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Hoffman KA, Graves C, Rowe K, Worth J, Pertl K, Laidler J, Korthuis P, McCarty D. Engaging the Great Circle: a qualitative study of the Confederated Tribes of Grand Ronde’s mobile medication unit. Ann Med 2024; 56:2306492. [PMID: 38271558 PMCID: PMC10812851 DOI: 10.1080/07853890.2024.2306492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The Confederated Tribes of the Grand Ronde Community of Oregon began a Mobile Medication Unit (MMU) as part of their Great Circle Recovery Opioid Treatment Program (OTP) to address elevated rates of opioid use disorder (OUD) among American Indians and Alaska Natives in Oregon. The MMU provides methadone or buprenorphine for individuals with OUD, enrolled in the OTP, who are living either on the reservation or in surrounding rural communities. An implementation study describes the service through document review and qualitatively assesses patient and staff experiences and the perceived barriers and facilitators to mobile services. METHODS Semi-structured qualitative interviews with patients (n = 11), MMU staff (n = 5), and the state opioid treatment authority (n = 1) gathered details on the initiative's development and operations. Provider interviews probed implementation experiences. Patient interviews focused on their experiences with the MMU and staff, changes in quality of life and recommendations for enhancing treatment. Interviews were transcribed and analysed using a Thematic Analysis approach. RESULTS Staff themes identified two driving forces (i.e. staff desire for an inclusive approach to wellness that is accessible to all community members; the catalysts for the MMU), two steps toward MMU development (i.e. Tribal approvals and support; the construction and maintenance of community relationships) and two perspectives on MMU implementation and impact (i.e. initial implementation barriers; facilitators and observations of how the MMU reduced stigma associated with agonist therapy). Patients' themes noted the MMU's professional and 'caring' environment, accessible rural locations and general suggestions including culturally responsive ancillary services. CONCLUSION The Great Circle MMU enhanced access to opioid agonist therapy for people with OUD (i.e. American Indians/Alaska Natives, and non-natives) living in rural communities. The Confederated Tribes of Grand Ronde operates the first Tribally owned OTP MMU, grounded in cultural humility and committed to Tribal members and the great circle of the larger community.
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Affiliation(s)
- Kim A. Hoffman
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - Chantell Graves
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Kelly Rowe
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Jennifer Worth
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Kellie Pertl
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - James Laidler
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - P. Todd Korthuis
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - Dennis McCarty
- Department of Medicine, OR Health and Science University, Portland, OR, USA
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McAnulty C, Bastien G, Ledjiar O, Eugenia Socias M, Le Foll B, Lim R, Jutras-Aswad D. Mediating effect of craving on the impact of buprenorphine/naloxone and methadone treatment on opioid use: Results from a randomized controlled trial. Addict Behav 2024; 154:108023. [PMID: 38579594 DOI: 10.1016/j.addbeh.2024.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The relationship between opioid craving and opioid use is unclear. We sought to determine to what extent craving mediated the relationship between opioid agonist therapy and changes in opioid use. METHODS Data came from a pragmatic, 24-week, pan-Canadian, multi-centric, open-label, randomized controlled trial comparing flexible buprenorphine/naloxone take-home doses to standard supervised methadone models of care for the treatment of prescription-type opioid use disorder. Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22. RESULTS Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, p < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; p < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (p < 0.001). CONCLUSIONS Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. Research is needed to develop a comprehensive understanding of factors mediating opioid use during opioid agonist therapy.
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Affiliation(s)
- Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Omar Ledjiar
- Unité de recherche Clinique appliquée (URCA), Research Centre, Centre Hospitalier Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada
| | - Bernard Le Foll
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, Ontario L9M 1G3, Canada
| | - Ron Lim
- Department of Psychiatry and Family Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
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Sason A, Adelson M, Schreiber S, Peles E. Fentanyl abuse proportion in methadone maintenance treatment, and patients' knowledge about its risks. J Psychiatr Res 2024; 173:254-259. [PMID: 38554621 DOI: 10.1016/j.jpsychires.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/12/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Fentanyl is not yet routinely monitored among methadone maintenance treatment (MMT) patients in Israel. We aimed 1. to evaluate urine fentanyl proportion changes over 3 years and characterize patients' characteristics 2. To study patients' self-report on fentanyl usage, and compare knowledge about fentanyl risk, before and following brief educational intervention. METHODS Fentanyl in the urine of all current MMT patients was tested every 3 months year between 2021 and 2023, and patients with positive urine fentanyl were characterized. Current patients were interviewed using a fentanyl knowledge questionnaire (effects, indications, and risks) before and following an explanation session. RESULTS Proportion of fentanyl ranged between 9.8 and 15.1%, and patients with urine positive for fentanyl (September 2023) were characterized as having positive urine for pregabalin, cocaine, and benzodiazepine (logistic regression). Of the current 260 patients (87% compliance), 78(30%) self-reported of fentanyl lifetime use ("Ever"), and 182 "never" use. The "Ever" group had higher Knowledge scores than the "Never", both groups improved following the explanatory session (repeated measure). The "Ever" group patients were found with urine positive for cannabis and benzodiazepine on admission to MMT, they were younger, did not manage to gain take-home dose privileges and had a higher fentanyl knowledge score (logistic regression). CONCLUSIONS In the absence of routine fentanyl tests, a high knowledge score, shorter duration in MMT, benzodiazepine usage on admission, and current cannabis usage, may hint of the possibility of fentanyl abuse.
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Affiliation(s)
- Anat Sason
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Schreiber
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University Faculty of Medical and Health Sciences, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University Faculty of Medical and Health Sciences, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Ibekwe SO, Everett L, Mondal S. Methadone Should Not Be Used in Cardiac Surgery as Part of Enhanced Recovery After Cardiac Surgery Protocol. J Cardiothorac Vasc Anesth 2024; 38:1272-1274. [PMID: 38503627 DOI: 10.1053/j.jvca.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 03/21/2024]
Affiliation(s)
| | - Lauren Everett
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Samhati Mondal
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.
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Fons RA, Hainsworth KR, Michlig J, Jablonski M, Czarnecki ML, Weisman SJ. Perioperative methadone for posterior spinal fusion in adolescents: Results from a double-blind randomized-controlled trial. Paediatr Anaesth 2024; 34:438-447. [PMID: 38288667 DOI: 10.1111/pan.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Posterior spinal fusion is the most common surgical procedure performed for correction of adolescent idiopathic scoliosis in the United States. Intraoperative methadone has been shown to improve pain control in adult patients undergoing complex spine surgery, and current pediatric studies show encouraging results; however, prospective randomized-controlled trials are lacking in the pediatric literature. AIMS We conducted a single-center double-blind randomized-controlled trial to compare intraoperative use of methadone to morphine in pediatric patients undergoing posterior spinal fusion. METHODS A total of 47 adolescents undergoing posterior spinal fusion were randomized (stratified by sex) to either a methadone (n = 25) or morphine (n = 22) group. The primary outcome was postoperative opioid consumption. Secondary outcomes included postoperative pain severity, opioid-related side effects, and ratio of patient-controlled analgesia injections: attempts as a behavioral index of uncontrolled pain. RESULTS Patients in the methadone group consumed less total opioid postoperatively (median [interquartile range], 0.3 mg/kg [0.1, 0.5]) than patients in the morphine group (0.3 mg/kg [0.2, 0.6]), median difference [95% confidence interval] -0.07 [-0.2 to 0.02]; (p = .026). Despite the lower amount of opioid used postoperatively, pain scores for the methadone group (3.5 [3.0, 4.3]) were not significantly different from those in the morphine group (4.0 [3.2, 5.0]; p = .250). Groups did not differ on opioid-related side effects. CONCLUSIONS A two-dose intraoperative methadone regimen resulted in decreased opioid consumption compared to morphine. Although the clinical significance of these results may be limited, the analgesic equipoise without increased opioid-related side effects and potential for a lower incidence of chronic pain may tip the balance in favor of routine methadone use for adolescents undergoing posterior spinal fusion.
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Affiliation(s)
- Roger A Fons
- Medical College of Wisconsin, Department of Anesthesiology, Milwaukee, Wisconsin, USA
- Children's Wisconsin, Wauwatosa, Wisconsin, USA
| | - Keri R Hainsworth
- Medical College of Wisconsin, Department of Anesthesiology, Milwaukee, Wisconsin, USA
- Children's Wisconsin, Wauwatosa, Wisconsin, USA
| | - Johanna Michlig
- Medical College of Wisconsin, Department of Anesthesiology, Milwaukee, Wisconsin, USA
- Children's Wisconsin, Wauwatosa, Wisconsin, USA
| | - Megan Jablonski
- Medical College of Wisconsin, Department of Anesthesiology, Milwaukee, Wisconsin, USA
- Children's Wisconsin, Wauwatosa, Wisconsin, USA
| | | | - Steven J Weisman
- Medical College of Wisconsin, Department of Anesthesiology, Milwaukee, Wisconsin, USA
- Children's Wisconsin, Wauwatosa, Wisconsin, USA
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Garcia S, Mali M, Grewal A. Pro: Methadone Should Be Used as a Part of Enhanced Recovery After Cardiac Surgery Protocol. J Cardiothorac Vasc Anesth 2024; 38:1268-1271. [PMID: 38458828 DOI: 10.1053/j.jvca.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Shelby Garcia
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Mitali Mali
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Ashanpreet Grewal
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.
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Dempsey S, O' Grady MJ. Current management of neonatal abstinence syndrome: a survey of practice in the UK and Ireland. Arch Dis Child Fetal Neonatal Ed 2024; 109:261-264. [PMID: 37879885 DOI: 10.1136/archdischild-2023-326204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To study the current management practices of neonatal abstinence syndrome (NAS) throughout the UK and Ireland and identify changes in practice from the most recent survey in 2008. DESIGN Postal questionnaire to a consultant paediatrician or neonatologist in all 215 neonatal units in the UK and Ireland in January 2020. RESULTS Response rate was 62%. An objective scoring tool was used in 97% of units and the Finnegan score was favoured by 70%. Morphine sulfate use as first line for the treatment of opiate withdrawal was almost universal and 70% used a dose of 40 µg/kg every 4 hours (240 µg/kg/day). Phenobarbitone administration as a second-line agent for opiate withdrawal increased to 61% of units with significant reductions in chloral hydrate and chlorpromazine use compared with the previous survey. Morphine sulfate and phenobarbitone remain the preferred first-line and second-line agents, respectively, for polysubstance withdrawal. There was a significant increase in chlorpromazine use as first line for polydrug withdrawal (1.5-14.2%). The practice of units discharging infants' home on medication increased to 46% from 29%. All units now permit breastfeeding in mothers taking methadone, compared with 81% previously. CONCLUSION AND RELEVANCE Compared with the previous survey, improvements in evidence-based practices were noted, highlighting the benefits of this type of research. Nonetheless, significant variation still exists in some aspects of the management of NAS. Post-discharge follow-up varies widely, with particular deficits in ophthalmology follow-up.
