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Maremmani I, Dematteis M, Gorzelanczyk EJ, Mugelli A, Walcher S, Torrens M. Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder. J Clin Med 2023; 12:5575. [PMID: 37685642 PMCID: PMC10488107 DOI: 10.3390/jcm12175575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/12/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Long-acting buprenorphine formulations have been recently marketed for the Opioid Agonist Treatment (OAT) of opioid use disorder (OUD) associated with medical, social, and psychological support. Their duration of action ranges from one week up to 6 months. The non-medical use of opioids is increasing with a parallel rise in lethal overdoses. Methadone and buprenorphine are the standard treatment for opioid dependence. Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing the risks of overdose, crime, and transmission of HIV (Human Immunodeficiency Virus) in people who use opioids; however, its effectiveness has been hindered by low rates of uptake and retention in treatment. Furthermore, both methadone and buprenorphine are widely diverted and misused. Thus, a crucial aspect of treating OUD is facilitating patients' access to treatment while minimizing substance-related harm and improving quality of life. The newly developed long-acting buprenorphine formulations represent a significant change in the paradigm of OUD treatment, allowing an approach individualized to patients' needs. Strengths of this individualized approach are improved adherence (lack of peaks and troughs in blood concentrations) and a reduced stigma since the patient doesn't need to attend their clinic daily or nearly daily, thus facilitating social and occupational integrations as the quality of life. However, less frequent attendance at the clinic should not affect the patient-physician relationship. Therefore, teleconsulting or digital therapeutic services should be developed in parallel. In addition, diversion and intravenous misuse of buprenorphine are unlikely due to the characteristics of these formulations. These features make this approach of interest for treating OUD in particular settings, such as subjects staying or when released from prison or those receiving long-term residential treatment for OUD in the therapeutic communities. The long-lasting formulations of buprenorphine can positively impact the OUD treatment and suggest future medical and logistic developments to maximize their personalized management and impact.
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Affiliation(s)
- Icro Maremmani
- VP Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy;
- UniCamillus, International Medical University in Rome, Via di Sant’Alessandro 8, 00131 Rome, Italy
| | - Maurice Dematteis
- Department of Pharmacology and Addiction Medicine, Grenoble-Alpes University Hospital, Grenoble Alpes University, Rue de la Chantourne, 38043 Grenoble, France;
| | - Edward J. Gorzelanczyk
- Department of Theoretical Basis of Biomedical Sciences and Medical Informatics, Nicolaus Copernicus University, Collegium Medicum, 85-067 Bydgoszcz, Poland;
- Faculty of Philosophy, Kazimierz Wielki University, 85-092 Bydgoszcz, Poland
- The Society for the Substitution Treatment of Addiction ”Medically Assisted Recovery”, 85-791 Bydgoszcz, Poland
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NeuroFarBa), University of Florence, Via della Pergola, 50121 Firenze, Italy;
| | - Stephan Walcher
- CONCEPT Center for Addiction Medicine, Kaiserstrasse 1, D-80801 Munich, Germany;
| | - Marta Torrens
- Addiction Research Group, Hospital del Mar Research Institute Barcelona, 08003 Barcelona, Spain
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Soriano V, Moreno-Torres V, Treviño A, Barreiro P, de Jesus F, Corral O, de Mendoza C. Safety considerations in the management of hepatitis C and HIV co-infection. Expert Opin Drug Saf 2023; 22:363-372. [PMID: 37096834 DOI: 10.1080/14740338.2023.2206647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Both HCV and HIV are highly prevalent infections with current estimates of 57 and 38 million people infected worldwide, respectively. Oral antivirals can be curative for HCV and rescue HIV patients from disease progression. Dual therapy in coinfected patients requires expertise. AREAS COVERED Four major issues challenge dual HCV and HIV treatment, including overlapping drug-related side effects, hepatitis B reactivation, immune reconstitution inflammatory syndromes (IRIS), and drug-drug interactions (DDI). A search was conducted in PubMed from January 2010 to March 2023. EXPERT OPINION The advent of second-generation direct-acting antivirals (DDA) that depict higher antiviral potency, fewer side effects, pangenotypic activity and are co-formulated has expanded the indication of HCV therapy and particularly in HIV-coinfected individuals. Sequential initiation of antiretrovirals (ARV) followed by DAA is generally preferred to start dual treatment concomitantly. Close monitoring of rare episodes of HBV reactivation and IRIS is warranted. The most frequent DDI between DAA and ARV affect drug metabolism by CYP450 induction/inhibition, leading to abnormal drug exposures. Throughout this mechanism interact most HCV and HIV protease inhibitors and non-nucleoside polymerase inhibitors. Exposure to some HIV and HCV nucleos(t)ide analogues (e.g. tenofovir and sofosbuvir, respectively) is subject to induction/inhibition of drug transporters and requires special attention in patients with renal insufficiency.
