1
|
Dennis BB, Sanger N, Bawor M, Naji L, Plater C, Worster A, Woo J, Bhalerao A, Baptist-Mohseni N, Hillmer A, Rice D, Corace K, Hutton B, Tugwell P, Thabane L, Samaan Z. A call for consensus in defining efficacy in clinical trials for opioid addiction: combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder. Trials 2020; 21:30. [PMID: 31907000 PMCID: PMC6945391 DOI: 10.1186/s13063-019-3995-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g., EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient-reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g., abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n = 28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, although they also stressed goals under-reported in clinical trials. Conclusions There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. Trial registration PROSPERO, CRD42013006507.
Collapse
Affiliation(s)
- Brittany B Dennis
- McMaster University Internal Medicine Residency Program, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Nitika Sanger
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Monica Bawor
- McMaster University Internal Medicine Residency Program, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Leen Naji
- Department of Family Medicine Residency Program, Michael G. Degroote School of Medicine, McMaster University, Hamilton, Canada
| | - Carolyn Plater
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, Hamilton General Hospital, Hamilton, Canada
| | - Julia Woo
- University of Toronto Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anuja Bhalerao
- University of Toronto Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Natasha Baptist-Mohseni
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Alannah Hillmer
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Danielle Rice
- Faculty of Science, Department of Psychology, McGill University, Montreal, Canada.,Center for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kim Corace
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Evaluation of Medicine, Hamilton, Canada.,System Linked Research Unit, Hamilton, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, Canada.
| |
Collapse
|
2
|
Zielinski L, Bhatt M, Sanger N, Plater C, Worster A, Varenbut M, Daiter J, Pare G, Marsh DC, Desai D, MacKillop J, Steiner M, McDermid Vaz S, Thabane L, Samaan Z. Association between cannabis use and methadone maintenance treatment outcomes: an investigation into sex differences. Biol Sex Differ 2017; 8:8. [PMID: 28367308 PMCID: PMC5372283 DOI: 10.1186/s13293-017-0130-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 03/07/2017] [Indexed: 12/29/2022] Open
Abstract
Background Cannabis will soon become legalized in Canada, and it is currently unclear how this will impact public health. Methadone maintenance treatment (MMT) is the most common pharmacological treatment for opioid use disorder (OUD), and despite its documented effectiveness, a large number of patients respond poorly and experience relapse to illicit opioids. Some studies implicate cannabis use as a risk factor for poor MMT response. Although it is well established that substance-use behaviors differ by sex, few of these studies have considered sex as a potential moderator. The current study aims to investigate sex differences in the association between cannabis use and illicit opioid use in a cohort of MMT patients. Methods This multicentre study recruited participants on MMT for OUD from Canadian Addiction Treatment Centre sites in Ontario, Canada. Sex differences in the association between any cannabis use and illicit opioid use were investigated using multivariable logistic regression. A secondary analysis was conducted to investigate the association with heaviness of cannabis use. Results The study included 414 men and 363 women with OUD receiving MMT. Cannabis use was significantly associated with illicit opioid use in women only (OR = 1.82, 95% CI 1.18, 2.82, p = 0.007). Heaviness of cannabis use was not associated with illicit opioid use in men or women. Conclusions This is the largest study to date examining the association between cannabis use and illicit opioid use. Cannabis use may be a sex-specific predictor of poor response to MMT, such that women are more likely to use illicit opioids if they also use cannabis during treatment. Women may show improved treatment outcomes if cannabis use is addressed during MMT.
Collapse
Affiliation(s)
- Laura Zielinski
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON Canada
| | - Meha Bhatt
- Health Research Methodology Graduate Program, McMaster University, Hamilton, ON Canada
| | - Nitika Sanger
- Medical Science Graduate Program, McMaster University, Hamilton, ON Canada
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, Hamilton, ON Canada
| | - Andrew Worster
- Canadian Addiction Treatment Centres, Hamilton, ON Canada.,Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Jeff Daiter
- Canadian Addiction Treatment Centres, Hamilton, ON Canada
| | - Guillaume Pare
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - David C Marsh
- Canadian Addiction Treatment Centres, Hamilton, ON Canada.,Northern Ontario School of Medicine, Sudbury, ON Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada.,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON Canada
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON Canada.,Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON Canada
| | - Stephanie McDermid Vaz
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada.,Cleghorn Early Intervention Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada.,Biostatistics Unit, Research Institute at St Joes, St. Joseph's Healthcare Hamilton, Hamilton, ON Canada
| | - Zainab Samaan
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada.,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON Canada
| |
Collapse
|
3
|
Naji L, Dennis BB, Bawor M, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, MacKillop J, Thabane L, Samaan Z. The association between age of onset of opioid use and comorbidity among opioid dependent patients receiving methadone maintenance therapy. Addict Sci Clin Pract 2017; 12:9. [PMID: 28347350 PMCID: PMC5369183 DOI: 10.1186/s13722-017-0074-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Opioid use disorder (OUD) affects approximately 21.9 million people worldwide. This study aims to determine the association between age of onset of opioid use and comorbid disorders, both physical and psychiatric, in patients receiving methadone maintenance treatment (MMT) for OUD. Understanding this association may inform clinical practice about important prognostic factors of patients on MMT, enabling clinicians to identify high-risk patients. Methods This study includes data collected between June 2011 and August 2016 for the Genetics of Opioid Addiction research collaborative between McMaster University and the Canadian Addiction Treatment Centers. All patients were interviewed by trained health professionals using the Mini-International Neuropsychiatric Interview and case report forms. Physical comorbidities were verified using patients’ electronic medical records. A multi-variable logistic regression model was constructed to determine the strength of the association between age of onset of opioid use and the presence of physical or psychiatric comorbidity while adjusting for current age, sex, body mass index, methadone dose and smoking status. Results Data from 627 MMT patients with a mean age of 38.8 years (SD = 11.07) were analyzed. Individuals with an age of onset of opioid use younger than 18 years were found to be at higher odds for having a physical or psychiatric comorbid disorder compared to individuals with an age of onset of opioid use of 31 years or older (odds ratio 2.94, 95% confidence interval 1.20, 7.19, p = 0.02). A significant association was not found between the risk of having a comorbidity and an age of onset of opioid use between 18 and 25 years or 26 and 30 years, compared to an age of onset of opioid use of 31 years or older. Conclusion Our study demonstrates that the younger one begins to use opioids, the greater their chance of having a physical or psychiatric co-morbidity. Understanding the risk posed by an earlier onset of opioid use for the later development of comorbid disorders informs clinical practice about important prognostic predictors and aids in the identification of high-risk patients.