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Affiliation(s)
- Sharon Dempsey
- Department of Paediatrics, Regional Hospital Mullingar, Mullingar, Westmeath, Ireland
| | - Michael J O' Grady
- Department of Paediatrics, Regional Hospital Mullingar, Mullingar, Westmeath, Ireland
- Women's and Children's Health, University College Dublin, Dublin, Ireland
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Nordgren J, Monwell B, Johnson B, Gunnarsson NV, Capusan AJ. Healthcare staff's perspectives on long-acting injectable buprenorphine treatment: a qualitative interview study. Addict Sci Clin Pract 2024; 19:25. [PMID: 38581022 PMCID: PMC10996245 DOI: 10.1186/s13722-024-00458-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Long-acting injectable buprenorphine (LAIB) formulations are a novel treatment approach in opioid agonist treatment (OAT), which provide patients with a steady dose administered weekly or monthly and thus reduce the need for frequent clinic visits. Several studies have analyzed patient experiences of LAIB but the perspective of OAT staff is unknown. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB. METHODS Individual qualitative interviews were conducted with OAT physicians (n = 10) in tandem with nine focus group sessions with OAT nurses and other staff categories (n = 41). The data was analyzed with thematic text analysis. RESULTS Five central themes were identified in the data: (1) advantages and disadvantages of LAIB, (2) patient categories that may or may not need LAIB, (3) patients' degrees of medication choice, (4) keeping tabs, control and treatment alliance, and (5) LAIB's impact on risk and enabling environments in OAT. Overall staff found more advantages than disadvantages with LAIB and considered that patients with ongoing substance use and low adherence were most likely to benefit from LAIB. However, less frequent visits were viewed as problematic in terms of developing a treatment alliance and being able to keep tabs on patients' clinical status. Clinics differed regarding patients' degrees of choice in medication, which varied from limited to extensive. LAIB affected both risk and enabling environments in OAT. CONCLUSIONS LAIB may strengthen the enabling environment in OAT for some patients by reducing clinic visits, exposure to risk environments, and the pressure to divert medication. A continued discussion about the prerequisites and rationale for LAIB implementation is needed in policy and practice.
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Affiliation(s)
- Johan Nordgren
- Department of Social Work, Malmö University, Nordenskiöldsgatan 1, 211 19, Malmö, Sweden.
| | - Bodil Monwell
- Department of Social Work, Jönköping University, Jönköping, Sweden
- Psychiatric clinic, County Hospital Ryhov, Jönköping, Sweden
| | - Björn Johnson
- School of Social Work, Lund University, Lund, Sweden
| | | | - Andrea Johansson Capusan
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Havig SM, Berg-Pedersen RM, Krabseth HM, Müller LD, Haugaa K, Zare HK, Gjesdal K, Krajci P, Opdal MS. Effect on QTc interval by switching from methadone to equipotent R-methadone dose in methadone maintenance treatment patients. Basic Clin Pharmacol Toxicol 2024; 134:519-530. [PMID: 38308508 DOI: 10.1111/bcpt.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
Methadone (R,S-methadone) can prolong the QT interval. R-methadone inhibits cardiac potassium channel function less than S-methadone. We tested if switching from methadone to R-methadone would reduce corrected QT (QTc) intervals in methadone maintenance treatment (MMT) patients. Nine patients, with automatically read QTc intervals ≥450 ms, were required to detect a 20 ms (clinically relevant) reduction in QTc intervals with 15 ms standard deviation (SD) and 90% power. Nine stabilized MMT patients, using median (range) 70 (40-120) mg methadone, were included. Data (ECG recordings, serum samples, and withdrawal symptoms) were collected both before drug intake (Cmin ) and at 3 h after drug intake (Cmax ), and were collected on the day before the switch from methadone to equipotent R-methadone dose and at 14 and 28 days after the switch. A cardiologist calculated QTc intervals retrospectively. Serum electrolytes and methadone concentrations were measured. Mean QTc intervals at Cmin were 472 ms and 422 ms on methadone (automatically and manually read) and 414 ms on R-methadone (manually read). Mean (SD) change in QTc intervals was -8 (10) ms (p = 0.047) at Cmin but non-significant at Cmax . R-methadone showed a concentration-dependent relationship with QTc intervals. Switching to R-methadone reduced QTc intervals, but far less than the 20 ms considered clinically relevant.
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Affiliation(s)
| | | | | | | | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Knut Gjesdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Krajci
- Department of Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Mimi Stokke Opdal
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Bakouni H, Sharafi H, Drouin S, Fortin R, Marsan S, Brissette S, Socias ME, Le Foll B, Lim R, Jutras-Aswad D. Associations Between Buprenorphine\Naloxone and Methadone Treatment and non-Opioid Substance Use in Prescription-Type Opioid Use Disorder: Secondary Analyses From the OPTIMA Study: Associations entre le traitement avec la buprénorphine/naloxone et avec la méthadone et l'utilisation de substances non opioïdes dans le trouble lié à l'usage d'opioïdes de type sur ordonnance : analyses secondaires de l'étude OPTIMA. Can J Psychiatry 2024; 69:252-263. [PMID: 37899716 PMCID: PMC10924583 DOI: 10.1177/07067437231210796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVES There is limited evidence on how opioid agonist treatment (OAT) may affect psychoactive non-opioid substance use in prescription-type opioid use disorder (POUD) and whether this effect might explain OAT outcomes. We aimed to assess the effect of methadone on non-opioid substance use compared to buprenorphine/naloxone (BUP/NX), to explore whether non-opioid substance use is associated with opioid use and retention in treatment, and to test non-opioid use as a moderator of associations between methadone with retention in OAT and opioid use compared to BUP/NX. METHODS This is a secondary analysis of data from the OPTIMA trial, an open-label, pragmatic, parallel, two-arm, pan-Canadian, multicentre, randomized-controlled trial to compare standard methadone model of care and flexible take-home dosing BUP/NX for POUD treatment. We studied the effect of methadone and BUP/NX on non-opioid substance use evaluated by urine drug screen (UDS) and by classes of non-opioid substances (i.e., tetrahydrocannabinol [THC], benzodiazepines, stimulants) (weeks 2-24) using adjusted generalized estimation equation (GEE). We studied the association between non-opioid substance-positive UDS and opioid-positive UDS and retention in treatment, using adjusted GEE and logistic regressions. RESULTS Overall, methadone was not associated with non-opioid substance-positive UDS compared to BUP/NX (OR: 0.78; 95%CI, 0.41 to 1.48). When non-opioid substances were studied separately, methadone was associated with lower odds of benzodiazepine-positive UDS (OR: 0.63; 95% CI: 0.40 to 0.98) and THC-positive UDS (OR: 0.47; 95% CI: 0.28 to 0.77), but not with different odds of stimulant-positive UDS (OR: 1.29; 95% CI: 0.78 to 2.16) compared to BUP/NX. Substance-positive UDS, overall and separate classes, were not associated with opioid-positive UDS or retention in treatment. CONCLUSION Methadone did not show a significant effect on overall non-opioid substance use in POUD compared to BUP/NX treatment but was associated with lower odds of benzodiazepine and THC use in particular. Non-opioid substance use did not predict OAT outcomes. Further research is needed to ascertain whether specific patterns of polysubstance use (quantity and frequency) may affect treatment outcomes.
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Affiliation(s)
- Hamzah Bakouni
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Heidar Sharafi
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Drouin
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Raphaelle Fortin
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Marsan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Suzanne Brissette
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Maria Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Ron Lim
- Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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Cooperman NA, Lu SE, Hanley AW, Puvananayagam T, Dooley-Budsock P, Kline A, Garland EL. Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:338-346. [PMID: 38061786 PMCID: PMC10704342 DOI: 10.1001/jamapsychiatry.2023.5138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
Importance Methadone treatment (MT) fails to address the emotion dysregulation, pain, and reward processing deficits that often drive opioid use disorder (OUD). New interventions are needed to address these factors. Objective To evaluate the efficacy of MT as usual (usual care) vs telehealth Mindfulness-Oriented Recovery Enhancement (MORE) plus usual care among people with an OUD and pain. Design, Setting, and Participants This study was a randomized clinical trial conducted from August 2020 to June 2022. Participants receiving MT for OUD and experiencing chronic pain were recruited at 5 clinics in New Jersey. Interventions In usual care, participants received MT, including medication and counseling. Participants receiving MORE plus usual care attended 8 weekly, 2-hour telehealth groups that provided training in mindfulness, reappraisal, and savoring in addition to usual care. Main Outcomes and Measure Primary outcomes were return to drug use and MT dropout over 16 weeks. Secondary outcomes were days of drug use, methadone adherence, pain, depression, and anxiety. Analyses were based on an intention-to-treat approach. Results A total of 154 participants (mean [SD] age, 48.5 [11.8] years; 88 female [57%]) were included in the study. Participants receiving MORE plus usual care had significantly less return to drug use (hazard ratio [HR], 0.58; 95% CI, 0.37-0.90; P = .02) and MT dropout (HR, 0.41; 95% CI, 0.18-0.96; P = .04) than those receiving usual care only after adjusting for a priori-specified covariates (eg, methadone dose and recent drug use, at baseline). A total of 44 participants (57.1%) in usual care and 39 participants (50.6%) in MORE plus usual care returned to drug use. A total of 17 participants (22.1%) in usual care and 10 participants (13.0%) in MORE plus usual care dropped out of MT. In zero-inflated models, participants receiving MORE plus usual care had significantly fewer days of any drug use (ratio of means = 0.58; 95% CI, 0.53-0.63; P < .001) than those receiving usual care only through 16 weeks. A significantly greater percentage of participants receiving MORE plus usual care maintained methadone adherence (64 of 67 [95.5%]) at the 16-week follow-up than those receiving usual care only (56 of 67 [83.6%]; χ2 = 4.49; P = .04). MORE reduced depression scores and ecological momentary assessments of pain through the 16-week follow-up to a significantly greater extent than usual care (group × time F2,272 = 3.13; P = .05 and group × time F16,13000 = 6.44; P < .001, respectively). Within the MORE plus usual care group, EMA pain ratings decreased from a mean (SD) of 5.79 (0.29) at baseline to 5.17 (0.30) at week 16; for usual care only, pain decreased from 5.19 (0.28) at baseline to 4.96 (0.29) at week 16. Within the MORE plus usual care group, mean (SD) depression scores were 22.52 (1.32) at baseline and 18.98 (1.38) at 16 weeks. In the usual care-only group, mean (SD) depression scores were 22.65 (1.25) at baseline and 20.03 (1.27) at 16 weeks. Although anxiety scores increased in the usual care-only group and decreased in the MORE group, this difference between groups did not reach significance (group × time unadjusted F2,272 = 2.10; P= .12; Cohen d = .44; adjusted F2,268 = 2.33; P = .09). Within the MORE plus usual care group, mean (SD) anxiety scores were 25.5 (1.60) at baseline and 23.45 (1.73) at 16 weeks. In the usual care-only group, mean (SD) anxiety scores were 23.27 (1.75) at baseline and 24.07 (1.73) at 16 weeks. Conclusions and Relevance This randomized clinical trial demonstrated that telehealth MORE was a feasible adjunct to MT with significant effects on drug use, pain, depression, treatment retention, and adherence. Trial Registration ClinicalTrials.gov Identifier: NCT04491968.