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Affiliation(s)
- Vicente Soriano
- Health Sciences School & Medical Center, Universidad Internacional La Rioja (UNIR), Madrid, Spain
| | - Víctor Moreno-Torres
- Health Sciences School & Medical Center, Universidad Internacional La Rioja (UNIR), Madrid, Spain
- Department of Internal Medicine, Puerta de Hierro University Hospital & Research Institute, Majadahonda, Madrid, Spain
| | - Ana Treviño
- Health Sciences School & Medical Center, Universidad Internacional La Rioja (UNIR), Madrid, Spain
| | - Pablo Barreiro
- Health Sciences School & Medical Center, Universidad Internacional La Rioja (UNIR), Madrid, Spain
- Infctious Diseases Unit, Emergency Hospital Enfermera Isabel Zendal, Madrid, Spain
| | - Fernando de Jesus
- Health Sciences School & Medical Center, Universidad Internacional La Rioja (UNIR), Madrid, Spain
| | - Octavio Corral
- Health Sciences School & Medical Center, Universidad Internacional La Rioja (UNIR), Madrid, Spain
| | - Carmen de Mendoza
- Department of Internal Medicine, Puerta de Hierro University Hospital & Research Institute, Majadahonda, Madrid, Spain
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Busschots D, Kremer C, Bielen R, Koc ÖM, Heyens L, Nevens F, Hens N, Robaeys G. Hepatitis C prevalence in incarcerated settings between 2013–2021: a systematic review and meta-analysis. BMC Public Health 2022; 22:2159. [PMID: 36419013 PMCID: PMC9685883 DOI: 10.1186/s12889-022-14623-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background The introduction of highly effective direct-acting antiviral therapy has changed the hepatitis C virus (HCV) treatment paradigm. However, a recent update on HCV epidemiology in incarcerated settings is necessary to accurately determine the extent of the problem, provide information to policymakers and public healthcare, and meet the World Health Organization's goals by 2030. This systematic review and meta-analysis were performed to determine the prevalence of HCV Ab and RNA in incarcerated settings. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of Science for papers published between January 2013 and August 2021. We included studies with information on the prevalence of HCV Ab or RNA in incarcerated settings. A random-effects meta-analysis was done to calculate the pooled prevalence and meta-regression to explore heterogeneity. Results Ninety-two unique sources reporting data for 36 countries were included. The estimated prevalence of HCV Ab ranged from 0.3% to 74.4%. HCV RNA prevalence (available in 46 sources) ranged from 0% to 56.3%. Genotypes (available in 19 sources) 1(a) and 3 were most frequently reported in incarcerated settings. HCV/HIV coinfection (available in 36 sources) was highest in Italy, Estonia, Pakistan, and Spain. Statistical analysis revealed that almost all observed heterogeneity reflects real differences in prevalence between studies, considering I2 was very high in the meta-analysis. Conclusions HCV in incarcerated settings is still a significant problem with a higher prevalence than in the general population. It is of utmost importance to start screening for HCV (Ab and RNA) in incarcerated settings to give clear, reliable and recent figures to plan further treatment. This is all in the context of meeting the 2030 WHO targets which are only less than a decade away. Trial registration PROSPERO: CRD42020162616 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14623-6.
