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Azar P, Kim JJ, Rohani E, Newman-Azar D, Narimani M, Machado J, Li VW. Case report: Local anesthesia with lidocaine infiltration for extended-release buprenorphine therapy. Front Psychiatry 2025; 16:1500799. [PMID: 39916746 PMCID: PMC11799565 DOI: 10.3389/fpsyt.2025.1500799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/08/2025] [Indexed: 02/09/2025] Open
Abstract
Background Extended-release buprenorphine (BUP-XR) is a once-monthly subcutaneous injection for the treatment of opioid use disorder. Injection-site pain is a common adverse event reported with BUP-XR administration. Notwithstanding the advantages of BUP-XR, subjective pain and anxiety associated with injections can compromise patients' willingness to receive treatment. Lidocaine is an amide-type agent and sodium channel blocker commonly used for local and regional anesthesia in various fields of medicine. Case presentation We present two cases involving lidocaine infiltration to the induction phase of BUP-XR therapy in an outpatient setting. Prior to the intervention, 2 mL of 1% lidocaine was infiltrated subcutaneously at the sites of the planned needle insertion for a numbing effect. The following BUP-XR therapy was well tolerated by both participants and reported as a painless procedure. Conclusions Lidocaine infiltration may be a feasible way to successfully initiate and provide BUP-XR therapy to those who may be deterred by injection-related risks. Our cases describe how lidocaine can be useful in mitigating injection-site pain and encouraging greater uptake, and in turn, greater retention in opioid agonist therapy.
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Affiliation(s)
- Pouya Azar
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jane J. Kim
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ella Rohani
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Dayyon Newman-Azar
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Matin Narimani
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jessica Machado
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Victor W. Li
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Calhoun S, Guo H, Fei Z, Lin C, Clingan SE, Zhu Y, Mooney LJ, Hser YI. Impact of COVID-19 on MOUD retention in a sample of rural primary care patients: A secondary analysis of electronic health records. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100276. [PMID: 39286538 PMCID: PMC11403463 DOI: 10.1016/j.dadr.2024.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 08/04/2024] [Accepted: 08/14/2024] [Indexed: 09/19/2024]
Abstract
Introduction There is limited research examining factors impacting MOUD retention in rural settings, especially within the context of the COVID-19 pandemic. Using electronic health records data collected as part of a NIDA Clinical Trials Network study (CTN-0102), this study explored how the onset of the COVID-19 pandemic may have impacted MOUD retention in a sample of 563 rural primary care patients. Methods Cox regression model was applied to examine if COVID-19 was related to treatment retention, controlling for demographics, clinic, insurance type, and other diagnoses. The independent variable was the number of days between the patient's first MOUD prescription date during the pre-COVID observation period (10/1/2019-3/13/2020) and the start of the COVID-19 pandemic. The dependent variable was retention on MOUD, defined as the time from the first MOUD prescription documented during the pre-COVID observation period to the first break in consecutive MOUD prescriptions (right censored at 180 days). Results The findings demonstrated that there was a reduced risk of a prescription break for every 10-day increase in the time from the first documented MOUD prescription to the onset of the COVID-19 pandemic (HR = 0.96, 95 % CI = 0.92-0.99; p = 0.011). Conclusions While the data did not include complete treatment histories to determine who was new to MOUD treatment, the findings suggest that patients whose first documented MOUD prescription in the dataset was closer to the onset of the pandemic had a greater likelihood of experiencing retention challenges. This underscores the importance for clinics to establish comprehensive contingency plans for future emergencies to ensure uninterrupted MOUD treatment and support, particularly for individuals in the early stabilization phase of their recovery.