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Affiliation(s)
- Nina A Cooperman
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Shou-En Lu
- Rutgers School of Public Health, Piscataway, New Jersey
| | - Adam W Hanley
- College of Social Work, University of Utah, Salt Lake City
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
| | - Thanusha Puvananayagam
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Patricia Dooley-Budsock
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Anna Kline
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
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12
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Trammel CJ, Whitley J, Kelly JC. Pharmacotherapy for opioid use disorder in pregnancy. Curr Opin Obstet Gynecol 2024; 36:74-80. [PMID: 38193300 DOI: 10.1097/gco.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Opioid use disorder (OUD) in pregnancy has significantly increased in the last decade, impacting 8.2 per 1000 deliveries. OUD carries significant risk of morbidity and mortality for both the birthing person and neonate, but outcomes for both are improved with opioid agonist treatment (OAT). Here, we describe the recommended forms of OAT in pregnancy, updates to the literature, and alternate OAT strategies, and share practical peripartum considerations for patients on OAT. RECENT FINDINGS Recent studies comparing buprenorphine and methadone have reaffirmed previous findings that buprenorphine is associated with superior outcomes for the neonate, without clear differences in morbidity or mortality for the birthing person. Optimal initiation and dosing of OAT remains unclear, with several recent studies evaluating methods of initiation, as well as a potential role for higher and more rapid dosing in the fentanyl era. Alternative products such as buprenorphine-naloxone and extended-release buprenorphine are of significant research interest, though randomized prospective data are not yet available. SUMMARY Buprenorphine and methadone are standard of care for treatment of OUD during pregnancy, and multiple patient factors impact the optimal choice. Insufficient data exist to recommend alternative agents as a primary strategy currently. All patients with OUD in pregnancy should be counseled regarding OAT. VIDEO http://links.lww.com/COOG/A94.
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Affiliation(s)
- Cassandra J Trammel
- Washington University in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, St. Louis, Missouri, USA
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Liu C, Li Y. Psychosocial combined with methadone maintenance treatments versus methadone maintenance treatments alone for treatment of opioid use disorder: A meta-analysis. J Addict Dis 2024; 42:126-135. [PMID: 36607171 DOI: 10.1080/10550887.2022.2158664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Psychosocial combined with methadone maintenance treatment aimed at opioid use disorder is effective, but the efficacy of the psychosocial intervention in such treatment is questionable. OBJECTIVES This study aims to evaluate the effectiveness of psychosocial plus methadone maintenance treatment versus methadone maintenance treatment alone for opioid use disorder in improving treatment retention and reducing drug use. METHODS An exhaustive literature search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure database, "the Wan Fang database, the VIP database, and the Chinese Biomedical Literature Database", and randomized controlled trials were identified from their inception to February 2021. RESULTS Twenty-four studies were included. The results of this meta-analysis showed that adding any psychosocial treatment to standard methadone maintenance treatment significantly improved the illicit drug use during the treatment relative risk (RR) 0.62 (95% CI 0.48 to 0.79), and retention in treatment RR 1.18 (95% CI 1.11 to 1.25). No statistically significant additional benefit was detected in terms of retention at follow-up RR 1.08 (95% CI 0.95 to 1.22). CONCLUSIONS The present evidence suggests that adding psychosocial intervention to methadone maintenance treatment significantly improves the nonuse of opioids and retention in treatment. It should be noted that psychosocial treatment is only beneficial for methadone treatment when methadone is provided in subtherapeutic doses. Additionally, the finding about the improvement effect of retention at follow-up did not achieve statistical significance. Due to the diversity of outcome indicators in relevant original studies, the included studies are limited.
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Affiliation(s)
- Chengbin Liu
- School of Sociology, Huazhong University of Science and Technology, Wuhan, China
| | - Yangyang Li
- School of Sociology, Huazhong University of Science and Technology, Wuhan, China
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14
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Jehan S, Zahnd WE, Wooten NR, Seay KD. Geographic variation in availability of opioid treatment programs across U.S. communities. J Addict Dis 2024; 42:136-146. [PMID: 36645315 DOI: 10.1080/10550887.2023.2165869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Methadone for Opioid Use Disorder (OUD) treatment is only dispensed at Opioid Treatment Programs (OTPs). Little is known about the geographic variation in OTP availability and community characteristics associated with the availability across smaller geographic communities in the U.S. To (1) describe geographic distribution of OTPs and (2) examine OTP availability by community characteristics in the contiguous U.S. at Zip Code Area Tabulation (ZCTA) level. Logistic regression was used to examine community characteristics associated with OTP availability (N = 30,367). Chi-square and t-tests were conducted to examine statistically significant differences in OTP availability. Maps and descriptive statistics were used to examine geographic variation in OTP availability. Only 5% (1,417) of ZCTAs had at least one OTP for a total of 1,682 OTPs. Rural ZCTAs had 50% lower odds of having an OTP compared to urban ZCTAs [AOR 0.5; (95% CI: 0.41-0.60)]. ZCTAs in the lowest income quartile had higher odds of having an OTP compared to ZCTAs in the highest income quartile [AOR 3.4; (95% CI: 2.71-4.18)]. Further, ZCTAs with OTPs had a higher proportion of minority residents [Black: 17.5% vs. 7.2%; Hispanic: 19.2% vs. 9%] and a lower proportion of White residents [55.1% vs. 78.2%]. Nationally, OTPs are extremely scarce with notable regional and urban-rural disparities. Potential solutions to address these disparities are discussed.
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Affiliation(s)
- Sadia Jehan
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Whitney E Zahnd
- Department of Health Policy and Management, University of Iowa, Iowa City, IA, USA
| | - Nikki R Wooten
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Kristen D Seay
- College of Social Work, University of South Carolina, Columbia, SC, USA
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15
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Gonzalez AM, Arlandson ME, Patel A, Premkumar A. Predictive Factors Associated with Naloxone Prescription among Pregnant People Admitted for the Management of Opioid Use Disorder. Am J Perinatol 2024; 41:539-542. [PMID: 36351448 DOI: 10.1055/a-1975-4534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Our objective was to examine the biomedical and sociodemographic factors associated with the prescription of naloxone among pregnant people with opioid-use disorder (OUD) who were admitted for initiation of medications for OUD (i.e., buprenorphine-containing medications or methadone) following the implementation of a statewide initiative focused on reducing adverse perinatal health outcomes. STUDY DESIGN This is a single-site, retrospective cohort study of pregnant people admitted for the management of OUD at an urban, tertiary care center between 2013 and 2020. The primary outcome is evidence of a prescription of naloxone, ascertained from the electronic medical record. Bivariate and multivariable logistic regression modeling was performed to evaluate biomedical and sociodemographic variables associated with a prescription for naloxone. Covariates for inclusion in the multivariate logistic regression model were selected based on a p < 0.05 on bivariate analysis. Statistical significance was set at p < 0.05. RESULTS One hundred and thirty-nine participants met the inclusion criteria. On bivariate analysis, people who received naloxone were more likely to be admitted after the initiation of a statewide initiative focused on reducing adverse perinatal outcomes associated with perinatal OUD. Those individuals reporting intravenous drug use (IVDU) were less likely to receive naloxone. On multivariate logistic regression, after controlling for IVDU and epoch of admission, both IVDU (adjusted odds ratio [aOR]: 0.27, 95% confidence interval [CI]: 0.11-0.70) and epoch of admission (aOR: 3.48, 95% CI: 1.28-9.50) were independently associated with receipt of prescription of take-home naloxone. CONCLUSION Naloxone prescription was independently associated with the epoch of admission and route of drug administration. These data can be useful in the evaluation and development of clinical practices to increase rates of naloxone prescription in pregnant people with OUD admitted for inpatient management. KEY POINTS · Thirty four percent of individuals with perinatal OUD were prescribed take-home naloxone (THN).. · Epoch of admission and route of drug administration were independently associated with THN.. · These data can be used to guide public health and clinical programming for pregnant people..
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Affiliation(s)
- Alba M Gonzalez
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mary E Arlandson
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Ashlesha Patel
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
- Department of Anthropology, The Graduate School, Northwestern University, Evanston, Illinois
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Bowman LA, Berger O, Nesbit S, Stoller KB, Buresh M, Stewart R. Operationalizing the new DEA exception: A novel process for dispensing of methadone for opioid use disorder at discharge from acute care settings. Am J Health Syst Pharm 2024; 81:204-218. [PMID: 38091380 DOI: 10.1093/ajhp/zxad288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
PURPOSE To describe one strategy for dispensing of methadone at emergency department (ED) and hospital discharge implemented within 2 urban academic medical centers. SUMMARY Expanding access to medications for opioid use disorder (OUD) is a national priority. ED visits and hospitalizations offer an opportunity to initiate or continue these lifesaving medications, including methadone and buprenorphine. However, federal regulations governing methadone treatment and significant gaps in treatment availability have made continuing methadone upon ED or hospital discharge challenging. To address this issue, the Drug Enforcement Administration (DEA) granted an exception allowing hospitals, clinics, and EDs to dispense a 72-hour supply of methadone while continued treatment is arranged. Though this exception addresses a critical unmet need, guidance for operationalizing this service is limited. To facilitate expanded patient access to methadone on ED or hospital discharge at 2 Baltimore hospitals, key stakeholders within the parent health system were identified, and a workgroup was formed. Processes were established for requesting, approving, preparing, and dispensing the methadone supply using an electronic health record order set. Multidisciplinary educational materials were created to support end users of the workflow. In the first 3 months of implementation, 42 requests were entered, of which 36 were approved, resulting in 79 dispensed methadone doses. CONCLUSION This project demonstrates feasibility of methadone dispensing at hospital and ED discharge. Further work is needed to evaluate impact on patient outcomes, such as hospital and ED utilization, length of stay, linkage to treatment, and retention in treatment.
