2021; 4:85-94. [PMID: 35782275 PMCID: PMC9219269 DOI: 10.1016/j.smhs.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 01/24/2023] Open
Abstract
Previous studies have shown that Taijiquan and Qigong exercise can effectively reduce depression and anxiety in healthy and clinical populations. At present, only a few reviews have elaborated on the premise of different types of interventions, and there is still a lack of studies that systematically summarize the clinical evidence of patients with substance use disorders. The purpose of this meta-analysis was to assess the impact of the Taijiquan and Qigong exercise on the mood of individuals with substance use disorders (SUD); Articles were searched in Pubmed, Embase, Cochrane Library, Web of Science, and CNKI from their inception to the May 24, 2021. All randomized controlled trials (RCT) using Taijiquan and Qigong intervention were included. With the Review Manager software to determine the effect (standardized mean difference, SMD), subgroup analysis was conducted to intervention type, exercise time, and exercise duration. Nine studies totaling 823 participants were included in the study. Overall results indicated that Taijiquan and Qigong exercise had significant benefits in reducing depression (SMD = −0.35, 95% CI: −0.53 to −0.18, Z = 4.00, p < 0.01) and anxiety (SMD = −0.31, 95% CI: −0.50 to −0.11, Z = 3.06, p < 0.01) symptoms in SUD. When depression and anxiety were examined separately, subgroup analysis demonstrated that Taijiquan intervention (SMD = −0.45, 95% CI: −0.71 to −0.19, Z = 3.39, p < 0.01) and Qigong intervention (SMD = −0.28, 95% CI −0.51 to −0.04, Z = 2.33, p = 0.02),30–60 min exercise time (SMD = −0.41, 95% CI: −0.61 to −0.20, Z = 3.82, p < 0.01) and duration of 9–12 weeks (SMD = −0.57, 95% CI: −1.10 to −0.04, Z = 2.10, p = 0.04) more than 12 weeks (SMD = −0.28, 95% CI: −0.50 to −0.07, Z = 2.59, p = 0.01) could effectively alleviate the symptoms of depression. Meanwhile, Qigong intervention (SMD = −0.31, 95% CI: −0.52 to −0.10, Z = 2.85, p < 0.01), 30–60 min exercise time (SMD = −0.29, 95% CI: −0.53 to −0.04, Z = 2.28, p = 0.02), more than 60 min exercise time (SMD = −0.54, 95% CI: −1.06 to −0.02, Z = 2.05, p = 0.04), and duration of less than 9 weeks (SMD = −0.35, 95% CI: −0.68 to −0.02, Z = 2.07, p = 0.04) had positive effects on alleviating anxiety symptoms with SUD. Taijiquan and Qigong exercise could reduce levels of anxiety and depression in those with SUD. Considering the small number of included studies, more reliable RCTs are needed on this topic.
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Logan G, Mirajkar A, Houck J, Rivera-Alvarez F, Drone E, Patel P, Craen A, Dub L, Elahi N, Lebowitz D, Walker A, Ganti L. Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department. Cureus 2021; 13:e19923. [PMID: 34966614 PMCID: PMC8710303 DOI: 10.7759/cureus.19923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
Objective We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. Methods This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. Results There were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). Conclusion Barriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.
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Affiliation(s)
- Gideon Logan
- Emergency Medicine, University of Central Florida/Hospital Corporation of America Graduate Medical Education (HCA GME) Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Amber Mirajkar
- Emergency Medicine, University of Central Florida/Hospital Corporation of America Graduate Medical Education (HCA GME) Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Jessica Houck
- Emergency Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Fernando Rivera-Alvarez
- Emergency Medicine, University of Central Florida/Hospital Corporation of America Graduate Medical Education (HCA GME) Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Emily Drone
- Department of Pediatric Emergency Medicine, Orlando Health, Orlando, USA
| | - Parth Patel
- Emergency Medicine, University of Central Florida/Hospital Corporation of America Graduate Medical Education (HCA GME) Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Alexandra Craen
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Larissa Dub
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Nubaha Elahi
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - David Lebowitz
- Emergency Medicine, University of Central Florida/Hospital Corporation of America Graduate Medical Education (HCA GME) Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
- Clinical Sciences, University of Central Florida College of Medicine, Orlando, USA
| | - Ayanna Walker
- Emergency Medicine, University of Central Florida College of Medicine/Hospital Corporation of America (HCA) Healthcare Graduate Medical Education Consortium of Greater Orlando, Orlando, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Latha Ganti
- Emergency Medicine, University of Central Florida/Hospital Corporation of America Graduate Medical Education (HCA GME) Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
- Clinical Sciences, University of Central Florida College of Medicine, Orlando, USA
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Corcorran MA, Ludwig-Baron N, Cheng DM, Lioznov D, Gnatienko N, Patts G, So-Armah K, Blokhina E, Bendiks S, Krupitsky E, Samet JH, Tsui JI. The Hepatitis C Continuum of Care Among HIV-Positive Persons with Heavy Alcohol Use in St. Petersburg, Russia. AIDS Behav 2021; 25:2533-2541. [PMID: 33730255 DOI: 10.1007/s10461-021-03214-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
This study describes the self-reported prevalence of hepatitis C virus (HCV) coinfection and the HCV care continuum among persons enrolled in the St PETER HIV Study, a randomized controlled trial of medications for smoking and alcohol cessation in HIV-positive heavy drinkers and smokers in St. Petersburg, Russia. Baseline health questionnaire data were used to calculate proportions and 95% confidence intervals for self-reported steps along the HCV continuum of care. The cohort included 399 HIV-positive persons, of whom 387 [97.0% (95% CI 95.3-98.7%)] reported a prior HCV test and 315 [78.9% (95% CI 74.9-82.9%)] reported a prior diagnosis of HCV. Among those reporting a diagnosis of HCV, 43 [13.7% (95% CI 9.9-17.4%)] had received treatment for HCV, and 31 [9.8% (95% CI 6.6-13.1%)] had been cured. Despite frequent HCV testing in this HIV-positive Russian cohort, the proportion reporting prior effective HCV treatment was strikingly low. Increased efforts are needed to scale-up HCV treatment among HIV-positive Russians in St. Petersburg.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | | | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Dmitry Lioznov
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Smorodintsev Research Institute of Influenza, St. Petersburg, Russian Federation
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Kaku So-Armah
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Erk MA, Firat S. Types of Medication-Assisted Treatment for Opioid Use Disorder in Turkey: The Perceptions of Inpatients about Treatment Success. Psychiatry Investig 2020; 17:1182-1190. [PMID: 33301668 PMCID: PMC8560342 DOI: 10.30773/pi.2020.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was the following. When the different dynamics of agonist or antagonist treatments considered it is assumed that the eligible treatment to the individual may be maintained with high efficacy. Thus, we aimed to examine the difference between treatment methods, considering sociodemographics and positive perception for treatment success. METHODS The number of 136 individuals which their ages range between 19-50 and have been getting agonist (buprenorphine/naloxone) or antagonist (naltrexone) treatment because of opioid use disorder while resting in clinics have been evaluated to reveal the factors that may alter their perception about treatment and have been compared with sociodemographic variables and characteristics such as sociotropic and autonomic. Therefore, "Sociodemographic Data Evaluation Form," "Predictive Factors for The Addiction Treatment Success Scale," and "Sociotropy-Autonomy Scale" were used to assess the sociodemographic data, the perception towards factors which have been affected to the treatment and characteristics. The data of the individuals have been collected by the researcher via face-to-face interviews while patients were residential in the clinic. RESULTS According to results of our study, it has been detected that there are some differences in the perception of treatment success between individuals who have been getting agonist or antagonist treatments such as treatment method (p<0.05), treatment frequency (p<0.01) and parents' vital statuses (p<0.05). CONCLUSION At the end of the study it has been understood that medical and social benefits after the selection of eligible treatment methods which is suitable for individual's perception and characteristics have to be considered.
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Affiliation(s)
- Mehmet Aykut Erk
- Çukurova University, Addiction and Forensic Sciences Institue, Adana, Turkey
| | - Sunay Firat
- Çukurova University, Addiction and Forensic Sciences Institue, Adana, Turkey
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Urits I, Patel A, Zusman R, Virgen CG, Mousa M, Berger AA, Kassem H, Jung JW, Hasoon J, Kaye AD, Viswanath O. A Comprehensive Update of Lofexidine for the Management of Opioid Withdrawal Symptoms. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:76-96. [PMID: 32733113 PMCID: PMC7377538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE OF REVIEW This is a comprehensive review of the literature regarding the use of Lofexidine for opiate withdrawal symptoms. It covers the background and necessity of withdrawal programs and the management of withdrawal symptoms and then covers the existing evidence of the use of Lofexidine for this purpose. RECENT FINDINGS Opiate abuse leads to significant pain and suffering. However, withdrawal is difficult and often accompanied by withdrawal symptoms and renewed cravings. These symptoms are driven mostly by signaling in the locus coeruleus and the mesolimbic system and a rebound increase in noradrenaline, producing symptoms such as anxiety, gastrointestinal upset, and tension. Lofexidine, an alpha-2 agonist, can be used to manage acute withdrawal symptoms before starting maintenance treatment with either methadone or buprenorphine. Lofexidine, if FDA approved for management of withdrawal symptoms and has been proved to be both effective and safe. SUMMARY Opiate addiction is increasing and plaguing the western world and specifically the U.S. It takes a large toll on both a personal and societal level and carries a high cost. Withdrawal is difficult, both related to withdrawal symptoms and renewed cravings. Lofexidine has been shown to be effective in reducing the former and could potentially aid in recovery and withdrawal.