Collapse
Affiliation(s)
- Leen Naji
- Michael Degroote School of Medicine, McMaster University, Hamilton, Canada
| | - Brittany Burns Dennis
- St. George's University of London, London, UK.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | | | | | - Jeff Daiter
- Canadian Addiction Treatment Centres, Richmond Hill, Canada
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, Richmond Hill, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - David C Marsh
- Canadian Addiction Treatment Centres, Richmond Hill, Canada.,Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Andrew Worster
- Canadian Addiction Treatment Centres, Richmond Hill, Canada.,Department of Medicine, Hamilton General Hospital, Hamilton, Canada
| | - Dipika Desai
- Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, Hamilton, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Lehana Thabane
- Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada.,Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada. .,Peter Boris Centre for Addictions Research, Hamilton, Canada. .,Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
| |
Collapse
|
4
|
Rosic T, Naji L, Bawor M, Dennis BB, Plater C, Marsh DC, Thabane L, Samaan Z. The impact of comorbid psychiatric disorders on methadone maintenance treatment in opioid use disorder: a prospective cohort study. Neuropsychiatr Dis Treat 2017; 13:1399-1408. [PMID: 28579787 PMCID: PMC5449137 DOI: 10.2147/ndt.s129480] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE There is a significant interindividual variability in treatment outcomes in methadone maintenance treatment (MMT) for opioid use disorder (OUD). This prospective cohort study examines the impact of comorbid psychiatric disorders on continued illicit opioid use in patients receiving MMT for OUD. METHODS Data were collected from 935 patients receiving MMT in outpatient clinics between June 2011 and June 2015. Using linear regression analysis, we evaluated the impact of having a comorbid psychiatric disorder on continued illicit opioid use during MMT, adjusting for important confounders. The main outcome measure was percentage of opioid-positive urine screens for 6 months. We conducted a subgroup analysis to determine the influence of specific comorbid psychiatric disorders, including substance use disorders, on continued illicit opioid use. RESULTS Approximately 80% of participants had at least one comorbid psychiatric disorder in addition to OUD, and 42% of participants had a comorbid substance use disorder. There was no significant association between having a psychiatric comorbidity and continuing opioid use (P=0.248). Results from subgroup analysis, however, suggest that comorbid tranquilizer (β=20.781, P<0.001) and cocaine (β=6.344, P=0.031) use disorders are associated with increased rates of continuing opioid use. CONCLUSION Results from our study may serve to guide future MMT guidelines. Specifically, we find that cocaine or tranquilizer use disorder, comorbid with OUD, places patients at high risk for poor MMT outcomes. Treatment centers may choose to gear more intensive therapy toward such populations.
Collapse
Affiliation(s)
| | - Leen Naji
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Lehana Thabane
- Biostatistics Unit, Research Institute, St Joseph's Healthcare.,Department of Clinical Epidemiology and Biostatistics, McMaster University.,Peter Boris Centre for Addictions Research
| | - Zainab Samaan
- Biostatistics Unit, Research Institute, St Joseph's Healthcare.,Department of Clinical Epidemiology and Biostatistics, McMaster University.,Peter Boris Centre for Addictions Research.,Mood Disorders Research Unit, St Joseph's Healthcare.,Population Genomics Program, Chanchlani Research Centre.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
5
|
Dennis BB, Bawor M, Paul J, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Thabane L, Samaan Z. Pain and Opioid Addiction: A Systematic Review and Evaluation of Pain Measurement in Patients with Opioid Dependence on Methadone Maintenance Treatment. ACTA ACUST UNITED AC 2016; 9:49-60. [PMID: 27021147 DOI: 10.2174/187447370901160321102837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND While chronic pain has been said to impact patient's response to methadone maintenance treatment for opioid dependence, the reported findings are inconsistent. These discrepancies may be a direct result of variations in the measurement of chronic pain or definitions of response to methadone treatment. The goal of this study is to evaluate the association between pain and substance use behaviour to determine the real impact of comorbid pain in the methadone population. We also aim to examine sources of variation across the literature with a specific focus on the measurement of pain. METHODS/DESIGN We performed a systematic review using an electronic search strategy across CINAHL, MEDLINE, Web of Science, PsychINFO, EMBASE, and the Cochrane Library including Cochrane Reviews and the Cochrane Central Register of Controlled Trials databases. Title, abstract, as well as full text screening and extraction were performed in duplicate. Studies evaluating the association between chronic pain and methadone maintenance treatment response were eligible for inclusion in this review. Using a sample of 297 methadone patients from the Genetics of Opioid Addiction (GENOA) research collaborative, we assessed the reliability of patient self-reported pain and the validated Brief Pain Inventory (BPI) assessment tool. RESULTS After screening 826 articles we identified five studies eligible for full text extraction, of which three showed a significant relationship between the presence of pain and the increase in substance abuse among patients on methadone for the treatment of opioid dependence. Studies varied largely in the definitions and measurement of both pain and response to treatment. Results from our validation of pain measurement in the GENOA sample (n=297) showed the use of a simple self-reported pain question is highly correlated to the use of the BPI. Simply asking patients whether they have pain showed a 44.2% sensitivity, 88.8% specificity, 84.4% PPV and 53.6% NPV to the BPI. The area under the ROC curve was 0.67 and the Pearson χ(2) was 37.3; (p<0.0001). DISCUSSION The field of addiction medicine is at a lack of consensus as to the real effect of chronic pain on treatment response among opioid dependent patients. Whether it be the lack of a single "gold standard" measurement of response, or a lack of consistent measurement of pain, it is difficult to summarize and compare the results of these relatively small investigations. In comparison to the BPI, use of the simple self-reported pain has lower sensitivity for identifying patients with pain, suggesting the inconsistencies in these studies may result from differences in pain measurement. Future validation studies of pain measurement are required to address the predictive value of self-reported pain.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Z Samaan
- Department of Psychiatry and Behavioural Neuroscience McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, Ontario, Canada.