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Affiliation(s)
- Lindsay A Bowman
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Olivia Berger
- Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Suzanne Nesbit
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kenneth B Stoller
- Johns Hopkins Broadway Center for Addiction, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan Buresh
- Bayview Medical Center Addiction Consult Service, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosalyn Stewart
- Johns Hopkins Hospital Addiction Consult Service, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Nakhaee S, Zadeh AA, Madadjoo Y, Azadi NA, Mansouri B. Evaluation of urinary trace element levels in patients with opioid use disorder undergoing methadone treatment in western Iran. Sci Rep 2024; 14:5662. [PMID: 38454098 PMCID: PMC10920885 DOI: 10.1038/s41598-024-56241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
The monitoring of essential and toxic elements in patients with Opioid Use Disorder (OUD) undergoing methadone treatment (MT) is important, and there is limited previous research on the urinary levels of these elements in MT patients. Therefore, the present study aimed to analyze certain elements in the context of methadone treatment compared to a healthy group. In this study, patients with opioid use disorder undergoing MT (n = 67) were compared with a healthy group of companions (n = 62) in terms of urinary concentrations of some essential elements (selenium (Se), zinc (Zn), copper (Cu), iron (Fe), manganese (Mn), calcium (Ca)) and toxic elements (lead (Pb), cadmium (Cd), arsenic (As), and chromium (Cr)). Urine samples were prepared using the acid digestion method with a mixture of nitric acid and perchloric acid and assessed using the ICP-MS method. Our results showed that the two groups had no significant differences in terms of gender, education level, occupation, and smoking status. Urinary concentrations of Se, Cu, and Fe levels were significantly lower in the MT group compared to the healthy subjects. However, the concentrations of Pb, Cd, As, Mn, Cr, and Ca in the MT group were higher than in the healthy group (p < 0.05). No significant difference was established between the levels of Zn in the two groups (p = 0.232). The results of regression analysis revealed that the differences between the concentration levels of all metals (except Zn) between two groups were still remained significant after adjusting for all variables (p < 0.05). The data obtained in the current study showed lower urinary concentrations of some essential elements and higher levels of some toxic elements in the MT group compared to the healthy subjects. These findings should be incorporated into harm-reduction interventions.
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Affiliation(s)
- Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadi Zadeh
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 9717113163, Iran
| | | | - Nammam Ali Azadi
- Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Borhan Mansouri
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Bovell-Ammon BJ, Yan S, Dunn D, Evans EA, Friedmann PD, Walley AY, LaRochelle MR. Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes. JAMA Netw Open 2024; 7:e242732. [PMID: 38497959 PMCID: PMC10949092 DOI: 10.1001/jamanetworkopen.2024.2732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/24/2024] [Indexed: 03/19/2024] Open
Abstract
Importance Agonist medications for opioid use disorder (MOUD), buprenorphine and methadone, in carceral settings might reduce the risk of postrelease opioid overdose but are uncommonly offered. In April 2019, the Massachusetts Department of Correction (MADOC), the state prison system, provided buprenorphine for incarcerated individuals in addition to previously offered injectable naltrexone. Objective To evaluate postrelease outcomes after buprenorphine implementation. Design, Setting, and Participants This cohort study with interrupted time-series analysis used linked data across multiple statewide data sets in the Massachusetts Public Health Data Warehouse stratified by sex due to differences in carceral systems. Eligible participants were individuals sentenced and released from a MADOC facility to the community. The study period for the male sample was January 2014 to November 2020; for the female sample, January 2015 to October 2019. Data were analyzed between February 2022 and January 2024. Exposure April 2019 implementation of buprenorphine during incarceration. Main Outcomes and Measures Receipt of MOUD within 4 weeks after release, opioid overdose, and all-cause mortality within 8 weeks after release, each measured as a percentage of monthly releases who experienced the outcome. Segmented linear regression analyzed changes in outcome rates after implementation. Results A total of 15 225 individuals were included. In the male sample there were 14 582 releases among 12 688 individuals (mean [SD] age, 35.0 [10.8] years; 133 Asian and Pacific Islander [0.9%], 4079 Black [28.0%], 4208 Hispanic [28.9%], 6117 White [41.9%]), a rate of 175.7 releases per month; the female sample included 3269 releases among 2537 individuals (mean [SD] age, 34.9 [9.8] years; 328 Black [10.0%], 225 Hispanic [6.9%], 2545 White [77.9%]), a rate of 56.4 releases per month. Among male participants at 20 months postimplementation, the monthly rate of postrelease buprenorphine receipt was higher than would have been expected under baseline trends (21.2% vs 10.6% of monthly releases; 18.6 additional releases per month). Naltrexone receipt was lower than expected (1.0% vs 6.0%; 8.8 fewer releases per month). Monthly rates of methadone receipt (1.4%) and opioid overdose (1.8%) were not significantly different than expected. All-cause mortality was lower than expected (1.9% vs 2.8%; 1.5 fewer deaths per month). Among female participants at 7 months postimplementation, buprenorphine receipt was higher than expected (31.6% vs 9.5%; 12.4 additional releases per month). Naltrexone receipt was lower than expected (3.4% vs 7.2%) but not statistically significantly different. Monthly rates of methadone receipt (1.1%), opioid overdose (4.8%), and all-cause mortality (1.6%) were not significantly different than expected. Conclusions and Relevance In this cohort study of state prison releases, postrelease buprenorphine receipt increased and naltrexone receipt decreased after buprenorphine became available during incarceration.
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Affiliation(s)
- Benjamin J. Bovell-Ammon
- Departments of Medicine and of Healthcare Delivery and Population Sciences, Baystate Health, Springfield, Massachusetts
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Shapei Yan
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Devon Dunn
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health & Health Sciences, Amherst
| | - Peter D. Friedmann
- Office of Research and Department of Medicine, University of Massachusetts Chan Medical School—Baystate and Baystate Health, Springfield
| | - Alexander Y. Walley
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Marc R. LaRochelle
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Lim S, Cherian T, Katyal M, Goldfeld KS, McDonald R, Wiewel E, Khan M, Krawczyk N, Braunstein S, Murphy SM, Jalali A, Jeng PJ, Rosner Z, MacDonald R, Lee JD. Jail-based medication for opioid use disorder and patterns of reincarceration and acute care use after release: A sequence analysis. J Subst Use Addict Treat 2024; 158:209254. [PMID: 38072387 PMCID: PMC10947890 DOI: 10.1016/j.josat.2023.209254] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Treatment with methadone and buprenorphine medications for opioid use disorder (MOUD) during incarceration may lead to better community re-entry, but evidence on these relationships have been mixed. We aimed to identify community re-entry patterns and examine the association between in-jail MOUD and a pattern of successful reentry defined by rare occurrence of reincarceration and preventable healthcare utilization. METHODS Data came from a retrospective, observational cohort study of 6066 adults with opioid use disorder who were incarcerated in New York City jails and released to the community during 2011-14. An outcome was community re-entry patterns identified by sequence analysis of 3-year post-release reincarceration, emergency department visits, and hospitalizations. An exposure was receipt of in-jail MOUD versus out-of-treatment (42 % vs. 58 %) for the last 3 days before discharge. The study accounted for differences in baseline demographic, clinical, behavioral, housing, and criminal legal characteristics between in-jail MOUD and out-of-treatment groups via propensity score matching. RESULTS This study identified five re-entry patterns: stability (64 %), hospitalization (23 %), delayed reincarceration (7 %), immediate reincarceration (4 %), and continuous incarceration (2 %). After addressing confounding, 64 % and 57 % followed the stability pattern among MOUD and out-of-treatment groups who were released from jail in 2011, respectively. In 2012-14, the prevalence of following the stability pattern increased year-by-year while a consistently higher prevalence was observed among those with in-jail MOUD. CONCLUSIONS Sequence analysis helped define post-release stability based on health and criminal legal system involvement. Receipt of in-jail MOUD was associated with a marker of successful community re-entry.
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Affiliation(s)
- Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America.
| | - Teena Cherian
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Monica Katyal
- NYC Health and Hospitals/Correctional Health Services, New York, NY, United States of America
| | - Keith S Goldfeld
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Ryan McDonald
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Ellen Wiewel
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Maria Khan
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Noa Krawczyk
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, Queens, NY, United States of America
| | - Sean M Murphy
- Weill Cornell Medical College, New York, NY, United States of America
| | - Ali Jalali
- Weill Cornell Medical College, New York, NY, United States of America
| | - Philip J Jeng
- Weill Cornell Medical College, New York, NY, United States of America
| | - Zachary Rosner
- NYC Health and Hospitals/Correctional Health Services, New York, NY, United States of America
| | - Ross MacDonald
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Joshua D Lee
- New York University Grossman School of Medicine, New York, NY, United States of America
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Noya A, Anat S, Shaul S, Miriam A, Einat P. Outcome in methadone maintenance treatment of immigrants from the former Union of Soviet Socialist Republics. Harm Reduct J 2024; 21:55. [PMID: 38429780 PMCID: PMC10905817 DOI: 10.1186/s12954-024-00970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
CONTEXT Immigrants from the former Union of Soviet Socialist Republics (USSR) are more prevalent in Methadone maintenance treatment (MMT) in Israel than their percentage in the general population. AIMS To compare their characteristics and outcomes to those of Israeli-born and other immigrant patients. METHODS Retention and survival since admission (June/1993-Dec/2022) until leaving treatment (for retention), or at the end of follow-up were analyzed. Vital data was taken from a national registry. Predictors were estimated using Kaplan-Meier and Cox regression models. RESULTS The USSR patients (N = 262) compared with other immigrants (N = 132) and Israeli-born (N = 696) were more educated (≥ 12y) (p < 0.001), admitted to MMT at a younger age (p < 0.001), following a shorter duration of opioid usage (p < 0.001). More of them ever injected drugs (p < 0.001) and ever drank alcohol (p < 0.001). One-year retention was comparable (77.2% vs. 75.6% and 72%, p = 0.2) as did opioid discontinuation in those who stayed (p = 0.2). Former USSR patients had longer cumulative retention of their first admission (p = 0.05) with comparable overall retention since first admission, and survival, although the age of death was younger. Specific origin within the former USSR found immigrants from the Russian Federation with the best outcome, and those from Ukraine as having high HIV seropositive and shorter retention. CONCLUSIONS Despite several characteristics known to be associated with poor outcomes, former USSR immigrants showed better adherence to MMT, reflected by their longer cumulative retention in their first admission, lower rate of readmissions, and a comparable survival and overall retention in treatment. An in depth study is needed in order to understand why they decease at a younger age.