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Increased Treatment Engagement and Adherence: Flexible Management with Prolonged-Release Buprenorphine in Treatment of Opioid Dependence. Case Rep Psychiatry 2021; 2021:6657350. [PMID: 33728083 PMCID: PMC7936910 DOI: 10.1155/2021/6657350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
Opioid dependence (OD) is effectively treated with well-evidenced regimens including psychosocial and opioid agonist pharmacotherapy. Many do not engage with treatment services; reasons include the burden of mandatory supervision and stigma. Injectable prolonged-release buprenorphine (PRB) offers choice and flexibility in treatment. Experience reported here demonstrates the potential for PRB to enable wider engagement with treatment services. Treatment was successful in patients unable to attend daily observed therapy due to work commitments, unable to use services for fear of stigma, or having not achieved goals on previous attempts with conventional approaches. PRB therapy was clinically successful without withdrawal signs or evidence of use of other drugs. Patient-reported outcomes were positive including maintained ability to work, manageable detoxification experience, and stigma-free treatment. This work provides evidence of PRB benefit in expanding treatment engagement.
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Hsiang JC, Sinnaswami P, Lee MY, Zhang MM, Quek KE, Tan KH, Wong YM, Thurairajah PH. Point-of-care hepatitis C screening with direct access referral to improve linkage of care among people with substance misuse: a pilot randomised study. Singapore Med J 2020; 63:86-92. [PMID: 32729280 DOI: 10.11622/smedj.2020116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Linkage to care among people with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine if point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group. METHODS All participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment. RESULTS 351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis. CONCLUSION PoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.
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Affiliation(s)
- John Chen Hsiang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.,Department of Gastroenterology, Sengkang General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pream Sinnaswami
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mui Yok Lee
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Meng Meng Zhang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Kwang Ee Quek
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Keng Hwee Tan
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Yew Meng Wong
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Prem Harichander Thurairajah
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Hospital, Singapore
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Lazarus JV, Pericàs JM, Picchio C, Cernosa J, Hoekstra M, Luhmann N, Maticic M, Read P, Robinson EM, Dillon JF. We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade. J Intern Med 2019; 286:503-525. [PMID: 31472002 DOI: 10.1111/joim.12972] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Globally, some 71 million people are chronically infected with hepatitis C virus (HCV). Marginalized populations, particularly people who inject drugs (PWID), have low testing, linkage to care and treatment rates for HCV. Several models of care (MoCs) and service delivery interventions have the potential to improve outcomes across the HCV cascade of care, but much of the relevant research was carried out when interferon-based treatment was the standard of care. Often it was not practical to scale-up these earlier models and interventions because the clinical care needs of patients taking interferon-based regimens imposed too much of a financial and human resource burden on health systems. Despite the adoption of highly effective, all-oral direct-acting antiviral (DAA) therapies in recent years, approaches to HCV testing and treatment have evolved slowly and often remain rooted in earlier paradigms. The effectiveness of DAAs allows for simpler approaches and has encouraged countries where the drugs are widely available to set their sights on the ambitious World Health Organization (WHO) HCV elimination targets. Since a large proportion of chronically HCV-infected people are not currently accessing treatment, there is an urgent need to identify and implement existing simplified MoCs that speak to specific populations' needs. This article aims to: (i) review the evidence on MoCs for HCV; and (ii) distil the findings into recommendations for how stakeholders can simplify the path taken by chronically HCV-infected individuals from testing to cure and subsequent care and monitoring.