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Affiliation(s)
- Ivan Urits
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Anjana Patel
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Robbie Zusman
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Celina Guadalupe Virgen
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Mohammad Mousa
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Amnon A Berger
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Hisham Kassem
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Jai Won Jung
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Jamal Hasoon
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Alan D Kaye
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Omar Viswanath
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
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Valbrun LP, Zvonarev V. The Opioid System and Food Intake: Use of Opiate Antagonists in Treatment of Binge Eating Disorder and Abnormal Eating Behavior. J Clin Med Res 2020; 12:41-63. [PMID: 32095174 PMCID: PMC7011935 DOI: 10.14740/jocmr4066] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/28/2019] [Indexed: 12/23/2022] Open
Abstract
Eating disorders (EDs) and substance use disorders (SUDs) commonly co-occur, especially in conjunction with affective syndromes, yet little is known about opiate abuse and ED symptoms in patients on naltrexone-bupropion therapy. Moreover, evidence suggests that the opioid system can also be regarded as one of the major systems regulating the anticipatory processes preceding binge eating episodes. The lack of evidence in the effectiveness of psychotherapy treatment in addition to psychotropic mediations compounds the difficulties in stabilizing individuals with EDs. This article aims to exhaustively review literature relating to the use of opioid antagonists in the management of binge eating disorder (BED) and other abnormal eating habits and how this can be augmented by the use of psychological approaches to come up with the most effective therapy or combination of therapies to manage these conditions. Although this approach is promising, it has not been evaluated. A review of the literature pertaining to the use of naltrexone in patients with EDs was performed through PubMed, PsycINFO and MEDLINE. We selected 63 relevant articles published between 1981 and 2018 and those written in English. Search terms included “Opioid antagonists”, “naltrexone”, “bupropion” and “Psychotherapy” each combined with “Binge Eating Disorder”, “Bulimia Nervosa”, “Anorexia Nervosa”, “Eating Disorder”, “EDNOS” and “Obesity”. While working with these articles, we also identified several problems related to use of these methods in real clinical practice. Seventy-seven articles were reviewed, and 63 were selected for inclusion. Data obtained from these sources confirmed that the blockade of opioid receptors diminishes food intake. More recent findings also indicate that the combination of bupropion and naltrexone can induce weight loss. Augmentation of this by introducing psychotherapy may lead to better outcomes. Cognitive behavioral therapy (CBT) was the most frequently recommended psychotherapy intervention, showing efficacy for EDs and chemical addictions as documented by most of the studies, but with uncertain efficacy when utilized as augmentation strategy. There are limited data supporting the use of psychotherapy in augmentation of standard therapy in ED; however, there is evidence to support that psychotherapy is safe in this population and has been effective in cases of patients with opiate addiction with and without psychiatric comorbidities as well as BED. More research is needed to establish treatment guidelines. Combining pharmacotherapeutic and psychotherapeutic interventions leads to the achievement of a better outcome in managing patients with EDs. Involving families or the use of support groups increases chances of adherence to the prescribed interventions resulting in higher rates of remission. However, it is clear that all of these interventions must occur in the context of a comprehensive treatment program. We believe that patient-specific psychotherapy may not only facilitate the treatment process, but also cause significant alterations in eating pattern. This approach for BED may lead to more significant treatment outcomes, but this possibility must be tested in larger samples.
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Affiliation(s)
- Leon P Valbrun
- Department of Psychiatry, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY 11213, USA
| | - Valeriy Zvonarev
- School of Behavioral Sciences, California Southern University, 3330 Harbor Blvd, Costa Mesa, CA 92626, USA
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Kreek MJ, Reed B, Butelman ER. Current status of opioid addiction treatment and related preclinical research. SCIENCE ADVANCES 2019; 5:eaax9140. [PMID: 31616793 PMCID: PMC6774730 DOI: 10.1126/sciadv.aax9140] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/06/2019] [Indexed: 05/23/2023]
Abstract
Opioid use disorders (OUDs) are diseases of the brain with behavioral, psychological, neurobiological, and medical manifestations. Vulnerability to OUDs can be affected by factors such as genetic background, environment, stress, and prolonged exposure to μ-opioid agonists for analgesia. Two standard-of-care maintenance medications, methadone and buprenorphine-naloxone, have a long-term positive influence on health of persons with opioid addiction. Buprenorphine and another medication, naltrexone, have also been approved for administration as monthly depot injections. However, neither medication is used as widely as needed, due largely to stigma, insufficient medical education or training, inadequate resources, and inadequate access to treatment. Ongoing directions in the field include (i) personalized approaches leveraging genetic factors for prediction of OUD vulnerability and prognosis, or for targeted pharmacotherapy, and (ii) development of novel analgesic medicines with new neurobiological targets with reduced abuse potential, reduced toxicity, and improved effectiveness, especially for chronic pain states other than cancer pain.
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11
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Ishiuji Y. Addiction and the itch‐scratch cycle. What do they have in common? Exp Dermatol 2019; 28:1448-1454. [DOI: 10.1111/exd.14029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/15/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Yozo Ishiuji
- Department of Dermatology The Jikei University School of Medicine Tokyo Japan
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Bradley ES, Liss D, Carreiro SP, Brush DE, Babu K. Potential uses of naltrexone in emergency department patients with opioid use disorder. Clin Toxicol (Phila) 2019; 57:753-759. [DOI: 10.1080/15563650.2019.1583342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Evan Stuart Bradley
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School and Umass Memorial Medical Center, Worcester, MA, USA
| | - David Liss
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephanie Pepper Carreiro
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School and Umass Memorial Medical Center, Worcester, MA, USA
| | - David Eric Brush
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School and Umass Memorial Medical Center, Worcester, MA, USA
| | - Kavita Babu
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School and Umass Memorial Medical Center, Worcester, MA, USA
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Bolshakova M, Bluthenthal R, Sussman S. Opioid use and misuse: health impact, prevalence, correlates and interventions. Psychol Health 2019; 34:1105-1139. [PMID: 31177850 PMCID: PMC7456364 DOI: 10.1080/08870446.2019.1622013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022]
Abstract
Objective: To provide a broad overview of the state of drug misuse research, particularly focusing on opioid drug use in the U.S.A. Design: An overview of published reviews of the literature. Results: Prescription opioid use has increased globally from 2008 to 2013, while use of opiates such as heroin and opium have remained stable in many countries, although, decreases have been observed in parts of Europe. Opioid misuse is highest in the United States; approximately 11.8 million Americans misused opioids in 2016. Demographic, genetic, psychosocial and structural/environmental factors all play a role in determining who will become an opioid misuser. Strategies such as increased prescribing of non-opioid derived pain relievers, expansion of medication treatment, distribution of naloxone for overdose reversal and supervised consumption sites are some of the solutions posed to reduce the spread and consequences of opioid misuse. Conclusion: Research focused on understanding of opioid neurobiology, as well as empirically based, effective alternatives to pain management and implementation studies on combined prevention and treatment approaches are needed. It will take the combined effort of community members, healthcare professionals, policymakers and researchers in order to prevent and treat opioid misuse.
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Affiliation(s)
- Maria Bolshakova
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
| | - Ricky Bluthenthal
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
| | - Steve Sussman
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
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Hermes G, Hyman SM, Fogelman N, Kosten TR, Sinha R. Lofexidine in Combination With Oral Naltrexone for Opioid Use Disorder Relapse Prevention: A Pilot Randomized, Double-Blind, Placebo-Controlled Study. Am J Addict 2019; 28:480-488. [PMID: 31448846 DOI: 10.1111/ajad.12942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/20/2019] [Accepted: 07/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Lofexidine (LFX), an α2A adrenergic receptor agonist, known to alleviate opioid withdrawal symptoms, was assessed in combination with oral naltrexone (NTX) for effects on opioid use outcomes and NTX treatment compliance. METHODS Detoxified individuals (ages 18-55, 80% male) with opioid use disorder Diagnostic and Statistical Manual of Mental Disorders, 4th edition were randomized to 2.4 mg/day of LFX (n = 26) or Placebo (PBO, n = 31) in a double-blind manner for 12 weeks of treatment. NTX compliance, opioid-free urine samples, opioid craving as well as vital signs, subjective opioid withdrawal symptoms were assessed. RESULTS Intent to treat analysis revealed significantly better control over opioid craving in the LFX/NTX vs PBO/NTX group (P < .03), but no differences between groups in NTX compliance, opioid use, and overall opioid craving. However, subject withdrawal due to medication intolerance was significantly higher in the LFX/NTX (5/26) vs PBO/NTX (0/31) (P < .01). Two additional patients were withdrawn due to acute hepatitis infection. Post hoc secondary analyses with the nonwithdrawn sample indicated significantly higher rates of treatment completion (P < .05) and NTX compliance (P < .01), lower percent opioid urine samples (P < .05), and lower overall opioid craving (P < .05) in the LFX/NTX vs the PBO/NTX group. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Although preliminary, these findings suggest that LFX at doses up to 2.4 mg/daily was safe and improved control over opioid cravings. Among those who tolerated the medication, LFX/NTX significantly improved the opioid craving, delayed return to opioid use, and improved treatment compliance and completion rates. These findings support further assessment of LFX dose titration schedule along with the adjunctive use of LFX with NTX treatment to enhance opioid relapse prevention. (Am J Addict 2019;00:1-9).
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Affiliation(s)
- Gretchen Hermes
- The Yale Stress Center, Yale University School of Medicine, New Haven, Connecticut
| | - Scott M Hyman
- Doctoral Program in Clinical Psychology, Albizu University, Doral, Florida
| | - Nia Fogelman
- The Yale Stress Center, Yale University School of Medicine, New Haven, Connecticut
| | | | - Rajita Sinha
- The Yale Stress Center, Yale University School of Medicine, New Haven, Connecticut
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Abstract
Opioid use disorder affects over 26 million individuals worldwide. There are currently three World Health Organization-recommended and US Food and Drug Administration-approved medication treatments for opioid use disorder: the full opioid agonist methadone, the opioid partial agonist buprenorphine, and the opioid receptor antagonist naltrexone. We provide a review of the use of buprenorphine for the treatment of opioid use disorder and discuss the barriers, challenges, risks, and efficacy of buprenorphine treatment vs. other treatments. Although evidence from numerous studies has shown buprenorphine to be effective for the treatment of opioid use disorder, a majority of patients with opioid use disorder do not receive buprenorphine, or any other medical treatment. We review the different formulations of buprenorphine, including newer long-acting injectable formulations that may decrease the risk of diversion and improve adherence.
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Tompkins CNE, Neale J, Marsden J, Strang J. Factors influencing recruitment to a randomised placebo-controlled trial of oral naltrexone and extended release implant naltrexone: Qualitative study. J Subst Abuse Treat 2019; 99:52-60. [PMID: 30797394 DOI: 10.1016/j.jsat.2019.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 01/20/2023]
Abstract
AIMS To understand the influences on recruitment to the Naltrexone Enhanced Addiction Treatment (NEAT) study, a randomised placebo-controlled trial of extended-release naltrexone (XR-NTX) implants for opioid use disorder (OUD), to learn lessons for the design and conduct of similar future research. METHODS 29 face-to-face, semi-structured qualitative interviews were conducted with patients recruited to NEAT (n = 6), patients not recruited (n = 11), researchers who designed the trial (n = 5), and staff who delivered the trial (n = 7). The social marketing mix was used as a framework to guide the data analyses. RESULTS Dimensions of the 7Ps of the social marketing mix - product, price, place, promotion, physical environment, people, and processes all influenced recruitment to the NEAT trial. Among other things, the potential to receive a naltrexone implant (product); the provision of transport passes and shopping vouchers (price); clear verbal explanations (promotion); familiarity of the trial setting (physical environment); and approachable, friendly and informative trial delivery staff (people) positively influenced recruitment. Whereas, wanting a less medical approach to recovery (product); the perceived time, physical, and psychological costs of taking part (price); service ideological opposition to naltrexone in recovery (place); inaccessible written information (promotion); the location and nature of the trial setting (physical environment); a lack of knowledge about implants (people); and the blind allocation and potential of placebo (processes) deterred people from joining the trial. CONCLUSIONS Qualitative research informed by the social marketing mix as an analytical framework yielded detailed insights into understanding the factors and circumstances that influenced recruitment to the NEAT trial. Our findings have implications for the planning and implementation of future addiction trials, especially trials of extended-release formulations.