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Affiliation(s)
- Ayali Noya
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Sason Anat
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Schreiber Shaul
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Adelson Miriam
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Peles Einat
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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21
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Morales P, Santiago L, Rosario J, Garcia-Fragoso L, Duconge J, Perez N, Santiago D. Neonatal Abstinence Syndrome and Corresponding Pharmacotherapy Approaches from 2 University-affiliated Neonatal Intensive Care Units in Puerto Rico (2018-2020). P R Health Sci J 2024; 43:25-31. [PMID: 38512758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Neonatal abstinence syndrome (NAS) is a set of drug withdrawal symptoms suffered by neonates exposed to drugs in utero. Several studies have widely described NAS incidence and treatment approach; however, little is known regarding the incidence and manifestations of this disease in Puerto Rico (PR). The principal aim of this study was to describe NAS incidence in the neonatal units of hospitals affiliated with the University of PR in terms of occurrence, clinical manifestations, and treatment approaches. METHODS Our study evaluated the medical records of NAS babies diagnosed from 2018 through 2020 at 2 hospitals affiliated with the University of PR Medical Sciences Campus. Descriptive and inferential statistics were employed to analyze trends. RESULTS We identified 12 neonates diagnosed with NAS, 5 with low birthweights (<2500 g); for a NAS incidence of 2 cases per 1000 admitted for the 3 years of recollected data. The urine toxicology results revealed that 9 had experienced intrauterine polydrug exposure. Phenobarbital loading dose were determined on the day of diagnosis (indicated by Finnegan score). The first manifestation of NAS symptoms varied: 8 neonates showed symptoms within 48 hours after birth, whereas 4 had withdrawal symptoms within 72-120 hours of their births. Differences between dosing practices and guidelines were observed, ranging from a 0.69% to a 25% difference during treatment initiation. CONCLUSION Further research on the incidence of NAS in PR (national level) is needed for a deeper understanding that we hope will lead to the development of enhanced treatment protocols in PR.
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Affiliation(s)
- Pamela Morales
- School of Pharmacy, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Laura Santiago
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Jessica Rosario
- Department of Pediatrics, San Juan City Hospital, San Juan, Puerto Rico
| | - Lourdes Garcia-Fragoso
- Neonatology section, Department of Pediatrics, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Jorge Duconge
- School of Pharmacy, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Naidy Perez
- The Alliance for Clinical and Translational Research
| | - Darlene Santiago
- School of Pharmacy, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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22
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Abraham AJ, Harris SJ, Yarbrough CR. Introduction of Medicare coverage in opioid treatment programs: Findings from the first three years. J Subst Use Addict Treat 2024; 158:209247. [PMID: 38072386 PMCID: PMC10947910 DOI: 10.1016/j.josat.2023.209247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Prior to January of 2020, there was no Medicare reimbursement for services delivered in opioid treatment programs (OTPs). OTPs are the only authorized providers of opioid use disorder (OUD) treatment with methadone, a critical tool to address the opioid overdose crisis. While prior research has examined the availability of MOUD other than methadone for Medicare beneficiaries, research has not identified organizational and local Medicare beneficiary characteristics associated with Medicare insurance acceptance among OTPs. OBJECTIVES This study has two objectives: 1) to determine the extent to which OTPs began accepting Medicare insurance in the first three years following the new Medicare OTP benefit; and 2) to identify organizational characteristics and local Medicare beneficiary characteristics associated with OTP acceptance of Medicare. METHODS We used data from the 2021-2023 National Directory of Drug and Alcohol Abuse Treatment Facilities to examine OTP acceptance of Medicare. We used logistic regression to identify organizational characteristics and local Medicare beneficiary characteristics associated with OTP acceptance of Medicare (n = 4630 OTPs). RESULTS By 2022, about 78.7 % of OTPs accepted Medicare, compared to only 41.1 % of non-OTPs. The odds of Medicare acceptance were lower among for-profit OTPs, compared to non-profit OTPs, and higher among OTPs that accepted Medicaid and private insurance. Additionally, the odds of accepting Medicare were lower for OTPs located in the Northeast, Midwest, and South, compared to OTPs located in the West. Finally, the odds of accepting Medicare were higher for OTPs located in counties with higher percentages of Non-Hispanic White Medicare beneficiaries. CONCLUSIONS We found high rates of Medicare acceptance among OTPs in the first three years of the Medicare OTP benefit, suggesting increased access to OUD treatment via OTPs for Medicare beneficiaries. While promising, results indicate potential geographic and racial/ethnic disparities in access to OTPs.
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Affiliation(s)
- Amanda J Abraham
- University of Georgia, School of Public and International Affairs, Department of Public Administration and Policy, United States of America.
| | - Samantha J Harris
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy and Management, United States of America
| | - Courtney R Yarbrough
- Emory University, Rollins School of Public Health, Department of Health Policy and Management, United States of America
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Atluru S, Bruehlman AK, Vaughn P, Schauberger CW, Smid MC. Naltrexone Compared With Buprenorphine or Methadone in Pregnancy: A Systematic Review. Obstet Gynecol 2024; 143:403-410. [PMID: 38227945 DOI: 10.1097/aog.0000000000005510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/30/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Although naltrexone is an evidence-based medication for opioid use disorder (MOUD), few data are available with use in pregnancy. Our objective was to assess outcomes of pregnant individuals with opioid use disorder (OUD) taking naltrexone compared with those taking methadone or buprenorphine. DATA SOURCES We undertook a systematic review using electronic database search (PubMed, CINAHL, EMBASE, PsycInfo), conference proceedings, and trial registries including ClinicalTrials.gov . METHODS OF STUDY SELECTION We conducted an electronic search of research articles through May 2023 for randomized controlled trials, prospective cohort, and retrospective cohort studies of naltrexone (oral, implant, or extended release) compared with methadone or buprenorphine (sublingual or extended release) among pregnant individuals with OUD. After double review of all articles, we abstracted obstetric (primary outcome: gestational age at delivery), neonatal (primary outcome: neonatal abstinence syndrome [NAS]), and substance use outcomes. TABULATION, INTEGRATION, AND RESULTS Five studies met eligibility criteria; four were retrospective cohort studies, and one was a prospective cohort study. Four studies included data on gestational age at delivery (weeks) with no difference detected between the two groups in any study (mean difference ranging -0.20, 95% CI, -1.49-1.09 to 0.8, 95% CI, -0.15 to 1.75). Three studies included data on NAS with all studies detecting a lower risk in the naltrexone group compared with methadone or buprenorphine (relative risk ranging from 0.08, 95% CI, 0.01-1.16 to 0.15, 95% CI, 0.06-0.36). Most studies (four of five) had a moderate or high potential for selection bias primarily driven by small sample size and lack of controlling for confounders. CONCLUSION Although the evidence base is limited, available data suggest that naltrexone use in pregnancy is a reasonable MOUD option with reassuring perinatal outcomes. To enhance confidence in this conclusion and to assess substance use outcomes, further comparative studies of pregnant people with OUD taking naltrexone and other MOUD types are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, 42017074249.
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Affiliation(s)
- Sreevalli Atluru
- Department of Family Medicine and Community Health, and the Division of Hospital Medicine, Department of Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison, and Addiction Medical Services, Onalaska, Wisconsin; the Department of Pediatrics, University of Utah School of Medicine, and the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah; and the Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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24
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Qin Y, Sun Q, Wang L, Hu F, Zhang Q, Wang W, Li W, Wang Y. DRD2 TaqIA polymorphism-related functional connectivity between anterior insula and dorsolateral prefrontal cortex predicts the retention time in heroin-dependent individuals under methadone maintenance treatment. Eur Arch Psychiatry Clin Neurosci 2024; 274:433-443. [PMID: 37400684 DOI: 10.1007/s00406-023-01626-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/22/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Dopamine receptor D2 (DRD2) TaqIA polymorphism has an influence on addiction treatment response and prognosis by mediating brain dopaminergic system efficacy. Insula is crucial for conscious urges to take drugs and maintain drug use. However, it remains unclear about the contribution of DRD2 TaqIA polymorphism to the regulation of insular on addiction behavioral and its relation with the therapeutic effect of methadone maintenance treatment (MMT). METHODS 57 male former heroin dependents receiving stable MMT and 49 matched male healthy controls (HC) were enrolled. Salivary genotyping for DRD2 TaqA1 and A2 alleles, brain resting-state functional MRI scan and a 24-month follow-up for collecting illegal-drug-use information was conducted and followed by clustering of functional connectivity (FC) patterns of HC insula, insula subregion parcellation of MMT patients, comparing the whole brain FC maps between the A1 carriers and non-carriers and analyzing the correlation between the genotype-related FC of insula sub-regions with the retention time in MMT patients by Cox regression. RESULTS Two insula subregions were identified: the anterior insula (AI) and the posterior insula (PI) subregion. The A1 carriers had a reduced FC between the left AI and the right dorsolateral prefrontal cortex (dlPFC) relative to no carriers. And this reduced FC was a poor prognostic factor for the retention time in MMT patients. CONCLUSION DRD2 TaqIA polymorphism affects the retention time in heroin-dependent individuals under MMT by mediating the functional connectivity strength between left AI and right dlPFC, and the two brain regions are promising therapeutic targets for individualized treatment.
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Affiliation(s)
- Yue Qin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China
- Department of Radiology, Xi'an Daxing Hospital, Xi'an, People's Republic of China
| | - Qinli Sun
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China
| | - Lei Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China
- Department of Radiology, Xi'an Daxing Hospital, Xi'an, People's Republic of China
| | - Feng Hu
- Department of Radiology, Hospital of Shaannxi Provincial Geology and Mineral Resources Bureau, Xi'an, People's Republic of China
| | - Qiuli Zhang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, 710038, People's Republic of China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, 710038, People's Republic of China.
| | - Yarong Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China.