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Affiliation(s)
- Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Huiying Guo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Zhe Fei
- Department of Statistics, University California, Riverside, CA, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Hammerslag LR, Talbert J, Slavova S, Lei F, Freeman PR, Marks KR, Fanucchi LC, Walsh SL, Lofwall MR. Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder (OUD) in Kentucky, before and after COVID-19 related buprenorphine access policy changes. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209391. [PMID: 38740189 PMCID: PMC11986849 DOI: 10.1016/j.josat.2024.209391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Long-acting injectable buprenorphine (LAI-bup) formulations have advantages over transmucosal buprenorphine (TM-bup), but barriers may limit their utilization. Several policies shifted during the COVID-19 pandemic to promote buprenorphine access. The federal government expanded telemedicine treatment for opioid use disorder and Kentucky (KY) Medicaid lifted prior authorization requirements (PAs) for LAI-bup (i.e., Sublocade®). This retrospective cohort study evaluated changes in LAI-bup access, utilization, and retention before and after these policy changes in KY. METHODS Individual-level TM-bup and LAI-bup dispensing record data from KY's prescription drug monitoring program examined LAI-bup utilization and retention, without a >30-day gap in coverage, for patients starting a new episode of LAI-bup treatment. Two key time periods were examined: pre-policy changes (Apr 1, 2019 - Dec 31, 2019) and post-policy changes (Apr 1, 2020 - Dec 31, 2020). Data on PA requests among Medicaid managed care organizations and availability of LAI-bup Risk Evaluation and Mitigation Strategy (REMS)-certified pharmacies were also obtained. A multivariable Cox proportional hazard regression model analysis compared pre- versus post-policy period treatment discontinuation. RESULTS The number of patients initiating LAI-bup increased from 211 to 481 over the two periods. By the end of the post-policy period, 24.3 % of eligible patients were retained on LAI-bup, versus 12.5 % in the pre-policy change period. The adjusted hazard ratio, comparing discontinuation during the post- versus pre-policy change periods, was 0.70 (95 % confidence interval: 0.55-0.89). There were also more REMS-certified pharmacies and providers in the post-policy change period. CONCLUSIONS LAI-bup access, utilization, and retention increased after several policy changes.
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Affiliation(s)
- Lindsey R Hammerslag
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States of America; Department of Internal Medicine, College of Medicine, University of Kentucky, United States of America.
| | - Jeffery Talbert
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States of America; Department of Internal Medicine, College of Medicine, University of Kentucky, United States of America
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, United States of America
| | - Feitong Lei
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America
| | - Katherine R Marks
- Department of Behavioral Science, College of Medicine, University of Kentucky, United States of America
| | - Laura C Fanucchi
- Department of Internal Medicine, College of Medicine, University of Kentucky, United States of America; Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, United States of America
| | - Sharon L Walsh
- Department of Behavioral Science, College of Medicine, University of Kentucky, United States of America; Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, United States of America
| | - Michelle R Lofwall
- Department of Behavioral Science, College of Medicine, University of Kentucky, United States of America; Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, United States of America
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Heil J, Salzman M, Hunter K, Baston KE, Milburn C, Schmidt R, Haroz R, Ganetsky VS. Evaluation of an injectable monthly extended-release buprenorphine program in a low-barrier specialty addiction medicine clinic. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209183. [PMID: 37879433 DOI: 10.1016/j.josat.2023.209183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Monthly injectable extended-release buprenorphine (XR-BUP) can address several systemic and individual barriers to consistent sublingual buprenorphine treatment for patients with opioid use disorder (OUD). Real-world evaluations of XR-BUP in the outpatient addiction treatment setting are limited. The purpose of this study was to compare 6-month treatment retention and urine drug tests between patients who initiated XR-BUP compared to those who were prescribed but did not initiate XR-BUP in a low-barrier addiction medicine specialty clinic. METHODS We conducted a retrospective cohort study