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Affiliation(s)
- Charlotte N E Tompkins
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom.
| | - Joanne Neale
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom; Centre for Social Research in Health, University of New South Wales, Sydney, Australia; South London & Maudsley (SLaM) NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8BB, United Kingdom.
| | - John Marsden
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom.
| | - John Strang
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom; South London & Maudsley (SLaM) NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8BB, United Kingdom.
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Substance Use Issues Among the Underserved. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cepeda JA, Eritsyan K, Vickerman P, Lyubimova A, Shegay M, Odinokova V, Beletsky L, Borquez A, Hickman M, Beyrer C, Martin NK. Potential impact of implementing and scaling up harm reduction and antiretroviral therapy on HIV prevalence and mortality and overdose deaths among people who inject drugs in two Russian cities: a modelling study. Lancet HIV 2018; 5:e578-e587. [PMID: 30033374 PMCID: PMC6188805 DOI: 10.1016/s2352-3018(18)30168-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Most new HIV infections among people who inject drugs (PWID) in eastern Europe and central Asia occur in Russia, where PWID have a high risk of overdose. In Russia, use of opioid agonist therapy (OAT) is prohibited, and coverage of needle and syringe programmes (NSPs) and antiretroviral therapy (ART) is poor. We aimed to assess the effects that scaling up harm reduction (ie, use of OAT and coverage of NSPs) and use of ART might have on HIV incidence and the frequency of fatal overdoses among PWID in two cities in the Ural Federal District and Siberian Federal District, where the prevalence of HIV is high or increasing in PWID. METHODS In this modelling study, we developed a dynamic deterministic model that simulated transmission of HIV through injection drug use and sex among PWID. We calibrated this model to HIV prevalence data among PWID in two Russian cities: Omsk (which has high but increasing prevalence of HIV among PWID) and Ekaterinburg (which has very high but stable prevalence of HIV). The source data were from research studies supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria and US Centers for Disease Control and Prevention and surveillance studies from WHO and regional AIDS centres. We modelled the effects of no intervention scale-up (no use of harm reduction measures and 30% of HIV-positive PWID receiving ART) versus combinations of scaling up of OAT, receipt of high coverage of NSPs, and use of ART on the incidence of HIV infections, mortality from HIV, and the frequency of fatal overdoses from 2018 to 2028. FINDINGS Without intervention, HIV prevalence among PWID in Omsk could increase from 30% in 2018 to 36% (2·5-97·5 percentile interval 22-52) in 2028 and remain high in Ekaterinburg, estimated at 60% (57-67) in 2028. Scaling up OAT to 50% coverage for a duration of 2 years could prevent 35% of HIV infections and 19% of deaths associated with HIV in Omsk and 20% (11-29) of HIV infections and 10% (4-14) of deaths associated with HIV in Ekaterinburg. Further, this scaling up could prevent 33% of overdose deaths over the next 10 years. Scaling up of NSPs and OAT to 50% coverage and tripling recruitment to ART (reaching about 65% of HIV-positive PWID) could prevent 58% (46-69) of HIV infections and 45% (36-54) of deaths associated with HIV in Omsk and 38% (26-50) of HIV infections and 32% (23-41) of deaths associated with HIV in Ekaterinburg by 2028. INTERPRETATION Legalisation of OAT and increased use of ART and NSPs for PWID are urgently needed to prevent HIV and fatal overdose among PWID in Russia. FUNDING National Institutes of Health and Elton John AIDS Foundation.
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Affiliation(s)
- Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA.
| | - Ksenia Eritsyan
- NGO Stellit, Saint Petersburg, Russia; Department of Sociology, National Research University Higher School of Economics, Saint Petersburg, Russia
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Dahl HM, Rezvyy G, Bogdanov A, Øiesvold T. Outpatient clinics treating substance use disorders in Northwest Russia and Northern Norway: a descriptive comparative study. Int J Circumpolar Health 2018; 76:1411733. [PMID: 29241406 PMCID: PMC5738642 DOI: 10.1080/22423982.2017.1411733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Both in Norway and Russia a considerable portion of the population have substance use disorders. However, the knowledge about outpatient services treating substance use disorders in Norway and Russia is limited. This study will describe and compare outpatient clinics treating substance use disorders in Arkhangelsk in Northwest Russia and in Bodø and Tromsø in Northern Norway on availability, accessibility and treated prevalence (patients treated in one year). The managers (N=3) of the outpatient clinics (N=3) were interviewed with the European Service Mapping Schedule (ESMS) and the International Classification of Mental Health Care (ICMHC). The interviews were supplemented by e-mail and phone calls. The treatment in Arkhangelsk was mainly biologically oriented (medical), while a greater variety of methods was available in Bodø and Tromsø. The clinic in Russia was a drop-in clinic, while in Norway patients needed a referral to get an appointment in the clinic. Patients treated in Arkhangelsk (treated prevalence) was 1662, while in Bodø it was 233 and in Tromsø 220. The present study revealed great differences between the clinics involved in accessibility, availability and treated prevalence. Cultural traditions and budgeting of the mental health care system could explain some of the findings.
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Affiliation(s)
- Helene Marie Dahl
- a Institute of Clinical Medicine, Faculty of Health Sciences , University of Tromsø, the Arctic University of Norway , Tromsø , Norway.,b Division of general psychiatry , Nordland Hospital , Bodø , Norway
| | - Grigory Rezvyy
- a Institute of Clinical Medicine, Faculty of Health Sciences , University of Tromsø, the Arctic University of Norway , Tromsø , Norway.,c Outpatient clinic of psychiatry , Kirkenes Hospital , Kirkenes , Norway
| | - Anatoly Bogdanov
- d Department of Psychiatry and Addictive Disorder , Arkhangelsk Clinical Psychiatric Hospital , Arkhangelsk region , Russia
| | - Terje Øiesvold
- a Institute of Clinical Medicine, Faculty of Health Sciences , University of Tromsø, the Arctic University of Norway , Tromsø , Norway.,b Division of general psychiatry , Nordland Hospital , Bodø , Norway
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Ghosh A, Basu D, Avasthi A. Buprenorphine-based opioid substitution therapy in India: A few observations, thoughts, and opinions. Indian J Psychiatry 2018; 60:361-366. [PMID: 30405267 PMCID: PMC6201663 DOI: 10.4103/psychiatry.indianjpsychiatry_218_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The most evidence-based treatment for opioid dependence is opioid agonist maintenance treatment also known as opioid substitution therapy (OST). However, there are some critical, yet unaddressed issues of buprenorphine-based substitution therapy, especially in the Indian context. These comprise of generalizability of the evidence for OST, especially for natural and pharmaceutical opioids and for all age groups, optimum dose and duration of OST, and mode of treatment delivery including the frequency of dispensing. Notwithstanding the use of buprenorphine-naloxone combination, abuse and diversion are serious but often underreported problems. There is an urgent need for health services research in India on OST, focusing on these aspects. Rather than directly copying from Western models, it is important to try to understand the useful and safe program and policy options likely to be applicable in the Indian setting, with our own assets as well as vulnerabilities.
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Affiliation(s)
- Abhishek Ghosh
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, PGIMER, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, PGIMER, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
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National Institute on Drug Abuse International Program: improving opioid use disorder treatment through international research training. Curr Opin Psychiatry 2018; 31:287-293. [PMID: 29771745 PMCID: PMC6050030 DOI: 10.1097/yco.0000000000000426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW For more than 25 years, the National Institute on Drug Abuse (NIDA) has supported research-training programs, establishing a global research network and expanding the knowledge base on substance use disorders. International research to inform approaches to opioid addiction is particularly important and relevant to the United States, where opioid misuse, addiction, and overdose constitute an emerging public health crisis. This article summarizes the NIDA International Program and illustrates its impact by reviewing recent articles about treatment approaches for opioid use disorders (OUD). RECENT FINDINGS Studies in several countries have demonstrated the effectiveness of physician office-based opioid substitution therapies. Other research has demonstrated the effectiveness of different formulations and doses of the opioid antagonist naltrexone, as well as different approaches to providing naloxone to treat opioid overdose. Continuing research into implementation of evidence-based treatment in international settings with limited resources is applicable to US regions that face similar structural, legal, and fiscal constraints. SUMMARY The current review describes international research on OUD treatment and opioid overdose, most coauthored by former NIDA fellows. The findings from outside the United States have important implications for best practices domestically and in other countries that are experiencing increases in OUD prevalence and related overdose deaths.
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A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in U.S. office-based practices. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:9-17. [DOI: 10.1016/j.drugpo.2017.11.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 11/27/2022]
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Bisaga A, Mannelli P, Sullivan MA, Vosburg SK, Compton P, Woody GE, Kosten TR. Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies. Am J Addict 2018; 27:177-187. [PMID: 29596725 PMCID: PMC5900907 DOI: 10.1111/ajad.12711] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Opioid use disorder (OUD) is a chronic condition with potentially severe health and social consequences. Many who develop moderate to severe OUD will repeatedly seek treatment or interact with medical care via emergency department visits or hospitalizations. Thus, there is an urgent need to develop feasible and effective approaches to help persons with OUD achieve and maintain abstinence from opioids. Treatment that includes one of the three FDA-approved medications is an evidence-based strategy to manage OUD. The purpose of this review is to address practices for managing persons with moderate to severe OUD with a focus on opioid withdrawal and naltrexone-based relapse-prevention treatment. METHODS Literature available on PubMed was used to review the evolution of treatment strategies from the 1960s onward to manage opioid withdrawal and initiate treatment with naltrexone. RESULTS Emerging practices for extended-release naltrexone induction include the use of agonist tapers and adjuvant medications. Clinical challenges frequently encountered when initiating this therapy include managing withdrawal and ongoing opioid use during treatment. Clinical factors may inform decisions regarding patient selection and length of naltrexone treatment, such as recent opioid use and patient preferences. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Treatment strategies to manage opioid withdrawal have evolved, but many patients with OUD do not receive medication for the prevention of relapse. Clinical strategies for induction onto extended-release naltrexone are now available and can be safely and effectively implemented in specialty and select primary care settings. (© 2018 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP);27:177-187).
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Affiliation(s)
- Adam Bisaga
- Department of PsychiatryColumbia University College of Physicians and SurgeonsNew YorkNew York
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth Carolina
| | - Maria A. Sullivan
- Department of PsychiatryColumbia University College of Physicians and SurgeonsNew YorkNew York
- Alkermes Inc.WalthamMassachusetts
| | | | - Peggy Compton
- Department of Family and Community HealthSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - George E. Woody
- Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania
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Dawson L, Strathdee SA, London AJ, Lancaster KE, Klitzman R, Hoffman I, Rose S, Sugarman J. Addressing ethical challenges in HIV prevention research with people who inject drugs. JOURNAL OF MEDICAL ETHICS 2018; 44:149-158. [PMID: 27114469 PMCID: PMC6367727 DOI: 10.1136/medethics-2015-102895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 03/23/2016] [Accepted: 04/04/2016] [Indexed: 05/15/2023]
Abstract
Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs (PWID). Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: (1) Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? (2) Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? (3) When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? (4) Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world.