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Grady D. The Importance of Treating Opioid Use Disorder in Pregnancy. JAMA Intern Med 2024; 184:255. [PMID: 38252422 DOI: 10.1001/jamainternmed.2023.7272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Deborah Grady
- Department of Medicine, University of California, San Francisco
- Deputy Editor, JAMA Internal Medicine
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26
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Qian G, Humphreys K, Goldhaber-Fiebert JD, Brandeau ML. Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis. Drug Alcohol Depend 2024; 256:111112. [PMID: 38335797 PMCID: PMC10940194 DOI: 10.1016/j.drugalcdep.2024.111112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/12/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
AIM To assess the effectiveness and cost-effectiveness of buprenorphine and methadone treatment in the U.S. if exemptions expanding coverage for substance use disorder services via telehealth and allowing opioid treatment programs to supply a greater number of take-home doses of medications for opioid use disorder (OUD) continue (Notice of Proposed Rule Making, NPRM). DESIGN SETTING AND PARTICIPANTS Model-based analysis of buprenorphine and methadone treatment for a cohort of 100,000 individuals with OUD, varying treatment retention and overdose risk among individuals receiving and not receiving methadone treatment compared to the status quo (no NPRM). INTERVENTION Buprenorphine and methadone treatment under NPRM. MEASUREMENTS Fatal and nonfatal overdoses and deaths over five years, discounted lifetime per person QALYs and costs. FINDINGS For buprenorphine treatment under the status quo, 1.21 QALYs are gained at a cost of $19,200/QALY gained compared to no treatment; with 20% higher treatment retention, 1.28 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment, and the strategy dominates the status quo. For methadone treatment under the status quo, 1.11 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment. In all scenarios, methadone provision cost less than $20,000/QALY gained compared to no treatment, and less than $50,000/QALY gained compared to status quo methadone treatment. CONCLUSIONS Buprenorphine and methadone OUD treatment under NPRM are likely to be effective and cost-effective. Increases in overdose risk with take-home methadone would reduce health benefits. Clinical and technological strategies could mitigate this risk.
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Affiliation(s)
- Gary Qian
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
| | - Keith Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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Kazi I, Chenoweth MJ, Jutras-Aswad D, Ahamad K, Socias ME, Le Foll B, Tyndale RF. Pharmacogenetics of Biochemically Verified Abstinence in an Opioid Agonist Therapy Randomized Clinical Trial of Methadone and Buprenorphine/Naloxone. Clin Pharmacol Ther 2024; 115:506-514. [PMID: 38009933 DOI: 10.1002/cpt.3112] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
Methadone and buprenorphine/naloxone are opioid agonist therapies for opioid use disorder treatment. Genetic factors contribute to individual differences in opioid response; however, little is known regarding genetic associations with clinical outcomes in people receiving opioid agonist therapies. Participants diagnosed with opioid use disorder, principally consisting of prescription opioids (licit or illicit), were randomized to methadone or buprenorphine/naloxone for 24 weeks of daily treatment (NCT03033732). Urine was collected at 12 biweekly study visits and analyzed for non-treatment opioids. Variants in genes involved in methadone metabolism (CYP2B6, CYP2C19, and CYP3A4), buprenorphine metabolism (CYP3A4 and UGT2B7), and μ-opioid receptor function (OPRM1) were genotyped and analyzed for their association with the number of non-treatment opioid-free urine screens. Primary analyses focused on the last 12 weeks (6 study visits, post-titration) of treatment among those reporting White ethnicity. Additional sensitivity and exploratory analyses were performed. Among methadone-treated participants (n = 52), the OPRM1 rs1799971 AA genotype (vs. G-genotypes, i.e., having one or two G alleles) was associated with greater opioid-free urine screens (incidence rate ratio = 5.24, 95% confidence interval (CI) = 2.43-11.26, P = 0.000023); longitudinal analyses showed a significant genotype-by-time interaction over the full 24 weeks (12 study visits, β = -0.28, 95% CI = -0.45 to -0.11, P = 0.0015). Exploratory analyses suggest an OPRM1 rs1799971 genotype effect on retention. No evidence of association was found between other genetic variants, including in metabolic variants, and non-treatment opioid-free urine screens in the methadone or buprenorphine/naloxone arms. Those with the OPRM1 rs1799971 G-genotypes may have a poorer response to methadone maintenance treatment, an effect that persisted through 24 weeks of treatment.
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Affiliation(s)
- Intishar Kazi
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Meghan J Chenoweth
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Keith Ahamad
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Homayra F, Enns B, Min JE, Kurz M, Bach P, Bruneau J, Greenland S, Gustafson P, Karim ME, Korthuis PT, Loughin T, MacLure M, McCandless L, Platt RW, Schnepel K, Shigeoka H, Siebert U, Socias E, Wood E, Nosyk B. Comparative Analysis of Instrumental Variables on the Assignment of Buprenorphine/Naloxone or Methadone for the Treatment of Opioid Use Disorder. Epidemiology 2024; 35:218-231. [PMID: 38290142 PMCID: PMC10833049 DOI: 10.1097/ede.0000000000001697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Instrumental variable (IV) analysis provides an alternative set of identification assumptions in the presence of uncontrolled confounding when attempting to estimate causal effects. Our objective was to evaluate the suitability of measures of prescriber preference and calendar time as potential IVs to evaluate the comparative effectiveness of buprenorphine/naloxone versus methadone for treatment of opioid use disorder (OUD). METHODS Using linked population-level health administrative data, we constructed five IVs: prescribing preference at the individual, facility, and region levels (continuous and categorical variables), calendar time, and a binary prescriber's preference IV in analyzing the treatment assignment-treatment discontinuation association using both incident-user and prevalent-new-user designs. Using published guidelines, we assessed and compared each IV according to the four assumptions for IVs, employing both empirical assessment and content expertise. We evaluated the robustness of results using sensitivity analyses. RESULTS The study sample included 35,904 incident users (43.3% on buprenorphine/naloxone) initiated on opioid agonist treatment by 1585 prescribers during the study period. While all candidate IVs were strong (A1) according to conventional criteria, by expert opinion, we found no evidence against assumptions of exclusion (A2), independence (A3), monotonicity (A4a), and homogeneity (A4b) for prescribing preference-based IV. Some criteria were violated for the calendar time-based IV. We determined that preference in provider-level prescribing, measured on a continuous scale, was the most suitable IV for comparative effectiveness of buprenorphine/naloxone and methadone for the treatment of OUD. CONCLUSIONS Our results suggest that prescriber's preference measures are suitable IVs in comparative effectiveness studies of treatment for OUD.
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Affiliation(s)
- Fahmida Homayra
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Benjamin Enns
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Jeong Eun Min
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Megan Kurz
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Bruneau
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Sander Greenland
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - P Todd Korthuis
- Addiction Medicine Section, Department of Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas Loughin
- Department of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Malcolm MacLure
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lawrence McCandless
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Robert William Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Kevin Schnepel
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Hitoshi Shigeoka
- Department of Economics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Uwe Siebert
- Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Program on Cardiovascular Research, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Eugenia Socias
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Chalabianloo F, Fadnes LT, Johansson KA, Høiseth G, Vold JH, Kringen MK, Spigset O, Bramness JG. Methadone pharmacokinetics in opioid agonist treatment: Influencing factors and clinical implications. Basic Clin Pharmacol Toxicol 2024; 134:333-344. [PMID: 38124280 DOI: 10.1111/bcpt.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND A considerable inter-individual variability has been reported in the relationship between methadone doses applied and serum concentrations achieved in methadone maintenance treatment. However, the underlying causes for this variability are not fully understood. OBJECTIVES We investigated the influence of genetic, pathophysiological and pharmacological factors on serum methadone concentration-to-dose ratio (CDR) and discussed the clinical implications of the findings. METHODS We used data from two retrospective laboratory databases and a prospective cohort study to investigate the impact on methadone CDR of hepatic cytochrome P450 enzyme system (CYP) genetic polymorphisms, age, sex, concomitant medication, liver fibrosis and body mass index through linear mixed model analyses. FINDINGS A positive association was found between CDR and the homozygous CYP2B6*6 genotype, concurrent treatment with CYP3A4 inhibitors and body mass index. CDR was lower among women and during concomitant use of CYP inducers. CDR was not associated with age or the degree of liver fibrosis in our investigations. CONCLUSIONS This research work supports the need for individually tailored dosage considering the various factors that influence methadone CDR. The gained knowledge can contribute to reducing the risks associated with the treatment and optimizing the desired outcomes.
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Affiliation(s)
- Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gudrun Høiseth
- Department of Forensic Medicine, Oslo University Hospital, Oslo, Norway
- Center for psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
| | - Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jørgen G Bramness
- Institute of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Competency Centre for Dual Disorder, Innland Hospital Trust, Hamar, Norway
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Krichbaum M, Fernandez D, Singh-Franco D. Barriers and Best Practices on the Management of Opioid Use Disorder. J Pain Palliat Care Pharmacother 2024; 38:56-73. [PMID: 38100521 DOI: 10.1080/15360288.2023.2290565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/26/2023] [Indexed: 12/17/2023]
Abstract
Opioids refer to chemicals that agonize opioid receptors in the body resulting in analgesia and sometimes, euphoria. Opiates include morphine and codeine; semi-synthetic opioids include heroin, hydrocodone, oxycodone, and buprenorphine; and fully synthetic opioids include tramadol, fentanyl and methadone. In 2021, an estimated 5.6 million individuals met criteria for opioid use disorder. This article provides an overview of the pharmacology of heroin and non-prescription fentanyl (NPF) and its synthetic analogues, and summarizes the literature related to the management of opioid use disorder, overdose, and withdrawal. This is followed by a description of barriers to treatment and best practices for management with a discussion on recent updates and their potential impact on this patient population. This is followed by a description of barriers to treatment and best practices for management with a discussion on recent updates and their potential impact on this patient population.