of adults with OUD prescribed XR-BUP between 12/1/2018 and 12/31/2020 in a low-barrier addiction medicine specialty clinic to compare 6-month treatment retention between patients who initiated XR-BUP and those who were prescribed but did not initiate XR-BUP (comparison group). Secondary outcomes included percent of urine toxicology tests negative for non-prescribed opioids. Multivariable logistic regression models evaluated factors associated with 6-month treatment retention and XR-BUP initiation. RESULTS Of the 233 patients prescribed XR-BUP, 148 (63.8 %) identified as non-Hispanic white, 218 (93.6 %) were insured by public insurance (Medicare/Medicaid), and nearly two-thirds were prescribed XR-BUP due to unstable OUD. Approximately 50 % of patients initiated XR-BUP treatment (mean number of injections = 3.7). About 60 % of XR-BUP-treated patients received supplemental sublingual buprenorphine and nearly two-thirds received a 300 mg maintenance dose. Six-month treatment retention was greater in the XR-BUP treatment versus comparison group (70.3 % vs. 36.5 %, p < 0.001). The XR-BUP treatment group had a higher percentage of opioid-negative urine toxicology tests versus the comparison group (67.2 % vs. 36.3 %, p < 0.001). Receipt of XR-BUP was an independent predictor of 6-month treatment retention (OR 5.40, 95 % CI 2.18-13.38). Those prescribed XR-BUP due to unstable OUD had lower odds of treatment retention (OR 0.41, 95 % CI 0.24-0.98) after controlling for receipt of XR-BUP and other variables known to impact retention. CONCLUSIONS XR-BUP improved 6-month treatment retention and resulted in a greater proportion of opioid-negative urine toxicology tests compared to a comparison group of patients who were prescribed but did not initiate XR-BUP. Patients with unstable OUD had lower odds of XR-BUP initiation, suggesting the need for targeted interventions to increase XR-BUP uptake in this high-risk population.
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Affiliation(s)
- Jessica Heil
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Matthew Salzman
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States; Cooper University Health Care, Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology, Camden, NJ, United States
| | - Krystal Hunter
- Cooper University Health Care, Cooper Research Institute, Camden, NJ, United States
| | - Kaitlan E Baston
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Christopher Milburn
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Ryan Schmidt
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States
| | - Rachel Haroz
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States; Cooper University Health Care, Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology, Camden, NJ, United States
| | - Valerie S Ganetsky
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ, United States.
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Iacono A, Wang T, Tadrous M, Campbell T, Kolla G, Leece P, Sproule B, Kleinman RA, Besharah J, Munro C, Doolittle M, Gomes T. Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada. Drug Alcohol Depend 2024; 254:111032. [PMID: 38043224 DOI: 10.1016/j.drugalcdep.2023.111032] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Uptake and retention for opioid agonist treatment (OAT) remains low. Novel extended-release formulations may improve OAT accessibility by reducing the frequency of healthcare visits. Our aim was to examine uptake, characteristics, treatment patterns and retention of individuals initiating extended-release subcutaneous buprenorphine (BUP-ER), a monthly injectable OAT. METHODS We conducted a population-based cohort study among adults aged 18+ initiated on BUP-ER between February 3, 2020 and March 31, 2022 in Ontario, Canada. Using administrative health data, we defined continuous BUP-ER use based on repeat injections within a 56-day period and used Kaplan-Meier curves to estimate time on treatment. Among new BUP-ER recipients, we described individual and prescriber characteristics, healthcare utilization and treatment patterns. RESULTS 2366 individuals initiated BUP-ER. The median time to BUP-ER discontinuation was 183 days (interquartile range: 66-428 days) and 52.0% of individuals were co-prescribed buprenorphine/naloxone at least once throughout the period of BUP-ER receipt. Among individuals who initiated on a dose of 300mg BUP-ER and had three or more injections, 18.8% continued to receive only 300mg doses (N=276 of 1470). Furthermore, 28.6% of those whose dose was reduced to 100mg (N=341 of 1194) had a subsequent dose increase to 300mg. CONCLUSIONS On average, people initiating BUP-ER discontinue within the first 6 months of treatment. While BUP-ER is likely providing an important OAT option, the high occurrence of discontinuation, supplementation with buprenorphine/naloxone, and frequent dose increases suggest inadequacy of current dosing recommendations among a proportion of individuals.