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Affiliation(s)
- Liza Dawson
- Division of AIDS, NIH/NIAID, Bethesda, Maryland, USA
| | | | | | | | | | - Irving Hoffman
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Scott Rose
- Family Health International, Durham, North Carolina, USA
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Shi Z, Wang AL, Jagannathan K, Fairchild VP, O'Brien CP, Childress AR, Langleben DD. Effects of extended-release naltrexone on the brain response to drug-related stimuli in patients with opioid use disorder. J Psychiatry Neurosci 2018; 43:170036. [PMID: 29485031 PMCID: PMC6019353 DOI: 10.1503/jpn.170036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/22/2017] [Accepted: 10/07/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Heightened response to drug-related cues is a hallmark of addiction. Extended-release naltrexone (XR-NTX) is a US Food and Drug Administration-approved pharmacotherapy for relapse prevention in patients with opioid use disorder (OUD). In these patients, XR-NTX has been shown to reduce brain responses to opioid-related visual stimuli. To assess the biomarker potential of this phenomenon, it is necessary to determine whether this effect is limited to opioid-related stimuli and whether it is associated with key OUD symptoms. METHODS Using functional MRI (fMRI), we measured the brain responses to opioid-related and control (i.e., sexual and aversive) images in detoxified patients with OUD before, during and after XR-NTX treatment. Craving and withdrawal severity were evaluated using clinician- and self-administered instruments during each session. RESULTS We included 24 patients with OUD in our analysis. During XR-NTX treatment, we found reduced responses to opioid-related stimuli in the nucleus accumbens (NAcc) and medial orbitofrontal cortex (mOFC). The reduction in mOFC response was specific to the opioid-related stimuli. The reduced NAcc and mOFC opioid cue reactivity was correlated with reduction in clinician-assessed and self-reported withdrawal symptoms, respectively. LIMITATIONS The study was not placebo-controlled owing to ethical, safety and feasibility concerns. CONCLUSION Extended-release naltrexone reduces the NAcc and mOFC cue reactivity in patients with OUD. This effect is specific to opioid-related stimuli in the mOFC only. The reduction in neural response to opioid-related stimuli is more robust in patients with greater decline in withdrawal severity. Our results support the clinical utility of mesocorticolimbic cue reactivity in monitoring the XR-NTX treatment outcomes and highlight the link between opioid withdrawal symptomatology and neural opioid cue reactivity.
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Affiliation(s)
- Zhenhao Shi
- From the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa. (Shi, Wang, Jagannathan, Fairchild, O'Brien, Childress, Langleben); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY (Wang); the Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pa. (Langleben); and the Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pa. (Langleben)
| | - An-Li Wang
- From the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa. (Shi, Wang, Jagannathan, Fairchild, O'Brien, Childress, Langleben); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY (Wang); the Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pa. (Langleben); and the Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pa. (Langleben)
| | - Kanchana Jagannathan
- From the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa. (Shi, Wang, Jagannathan, Fairchild, O'Brien, Childress, Langleben); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY (Wang); the Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pa. (Langleben); and the Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pa. (Langleben)
| | - Victoria P Fairchild
- From the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa. (Shi, Wang, Jagannathan, Fairchild, O'Brien, Childress, Langleben); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY (Wang); the Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pa. (Langleben); and the Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pa. (Langleben)
| | - Charles P O'Brien
- From the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa. (Shi, Wang, Jagannathan, Fairchild, O'Brien, Childress, Langleben); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY (Wang); the Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pa. (Langleben); and the Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pa. (Langleben)
| | - Anna Rose Childress
- From the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa. (Shi, Wang, Jagannathan, Fairchild, O'Brien, Childress, Langleben); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY (Wang); the Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pa. (Langleben); and the Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pa. (Langleben)
| | - Daniel D Langleben
- From the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa. (Shi, Wang, Jagannathan, Fairchild, O'Brien, Childress, Langleben); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY (Wang); the Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pa. (Langleben); and the Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pa. (Langleben)
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Kelly MM, Reilly E, Quiñones T, Desai N, Rosenheck R. Long-acting intramuscular naltrexone for opioid use disorder: Utilization and association with multi-morbidity nationally in the Veterans Health Administration. Drug Alcohol Depend 2018; 183:111-117. [PMID: 29245103 DOI: 10.1016/j.drugalcdep.2017.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/01/2017] [Accepted: 10/11/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Long acting intramuscular (IM) naltrexone is an effective treatment for opioid use disorder (OUD), but rates and correlates of its use have not been studied. METHODS National administrative from the Veterans Health Administration (VHA) from Fiscal Year 2012 identified only 16 VHA facilities that prescribed IM naltrexone to 5 or more veterans diagnosed with OUD. Data from these facilities were used to identify sociodemographic, diagnostic, and service use characteristics, including use of psychotropic medication, that were characteristic of veterans who filled prescriptions for IM naltrexone. This was in comparison to users of opiate agonist treatments (methadone or buprenorphine) or veterans with no pharmacologic treatment for OUD. Comparisons were made using both bi-variate analyses and multivariable logistic regression. RESULTS Only 179 of 16,402 veterans with OUD (1%) at these 16 facilities filled a prescription for IM naltrexone and only 256 of 99,394 (0.26%) nationally. These veterans were characterized by past homelessness, co-morbid alcohol use disorder, multiple psychiatric disorders, and a greater likelihood of psychiatric hospitalization, as well as mental health outpatient and antidepressant medication use. CONCLUSIONS IM naltrexone is rarely used for OUD and is primarily used for patients with multiple co-morbidities, especially alcohol use disorder and serious mental illness. The use of this treatment illustrates many of the principles identified by the emerging focus on multi-morbidity as a critical feature of clinical practice.
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Affiliation(s)
- Megan M Kelly
- VISN 1 VA New England Mental Illness Research, Education, and Clinical Center, USA; Social and Community Reintegration Research Program, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA.
| | - Erin Reilly
- Social and Community Reintegration Research Program, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA
| | - Timothy Quiñones
- Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA
| | - Nitigna Desai
- VISN 1 VA New England Mental Illness Research, Education, and Clinical Center, USA; Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA; Boston University School of Medicine,72 E. Concord Street, Boston, MA 02118, USA
| | - Robert Rosenheck
- VISN 1 VA New England Mental Illness Research, Education, and Clinical Center, USA; VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Yale University School of Medicine,333 Cedar Street, New Haven, CT 06510, USA
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Marcus R, Bojko MJ, Mazhnaya A, Makarenko I, Filippovych S, Dvoriak S, Altice FL, Springer SA. A qualitative assessment of attitudes about and preferences for extended-release naltrexone, a new pharmacotherapy to treat opioid use disorders in Ukraine. J Subst Abuse Treat 2018; 86:86-93. [PMID: 29415856 DOI: 10.1016/j.jsat.2018.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 12/23/2022]
Abstract
Numerous individual barriers, including negative attitudes toward opioid agonist therapies (OAT), have undermined HIV prevention efforts in Ukraine where the epidemic is concentrated in people who inject drugs (PWID). The recent availability of extended-release naltrexone (XR-NTX), an opioid antagonist, provides new opportunities for treatment and prevention, but little is known about patient preferences. We conducted qualitative analysis using focus groups (FG) of PWID recruited based on OAT experience: currently, previously, and never on OAT in five Ukrainian cities. FG included 199 PWID in 25 focus groups. Focus group transcripts were coded and analyzed using a modified grounded theory approach to identify common themes and domains related to attitudes about and preferences for XR-NTX, relative to other treatments. Interest in XR-NTX was supported if supervised opioid withdrawal and psychological support were assured. Other factors supporting XR-NTX included a focus on younger PWID early in their injection career and motivated for recovery. Perceptions of recovery included not receiving psychoactive medications like methadone or buprenorphine. With more information, XR-NTX could be a viable option for PWID in Ukraine, especially if concerns regarding withdrawal and psychological support are adequately addressed.
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Affiliation(s)
- Ruthanne Marcus
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
| | - Martha J Bojko
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | | | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA; Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Sandra A Springer
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
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Abstract
INTRODUCTION Substance use disorders are a group of chronic relapsing disorders of the brain, which have massive public health and societal impact. In some disorders (e.g., heroin/prescription opioid addictions) approved medications have a major long-term benefit. For other substances (e.g., cocaine, amphetamines and cannabis) there are no approved medications, and for alcohol there are approved treatments, which are not in wide usage. Approved treatments for tobacco use disorders are available, and novel medications are also under study. Areas covered: Medication-based approaches which are in advanced preclinical stages, or which have reached proof-of concept clinical laboratory studies, as well as clinical trials. Expert opinion: Current challenges involve optimizing translation between preclinical and clinical development, and between clinical laboratory studies to therapeutic clinical trials. Comorbidities including depression or anxiety are challenges for study design and analysis. Improved pharmacogenomics, biomarker and phenotyping approaches are areas of interest. Pharmacological mechanisms currently under investigation include modulation of glutamatergic, GABA, vasopressin and κ-receptor function, as well as inhibition of monoamine re-uptake. Other factors that affect potential market size for emerging medications include stigma, availability of treatment settings, adoption by clinicians, and the prevalence of persons with SUD who are not actively treatment-seeking.
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Affiliation(s)
- Eduardo R Butelman
- a Laboratory in the Biology of Addictive Diseases , The Rockefeller University , New York , NY , USA
| | - Mary Jeanne Kreek
- a Laboratory in the Biology of Addictive Diseases , The Rockefeller University , New York , NY , USA
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Friedmann PD, Dunn KE, Nunes EV, O'Brien CP. Effectiveness, Implementation and Real-World Experience with Extended-Release Naltrexone (XR-NTX): A Special Issue of JSAT. J Subst Abuse Treat 2017; 85:31-33. [PMID: 29273249 DOI: 10.1016/j.jsat.2017.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Peter D Friedmann
- Office of Research and Department of Medicine, University of Massachusetts-Baystate and Baystate Health, Springfield, MA.