| |
Collapse
|
6
|
Naji L, Dennis BB, Bawor M, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Thabane L, Samaan Z. A Prospective Study to Investigate Predictors of Relapse among Patients with Opioid Use Disorder Treated with Methadone. Subst Abuse 2016; 10:9-18. [PMID: 27103815 PMCID: PMC4827793 DOI: 10.4137/sart.s37030] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Concomitant opioid abuse is a serious problem among patients receiving methadone maintenance treatment (MMT) for opioid use disorder. This is an exploratory study that aims to identify predictors of the length of time a patient receiving MMT for opioid use disorder remains abstinent (relapse-free). METHODS Data were collected from 250 MMT patients enrolled in addiction treatment clinics across Southern Ontario. The impact of certain clinical and socio-demographic factors on the outcome (time until opioid relapse) was determined using a Cox proportional hazard model. RESULTS History of injecting drug use behavior (hazard ratio (HR): 2.26, P = 0.042), illicit benzodiazepine consumption (HR: 1.07, P = 0.002), and the age of onset of opioid abuse (HR: 1.10, P < 0.0001) are important indicators of accelerated relapse among MMT patients. Conversely, current age is positively associated with duration of abstinence from illicit opioid use, serving as a protective factor against relapse (HR: 0.93, P = 0.003). CONCLUSION This study helps to identify patients at increased risk of relapse during MMT, allowing health care providers to target more aggressive adjunct therapies toward high-risk patients.
Collapse
Affiliation(s)
- Leen Naji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brittany B Dennis
- St. George's University of London, London, United Kingdom.; Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada
| | - Monica Bawor
- St. George's University of London, London, United Kingdom
| | - Carolyn Plater
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada
| | - Andrew Worster
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada.; Department of Medicine, Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Jeff Daiter
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada
| | - David C Marsh
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada.; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada.; Centre for Evaluation of Medicine, Hamilton, ON, Canada.; System Linked Research Unit, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada.; Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, ON, Canada.; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| |
Collapse
|
7
|
Dennis BB, Roshanov PS, Bawor M, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z. Usefulness of the Brief Pain Inventory in Patients with Opioid Addiction Receiving Methadone Maintenance Treatment. Pain Physician 2016; 19:E181-E195. [PMID: 26752486] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Chronic pain is implicated as a risk factor for illicit opioid use among patients with opioid addiction treated with methadone. However, there exists conflicting evidence that supports and refutes this claim. These discrepancies may stem from the large variability in pain measurement reported across studies. OBJECTIVES We aim to determine the clinical and demographic characteristics of patients reporting pain and evaluate the prognostic value of different pain classification measures in a sample of opioid addiction patients. STUDY DESIGN Multi-center prospective cohort study. SETTING Methadone maintenance treatment facilities for managing patients with opioid addiction. METHODS This study includes participants from the Genetics of Opioid Addiction (GENOA) prospective cohort study. We assessed the prognostic value of different pain measures for predicting opioid relapse. Pain measures include the Brief Pain Inventory (BPI) and patients' response to a direct pain question all study participants were asked from the GENOA case report form (CRF) "are you currently experiencing or have been diagnosed with chronic pain?" Performance characteristics of the GENOA CRF pain measure was estimated with sensitivity and specificity using the BPI as the gold standard reference. Prognostic value was assessed using pain classification as the primary independent variable in an adjusted analysis using 1) the percentage of positive opioid urine screens and 2) high-risk opioid use (= 50% positive opioid urine screens) as the dependent variables in a linear and logistic regression analyses, respectively. RESULTS Among participants eligible for inclusion (n = 444) the BPI was found to be highly sensitive, classifying a large number of GENOA participants with pain (n = 281 of the 297 classified with pain, 94.6%) in comparison to the GENOA CRF (n = 154 of 297 classified with pain, 51.8%). Participants concordantly classified as having pain according to the GENOA CRF and BPI were found to have an estimated 7.79% increase in positive opioid urine screens (estimated coefficient: 7.79; 95% CI 0.74, 14.85: P = 0.031) and a 4 times greater odds (odds ratio [OR]: 4.10 P = 0.008; 95% CI: 1.44, 11.63) of engaging in a "high risk" level of illicit opioids use. The prognostic relevance of pain classification was not maintained for the additional participants classified by the BPI (n = 143 discordant). CONCLUSION These results suggest that while the BPI may be more sensitive in capturing pain among patients with opioid addiction, this tool is of less value for predicting the impact of pain on illicit opioid use for opioid addiction patients on methadone maintenance treatment. The GENOA CRF showed high predictive ability, whereby patients classified according to the GENOA CRF are at serious risk for opioid relapse. Using the appropriate tool to assess pain in opioid addiction may serve to improve the current detection and management of comorbid pain. LIMITATIONS We caution the interpretation of these result since they are still reflective of participants already maintained on an opioid substitution therapy (OST), which can largely differ from patients who drop out of methadone maintenance treatment (MMT) or never seek treatment altogether.