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Affiliation(s)
- Anita Iacono
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Tianru Wang
- ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Mina Tadrous
- University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada
| | - Tonya Campbell
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, British Columbia V8N 5M8, Canada
| | - Pamela Leece
- Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada; University of Toronto Department of Family and Community Medicine, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Public Health Ontario, 480 University Ave #300, Toronto, Ontario M5G 1V2, Canada; University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada
| | - Beth Sproule
- University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada
| | - Robert A Kleinman
- Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada
| | - Jes Besharah
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto Institute for Health Policy, Management and Evaluation, 155 College St 4th Floor, Toronto Ontario M5T 3M6, Canada; Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada; Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, British Columbia V8N 5M8, Canada; University of Toronto Department of Family and Community Medicine, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Public Health Ontario, 480 University Ave #300, Toronto, Ontario M5G 1V2, Canada; University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada; Ontario Drug Policy Research Network Lived Experience Advisory Group, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Charlotte Munro
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto Institute for Health Policy, Management and Evaluation, 155 College St 4th Floor, Toronto Ontario M5T 3M6, Canada; Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada; Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, British Columbia V8N 5M8, Canada; University of Toronto Department of Family and Community Medicine, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Public Health Ontario, 480 University Ave #300, Toronto, Ontario M5G 1V2, Canada; University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada; Ontario Drug Policy Research Network Lived Experience Advisory Group, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - McCaffrey Doolittle
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto Institute for Health Policy, Management and Evaluation, 155 College St 4th Floor, Toronto Ontario M5T 3M6, Canada; Women's College Hospital, 76 Grenville St Toronto, Ontario M5S 1B2, Canada; Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada; University of Toronto Department of Psychiatry, 250 College Street 8th floor, Toronto Ontario M5T 1R8, Canada; Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, British Columbia V8N 5M8, Canada; University of Toronto Department of Family and Community Medicine, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Public Health Ontario, 480 University Ave #300, Toronto, Ontario M5G 1V2, Canada; University of Toronto Dalla Lana School of Public Health, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada; Ontario Drug Policy Research Network Lived Experience Advisory Group, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; University of Toronto Leslie Dan Faculty of Pharmacy, 144 College StToronto, Ontario M5S 3M2, Canada; ICES, V1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; University of Toronto Institute for Health Policy, Management and Evaluation, 155 College St 4th Floor, Toronto Ontario M5T 3M6, Canada.
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Abstract
This paper is the forty-fifth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2022 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, USA.
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Parkin S, Neale J, Strang J. Non-Prescribed Substance Use during the First Month of Treatment by People Receiving Depot Buprenorphine for Opioid Use Disorder. Subst Use Misuse 2023; 58:1696-1706. [PMID: 37571999 DOI: 10.1080/10826084.2023.2244064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants' reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients' initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.
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Affiliation(s)
- Stephen Parkin
- Institute of Psychiatry, National Addiction Centre, King's College London, London, UK
| | - Joanne Neale
- Institute of Psychiatry, National Addiction Centre, King's College London, London, UK
- Centre for Social Research in Health, University of New South Wales, Kensington, Australia
| | - John Strang
- Institute of Psychiatry, National Addiction Centre, King's College London, London, UK
- South London & Maudsley (SLaM), NHS Foundation Trust, London, UK
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Cuperfain AB, Katznelson G, Costa T, Wong P, Beyraghi N, George TP, Lofwall MR, Chopra N. Factors to guide the use of extended-release buprenorphine formulations for specific patient populations. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2174908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Ari B. Cuperfain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gali Katznelson
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tianna Costa
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Wong
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Narges Beyraghi
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Tony P. George
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle R. Lofwall
- Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Nitin Chopra
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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