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Affiliation(s)
- J V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - J M Pericàs
- Infectious Diseases and Clinical Microbiology Territorial Direction, Translational Research Group on Infectious Diseases of Lleida (TRIDLE), Biomedical Research Institute Dr Pifarré Foundation, Lleida, Spain
| | - C Picchio
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - J Cernosa
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Hoekstra
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - N Luhmann
- Médecins du Monde France, Paris, France
| | - M Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - P Read
- Kirketon Road Centre, Sydney, NSW, Australia
| | - E M Robinson
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
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Stöver H, Meroueh F, Marco A, Keppler K, Saiz de la Hoya P, Littlewood R, Wright N, Nava F, Alam F, Walcher S, Somaini L. Offering HCV treatment to prisoners is an important opportunity: key principles based on policy and practice assessment in Europe. BMC Public Health 2019; 19:30. [PMID: 30621658 PMCID: PMC6323720 DOI: 10.1186/s12889-018-6357-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/21/2018] [Indexed: 02/07/2023] Open
Abstract
Background Prisoners have a high prevalence of hepatitis C virus (HCV) infection but may find it difficult to access healthcare services. This may be related to risk behaviour including history of injecting drugs and marginalisation related to problem drug use/ opioid use disorder (OUD). Direct-acting antiviral products with superior efficacy and safety compared to interferon-based regimens offer HCV cure. Many citizens in Europe have been treated, although few received therapy in prisons. Methods Analysis of prisoner HCV treatment need and policy determinants of clinical practice was completed for 5 EU countries. Evidence was collected from national statistical sources and peer-reviewed publications to describe prison populations and HCV prevalence, to map national prison/ HCV health policy or guidance. A consensus of important principles for prisoner HCV care was developed. Results Data from published sources describing prisoner HCV prevalence is limited. Prisoner population requiring HCV treatment is not known; estimated numbers based on analysis of evidence: England and Wales, 9000, France, 8000, Spain, 6000, Italy, 6000, Germany, 6000. Treatment access: national law defines right to equivalent care in all countries implying access to HCV therapy in prison similar to community; useful prisoner HCV guidance facilitating treatment decisions present in: 4 of 5 national/ regional HCV policy documents, 4 of 5 national prison healthcare policies. Four of five had practical prison HCV clinical guidelines. Despite existence of policy, implementation of guidance, and so HCV treatment, is suboptimal in many locations. Conclusions Prison is an important location to detect, address and treat HCV infection in people who may be underserved for healthcare and find it difficult to navigate community treatment pathways. This is often related to problems with OUD and resulting social inequity. HCV management in prisons must be improved. Policy and clinical practice guidance must be set to promote treatment, and practical steps to make treatment easy should be followed including education to promote engagement, set-up of optimal screening and work up processes with modern tools to reduce time needed/ achieve efficiency; programs to make it easier to get specialists’ input include remote working and nurse-led services.
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Affiliation(s)
- H Stöver
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany.
| | - F Meroueh
- Health Unit, Villeneuve les Maguelone, France
| | - A Marco
- Penitentiary Program, Catalan Health Institute, Barcelona, Spain
| | | | | | | | - N Wright
- Spectrum Community Health CIC, Wakefield, UK
| | - F Nava
- University of Modena and Reggio Emilia, University Hospital Policlinico of Modena, Modena, Italy
| | - F Alam
- Divisional Medical Director, Central and North West London NHS Foundation Trust, London, UK
| | - S Walcher
- CONCEPT, Addiction Medicine, Munich, Germany
| | - L Somaini
- Addiction Treatment Centre, Biella, Italy
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Roncero C, Ryan P, Littlewood R, Macías J, Ruiz J, Seijo P, Palma-Álvarez RF, Vega P. Practical steps to improve chronic hepatitis C treatment in people with opioid use disorder. Hepat Med 2018; 11:1-11. [PMID: 30613166 PMCID: PMC6307489 DOI: 10.2147/hmer.s187133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES People with a history of injecting drugs have high prevalence of hepatitis C virus (HCV) infection, and many have opioid use disorder (OUD). Modern HCV therapies with improved efficacy and tolerability are available, but access is often limited for this group, who may be underserved for health care and face social inequity. This work develops practical steps to improve HCV care in this population. METHODS Practical steps to improve HCV care in OUD populations were developed based on clinical experience from Spain, structured assessment of published evidence. RESULTS Options for improving care at engagement/screening stages include patient education programs, strong provider-patient relationship, peer support, and adoption of rapid effective screening tools. To facilitate work up/treatment, start options include simplified work up process, integration of HCV and OUD care, and continuous psychosocial support prior, during, and after HCV treatment. CONCLUSION It is important to plan on local basis to set up a joint integrated approach between specific drug treatment services and local points of HCV care. The elements for a specific integrated program should be chosen from options identified, including education services, peer input, organization to make HCV screening and treatment easier by co-location of services, and wider access to prescribing direct-acting antiviral (DAA) therapy.