Collapse
Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada
| | - Pavel S Roshanov
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Monica Bawor
- Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada; McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, Hamilton, Canada
| | - James Paul
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Department of Anesthesia, McMaster University, Hamilton, Canada
| | - Michael Varenbut
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Jeff Daiter
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Guillame Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew Worster
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Canada
| | - Dipika Desai
- Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada; Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada; Centre for Evaluation of Medicine, St Joseph's Healthcare-Hamilton, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada; Peter Boris Centre for Addictions Research, Canada
| |
Collapse
|
8
|
Bawor M, Dennis BB, Varenbut M, Daiter J, Marsh DC, Plater C, Worster A, Steiner M, Anglin R, Pare G, Desai D, Thabane L, Samaan Z. Sex differences in substance use, health, and social functioning among opioid users receiving methadone treatment: a multicenter cohort study. Biol Sex Differ 2015; 6:21. [PMID: 26557977 PMCID: PMC4640383 DOI: 10.1186/s13293-015-0038-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022] Open
Abstract
Background Despite the growing numbers of men and women with opioid use disorder in Canada, sex-specific issues in treatment have not been re-examined in the current population of patients with opioid addiction. We aimed to evaluate sex differences in substance use, health, and social functioning among men and women currently receiving methadone treatment for opioid use disorder in Ontario, Canada. Methods We recruited 503 participants with opioid dependence disorder receiving methadone maintenance treatment. We collected data on demographics, treatment characteristics, psychiatric history, addiction severity, and drug use patterns through urinalysis. We performed adjusted univariate analyses and logistic regression to identify distinct factors affecting men and women. Results Among our sample of 54 % (n = 266) men and 46 % women (n = 226) with mean age 38.3 years, less than half of participants were employed (35.6 %) and married (31.8 %) and had completed a high school education (27.9 %). Compared to men, women had frequent physical and psychological health problems, family history of psychiatric illness, and childcare responsibilities and began using opioids through a physician prescription. Men had higher rates of employment, cigarette smoking, and cannabis use compared to women. Conclusions Our results have revealed different patterns of substance use, health, and social functioning among men and women currently receiving methadone treatment for opioid addiction in Ontario, Canada. This information can be used to develop an integrative treatment regimen that caters to the individual needs of men and women, as well as to inform methadone treatment protocols to include specialized services (including vocational counseling, childcare and parenting assistance, medical assistance, relationship or domestic violence counseling, etc.) and increase their availability and accessibility on a larger scale.
Collapse
Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario Canada ; St. George's, University of London, London, UK ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada ; Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario Canada
| | - Brittany B Dennis
- St. George's, University of London, London, UK ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada ; Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
| | - Michael Varenbut
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada
| | - Jeff Daiter
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada
| | - David C Marsh
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada ; Northern Ontario School of Medicine, Laurentian Campus, Sudbury, Ontario Canada
| | - Carolyn Plater
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada
| | - Andrew Worster
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada ; Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada ; Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario Canada ; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario Canada ; Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario Canada
| | - Rebecca Anglin
- Department of Medicine, McMaster University, Hamilton, Ontario Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario Canada
| | - Guillaume Pare
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, Ontario Canada
| | - Zainab Samaan
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada ; Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario Canada ; Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, Ontario L8N 3K7 Canada
| |
Collapse
|
9
|
Dennis BB, Roshanov PS, Naji L, Bawor M, Paul J, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Samaan Z, Thabane L. Opioid substitution and antagonist therapy trials exclude the common addiction patient: a systematic review and analysis of eligibility criteria. Trials 2015; 16:475. [PMID: 26489415 PMCID: PMC4618532 DOI: 10.1186/s13063-015-0942-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/03/2015] [Indexed: 01/01/2023] Open
Abstract
Background Eligibility criteria that result in the exclusion of a substantial number of patients from randomized trials jeopardize the generalizability of treatment effect to much of the clinical population. This is important when evaluating opioid substitution and antagonist therapies (OSATs), especially given the challenges associated with treating the opioid-dependent population. We aimed to identify OSAT trials' eligibility criteria, quantify the percentage of the clinical population excluded by these criteria, and determine how OSAT guidelines incorporate evidence from these trials. Methods We performed a systematic review to identify the eligibility criteria used across trials. We searched Medline, EMBASE, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry (CTR), World Health Organization International CTR Platform Search Portal, and the National Institutes of Health CTR databases from inception to January 1, 2014. To quantify the effect of trials' eligibility criteria on generalizability, we applied these criteria to data from an observational study of opioid-dependent patients (n = 394). We then accessed the Canadian, American, British, and World Health Organization (WHO) OSAT guidelines to evaluate how evidence is used in the recommendations. Results Among the 60 trials identified the majority (≥50 % of trials) exclude patients with psychiatric (60 %) and physical comorbidity (51.7 %). Additionally, we found 19 trials exclude patients with current alcohol/substance-use problems (31.7 %), and 29 (48.3 %) exclude patients taking psychotropic medications. These criteria were restrictive and in some cases rendered 70 % of the observational sample ineligible. North American OSAT guidelines made strong recommendations supported by evidence with poor generalizability. National Institute of Health and Care Excellence (NICE) and WHO guidelines for opioid misuse provide a critical assessment of the literature used to inform their recommendations. Conclusions Trials assessing OSATs often exclude patients with concurrent disorders. If the excluded patients respond differently to treatment, results from these trials are likely to overestimate the true effectiveness of OSATs. North American guidelines should consider these limitations when drafting clinical recommendations. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0942-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Pavel S Roshanov
- Schulich School of Medicine and Dentistry, University of Western Ontario, 4, 1465 Richmond Street, London, ON, N6G 2M1, Canada.
| | - Leen Naji
- Michael G. Degroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Monica Bawor
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - James Paul
- Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada.
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Andrew Worster
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada. .,Department of Medicine, Hamilton General Hospital, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada.
| | - Michael Varenbut
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada.
| | - Jeff Daiter
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada.
| | - David C Marsh
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada. .,Northern Ontario School of Medicine, Ramsey Lake Road, Sudbury, ON, P0M, Canada.