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edward V Nunes
- New York State Psychiatric Institute, Columbia University Medical Center New York, NY
| | - Charles P O'Brien
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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Marcus R, Makarenko I, Mazhnaya A, Zelenev A, Polonsky M, Madden L, Filippovych S, Dvoriak S, Springer SA, Altice FL. Patient preferences and extended-release naltrexone: A new opportunity to treat opioid use disorders in Ukraine. Drug Alcohol Depend 2017; 179:213-219. [PMID: 28806638 PMCID: PMC5599372 DOI: 10.1016/j.drugalcdep.2017.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/12/2017] [Accepted: 07/15/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Scaling up HIV prevention for people who inject drugs (PWID) using opioid agonist therapies (OAT) in Ukraine has been restricted by individual and structural factors. Extended-release naltrexone (XR-NTX), however, provides new opportunities for treating opioid use disorders (OUDs) in this region, where both HIV incidence and mortality continue to increase. METHODS Survey results from 1613 randomly selected PWID from 5 regions in Ukraine who were currently, previously or never on OAT were analyzed for their preference of pharmacological therapies for treating OUDs. For those preferring XR-NTX, independent correlates of their willingness to initiate XR-NTX were examined. RESULTS Among the 1613 PWID, 449 (27.8%) were interested in initiating XR-NTX. Independent correlates associated with interest in XR-NTX included: being from Mykolaiv (AOR=3.7, 95% CI=2.3-6.1) or Dnipro (AOR=1.8, 95% CI=1.1-2.9); never having been on OAT (AOR=3.4, 95% CI=2.1-5.4); shorter-term injectors (AOR=0.9, 95% CI 0.9-0.98); and inversely for both positive (AOR=0.8, CI=0.8-0.9), and negative attitudes toward OAT (AOR=1.3, CI=1.2-1.4), respectively. CONCLUSIONS In the context of Eastern Europe and Central Asia where HIV is concentrated in PWID and where HIV prevention with OAT is under-scaled, new options for treating OUDs are urgently needed. FINDINGS here suggest that XR-NTX could become an option for addiction treatment and HIV prevention especially for PWID who have shorter duration of injection and who harbor negative attitudes to OAT. Decision aids that inform patient preferences with accurate information about the various treatment options are likely to guide patients toward better, patient-centered treatments and improve treatment entry and retention.
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Affiliation(s)
- Ruthanne Marcus
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
| | | | | | - Alexei Zelenev
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Maxim Polonsky
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Sandra A Springer
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA; Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven CT, USA; Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Kowalchuk AA, Gonzalez SJ, Zoorob RJ. Substance Use Issues Among the Underserved: United States and International Perspectives. Prim Care 2017; 44:113-125. [PMID: 28164811 DOI: 10.1016/j.pop.2016.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Substance use affects people of all ages, cultures, and socioeconomic levels. Most underserved populations have lower rates of substance use than the general population in a given society, excluding tobacco use. The impact of substance use is more severe, however, in the underserved, with higher rates of incarceration, job loss, morbidity, and mortality. Innovative solutions are being developed to address these differences. Working together, underserved patients with substance use problems can be helped on their journeys toward health and wholeness.
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Affiliation(s)
- Alicia Ann Kowalchuk
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA.
| | - Sandra J Gonzalez
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA
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Extended-release naltrexone for pre-release prisoners: A randomized trial of medical mobile treatment. Contemp Clin Trials 2016; 53:130-136. [PMID: 28011389 DOI: 10.1016/j.cct.2016.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Extended-release naltrexone (XR-NTX), is an effective treatment for opioid use disorder but is rarely initiated in US prisons or with criminal justice populations. Mobile treatment for chronic diseases has been implemented in a variety of settings. Mobile treatment may provide an opportunity to expand outreach to parolees to surmount barriers to traditional clinic treatment. METHODS Male and female prisoners (240) with pre-incarceration histories of opioid use disorder who are within one month of release from prison will be enrolled in this randomized clinical trial. Participants are randomized to one of two study arms: 1) [XR-NTX-OTx] One injection of long-acting naltrexone in prison, followed by 6 monthly injections post-release at a community opioid treatment program; or 2) [XR-NTX+ MMTx] One injection of long-acting naltrexone in prison followed by 6 monthly injections post-release at the patient's place of residence utilizing mobile medical treatment. The primary outcomes are: treatment adherence; opioid use; criminal activity; re-arrest; reincarceration; and HIV risk-behaviors. RESULTS We describe the background and rationale for the study, its aims, hypotheses, and study design. CONCLUSIONS The use of long-acting injectable naltrexone may be a promising form of treatment for pre-release prisoners. Finally, as many individuals in the criminal justice system drop out of treatment, this study will assess whether treatment at their place of residence will improve adherence and positively affect treatment outcomes. ClinicalTrials.gov: NCT02867124.
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Ayanga D, Shorter D, Kosten TR. Update on pharmacotherapy for treatment of opioid use disorder. Expert Opin Pharmacother 2016; 17:2307-2318. [PMID: 27734745 DOI: 10.1080/14656566.2016.1244529] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Opioid Use Disorder (OUD) is a significant public health concern, negatively impacting the medical, psychological, and social domains of an individual's life as well as creating substantial burdens for society. Effective treatment interventions are necessary for reduction of OUD and its consequences. Pharmacotherapy represents a central component of management. Areas covered: This review focuses on pharmacologic strategies for OUD treatment, discussing both primary as well as adjunctive therapy modalities. We will discuss both medications used during detoxification to treat withdrawal, as well as those used as maintenance therapy. Detox medications include alpha-2 adrenergic agonists, such as clonidine, as well as the μ-opioid agonist, methadone, and the μ-opioid partial agonist, buprenorphine. Opioid maintenance treatment (OMT) is also discussed, focusing on those medications meant to substitute abused opioids and includes the agonists, methadone and buprenorphine, as well as supervised intravenous heroin, and opioid antagonist, naltrexone. Expert opinion: Medication therapy for treatment of OUD has demonstrated efficacy and is of great clinical benefit. While agonist treatment with methadone or buprenorphine remains the gold standard, there is an important place for use of long-acting antagonist therapy with naltrexone. Continued investigation into treatment paradigms and behavioral platforms which optimize medication therapy is most needed.
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Affiliation(s)
- Daniel Ayanga
- a Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
| | - Daryl Shorter
- b Research Service Line, Michael E. DeBakey VA Medical Center, Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
| | - Thomas R Kosten
- c Departments of Psychiatry; Neuroscience; Pharmacology; Immunology & Pathology , Baylor College of Medicine, Michael E. DeBakey VA Medical Center , Houston , TX , USA
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Tsui JI, Ko SC, Krupitsky E, Lioznov D, Chaisson CE, Gnatienko N, Samet JH. Insights on the Russian HCV Care Cascade: Minimal HCV Treatment for HIV/HCV Co-infected PWID in St. Petersburg. HEPATOLOGY, MEDICINE AND POLICY 2016; 1. [PMID: 28217368 PMCID: PMC5313079 DOI: 10.1186/s41124-016-0020-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The human immunodeficiency virus (HIV) epidemic in Russia, driven by injection drug use, has seen a steady rise in the past two decades. Hepatitis C virus (HCV) infection is highly prevalent in people who inject drugs (PWID). The study aimed to describe the current frequency of HCV testing and treatment among HIV-infected PWID in St. Petersburg, Russia. Methods This study examined baseline data from the “Linking Infectious and Narcology Care” (LINC) and “Russia Alcohol Research Collaboration on HIV/AIDS” (Russia ARCH) studies. Participants included in this analysis were HIV-infected with a history of injection drug use. Descriptive statistics were performed to assess frequency of HCV testing and treatment. Results Participants (n = 349 [LINC], 207 [Russia ARCH]) had a mean age of 33.8 years (IQR: 31–37) in LINC and 33.0 (IQR: 30–36) in Russia ARCH; 26.6 % (LINC) and 29.0 % (Russia ARCH) were female; 100 % were Caucasian. Nearly all participants had been tested for HCV (98.9 % in LINC, 97.1 % in Russia ARCH). Almost all reported being diagnosed HCV positive (98.9 % in LINC, 97.1 % in Russia ARCH). Only 2.3 % of LINC and 5.0 % of Russia ARCH participants reported ever receiving HCV treatment. Conclusions Among these cohorts of HIV-infected PWID in St. Petersburg, Russia, as of 2015 nearly all reported being tested for HCV and testing positive, while only 3.3 % received any HCV treatment. In this new era of effective HCV pharmacotherapy, an enormous chasm in the HCV treatment cascade in Russia exists providing substantial opportunities for curing HCV in HIV-infected Russians with a history of injection drug use. Trial registration The studies described were registered with ClinicalTrials.gov through the National Institutes of Health: Linking Infectious and Narcology Care in Russia (LINC) - NCT01612455, registered 1 June 2012, first participant enrolled 3 July 2012; Alcohol’s Impact on Inflammatory Markers in HIV Disease - Russia ARCH Cohort - NCT01614626, registered 25 May 2012, first participant enrolled 15 November 2012. Electronic supplementary material The online version of this article (doi:10.1186/s41124-016-0020-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith I Tsui
- Department of Medicine, Section of General Internal Medicine, University of Washington School of Medicine and Harborview Hospital, 325 9th Ave, Seattle, WA 98104, USA
| | - Stephen C Ko
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3nd Floor, Boston, MA 02118, USA
| | - Evgeny Krupitsky
- St. Petersburg Bekhterev Research Psychoneurological Institute, Bekhtereva St., 3, St. Petersburg 192019, Russian Federation; First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russian Federation
| | - Dmitry Lioznov
- First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russian Federation; Pasteur Research Institute of Epidemiology and Microbiology, St. Petersburg, Russian Federation, Mira St. 14, St. Petersburg, 197101, Russian Federation
| | - Christine E Chaisson
- Data Coordinating Center, Boston University School of Public Health, 85 East Newton Street, 9th Floor, Boston, MA 02118, USA
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
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Vasilev G, Milcheva S, Vassileva J. Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2016; 3:293-305. [PMID: 27493878 PMCID: PMC4968876 DOI: 10.1007/s40501-016-0089-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The global prevalence in the use of opiates and opioids has remained stable, though there were some unprecedented recent increases in opioid use and associated mortality and morbidity in the United States. Internationally, there is a strong tendency for consolidation of drug treatment strategies in favor of more systematic, structured and balanced approaches to regional and national drug policies. However, there are considerable differences in the scope, focus, and implementation of national drug policies and the political context is shaping drug prevention, treatment and rehabilitation efforts to an extent not typically observed in other public health domains. As a result, though in theory, there is a considerable multi-national agreement about the efficacy and effectiveness of different treatment modalities for opioid dependence, in practice, there are striking differences among different world regions and countries in the degree of implementation of these treatment modalities into clinical practice. Such discrepancies between theory and practice are observed even in high-income countries such as the United States and European Union member states, where evidence-based treatment modalities are still not well implemented into clinical practice. Despite the lack of evidence-based support for the role of detoxification as a stand-alone treatment for opioid use disorders, it appears to be the most widely used intervention for opioid use across the world.