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Affiliation(s)
- Michelle Krichbaum
- Clinical Manager-Pain Management and Palliative Care, Baptist Health South Florida, Miami, FL, USA
| | | | - Devada Singh-Franco
- Associate Professor, Pharmacy Practice, Nova Southeastern University, Health Professions Division, Barry and Judy Silverman College of Pharmacy, Fort Lauderdale, FL, USA
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Poland C, Stoltman JJK, Felton JW. Medication for the Treatment of Opioid Use Disorder in Pregnancy Is Essential. JAMA Intern Med 2024; 184:254-255. [PMID: 38252452 DOI: 10.1001/jamainternmed.2023.6977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Cara Poland
- Henry Ford Health + Michigan State University Health Sciences, Grand Rapids
| | | | - Julia W Felton
- Henry Ford Health + Michigan State University Health Sciences, Grand Rapids
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Martin FS, Gosse M, Whelan E. 'Planning for a healthy baby and a healthy pregnancy': A critical analysis of Canadian clinical practice guidelines for the treatment of opioid dependence during pregnancy. Sociol Health Illn 2024; 46:514-533. [PMID: 37843508 DOI: 10.1111/1467-9566.13721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/06/2023] [Indexed: 10/17/2023]
Abstract
As opioid fatalities rise in North America, the need to improve the supports available to those who are dependent on opioids and pregnant has become more urgent. This paper discusses the social organisation of drug treatment supports for those who are pregnant, using Canadian clinical practice guidelines (CPGs) for methadone maintenance treatment (MMT) as a case study. Pregnant patients are a priority population for MMT, both in Canada and internationally; the regulatory bodies that oversee MMT in Canada are the provincial Colleges of Physician and Surgeons and Health Canada. The paper analyses MMT CPGs published by these agencies, comparing their general recommendations to those specific to pregnant patients. We demonstrate that the guidelines address few treatment considerations for pregnant patients, other than improved birth outcomes and child welfare, despite acknowledging their more complex needs. Drawing on social science studies of gender and drugs, we argue that MMT CPGs therefore perpetuate the intensified surveillance and foetal prioritisation that have long generated barriers to care for opiate-dependent pregnant patients. We also discuss how and why the CPGs ultimately only reinforced these current limitations in the drug treatment sector.
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Affiliation(s)
- Fiona S Martin
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Meghan Gosse
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma Whelan
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
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Zorani S, Peles E. Is pain empathy associated with pain indices and trauma history? A comparison between patients receiving methadone maintenance treatment and healthy controls. J Psychiatr Res 2024; 171:286-295. [PMID: 38335639 DOI: 10.1016/j.jpsychires.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND To study whether pain empathy and theory of mind (ToM) are related to pain indices and trauma experience, we studied opioid users receiving methadone maintenance treatment (MMT), a population with a history of traumas and a high prevalence of chronic pain. METHODS MMT patients (n = 53), substance abuse-free, with no impaired cognition (Montreal Cognitive Assessment (MoCA) ≥24), were compared to healthy controls (HC) matched by age and gender (n = 66). All participants were assessed using Reading the Mind in the Eyes (RMET) for ToM, empathy (Interpersonal Reactivity Index [IRI], Empathy Quotient Scale for Adults [EQ60]), and Pain Empathy [PE task]). An algometer was used for pain pressure threshold, and supra-pain threshold was rated using a visual analog scale (VAS). Catastrophizing, McGill pain, Negative life events (NLE), and MoCA questionnaires were administered. Substance abuse was tested in the urine of MMT patients and self-reported by HC. RESULTS MMT, compared to HC, were less educated with more NLE and a lower RMET (logistic regression). Groups had comparable empathy and pain indices, except for higher supra-threshold VAS rating and catastrophizing in univariate analyses. Pain empathy (PE) correlated with NLE in HC, and in MMT, with catastrophizing, which correlated with NLE, perceived stress, and pain intensity. Higher empathy was observed in 18 participants with a history of sexual abuse (83.3 % belong to the MMT group). CONCLUSIONS Pain Empathy was found to be associated with personal suffering experience in both groups, as reflected by correlations with NLE in HC and with catastrophizing, which correlates with NLE, stress, and pain intensity, in MMT.
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Affiliation(s)
- Shlomit Zorani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; D Miriam and Sheldon G. Adelson Clinic for Drug Use, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Einat Peles
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; D Miriam and Sheldon G. Adelson Clinic for Drug Use, Treatment and Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Nedjat S, Wang Y, Eshtiaghi K, Fleming M. Is there a disparity in medications for opioid use disorder based on race/ethnicity and gender? A systematic review and meta-analysis. Res Social Adm Pharm 2024; 20:236-245. [PMID: 38101952 DOI: 10.1016/j.sapharm.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Access to medications for opioid use disorder (MOUD) among racial/ethnic minorities is a growing concern. OBJECTIVES Inequalities in receiving MOUD among gender and racial/ethnic groups were examined in this systematic review. METHODS Studies were retrieved by searching various databases and reference lists of reviews and selected full texts. Adjusted Odds Ratios (AORs) comparing MOUDs among racial/ethnic minorities to Whites were extracted or estimated from their findings. Meta-analysis was performed using STATA 17. RESULTS After screening 2438 records, 19 studies were included in this review in two categories. The first category consists of 11 studies comparing receiving MOUD between different races/ethnicities and genders at the individual level. The meta-analysis regarding AORs comparing Blacks, Hispanics, Asians, Native Americans/Alaska-Natives, Hawaiians, and mixed-race patients with Whites were 0.56 (95 % CI: 0.45-0.68), 0.72 (95 % CI: 0.55-0.94), 0.85 (95 % CI: 0.72-0.99), 0.88 (95%CI: 0.73-1.04), 0.27 (95 % CI: 0.03-2.18), and 0.97 (95 % CI: 0.81-1.16), respectively. The AOR of receiving MOUD for all minorities compared to Whites was 0.70 (95 % CI: 0.61-0.80). Overall AOR comparing MOUD for females to males was 0.95 (95 % CI: 0.87-1.04). The second category of articles compared buprenorphine and methadone treatment among ethnic/racial minorities and Whites. CONCLUSIONS Compared to Whites, Blacks, Hispanics, and Asians have limited access to MOUD. The findings suggest that methadone is the predominant medication for racial/ethnic minorities, while Whites and high-income communities receive buprenorphine more. It is crucial to re-design policies to bridge the gap in access to MOUD.
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Affiliation(s)
- Saharnaz Nedjat
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Yun Wang
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Khashayar Eshtiaghi
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Marc Fleming
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA.
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Goich M, Bascuñán A, Faúndez P, Siel D. Comparison of analgesic efficacy of tramadol, morphine and methadone in cats undergoing ovariohysterectomy. J Feline Med Surg 2024; 26:1098612X231224662. [PMID: 38545955 DOI: 10.1177/1098612x231224662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVES The aim of this study was to compare the analgesic efficacy and the effect on physiological variables and behavior of the use of tramadol, methadone and morphine as preoperative analgesia in healthy cats undergoing elective ovariohysterectomy. METHODS Cats undergoing ovariohysterectomy were randomly assigned to receive one of the following premedication treatments intramuscularly: methadone (0.2 mg/kg; n = 10); morphine (0.2 mg/kg; n = 10); or tramadol (3 mg/kg; n = 10). Induction of anesthesia was done with propofol, and maintenance of anesthesia was done with isoflurane. Intraoperative heart rate, arterial blood pressure, respiratory rate, end-tidal isoflurane concentration and frequency of rescue analgesia (fentanyl 2.5 µg/kg) were compared between groups. Postoperative analgesia was assessed using the UNESP-Botucatu Multidimensional Composite Pain Scale, and perioperative serum glucose, cortisol concentrations and postoperative rescue analgesia were evaluated. RESULTS Intraoperative rescue analgesia was required in 76.5% of cats at some time during surgery, and 27% of cats required postoperative rescue analgesia up to 6 h after extubation. There were no significant differences between groups with respect to intraoperative and postoperative rescue analgesia, pain scale scores and end-tidal isoflurane concentrations. In the immediate postoperative period, after extubation, most of the patients presented with hypothermia; however, 1-6 h postoperatively, hyperthermia was observed in most of the patients, and was most common in the tramadol group. CONCLUSIONS AND CLINICAL RELEVANCE Under the conditions of this study, methadone, morphine and tramadol produced satisfactory postoperative analgesia in most of the cats undergoing ovariohysterectomy, and the effects lasted up to 6 h postoperatively. Intraoperative analgesia was not sufficient in most cases. Significant cardiovascular or respiratory effects contraindicating the use of these drugs were not found. Postanesthetic hyperthermia occurred with all opioids studied and was more frequent in the tramadol group.
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Affiliation(s)
- Mariela Goich
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Alejandra Bascuñán
- Hospital Clínico Veterinario de la Universidad de Chile sede Bilbao, Santiago, Chile
| | - Patricio Faúndez
- Hospital Clínico Veterinario de la Universidad de Chile sede Bilbao, Santiago, Chile
| | - Daniela Siel
- Escuela de Medicina Veterinaria, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
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Morin KA, Tatangelo M, Marsh D. Canadian Addiction Treatment Centre (CATC) opioid agonist treatment cohort in Ontario, Canada. BMJ Open 2024; 14:e080790. [PMID: 38401902 PMCID: PMC10895228 DOI: 10.1136/bmjopen-2023-080790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/14/2024] [Indexed: 02/26/2024] Open
Abstract
PURPOSE The Canadian Addiction Treatment Centre (CATC) cohort was established during a period of increased provision of opioid agonist treatment (OAT), to study patient outcomes and trends related to the treatment of opioid use disorder (OUD) in Canada. The CATC cohort's strengths lie in its unique physician network, shared care model and event-level data, making it valuable for validation and integration studies. The CATC cohort is a valuable resource for examining OAT outcomes, providing insights into substance use trends and the impact of service-level factors. PARTICIPANTS The CATC cohort comprises 32 246 people who received OAT prescriptions between April 2014 and February 2021, with ongoing tri-annual updates planned until 2027. The cohort includes data from all CATC clinics' electronic medical records and includes demographic information and OAT clinical indicators. FINDINGS TO DATE This cohort profile describes the demographic and clinical characteristics of patients being treated in a large OAT physician network. As well, we report the longitudinal OAT retention by treatment type during a time of increasing exposure to a contaminated dangerous drug supply. Notable findings also include retention differences between methadone (32% of patients at 1 year) and buprenorphine (20% at 1 year). Previously published research from this cohort indicated that patient-level factors associated with retention include geographic location, concurrent substance use and prior treatment attempts. Service-level factors such as telemedicine delivery and frequency of urine drug screenings also influence retention. Additionally, the cohort identified rising OAT participation and a substantial increase in fentanyl use during the COVID-19 pandemic. FUTURE PLANS Future research objectives are the longitudinal evaluation of retention and flexible modelling techniques that account for the changes as patients are treated with OAT. Furthermore, future research aims are the use of conditional models, and linkage with provincial-level administrative datasets.