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L9C 0E3, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Centre for Evaluation of Medicine, 25 Main Street West, Hamilton, ON, L8P 1H1, Canada. .,System Linked Research Unit, 175 Longwood Road, South Hamilton, L8P 0A1, Canada.
| |
Collapse
|
10
|
Bawor M, Dennis BB, Tan C, Pare G, Varenbut M, Daiter J, Plater C, Worster A, Marsh DC, Steiner M, Anglin R, Desai D, Thabane L, Samaan Z. Contribution of BDNF and DRD2 genetic polymorphisms to continued opioid use in patients receiving methadone treatment for opioid use disorder: an observational study. Addict Sci Clin Pract 2015; 10:19. [PMID: 26437921 PMCID: PMC4672523 DOI: 10.1186/s13722-015-0040-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/24/2015] [Indexed: 12/14/2022] Open
Abstract
Background The heritability of opioid use disorder has been widely investigated; however, the influence of specific genes on methadone treatment outcomes is not well understood. The association between response to methadone treatment and genes that are involved in substance use behaviors and reward mechanisms is poorly understood, despite evidence suggesting their contribution to opioid use disorder. The aim of this study was to investigate the effect of brain-derived neurotrophic factor (BDNF) and dopamine receptor D2 (DRD2) polymorphisms on continued opioid use among patients on methadone treatment for opioid use disorder. Methods BDNF 196G>A (rs6265) and DRD2-241A>G (rs1799978) genetic variants were examined in patients with opioid use disorder who were recruited from methadone treatment clinics across Southern Ontario, Canada. We collected demographic information, substance use history, blood for genetic analysis, and urine to measure opioid use. We used regression analysis to examine the association between continued opioid use and genetic variants, adjusting for age, sex, ethnicity, methadone dose, duration in treatment, and number of urine screens. Results Among 240 patients treated with methadone for opioid use disorder, 36.3 percent (n = 87) and 11.3 percent (n = 27) had at least one risk allele for rs6265 and rs1799978, respectively. These genetic variants were not significantly associated with continued opioid use while on methadone maintenance treatment [rs6265: odds ratio (OR) = 1.37, 95 % confidence interval (CI) = 0.792, 2.371, p = 0.264; rs1799978: OR 1.27, 95 % CI 0.511, 3.182, p = 0.603]. Conclusions Despite an association of BDNFrs6265 and DRD2rs1799978 with addictive behaviors, these variants were not associated with continued illicit opioid use in patients treated with methadone. Problematic use of opioids throughout treatment with methadone may be attributed to nongenetic factors or a polygenic effect requiring further exploration. Additional research should focus on investigating these findings in larger samples and different populations.
Collapse
Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Program, McMaster University, Hamilton, ON, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| | - Brittany B Dennis
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
| | - Charlie Tan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Guillaume Pare
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
| | - Michael Varenbut
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada.
| | - Jeff Daiter
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada.
| | - Carolyn Plater
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada.
| | - Andrew Worster
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada. .,Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - David C Marsh
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada. .,Northern Ontario School of Medicine, Laurentian Campus, Sudbury, ON, Canada.
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. .,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
| | - Rebecca Anglin
- Department of Medicine, McMaster University, Hamilton, ON, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON, Canada. .,System Linked Research Unit, Hamilton, ON, Canada.
| | - Zainab Samaan
- MiNDS Neuroscience Program, McMaster University, Hamilton, ON, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. .,Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON, L8N 3K7, Canada.
| |
Collapse
|
11
|
Dennis BB, Bawor M, Naji L, Chan CK, Varenbut J, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z. Impact of Chronic Pain on Treatment Prognosis for Patients with Opioid Use Disorder: A Systematic Review and Meta-analysis. Subst Abuse 2015; 9:59-80. [PMID: 26417202 PMCID: PMC4573077 DOI: 10.4137/sart.s30120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/12/2015] [Accepted: 07/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND While a number of pharmacological interventions exist for the treatment of opioid use disorder, evidence evaluating the effect of pain on substance use behavior, attrition rate, and physical or mental health among these therapies has not been well established. We aim to evaluate these effects using evidence gathered from a systematic review of studies evaluating chronic non-cancer pain (CNCP) in patients with opioid use disorder. METHODS We searched the Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Dissertations and theses Database, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform Search Portal, and National Institutes for Health Clinical Trials Registry databases to identify articles evaluating the impact of pain on addiction treatment outcomes for patients maintained on opioid agonist therapy. RESULTS Upon screening 3,540 articles, 14 studies with a combined sample of 3,128 patients fulfilled the review inclusion criteria. Results from the meta-analysis suggest that pain has no effect on illicit opioid consumption [pooled odds ratio (pOR): 0.70, 95%CI 0.41–1.17; I2 = 0.0] but a protective effect for reducing illicit non-opioid substance use (pOR: 0.57, 95%CI 0.41–0.79; I2 = 0.0). Studies evaluating illicit opioid consumption using other measures demonstrate pain to increase the risk for opioid abuse. Pain is significantly associated with the presence of psychiatric disorders (pOR: 2.18; 95%CI 1.6, 2.9; I2 = 0.0%). CONCLUSION CNCP may increase risk for continued opioid abuse and poor psychiatric functioning. Qualitative synthesis of the findings suggests that major methodological differences in the design and measurement of pain and treatment response outcomes are likely impacting the effect estimates.
