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FitzGerald G, MacCartney P, Cook J, Crawford S, Naren T. Time for Australia to increase take away doses in opioid agonist treatment. Int J Drug Policy 2024; 127:104420. [PMID: 38614016 DOI: 10.1016/j.drugpo.2024.104420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
Opioid Agonist Treatment is the cornerstone of minimising harms related to opioid use, however its uptake is limited by a tightly regulated and stigmatising treatment environment. The COVID-19 pandemic necessitated relaxation of some treatment restrictions, with global evidence pointing to more patient-centred care in this time. In light of local evidence to support the safety of increased access to takeaway doses and a precedent set by the Substance Abuse and Mental Health Administration, we recommend adoption of the Australian Interim Medication Assisted Treatment of Opioid Dependence guidance in Australia.
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Affiliation(s)
- Grace FitzGerald
- Drug Health Services, Western Health, 3-7 Eleanor St, Footscray, VIC 3031, Australia.
| | - Paul MacCartney
- Cohealth Innerspace, 4-6 Johnston St, Collingwood, VIC 3066, Australia
| | - Jon Cook
- Drug Health Services, Western Health, 3-7 Eleanor St, Footscray, VIC 3031, Australia
| | - Sione Crawford
- Harm Reduction Victoria, 299-305 Victoria St, Brunswick, VIC 3056, Australia
| | - Thileepan Naren
- Drug Health Services, Western Health, 3-7 Eleanor St, Footscray, VIC 3031, Australia; Monash University, Wellington Road, Clayton, VIC 3800, Australia
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Russell C, Ashley J, Ali F, Bozinoff N, Corace K, Marsh DC, Mushquash C, Wyman J, Zhang M, Lange S. Examining inequities in access to opioid agonist treatment (OAT) take-home doses (THD): A Canadian OAT guideline synthesis and systematic review. Int J Drug Policy 2024; 127:104343. [PMID: 38554565 DOI: 10.1016/j.drugpo.2024.104343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/08/2024] [Accepted: 01/30/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Daily supervised Opioid Agonist Treatment (OAT) medication has been identified as a barrier to treatment retention. Canadian OAT guidelines outline take-home dose (THD) criteria, yet, OAT prescribers use their clinical judgement to decide whether an individual is 'clinically stable' to receive THD. There is limited information regarding whether these decisions may result in inequitable access to THD, including in the context of updated COVID-19 guidance. The current Canadian OAT THD guideline synthesis and systematic review aimed to address this knowledge gap. METHODS This systematic review included a two-pronged approach. First, we searched available academic literature in Embase, Medline, and PsychINFO up until October 12th, 2022, to identify studies that compared characteristics of individuals on OAT who had and had not been granted access to THD to explore potential inequities in access. Next, we identified all Canadian national and provincial OAT guidelines through a semi-structured grey literature search (conducted between September-October 2022) and extracted all THD 'stability' and allowances/timeline criteria to compare against characteristics identified in the literature search. Data from both review arms were synthesized and narratively presented. RESULTS A total of n = 56 guidelines and n = 7 academic studies were included. The systematic review identified a number of patient characteristics such as age, sex, race/ethnicity, marital status, housing, employment, neighborhood income, drug use, mental health, health service utilization, as well as treatment duration that were associated with differential access to THD. The Canadian OAT THD guideline synthesis identified many of these same characteristics as 'stability' criteria, underscoring the potential for Canadian OAT guidelines to result in inequitable access to THD. CONCLUSIONS This two-pronged literature review demonstrated that current guidelines likely contribute to inequitable OAT THD access due primarily to inconsistent 'stability' criteria across guidelines. More research is needed to understand differential OAT THD access with a focus on prescriber decision-making and evaluating associated treatment and safety outcomes. The development of a client-centered, equity-focused, and evidence-informed decision making framework that incorporates more clear definitions of 'stability' criteria and indications for prescriber discretion is warranted.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1; Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada, M5S 1A8.
| | - Jenna Ashley
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1; Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1
| | - Nikki Bozinoff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario, Canada, M5T 1R8; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Canada, M5G1V7
| | - Kim Corace
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, Canada, K1H 8M5; Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Center, 1145 Carling Avenue, Ottawa, Ontario, Canada, K1Z 7K4; University of Ottawa Institute of Mental Health Research, The Royal Ottawa Mental Health Center, 1145 Carling Avenue, Ottawa, Ontario, Canada, K1Z 7K4
| | - David C Marsh
- NOSM University, 935 Ramsey Lake Road, Sudbury, Ontario, Canada, P3E 2C6; ICES North, 56 Walford Road, Sudbury, Ontario, Canada, P3E 2H3; Health Science North Research Institute, 56 Walford Road, Sudbury, Ontario, Canada, P3E 2H3
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada
| | - Jennifer Wyman
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Canada, M5G1V7; Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - Maria Zhang
- Pharmacy Services, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada, M6J 1H4; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Canada, M5S 3M2
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada, M5S 1A8; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario, Canada, M5T 1R8; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada, M5T 1R8
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Liu PS, Kuo TY, Chen IC, Lee SW, Chang TG, Chen HL, Chen JP. Optimizing methadone dose adjustment in patients with opioid use disorder. Front Psychiatry 2024; 14:1258029. [PMID: 38260800 PMCID: PMC10800821 DOI: 10.3389/fpsyt.2023.1258029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Opioid use disorder is a cause for concern globally. This study aimed to optimize methadone dose adjustments using mixed modeling and machine learning. Methods This retrospective study was conducted at Taichung Veterans General Hospital between January 1, 2019, and December 31, 2020. Overall, 40,530 daily dosing records and 1,508 urine opiate test results were collected from 96 patients with opioid use disorder. A two-stage approach was used to create a model of the optimized methadone dose. In Stage 1, mixed modeling was performed to analyze the association between methadone dose, age, sex, treatment duration, HIV positivity, referral source, urine opiate level, last methadone dose taken, treatment adherence, and likelihood of treatment discontinuation. In Stage 2, machine learning was performed to build a model for optimized methadone dose. Results Likelihood of discontinuation was associated with reduced methadone doses (β = 0.002, 95% CI = 0.000-0.081). Correlation analysis between the methadone dose determined by physicians and the optimized methadone dose showed a mean correlation coefficient of 0.995 ± 0.003, indicating that the difference between the methadone dose determined by physicians and that determined by the model was within the allowable range (p < 0.001). Conclusion We developed a model for methadone dose adjustment in patients with opioid use disorders. By integrating urine opiate levels, treatment adherence, and likelihood of treatment discontinuation, the model could suggest automatic adjustment of the methadone dose, particularly when face-to-face encounters are impractical.
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Affiliation(s)
- Po-Shen Liu
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Teng-Yao Kuo
- Fundamental General Education Center, National Chinyi University of Technology, Taiping, Taiwan
| | - I-Chun Chen
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shu-Wua Lee
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ting-Gang Chang
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hou-Liang Chen
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Jun-Peng Chen
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
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