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Affiliation(s)
- Georgi Vasilev
- Bulgarian Addictions Institute, 93 Antim I, Sofia 1303, Bulgaria, Tel: 00359 885 000 533
| | - Svetla Milcheva
- University Hospital Sveta Marina, 1 Hristo Smirnenski blvd, Varna 9100, Bulgaria, Tel: 00359 889 317 293
| | - Jasmin Vassileva
- Department of Psychiatry, Virginia Commonwealth University, 203 E. Cary Street, Richmond VA 23219, USA, Tel: 804 828 5807
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Lee JD, Nunes EV, Mpa PN, Bailey GL, Brigham GS, Cohen AJ, Fishman M, Ling W, Lindblad R, Shmueli-Blumberg D, Stablein D, May J, Salazar D, Liu D, Rotrosen J. NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study design and rationale. Contemp Clin Trials 2016; 50:253-64. [PMID: 27521809 DOI: 10.1016/j.cct.2016.08.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/26/2016] [Accepted: 08/09/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION For opioid-dependent patients in the US and elsewhere, detoxification and counseling-only aftercare are treatment mainstays. Long-term abstinence is rarely achieved; many patients relapse and overdose after detoxification. Methadone, buprenorphine-naloxone (BUP-NX) and extended-release naltrexone (XR-NTX) can prevent opioid relapse but are underutilized. This study is intended to develop an evidence-base to help patients and providers make informed choices and to foster wider adoption of relapse-prevention pharmacotherapies. METHODS The National Institute on Drug Abuse's Clinical Trials Network (CTN) study CTN-0051, X:BOT, is a comparative effectiveness study of treatment for 24weeks with XR-NTX, an opioid antagonist, versus BUP-NX, a high affinity partial opioid agonist, for opioid dependent patients initiating treatment at 8 short-term residential (detoxification) units and continuing care as outpatients. Up to 600 participants are randomized (1:1) to XR-NTX or BUP-NX. RESULTS The primary outcome is time to opioid relapse (i.e., loss of persistent abstinence) across the 24-week treatment phase. Differences between arms in the distribution of time-to-relapse will be compared (construction of the asymptotic 95% CI for the hazard ratio of the difference between arms). Secondary outcomes include proportions retained in treatment, rates of opioid abstinence, adverse events, cigarette, alcohol, and other drug use, and HIV risk behaviors; opioid cravings, quality of life, cognitive function, genetic moderators, and cost effectiveness. CONCLUSIONS XR-NTX and BUP-NX differ considerably in their characteristics and clinical management; no studies to date have compared XR-NTX with buprenorphine maintenance. Study design choices and compromises inherent to a comparative effectiveness trial of distinct treatment regimens are reviewed. CLINICAL TRIAL REGISTRATION NCT02032433.
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Affiliation(s)
- Joshua D Lee
- New York University School of Medicine, New York, NY, United States.
| | - Edward V Nunes
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, United States
| | | | - Genie L Bailey
- Warren Alpert Medical School, Brown University, Providence, RI, United States; Stanley Street Treatment & Resources, Fall River, MA, United States
| | | | - Allan J Cohen
- Bay Area Addiction Research & Treatment, San Francisco, CA, United States
| | - Marc Fishman
- Mountain Manor Treatment Center, Baltimore, MD, United States
| | - Walter Ling
- UCLA Integrated Substance Abuse Program, Los Angeles, CA, United States
| | | | | | - Don Stablein
- The Emmes Corporation, Rockville, MD, United States
| | - Jeanine May
- The Emmes Corporation, Rockville, MD, United States
| | | | - David Liu
- National Institute on Drug Abuse, Rockville, MD, United States
| | - John Rotrosen
- New York University School of Medicine, New York, NY, United States
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Mendelevich VD, Zalmunin KY. Paradoxes of evidence in Russian addiction medicine. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2016; 27 Suppl 1:S102-3. [PMID: 26639682 DOI: 10.3233/jrs-150708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For many years, clinical protocols for treatment of drug abuse patients and treatment standards in Russian Federation were not grounded on the principles of evidence-based medicine [1]. Recommendations for use of certain drugs were not accompanied by any indication of the level of credibility of the evidence supporting it. The appearance in 2014 of such indications in clinical recommendations can be considered a significant step forward for the science of addiction medicine [2]. OBJECTIVE To compare Russian evidence and practice in addiction medicines with international standards. METHODS Situation and literature analysis. RESULTS The analysis shows that in the wording of recommendations on the use of medicines, some were subject of serious methodological errors. For some drugs globally there is high quality evidence supporting effects of certain drugs globally, but this is not recognized in Russia. As a result, Russian standards of clinical care for the treatment of dependency syndrome are radically different to the standards of therapy, presented in the WHO recommendations. This is due both to the disregard of the meta-analyses presented in the Cochrane reviews and also to the specific bioethical preferences in drug treatment in Russia.It is known that there is no convincing data on the effectiveness and safety of antipsychotics in the treatment of alcohol dependence syndrome [3]. 13 randomized trials with a double blind placebo-controlled design involving 1593 patients assessing effects of amisulpride, aripiprazole, flupentixolum dekonoat, olanzapine, quetiapine, tiapride showed that antipsychotics do not result in abstinence, do not reduce abuse and do not stop craving in alcoholic patients: "Antipsychotics should not be used in patients with a primary diagnosis of dependence. Appointment of antipsychotics for the treatment of substance abuse disorders are contraindicated, since not only does it not improve the condition of patients, but it can even worsen the course of the disease, leading to a reduction in the duration and quality of the remission, and is fraught with serious side effects that threaten the health of patients."SSRI antidepressants indirectly improve the results of treatment of comorbid alcoholism in depressed patients, without affecting alcohol dependence per se. Also, there is currently no convincing evidence of the efficacy of anticonvulsants in the treatment of dependence syndrome, particularly alcohol.Despite the fact that traditional psychotherapeutic interventions remain widespread in practice, and treatment of alcohol dependence syndrome showed high efficiency, there is no convincing evidence for long-term benefits as opposed to short-term benefits.The Cochrane Review with data based on 146 scientific studies involving 21,404 patients confirmed the effectiveness of opioid receptor agonists in treatment of opioid dependence. This therapy showed a statistically significant reduction in the use of illegal drugs, HIV transmission and risky sexual behavior, and was significantly more effective compared to the conventional maintenance therapy with opioid receptor antagonists. In countries, where law prohibits prescribing and use of opioid agonists for opioid dependence treatment, the drugs of choice are antagonists.A meta-analysis of thirteen randomized placebo-controlled trials of oral form of naltrexone (1158 subjects), did not show any advantages of this type of treatment both for management and prevention of relapse compared with placebo [4]. Special studies also showed no inclination to reduce the use of opiates in patients receiving naltrexone [5]. However, studies carried out in Russia, showed the best results for daily intake of naltrexone after detoxification, which increased the duration of remission [6]. It was noted that the effect is associated with higher levels of adherence and family support in the examined population.An overview based on controlled clinical studies on the use of antipsychotic drugs (neuroleptics) in patients dependent on opioids revealed no evidence of effectiveness of this approach. It was concluded that the use of antipsychotics is justified only in the presence of co-morbid psychiatric problems in patients [7]. In a recent meta-analytic review on the use of atypical antipsychotics for off-label indications (off-label), there was a lack of data to support the effectiveness of their use in substance abuse [8, 9]. The effectiveness of anticonvulsants in the treatment of opioid dependence syndrome has not been proven.In connection with the above puzzling fact, for Russian standards of treatment (clinical guidelines) the level of credibility of the effectiveness of antipsychotics and antidepressants in treatment of substance abuse is assessed as A or B. This paradox raises the question of the methodology for determining the level of credibility of evidence. It should be noted that Russian recommendations for inclusion of certain drugs and therapies are based on sufficient consensus of experts rather than on the results of meta-analyses [2]. CONCLUSIONS This fact casts doubt on credibility and validity of scientific recommendations. Thus, one may say that Russian addiction medicine is not based on evidence, which is, in our view, erroneous and may impair the quality of care.
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Quednow BB, Herdener M. Human pharmacology for addiction medicine. PROGRESS IN BRAIN RESEARCH 2016; 224:227-50. [DOI: 10.1016/bs.pbr.2015.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cousins SJ, Radfar SR, Crèvecoeur-MacPhail D, Ang A, Darfler K, Rawson RA. Predictors of Continued Use of Extended-Released Naltrexone (XR-NTX) for Opioid-Dependence: An Analysis of Heroin and Non-Heroin Opioid Users in Los Angeles County. J Subst Abuse Treat 2015; 63:66-71. [PMID: 26823295 DOI: 10.1016/j.jsat.2015.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 12/13/2022]
Abstract
Extended-release naltrexone (XR-NTX) is associated with an increased number of opioid-free days, improved adherence rates in substance use disorder treatment programs, and reduced cravings and drug-seeking behaviors. There is little evidence on the predictive associations between baseline characteristics of opioid-dependent patients and XR-NTX utilization. Some studies have demonstrated better pharmacotherapy adherence and/or retention rates among non-heroin opioid users compared to heroin users. This study examines predictive associations between characteristics of patients and XR-NTX utilization, as well as participants' urge to use opiates. Our findings suggest that XR-NTX may contribute to decreases in urges to use among both heroin and non-heroin opioid users. Non-heroin opioid users and heroin users were retained in XR-NTX treatment for comparable periods of time. However, those who identified as homeless, injected opioids (regardless of opioid-type), or were diagnosed with a mental illness were less likely to be retained in treatment with XR-NTX.
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Affiliation(s)
- Sarah J Cousins
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, USA 90025.
| | - Seyed Ramin Radfar
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, USA 90025; Isfahan University of Medical Science, Hezar Jerib Avenue, Isfahan, Iran 81745
| | - Desirée Crèvecoeur-MacPhail
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, USA 90025
| | - Alfonso Ang
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, USA 90025
| | - Kendall Darfler
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, USA 90025
| | - Richard A Rawson
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, USA 90025
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Krupitsky EM, Blokhina EA, Zvartau EE, Verbitskaya VE, Bushara EM, Tiurina AA, Palatkin VY, Yaroslavtseva TS, Burakov AM, Masalov DV, Romanova TN, Grininko AY, Sinha R, Kosten T. [A double-blind randomized placebo-controlled study of the efficacy of the combined treatment with naltrexone and guanfacine for relapse prevention in opiate dependence]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:39-46. [PMID: 26525620 DOI: 10.17116/jnevro201511510139-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Authors studied the effect of α-2-adrenoreceptor agonist guanfacine on replace prevention in opiate addicts. MATERIAL AND METHODS Three hundred and one recently detoxified opiate addicts were randomized under the double-blind double-dummy conditions into one of four treatment groups: naltrexone 50 mg/day+guanfacine 1 mg/day (N+G), naltrexone+guanfacine placebo (N+GP), naltrexone placebo+guanfacine (NP+G), and double placebo (NP+GP). The primary outcome was retention in treatment. The secondary outcomes were perceived stress (Perceived Stress Scale) and craving. RESULTS At the end of six months, 20 (26.7%) patients in the N+G group and 15 (19.7%) (p=0.26 to N+G) in N+GP group were retained in treatment compared to 5 (6.7%) in the NP+G group (p=0.002 to N+G group and p=0.017 to N+GP group) and 8 (10.7%) in the double placebo group (p=0.013 to N+G group). There is no significant difference in retention between the N+G group and N+GP group at the end of treatment. CONCLUSION Guanfacine had significant craving and stress reducing effect. Naltrexone was more effective than placebo for relapse prevention in opioid dependent patients. The efficacy of the combination of naltrexone and guanfacine was comparable to naltrexone alone. Guanfacine moderately reduced both stress and craving.