Collapse
Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. ; McMaster Integrative Neuroscience Discovery and Study (MiNDS) Program, McMaster University, Hamilton, ON, Canada
| | - Leen Naji
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Carol K Chan
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Jaymie Varenbut
- Department of Biological Sciences, Western University, London, ON, Canada
| | - James Paul
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ; Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | | | - Jeff Daiter
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - David C Marsh
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada. ; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Andrew Worster
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada. ; Department of Medicine, Hamilton General Hospital, Hamilton, ON, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada. ; Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, ON Canada. ; Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, ON, Canada. ; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada. ; Peter Boris Centre for Addictions Research, Hamilton, ON, Canada
| |
Collapse
|
12
|
Bawor M, Dennis BB, Bhalerao A, Plater C, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Steiner M, Anglin R, Pare G, Thabane L, Samaan Z. Sex differences in outcomes of methadone maintenance treatment for opioid use disorder: a systematic review and meta-analysis. CMAJ Open 2015; 3:E344-51. [PMID: 26457294 PMCID: PMC4596116 DOI: 10.9778/cmajo.20140089] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Opioid use disorder is a serious international concern with limited treatment success. Men and women differ in their susceptibility to opioid use disorder and response to methadone treatment and can therefore benefit from sex-specific treatment. We performed a systematic review of the literature on outcomes of methadone maintenance treatment for opioid use disorder in men and women related to drug use, health status and social functioning. METHODS We searched PubMed, Embase, PsycINFO and CINAHL for observational or randomized controlled studies involving adults 18 years of age or older undergoing methadone treatment for opioid use disorder. Studies were included if they investigated sex differences in methadone treatment outcomes. Two authors independently reviewed and extracted data. Meta-analyses were performed when possible; risk of bias and quality of evidence were also assessed. RESULTS Twenty studies with 9732 participants were included, of which 18 were observational and 2 were randomized controlled trials. Men and women differed significantly in alcohol use (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31 to 0.86), amphetamine use (OR 1.47, 95% CI 1.12 to 1.94), legal involvement (OR 0.63, 95% CI 0.47 to 0.84) and employment during treatment (OR 0.39, 95% CI 0.21 to 0.73). Opioid use patterns were similar among men and women. Risk of bias was moderate, and quality of evidence was generally low. INTERPRETATION Sex differences were evident in polysubstance use, legal involvement and employment status among men and women receiving methadone treatment for opioid use disorders. Although the quality of evidence was low, our review highlights the need for improved implementation of sex-specific treatment strategies.
Collapse
Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Brittany B Dennis
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Anuja Bhalerao
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Carolyn Plater
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Andrew Worster
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Michael Varenbut
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Jeff Daiter
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - David C Marsh
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Dipika Desai
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Meir Steiner
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Rebecca Anglin
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Guillaume Pare
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Lehana Thabane
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Zainab Samaan
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| |
Collapse
|
13
|
Dennis BB, Bawor M, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z. The impact of chronic pain on opioid addiction treatment: a systematic review protocol. Syst Rev 2015; 4:49. [PMID: 25927914 PMCID: PMC4403999 DOI: 10.1186/s13643-015-0042-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/02/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The consequences of opioid relapse among patients being treated with opioid substitution treatment (OST) are serious and can result in abnormal cardiovascular function, overdose, and mortality. Chronic pain is a major risk factor for opioid relapse within the addiction treatment setting. There exist a number of opioid maintenance therapies including methadone, buprenorphine, naltrexone, and levomethadyl acetate (LAAM), of which the mediating effects of pain on treatment attrition, substance use behavior, and social functioning may differ across therapies. We aim to 1) evaluate the impact of pain on the treatment outcomes of addiction patients being managed with OST and 2) identify the most recently published opioid maintenance treatment guidelines from the United States, Canada, and the UK to determine how the evidence is being translated into clinical practice. METHODS/DESIGN The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Dissertations and theses Database, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. We will search www. GUIDELINES gov and the National Institute for Care and Excellence (NICE) databases to identify the most recently published OST guidelines. All screening and data extraction will be completed in duplicate. Provided the data are suitable, we will perform a multiple treatment comparison using Bayesian meta-analytic methods to produce summary statistics estimating the effect of chronic pain on all OSTs. Our primary outcome is substance use behavior, which includes opioid and non-opioid substance use. We will also evaluate secondary endpoints such as treatment retention, general physical health, intervention adherence, personal and social functioning, as well as psychiatric symptoms. DISCUSSION This review will capture the experience of treatment outcomes for a sub-population of opioid addiction patients and provide an opportunity to distinguish the best quality guidelines for OST. If chronic pain truly does result in negative consequences for opioid addiction patients, it is important we identify which OSTs are most appropriate for chronic pain patients as well as ensure the treatment guidelines incorporate this information. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014015 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014015#.VS1Qw1wkKGM.
Collapse
Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - James Paul
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - Michael Varenbut
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada.
| | - Jeff Daiter
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada.
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada.
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - David C Marsh
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. .,Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, Ontario, P3E 2C6, Canada.
| | - Andrew Worster
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. .,Department of Medicine, Hamilton General Hospital, 237 Barton St East, Hamilton, Ontario, L8L 2X2, Canada.
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Departments of Pediatrics and Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Departments of Pediatrics and Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,St. Joseph's Healthcare Hamilton, Centre for Evaluation of Medicine, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. .,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada. .,Peter Boris Centre for Addictions Research, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| |
Collapse
|
14
|
Bawor M, Bami H, Dennis BB, Plater C, Worster A, Varenbut M, Daiter J, Marsh DC, Steiner M, Anglin R, Coote M, Pare G, Thabane L, Samaan Z. Testosterone suppression in opioid users: a systematic review and meta-analysis. Drug Alcohol Depend 2015; 149:1-9. [PMID: 25702934 DOI: 10.1016/j.drugalcdep.2015.01.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/13/2015] [Accepted: 01/29/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Whether used for pain management or recreation, opioids have a number of adverse effects including hormonal imbalances. These imbalances have been reported to primarily involve testosterone and affect both males and females to the point of interfering with successful treatment and recovery. We conducted a systematic review and meta-analysis to determine the extent that opioids affect testosterone levels in both men and women, which may be relevant to improved treatment outcomes for opioid dependence and for pain management. METHODS We searched PubMed, EMBASE, PsycINFO, and CINAHL for relevant articles and included studies that examined testosterone levels in men and women while on opioids. Data collection was completed in duplicate. RESULTS Seventeen studies with 2769 participants (800 opioid users and 1969 controls) fulfilled the review inclusion criteria; 10 studies were cross-sectional and seven were cohort studies. Results showed a significant difference in mean testosterone level in men with opioid use compared to controls (MD=-164.78; 95% CI: -245.47, -84.08; p<0.0001). Methadone did not affect testosterone differently than other opioids. Testosterone levels in women were not affected by opioids. Generalizability of results was limited due to high heterogeneity among studies and overall low quality of evidence. CONCLUSIONS Our findings demonstrated that testosterone level is suppressed in men with regular opioid use regardless of opioid type. We found that opioids affect testosterone levels differently in men than women. This suggests that opioids, including methadone, may have different endocrine disruption mechanisms in men and women, which should be considered when treating opioid dependence.