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Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain,
| | - Pablo Ryan
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | - Juan Macías
- Department of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain
| | - Juan Ruiz
- Provincial Center of Drug Addiction, Malaga, Spain
| | - Pedro Seijo
- Addiction Treatment Center of Villamartín, Cádiz, Spain
| | - Raúl Felipe Palma-Álvarez
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain
- Psychiatry Service, Biomedical Research Networking Center for Mental Health Network, Vall Hebron University Hospital, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Pablo Vega
- Spanish Society of Dual Diagnosis, Bilbao, Spain
- Institute of Addictions, Madrid, Spain
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Chen Z, Wang Y, Wang R, Xie J, Ren Y. Efficacy of Acupuncture for Treating Opioid Use Disorder in Adults: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:3724708. [PMID: 30622598 PMCID: PMC6304557 DOI: 10.1155/2018/3724708] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/26/2018] [Accepted: 11/11/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the efficacy of acupuncture in treating opioid use disorder (OUD). DESIGN Systematic review and meta-analysis. METHODS PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, ProQuest Dissertation and Theses, Allied and Complementary Medicine Database (AMED), Clinicaltrials.gov, and who.int/trialsearch were searched from inception to 23 December 2017. The methodological quality of selected studies and the quality of evidence for outcomes were assessed, respectively, by the Cochrane risk of bias assessment tool and the GRADE approach. Statistical analyses were conducted by RevMan 5.3. RESULTS A total of nine studies involving 1063 participants fulfilled the inclusion criteria. The results showed that acupuncture could be more beneficial than no treatment/sham acupuncture in terms of changes in craving for opioid (MD -2.18, 95% CI -3.10 to -1.26), insomnia (MD 2.31, 95% CI 1.97 to 2.65), and depression (SMD -1.50, 95% CI -1.85 to -1.15). In addition, these findings showed that, compared to sham electroacupuncture (EA), EA had differences in alleviating symptoms of craving (SMD -0.50, 95% CI -0.94 to -0.05) and depression (SMD -1.07, 95% CI -1.88 to -0.25) and compared to sham transcutaneous acupoint electrical stimulation (TEAS), TEAS had differences in alleviating symptoms of insomnia (MD 2.31, 95% CI 1.97 to 2.65) and anxiety (MD -1.26, 95% CI -1.60 to -0.92) compared to no treatment/sham TEAS. CONCLUSIONS Acupuncture could be effective in treating OUD. Moreover, EA could effectively alleviate symptoms of craving for opioid and depression, and TEAS could be beneficial in improving symptoms of insomnia and anxiety. Nevertheless, the conclusions were limited due to the low-quality and small number of included studies. PROSPERO registration number is CRD42018085063.
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Affiliation(s)
- Zhihan Chen
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yitong Wang
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rui Wang
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jin Xie
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yulan Ren
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Gilman M, Li L, Hudson K, Lumley T, Myers G, Corte C, Littlewood R. Current and future options for opioid use disorder: a survey assessing real-world opinion of service users on novel therapies including depot formulations of buprenorphine. Patient Prefer Adherence 2018; 12:2123-2129. [PMID: 30349206 PMCID: PMC6188959 DOI: 10.2147/ppa.s180641] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Integrated treatment for opioid use disorder (OUD) includes opioid agonist therapy (OAT) such as methadone and buprenorphine with well-evidenced benefits. Treatment with typical existing oral medications is associated with burdens and limits to successful outcomes (frequent dosing, attendance for collection/consumption, difficulty in achieving optimal dosing, misuse, diversion, accidental exposure, and stigma from the treatment process). Novel medications include injected depot formulations with less frequent administration, providing consistent drug levels after dosing. This survey assesses the opinion of those with OUD treatment services lived experience to inform future medication choices. PATIENTS AND METHODS A survey of people with experience of OUD pharmacotherapy - the treatment system - was completed. Participants reviewed statements describing elements of OUD care using 7-point Likert scales to indicate their level of agreement or disagreement. Data were assessed using descriptive analysis. RESULTS In total, 35 people (16 in treatment; 19 with previous history of treatment) completed the survey. Average drug-use duration, 20 years, commonly included injected opioids. The majority agreed treatment was effective, but not tailored to their individual needs and limited normal day-to-day activities. Opinions on novel depot medications included the following: agreement on its potential to make life easier, reduce stigma, free-up time for preferred activities. Participants did not report concerns over the effectiveness and safety of depot medications, nor about reduced contact with treatment services that could be associated with less frequent dosing. CONCLUSION This survey provides a useful initial record of the opinions of people experienced in OUD treatment services on novel depot medications, which may result in important benefits. Care providers and policy makers should continue to work with those with lived experience to understand the specific opportunity provided by such innovation.
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Affiliation(s)
| | - Li Li
- Applied Strategic, London, UK
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