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Affiliation(s)
- E M Krupitsky
- Pavlov First St. Petersburg State Medical University, St. Petersburg; Bekhterev St. Petersburg Research Psychoneurological Institute, St. Petersburg
| | - E A Blokhina
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - E E Zvartau
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - V E Verbitskaya
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - E M Bushara
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - A A Tiurina
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - V Ya Palatkin
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - T S Yaroslavtseva
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - A M Burakov
- Leningrad Obllast Narcological Dispensary, Leningrad oblast
| | - D V Masalov
- Leningrad Obllast Narcological Dispensary, Leningrad oblast
| | - T N Romanova
- Leningrad Obllast Narcological Dispensary, Leningrad oblast
| | - A Ya Grininko
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - R Sinha
- Yale University, Department of Psychiatry, New Haven, USA
| | - T Kosten
- Beylor College of Medicine, Houston, USA
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Dayal P, Balhara YPS, Mishra AK. An open label naturalistic study of predictors of retention and compliance to naltrexone maintenance treatment among patients with opioid dependence. JOURNAL OF SUBSTANCE USE 2015. [DOI: 10.3109/14659891.2015.1021867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rieckmann T, Abraham A, Zwick J, Rasplica C, McCarty D. A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation. Health Serv Res 2015; 50:1125-45. [PMID: 25532616 PMCID: PMC4545350 DOI: 10.1111/1475-6773.12273] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT). DATA SOURCES/STUDY SETTING Primary data collected from representatives of 50 states and the District of Columbia's Single State Authorities from 2007 to 2009. STUDY DESIGN/DATA COLLECTION The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs. PRINCIPAL FINDINGS Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged. CONCLUSIONS Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act.
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Affiliation(s)
- Traci Rieckmann
- Address correspondence to Traci Rieckmann, Ph.D., Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., CSB 669, Portland, OR 97239; e-mail:
| | - Amanda Abraham
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Janet Zwick
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Caitlin Rasplica
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Dennis McCarty
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
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Gordon MS, Kinlock TW, Vocci FJ, Fitzgerald TT, Memisoglu A, Silverman B. A Phase 4, Pilot, Open-Label Study of VIVITROL® (Extended-Release Naltrexone XR-NTX) for Prisoners. J Subst Abuse Treat 2015; 59:52-8. [PMID: 26299956 DOI: 10.1016/j.jsat.2015.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/07/2015] [Accepted: 07/13/2015] [Indexed: 11/28/2022]
Abstract
This was a Phase 4, pilot, open-label feasibility study of extended-release injectable naltrexone (XR-NTX) administered to pre-release prisoners having a history of pre-incarceration opioid disorder. We evaluated the relationship between XR-NTX adherence and criminal recidivism (re-arrest and re-incarceration) and opioid and cocaine use. Twenty-seven pre-release male and female prisoners who had opioid disorders during the year prior to index incarceration were recruited and received one XR-NTX injection once each month for 7 months (1 injection pre-release from prison and 6 injections in the community) and of those 27, 10 (37%) were retained in treatment at 7-months post release. Results indicate those completing 6 compared to those completing <6 injections were less likely to test positive for opioids in the community (0% vs. 62.5%, respectively; p=0.003). Although not statistically significant, individuals who did not complete all 6 injections were more likely to be re-arrested compared to those completing all 6 community injections (31.3% vs. 0%, respectively; p=0.123). Contingent upon further study of a randomized controlled trial, XR-NTX may be a feasible option in the prison setting in view of the lack of potential for diversion. Furthermore, these data suggest that completing the entire course of treatment (6 injections) may reduce opioid use and, to a lesser degree, re-arrest and re-incarceration.
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Affiliation(s)
- Michael S Gordon
- Friends Research Institute, Inc.; Department of Criminal Justice, Stevenson University.
| | - Timothy W Kinlock
- Friends Research Institute, Inc.; School of Criminal Justice, University of Baltimore
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Nunes EV, Krupitsky E, Ling W, Zummo J, Memisoglu A, Silverman BL, Gastfriend DR. Treating Opioid Dependence With Injectable Extended-Release Naltrexone (XR-NTX): Who Will Respond? J Addict Med 2015; 9:238-43. [PMID: 25901451 PMCID: PMC4450918 DOI: 10.1097/adm.0000000000000125] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/20/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Once-monthly intramuscular extended-release naltrexone (XR-NTX) has demonstrated efficacy for the prevention of relapse in opioid dependence, providing an alternative to agonist or partial agonist maintenance (ie, methadone and buprenorphine). The question remains, for whom is this unique treatment most efficacious and can patient-treatment matching factors be identified? METHODS A moderator analysis was conducted on a previously reported 24-week, placebo-controlled, multisite, randomized controlled trial of XR-NTX (n = 126) versus placebo (n = 124) among recently detoxified opioid-dependent adults in Russia, which showed XR-NTX superior to placebo in proportion of opioid abstinent weeks. The moderator analysis examined a dichotomous indicator of good clinical response-achieving at least 90% of weeks abstinent over the 24-week trial. A series of logistic regression models were fit for this outcome as functions of treatment (XR-NTX vs placebo), each baseline moderator variable, and their interactions. The 25 baseline variables included demographics, clinical severity (Addiction Severity Index, SF-36, and Clinical Global Impression-Severity), functioning (EQ-5D), craving, and HIV serostatus (HIV+). RESULTS More XR-NTX patients achieved 90% abstinence (64/126, 51%) versus placebo (39/124, 31%; P = 0.002). There were no significant interactions between baseline variables and treatment. There was a significant main effect of Clinical Global Impression-Severity score (P = 0.02), such that higher severity score was associated with a lower rate of Good Clinical Response. CONCLUSIONS The absence of significant baseline by treatment interactions indicates that no patient-treatment matching variables could be identified. This suggests that XR-NTX was effective in promoting abstinence from opioids across a range of demographic and severity characteristics.
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Affiliation(s)
- Edward V. Nunes
- From the New York State Psychiatric Institute and Department of Psychiatry (EVN), Columbia University, New York, NY; Bekhterev Research Psychoneurological Institute and St Petersburg State Pavlov Medical University (EK), Russia; Department of Psychiatry and Biobehavioral Sciences (WL), University of California, Los Angeles, CA; Alkermes, Inc (JZ, AM, BLS), Waltham, MA; and Treatment Research Institute (DRG), Philadelphia, PA
| | - Evgeny Krupitsky
- From the New York State Psychiatric Institute and Department of Psychiatry (EVN), Columbia University, New York, NY; Bekhterev Research Psychoneurological Institute and St Petersburg State Pavlov Medical University (EK), Russia; Department of Psychiatry and Biobehavioral Sciences (WL), University of California, Los Angeles, CA; Alkermes, Inc (JZ, AM, BLS), Waltham, MA; and Treatment Research Institute (DRG), Philadelphia, PA
| | - Walter Ling
- From the New York State Psychiatric Institute and Department of Psychiatry (EVN), Columbia University, New York, NY; Bekhterev Research Psychoneurological Institute and St Petersburg State Pavlov Medical University (EK), Russia; Department of Psychiatry and Biobehavioral Sciences (WL), University of California, Los Angeles, CA; Alkermes, Inc (JZ, AM, BLS), Waltham, MA; and Treatment Research Institute (DRG), Philadelphia, PA
| | - Jacqueline Zummo
- From the New York State Psychiatric Institute and Department of Psychiatry (EVN), Columbia University, New York, NY; Bekhterev Research Psychoneurological Institute and St Petersburg State Pavlov Medical University (EK), Russia; Department of Psychiatry and Biobehavioral Sciences (WL), University of California, Los Angeles, CA; Alkermes, Inc (JZ, AM, BLS), Waltham, MA; and Treatment Research Institute (DRG), Philadelphia, PA
| | - Asli Memisoglu
- From the New York State Psychiatric Institute and Department of Psychiatry (EVN), Columbia University, New York, NY; Bekhterev Research Psychoneurological Institute and St Petersburg State Pavlov Medical University (EK), Russia; Department of Psychiatry and Biobehavioral Sciences (WL), University of California, Los Angeles, CA; Alkermes, Inc (JZ, AM, BLS), Waltham, MA; and Treatment Research Institute (DRG), Philadelphia, PA
| | - Bernard L. Silverman
- From the New York State Psychiatric Institute and Department of Psychiatry (EVN), Columbia University, New York, NY; Bekhterev Research Psychoneurological Institute and St Petersburg State Pavlov Medical University (EK), Russia; Department of Psychiatry and Biobehavioral Sciences (WL), University of California, Los Angeles, CA; Alkermes, Inc (JZ, AM, BLS), Waltham, MA; and Treatment Research Institute (DRG), Philadelphia, PA
| | - David R. Gastfriend
- From the New York State Psychiatric Institute and Department of Psychiatry (EVN), Columbia University, New York, NY; Bekhterev Research Psychoneurological Institute and St Petersburg State Pavlov Medical University (EK), Russia; Department of Psychiatry and Biobehavioral Sciences (WL), University of California, Los Angeles, CA; Alkermes, Inc (JZ, AM, BLS), Waltham, MA; and Treatment Research Institute (DRG), Philadelphia, PA
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Jackson H, Mandell K, Johnson K, Chatterjee D, Vanness DJ. Cost-Effectiveness of Injectable Extended-Release Naltrexone Compared With Methadone Maintenance and Buprenorphine Maintenance Treatment for Opioid Dependence. Subst Abus 2015; 36:226-31. [PMID: 25775099 PMCID: PMC4470733 DOI: 10.1080/08897077.2015.1010031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to estimate the cost-effectiveness of injectable extended-release naltrexone (XR-NTX) compared with methadone maintenance and buprenorphine maintenance treatment (MMT and BMT, respectively) for adult males enrolled in treatment for opioid dependence in the United States from the perspective of state-level addiction treatment payers. METHODS A Markov model with daily time cycles was used to estimate the incremental cost per opioid-free day in a simulated cohort of adult males aged 18-65 over a 6-month period from the state health program perspective. RESULTS XR-NTX is predicted to be more effective and more costly than methadone or buprenorphine in our target population, with an incremental cost per opioid-free day gained relative to the next-most effective treatment (MMT) of $72. The cost-effectiveness of XR-NTX relative to MMT was driven by its effectiveness in deterring opioid use while receiving treatment. CONCLUSIONS XR-NTX is a cost-effective medication for treating opioid dependence if state addiction treatment payers are willing to pay at least $72 per opioid-free day.