Collapse
Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Herman Bami
- Undergraduate BHSc Program, Faculty of Health Sciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Brittany B Dennis
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Health Research Methodology Graduate Program, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada
| | - Andrew Worster
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada; Department of Medicine, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Michael Varenbut
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada
| | - Jeff Daiter
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada; Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada; Department of Obstetrics and Gynecology, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Rebecca Anglin
- Department of Medicine, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Margaret Coote
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada
| | - Guillaume Pare
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Biostatistics Unit, Centre for Evaluation of Medicine, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada
| | - Zainab Samaan
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
| |
Collapse
|
15
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| |
Collapse
|
16
|
Bawor M, Dennis BB, Samaan MC, Plater C, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Steiner M, Anglin R, Coote M, Pare G, Thabane L, Samaan Z. Methadone induces testosterone suppression in patients with opioid addiction. Sci Rep 2014; 4:6189. [PMID: 25155550 PMCID: PMC4143768 DOI: 10.1038/srep06189] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/06/2014] [Indexed: 11/29/2022] Open
Abstract
Sex hormones may have a role in the pathophysiology of substance use disorders, as demonstrated by the association between testosterone and addictive behaviour in opioid dependence. Although opioid use has been found to suppress testosterone levels in men and women, the extent of this effect and how it relates to methadone treatment for opioid dependence is unclear. The present multi-centre cross-sectional study consecutively recruited 231 patients with opioid dependence from methadone clinics across Ontario, Canada between June and December of 2011. We obtained demographic details, substance use, psychiatric history, and blood and urine samples from enrolled subjects. The control group included 783 non-opioid using adults recruited from a primary care setting in Ontario, Canada. Average testosterone level in men receiving methadone treatment was significantly lower than controls. No effect of opioids including methadone on testosterone level in women was found and testosterone did not fluctuate significantly between menstrual cycle phases. In methadone patients, testosterone level was significantly associated with methadone dose in men only. We recommend that testosterone levels be checked in men prior and during methadone and other opioid therapy, in order to detect and treat testosterone deficiency associated with opioids and lead to successful methadone treatment outcomes.
Collapse
Affiliation(s)
- Monica Bawor
- 1] MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON [2] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON
| | - Brittany B Dennis
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Health Research Methodology Graduate Program, McMaster University, Hamilton, ON [3] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - M Constantine Samaan
- Division of Pediatric Endocrinology, Department of Pediatrics, McMaster University, Hamilton, ON
| | | | - Andrew Worster
- 1] Ontario Addiction Treatment Centres, Ontario, Canada [2] Department of Medicine, McMaster University, Hamilton, ON
| | | | - Jeff Daiter
- Ontario Addiction Treatment Centres, Ontario, Canada
| | - David C Marsh
- 1] Ontario Addiction Treatment Centres, Ontario, Canada [2] Northern Ontario School of Medicine, Sudbury, ON
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON
| | - Meir Steiner
- 1] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON [2] Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON [3] Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON
| | - Rebecca Anglin
- 1] Department of Medicine, McMaster University, Hamilton, ON [2] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
| | - Margaret Coote
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON
| | - Guillaume Pare
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - Lehana Thabane
- 1] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON [2] Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON, Canada
| | - Zainab Samaan
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON [3] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
| |
Collapse
|
17
|
Dennis BB, Samaan MC, Bawor M, Paul J, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Thabane L, Samaan Z. Evaluation of clinical and inflammatory profile in opioid addiction patients with comorbid pain: results from a multicenter investigation. Neuropsychiatr Dis Treat 2014; 10:2239-47. [PMID: 25429222 PMCID: PMC4242695 DOI: 10.2147/ndt.s72785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Chronic pain is the most commonly reported comorbidity among patients with opioid addiction receiving methadone maintenance treatment (MMT), with an estimated prevalence ranging between 30% and 55%. Evidence suggests that patients with comorbid pain are at high risk for poor treatment response, including continued illicit substance use. Due to the important relationship between the presence of pain and illicit substance abuse within the MMT setting, it is imperative that we target our efforts toward understanding the characteristics of this patient population. METHODS The primary objective of this study was to explore the clinical and inflammatory profile of MMT patients reporting comorbid pain. This multicenter study enrolled patients (n=235) on MMT for the treatment of opioid dependence. Clinical history and blood and urine data were collected. Blood samples were obtained for estimating the serum levels of inflammatory markers (tumor necrosis factor [TNF]-α, interleukin-1 receptor antagonist [IL-1ra], IL-6, IL-8, IL-10, interferon [IFN]-γ and chemokine (C-C motif) ligand 2 [CCL2]). The study objectives were addressed using a descriptive statistical summary and a multivariable logistic regression model constructed in STATA version 12. RESULTS Among the participants eligible for inclusion (n=235), serum IFN-γ level and substance abuse behavior proved to be important delineating characteristics for the detection of comorbid pain. Analysis of inflammatory profile showed IFN-γ to be significantly elevated among patients reporting comorbid pain (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.17, 3.50; P=0.01). Patients reporting comorbid pain were also found to have an increase in positive opioid urine screens (OR: 1.02; 95% CI: 1.00, 1.03; P=0.01), indicating an increase in illicit opioid consumption. CONCLUSION MMT patients with comorbid pain were shown to have elevated IFN-γ and higher rates of continued opioid abuse. The ability to objectively distinguish between patients with comorbid pain may help to both improve the prediction of poor responders to MMT as well as identify treatment approaches such as anti-inflammatory medications as safe alternatives for MMT patients with comorbid pain.