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Affiliation(s)
- Heide Jackson
- a Department of Population Health Sciences , University of Wisconsin School of Medicine and Public Health , Madison , Wisconsin , USA
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46
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Rawson RA, Woody G, Kresina TF, Gust S. The globalization of addiction research: capacity-building mechanisms and selected examples. Harv Rev Psychiatry 2015; 23:147-56. [PMID: 25747927 PMCID: PMC4356020 DOI: 10.1097/hrp.0000000000000067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the past decade, the amount and variety of addiction research around the world has increased substantially. Researchers in Australia, Canada, United Kingdom, United States, and western Europe have significantly contributed to knowledge about addiction and its treatment. However, the nature and context of substance use disorders and the populations using drugs are far more diverse than is reflected in studies done in Western cultures. To stimulate new research from a diverse set of cultural perspectives, the National Institute on Drug Abuse (NIDA) has promoted the development of addiction research capacity and skills around the world for over 25 years. This review will describe the programs NIDA has developed to sponsor international research and research fellows and will provide some examples of the work NIDA has supported. NIDA fellowships have allowed 496 individuals from 96 countries to be trained in addiction research. The United Arab Emirates and Saudi Arabia have recently developed funding to support addiction research to study, with advice from NIDA, the substance use disorder problems that affect their societies. Examples from Malaysia, Tanzania, Brazil, Russian Federation, Ukraine, Republic of Georgia, Iceland, China, and Vietnam are used to illustrate research being conducted with NIDA support. Health services research, collaboratively funded by the U.S. National Institutes of Health and Department of State, addresses a range of addiction service development questions in low- and middle-income countries. Findings have expanded the understanding of addiction and its treatment, and are enhancing the ability of practitioners and policy makers to address substance use disorders.
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Affiliation(s)
- Richard A. Rawson
- Professor and Co-Director, UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles
| | - George Woody
- Professor, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania Principal Investigator, Delaware Valley Node of Clinical Trials Network, Treatment Research Institute
| | - Thomas F. Kresina
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland
| | - Steve Gust
- Director, International Program, National Institute on Drug Abuse, United States National Institutes of Health
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Krupitsky ЕМ, Kibitov АО, Blokhina ЕА, Verbitskaya ЕV, Brodyansky VМ, Alekseeva NP, Bushara NМ, Yaroslavtseva ТS, Palatkin VY, Masalov DV, Burakov АМ, Romanova ТN, Sulimov GY, Kosten Т, Nielsen D, Zvartau EE, Woody D. [Stabilization of remission in patients with opioid dependence with naltrexone implant: a pharmacogenetic approach]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:14-23. [PMID: 26288297 DOI: 10.17116/jnevro20151154214-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the effect of opioid receptor genes and dopamine system genes polymorphisms on treatment outcomes of opioid dependence with implantable and oral naltrexone. MATERIAL AND METHODS Authors carried out a randomized double-blind, double-dummy, placebo-controlled clinical trial. Three hundred and six patients with opioid dependence were randomized into 3 equal treatment groups. The first group received implantation of 1000 mg naltrexone every 2 months during 6 months + oral naltrexone placebo; the second group - placebo implant every 2 months + oral naltrexone (50mg/day) and the third group - placebo implant + oral naltrexone placebo. It was genotyped polymorphisms in the following genes: mu-opioid receptor (OPRM1), kappa-opioid receptor (OPRK1), catechol-O-methyltransferase (COMT), dopamine receptors types 2 (DRD2) and 4 (DRD4), dopamine-beta-hydroxylase, and dopamine transporter (DAT1). RESULTS Regardless of treatment several polymorphisms of these genes were associated with high risk of relapse: an allele L (2R) DRD4 120bp (p=0.05; OR (95% CI)=3.3(1.1-10.1)); an allele С DRD2 NcoI (р=0,051; OR (95% CI)=2,86 (1,09-7,52)); the genotype 9.9 DAT VNTR 40bp (р=0,04; OR (95% CI)=1,4 (1,3-1,5)); on the contrary, (СС+СТ)-(ТТ)) variants of OPRK1-DRD2Ncol increased a chance to complete treatment program (р=0,004; OR (95% CI)=7.4 (1.8-30.4)), Kaplan-Meier survival analysis (р=0,016). The probability of completing treatment program by the carriers of these variants was higher in the oral naltrexone group (p=0.016), lower in the double placebo group (p=0.015), but did not influence on treatment outcomes in the naltrexone-implant group. CONCLUSION Naltrexone-implant is a highly effective medication for treatment of opioid dependence and its effectiveness exceeds that of oral naltrexone and placebo. The study has shown the joint influence of opioid receptor genes and genes of dopaminergic system on treatment outcomes of opioid dependence. Genetic analysis is useful for determining potential responders to naltrexone treatment of opioid dependence.
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Affiliation(s)
- Е М Krupitsky
- Pavlov First St. Petersburg State Medical University, St. Petersburg; Bekhterev St. Petersburg Research Psychoneurological Institute, St. Petersburg
| | - А О Kibitov
- National Research Center of Narcology, Moscow
| | - Е А Blokhina
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - Е V Verbitskaya
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | | | - N P Alekseeva
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - N М Bushara
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - Т S Yaroslavtseva
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - V Ya Palatkin
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - D V Masalov
- Leningrad Oblast Narcology Dispensary, Leningrad Oblast
| | - А М Burakov
- Leningrad Oblast Narcology Dispensary, Leningrad Oblast
| | - Т N Romanova
- Leningrad Oblast Narcology Dispensary, Leningrad Oblast
| | | | - Т Kosten
- Baylor College of Medicine, Houston, USA
| | - D Nielsen
- Baylor College of Medicine, Houston, USA
| | - E E Zvartau
- Pavlov First St. Petersburg State Medical University, St. Petersburg
| | - D Woody
- Pennsylvanian University, USA
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Dennis BB, Naji L, Bawor M, Bonner A, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Samaan Z, Thabane L. The effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment comparison protocol. Syst Rev 2014; 3:105. [PMID: 25239213 PMCID: PMC4171401 DOI: 10.1186/2046-4053-3-105] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/03/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Opioids are psychoactive analgesic drugs prescribed for pain relief and palliative care. Due to their addictive potential, effort and vigilance in controlling prescriptions is needed to avoid misuse and dependence. Despite the effort, the prevalence of opioid use disorder continues to rise. Opioid substitution therapies are commonly used to treat opioid dependence; however, there is minimal consensus as to which therapy is most effective. Available treatments include methadone, heroin, buprenorphine, as well as naltrexone. This systematic review aims to assess and compare the effect of all available opioid substitution therapies on the treatment of opioid dependence. METHODS/DESIGN The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. The title, abstract, and full-text screening will be completed in duplicate. When appropriate, multiple treatment comparison Bayesian meta-analytic methods will be performed to deduce summary statistics estimating the effectiveness of all opioid substitution therapies in terms of retention and response to treatment (as measured through continued opioid abuse). DISCUSSION Using evidence gained from this systematic review, we anticipate disseminating an objective review of the current available literature on the effectiveness of all opioid substitution therapies for the treatment of opioid use disorder. The results of this systematic review are imperative to the further enhancement of clinical practice in addiction medicine. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006507.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
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Jhugroo A, Ellayah D, Norman A, Hulse G. Naltrexone implant treatment for buprenorphine dependence--Mauritian case series. J Psychopharmacol 2014; 28:800-3. [PMID: 24695742 DOI: 10.1177/0269881114528592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although substitution therapy with opiate agonist treatments such as methadone and buprenorphine has resulted in a reduction of illicit drug use related harm, such treatment has also resulted in severe problems in some countries where opioid-dependent individuals now inject illicitly sold buprenorphine or buprenorphine-naloxone instead of heroin. There is no approved treatment for buprenorphine dependence. Naltrexone is an opioid antagonist which has been used for the treatment of both alcohol and opioid dependencies. Although both buprenorphine and heroin resemble each other concerning their effects, buprenorphine has a higher affinity to opioid receptors than heroin. Therefore, it is not known if naltrexone can block the psychoactive effects of buprenorphine as it does for heroin. This paper presents observational case series data on the use of a sustained-release naltrexone implant for the treatment of buprenorphine dependence. To the authors' knowledge this is the first use of sustained-release naltrexone for this indication.
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Affiliation(s)
- Anil Jhugroo
- Department of Medicine, University of Mauritius, Reduit, Mauritius
| | - Darmen Ellayah
- APPEL Centre for Drug and Alcohol Counselling and Community Rehabilitation, Roche Bois, Mauritius
| | - Amanda Norman
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA Australia
| | - Gary Hulse
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA Australia
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Goonoo N, Bhaw-Luximon A, Ujoodha R, Jhugroo A, Hulse GK, Jhurry D. Naltrexone: a review of existing sustained drug delivery systems and emerging nano-based systems. J Control Release 2014; 183:154-66. [PMID: 24704710 DOI: 10.1016/j.jconrel.2014.03.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
Narcotic antagonists such as naltrexone (NTX) have shown some efficiency in the treatment of both opiate addiction and alcohol dependence. A few review articles have focused on clinical findings and pharmacogenetics of NTX, advantages and limitations of sustained release systems as well as pharmacological studies of NTX depot formulations for the treatment of alcohol and opioid dependency. To date, three NTX implant systems have been developed and tested in humans. In this review, we summarize the latest clinical data on commercially available injectable and implantable NTX-sustained release systems and discuss their safety and tolerability aspects. Emphasis is also laid on recent developments in the area of nanodrug delivery such as NTX-loaded micelles and nanogels as well as related research avenues. Due to their ability to increase the therapeutic index and to improve the selectivity of drugs (targeted delivery), nanodrug delivery systems are considered as promising sustainable drug carriers for NTX in addressing opiate and alcohol dependence.
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Affiliation(s)
- Nowsheen Goonoo
- ANDI Centre of Excellence for Biomedical and Biomaterials Research, MSIRI Building, University of Mauritius, Réduit, Mauritius
| | - Archana Bhaw-Luximon
- ANDI Centre of Excellence for Biomedical and Biomaterials Research, MSIRI Building, University of Mauritius, Réduit, Mauritius
| | - Reetesh Ujoodha
- ANDI Centre of Excellence for Biomedical and Biomaterials Research, MSIRI Building, University of Mauritius, Réduit, Mauritius
| | - Anil Jhugroo
- Dept. of Medicine, University of Mauritius, Réduit, Mauritius
| | - Gary K Hulse
- School of Psychiatry and Clinical Neurosciences, The University of Western Australia, M521, D Block, QEII Medical Centre, Nedlands, WA 6009, Australia
| | - Dhanjay Jhurry
- ANDI Centre of Excellence for Biomedical and Biomaterials Research, MSIRI Building, University of Mauritius, Réduit, Mauritius.
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