Collapse
Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - M Constantine Samaan
- Department of Pediatrics, Division of Pediatric Endocrinology, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Andrew Worster
- Department of Medicine, Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Jeff Daiter
- Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada ; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Centre for Evaluation of Medicine, Hamilton, ON, Canada ; System Linked Research Unit, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
18
|
Samaan Z, Bawor M, Dennis BB, Plater C, Varenbut M, Daiter J, Worster A, Marsh DC, Tan C, Desai D, Thabane L, Pare G. Genetic influence on methadone treatment outcomes in patients undergoing methadone maintenance treatment for opioid addiction: a pilot study. Neuropsychiatr Dis Treat 2014; 10:1503-8. [PMID: 25187714 PMCID: PMC4149396 DOI: 10.2147/ndt.s66234] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Treatment of opioid addiction with methadone is effective; however, it is known to produce interindividual variability. This may be influenced in part by genetic variants, which can increase the initial risk of developing opioid addiction as well as explain differences in response to treatment. This pilot study aimed to assess the feasibility of conducting a full-scale genetic analysis to identify genes that predict methadone treatment outcomes in this population. METHODS This was a cross-sectional observational study of patients admitted to a methadone maintenance treatment program for opioid addiction. We obtained demographic and clinical characteristics in addition to blood and urine samples, for the assessment of treatment outcomes. RESULTS The recruitment process yielded 252 patients, representing a 20% recruitment rate. We conducted genetic testing based on a 99.6% rate of provision of DNA samples. The average retention in treatment was 3.4 years, and >50% of the participants reported psychiatric and medical comorbidities. BDNF rs6265 and DRD2 rs1799978 were the common single nucleotide polymorphisms (SNPs) selected for the feasibility study. DISCUSSION This study met our predetermined feasibility criteria; recruitment, response rates, and genetic testing were feasible; treatment duration was sufficient for follow up; and the prevalence of comorbid conditions indicated the need for reliable psychiatric and chronic pain measures. The study strengths included effective collaboration with clinics and the generalizability of sample population. Key learning points show the need for assessment of treatment outcomes on multiple domains, implementation of follow up, and the development of standardized training for the study clinical staff.
Collapse
Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada ; MiNDS Neuroscience Program, McMaster University, Hamilton, Ontario, Canada
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada ; MiNDS Neuroscience Program, McMaster University, Hamilton, Ontario, Canada
| | - Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Michael Varenbut
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Jeffrey Daiter
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Andrew Worster
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada ; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada ; Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Charlie Tan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, McMaster University, Hamilton, Ontario, Canada ; System Linked Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Pare
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
19
|
Leclerc JC, Plater C, Connan F, Debré P. T cell-mediated immunity to oncornavirus-induced tumors. IV. Preliminary evidence for a specific suppression of anti-Moloney cell-mediated immune response by autoimmune T cells. Eur J Immunol 1981; 11:45-7. [PMID: 6452279 DOI: 10.1002/eji.1830110110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Previous reports have demonstrated that adult C57BL/6 mice infected with murine sarcoma virus (MSV) develop a strong cell-mediated immune response against Friend, Moloney, Rauscher virus-induced type-specific (FMR) antigens and reject their tumors. To demonstrate a possible role for auto-anti-MSV T blasts, syngeneic C57BL/6 mice were immunized with highly enriched anti-FMR cytolytic T cells. One of 3 pools of these autoimmune T cells prepared from 12 surviving immunized mice (a) inhibited specifically the in vitro anti-MSV cytolysis generation and (b) enhanced drastically the MSV tumor growth in vivo. The possibility for such an immunization procedure to induce anti-idiotype T cells, the repeatability of this effect and the relationship of the suppressor cells with antigen-specific suppressor cells and other components of the anti-MSV immune response are discussed.
Collapse
|
20
|
Plater C, Debré P, Leclerc JC. T cell-mediated immunity to oncornavirus-induced tumors. III. Specific and nonspecific suppression in tumor-bearing mice. Eur J Immunol 1981; 11:39-44. [PMID: 6452278 DOI: 10.1002/eji.1830110109] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A strong cell-mediated immune response against Friend, Moloney, Rauscher virus-induced (FMR) cell surface antigens has been demonstrated previously in mice which reject oncornavirus-induced tumors. In order to identify an eventual suppressor mechanism in animals with progressively growing tumors, experiments were initiated in C57BL/6 mice bearing either a murine sarcoma virus (MSV) tumor or Moloney virus-induced lymphoma (MBL2). Progressive tumor growth was induced (a) in viremic animals first infected with Moloney murine leukemia virus (M.Mu LV), then inoculated as adult with MSV; (b) in nonviremic animals injected with MBL2 lymphoma cells. In the absence of tumor cells, viremia induces specific tolerance for which there is no evidence for suppressor cells. In tumor-bearing mice, specific suppressor T cells are detected which are able to inhibit the generation of anti-FMR cytolytic T lymphocytes in vitro and enhance the tumor growth in vivo. In addition to the specific suppressor T cells, a nonspecific suppressive activity mediated by metastatic T lymphoma cells is demonstrated in the spleens of lymphoma-bearing animals. The respective role of the virus and tumor cells in the induction of tolerance to M.MuLV-induced antigens, and their relationship to other components of the specific cell-mediated immune response is discussed.
Collapse
|
21
|
Fridman WH, Fradelizi D, Guimezanes A, Plater C, Leclerc JC. The role of the Fc receptor (FcR) of thymus-derived lymphocytes. II. Presence of FcR on suppressor cells and direct involvement in suppression. Eur J Immunol 1977; 7:549-54. [PMID: 302794 DOI: 10.1002/eji.1830070811] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
22
|
Leclerc JC, Plater C, Fridman WH. The role of the Fc receptor (FcR) of thymus-derived lymphocytes. I. Presence of FcR on cytotoxic lymphocytes and absence of direct role in cytotoxicity. Eur J Immunol 1977; 7:543-8. [PMID: 302793 DOI: 10.1002/eji.1830070810] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|