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Affiliation(s)
- Kristen A Morin
- Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
- Health Sciences North, Sudbury, Ontario, Canada
- ICES North, Sudbury, Ontario, Canada
| | - Mark Tatangelo
- Health Sciences North, Sudbury, Ontario, Canada
- ICES North, Sudbury, Ontario, Canada
| | - David Marsh
- Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
- Health Sciences North, Sudbury, Ontario, Canada
- ICES North, Sudbury, Ontario, Canada
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Chung YCE, Tung YC, Wang SC, Huang CL, Chen LY, Chen WJ. Assessing the impact of public funding in alleviating participant reduction and improving the retention rate in methadone maintenance treatment clinics in Taiwan: an interrupted time series analysis. Implement Sci 2024; 19:18. [PMID: 38389082 PMCID: PMC10885479 DOI: 10.1186/s13012-024-01351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Given the steady decline in patient numbers at methadone maintenance treatment (MMT) clinics in Taiwan since 2013, the government initiated Patients' Medical Expenditure Supplements (PMES) in January 2019 and the MMT Clinics Accessibility Maintenance Program (MCAM) in September 2019. This study aims to evaluate the impact of the PMES and MCAM on the enrollment and retention of patients attending MMT clinics and whether there are differential impacts on MMT clinics with different capacities. METHODS The monthly average number of daily participants and 3-month retention rate from 2013 to 2019 were extracted from MMT databases and subjected to single interrupted time series analysis. Pre-PMES (from February 2013 to December 2018) was contrasted with post-PMES, either from January 2019 to December 2019 for clinics funded solely by the PMES or from January 2019 to August 2019 for clinics with additional MCAM. Pre-MCAM (from January 2019 to August 2019) was contrasted with post-MCAM (from September 2019 to December 2019). Based on the monthly average number of daily patients in 2018, each MMT clinic was categorized as tiny (1-50), small (51-100), medium (101-150), or large (151-700) for subsequent stratification analysis. RESULTS In terms of participant numbers after the PMES intervention, a level elevation and slope increase were detected in the clinics at every scale except medium in MMT clinics funded solely by PMES. In MMT clinics with subsequent MCAM, a level elevation was only detected in small-scale clinics, and a slope increase in the participant numbers was detected in tiny- and small-scale clinics. The slope decrease was also detected in medium-scale clinics. In terms of the 3-month retention rate, a post-PMES level elevation was detected at almost every scale of the clinics, and a slope decrease was detected in the overall and tiny-scale clinics for both types of clinics. CONCLUSIONS Supplementing the cost of a broad treatment repertoire enhances the enrollment of people with heroin use in MMTs. Further funding of human resources is vital for MMT clinics to keep up with the increasing numbers of participants and their retention.
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Affiliation(s)
- Yu-Chu Ella Chung
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chieh-Liang Huang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Lian-Yu Chen
- Department of Mental Health, Ministry of Health and Welfare, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei J Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Michener PS, Evans EA, Ferguson WJ, Friedmann PD. Diffusion of medications for opioid use disorder treatment in jail settings: a convergent mixed methods study of jail staff perspectives. Addict Sci Clin Pract 2024; 19:10. [PMID: 38347634 PMCID: PMC10863078 DOI: 10.1186/s13722-024-00440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Implementation of medications for opioid use disorder (MOUD) in jails varies by facility and across states. Organizational climate, including staff attitudes toward change and exposure to education, can influence perceptions of innovations like MOUD in jails. Using a mixed methods design, we aimed to understand the association between organizational climate and jail staff perceptions of MOUD. METHODS Jail staff (n = 111) who operate MOUD programs in 6 Massachusetts jails completed surveys that included the Organizational Readiness for Implementing Change (ORIC) survey. Random effects logistic regression models assessed associations between organizational climate and several outcomes of perceived MOUD efficacy, acceptability, and knowledge, while controlling for covariates. Jail staff (N = 61) participated in qualitative interviews and focus groups focused on organizational climate and knowledge diffusion, which we analyzed using inductive and deductive methods. RESULTS The results indicate that organizational change readiness on the ORIC was associated with positive perceptions of MOUD, and educational resources facilitated MOUD implementation. Greater ORIC was associated with higher perception of methadone as highly acceptable for jail populations (Odds ratio [OR] 2.3, 95% Confidence Interval [CI] 1.2 to 4.4), and high knowledge of methadone (OR 2.3, 95% CI 1.1 to 4.9), with similar magnitude of effects for buprenorphine. High levels of training for jail staff on methadone and buprenorphine were also associated with higher knowledge of these medications (Methadone: OR 7.2, 95% CI 2.2 to 23.2; Buprenorphine: OR 3.4, 95% CI 1.2 to 9.5). Qualitative results point towards the importance of organizational climate and elucidate educational strategies to improve staff perceptions of MOUD. CONCLUSION Results underscore the importance of organizational climate for successful implementation of jail MOUD programs and provide support for medication-specific educational resources as a facilitator of successful MOUD implementation in jail settings. Findings highlight implementation strategies that may improve jail staff perceptions of MOUD.
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Affiliation(s)
- Pryce S Michener
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Peter D Friedmann
- Department of Medicine, University of MA Chan Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA
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Haupt LM, Haywood A, Sutherland HG, Yu C, Albury CL, Pharasi A, Zunk M, George R, Griffiths LR, Good P, Hardy J. The effects of OPRM1 118A>G on methadone response in pain management in advanced cancer at end of life. Sci Rep 2024; 14:3411. [PMID: 38341456 PMCID: PMC10858860 DOI: 10.1038/s41598-024-54009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
Cancer pain is the most feared symptom at end of life. Methadone has advantages over other opioids but is associated with significant variability in clinical response, making dosing challenging in practice. OPRM1 is the most studied pharmacogene associated with the pharmacodynamics of opioids, however reports on the association of the A118G polymorphism on opioid dose requirements are conflicting, with no reports including methadone as the primary intervention. This association study on OPRM1 A118G and response to methadone for pain management, includes a review of this genetic factor's role in inter-patient variability. Fifty-four adult patients with advanced cancer were recruited in a prospective, multi-centre, open label dose individualization study. Patient characteristics were not shown to influence methadone response, and no significant associations were observed for methadone dose or pain score. The findings of our review of association studies for OPRM1 A118G in advanced cancer pain demonstrate the importance of taking ancestry into account. While our sample size was small, our results were consistent with European populations, but in contrast to studies in Chinese patients, where carriers of the A118G polymorphism were associated with higher opioid dose requirements. Pharmacogenetic studies in palliative care are challenging, continued contribution will support future genotype-based drug dosing guidelines.
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Affiliation(s)
- Larisa M Haupt
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.
- ARC Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology (QUT), Brisbane, Australia.
- Max Planck Queensland Centre for the Materials Sciences of Extracellular Matrices, Brisbane, Australia.
| | - Alison Haywood
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia.
- Mater Research Institute-The University of Queensland, Brisbane, Australia.
| | - Heidi G Sutherland
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Chieh Yu
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
- Department of Cell and Tissue Biology, University of California, San Francisco, USA
| | - Cassie L Albury
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Anushka Pharasi
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Mathew Zunk
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Rani George
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
- Cancer Trials Unit, Division of Cancer Services, Metro South Health, Brisbane, Australia
| | - Lyn R Griffiths
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Phillip Good
- Mater Research Institute-The University of Queensland, Brisbane, Australia
- Department of Palliative Care, St Vincent's Private Hospital, Brisbane, Australia
| | - Janet Hardy
- Mater Research Institute-The University of Queensland, Brisbane, Australia
- Department of Palliative and Supportive Care, Mater Health, Brisbane, Australia
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Michener PS, Knee A, Wilson D, Boama-Nyarko E, Friedmann PD. Association of random and observed urine drug screening with long-term retention in opioid treatment programs. Drug Alcohol Depend 2024; 255:111067. [PMID: 38183832 PMCID: PMC10956422 DOI: 10.1016/j.drugalcdep.2023.111067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND In the US, opioid treatment providers (OTPs) have wide latitude to perform urine drug screening (UDS) and discharge clients for positive results. OTP clients have identified randomized and directly observed UDS as potentially stigmatizing, but little research has examined the association between UDS modality and retention in OTPs. METHODS This cross-sectional study uses the 2016-2017 NDATSS wave among OTPs that administered methadone. The exposure was a 4-level variable based on whether OTPs had a high percentage (≥ 90% of clients) who experienced randomized, observed, both, or neither modality of UDS. The outcome was the proportion of clients retained in treatment 1 year or longer (long-term retention). Analyses were conducted using fractional logit regression with survey weighting and presented as percentages and 95% confidence intervals. We also present how policies for involuntary clinic discharge modify these effects. RESULTS 150 OTPs were eligible with a median of 310 clients. 40 (27%) OTPs did not highly utilize either randomized or observed UDS, 22 (15%) only highly utilized observed UDS, 42 (28%) only highly utilized randomized UDS and 46 (31%) utilized both practices on ≥ 90% of clients. Adjusted estimates for long-term retention ranged from 57.7% in OTPs that conducted both randomized and observed UDS on ≥ 90% of clients and 70.4% in OTPs that did not highly utilize these practices. Involuntary discharge may moderate this relationship. CONCLUSION Findings showed an association between high utilization of randomized and observed UDS and decreased long-term retention, suggesting that UDS modality may impact long-term OTP retention.
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Affiliation(s)
- Pryce S Michener
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA.
| | - Alexander Knee
- Dept. of Medicine, UMass Chan Medical School - Baystate, 759 Chestnut St, Springfield, MA 01199, USA; Epidemiology/Biostatistics Research Core - Baystate Medical Center, Office of Research, 3601 Main Street, Third Floor, Springfield, MA 01199, USA
| | - Donna Wilson
- Dept. of Medicine, UMass Chan Medical School - Baystate, 759 Chestnut St, Springfield, MA 01199, USA; Epidemiology/Biostatistics Research Core - Baystate Medical Center, Office of Research, 3601 Main Street, Third Floor, Springfield, MA 01199, USA
| | - Esther Boama-Nyarko
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA
| | - Peter D Friedmann
- Dept. of Medicine, UMass Chan Medical School - Baystate, 759 Chestnut St, Springfield, MA 01199, USA
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McLellan AT. Can Smartphone-Based Support Apps Add Value to the Treatment of Opioid Use Disorder? Am J Psychiatry 2024; 181:87-88. [PMID: 38298081 DOI: 10.1176/appi.ajp.20230976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- A Thomas McLellan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Giles M, Reynales L, Jayaraman A, Kaplan O, Verma K, Wiest K, Denney S, Hart C, Bailey SR, Choi D, Hoffman KA, McGovern MP, McCarty D. Usability and feasibility of a take-home methadone web-application for opioid treatment program patients: A Small Business Innovation Research mixed methods study. J Subst Use Addict Treat 2024; 157:209181. [PMID: 37858794 PMCID: PMC10932827 DOI: 10.1016/j.josat.2023.209181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/07/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Most patients in opioid treatment programs (OTPs) attend daily for observed dosing. A Stage IA (create and adapt) and a Stage IB (feasibility and pilot) mixed method studies tested a web-application (app) designed to facilitate access to take-home methadone. METHODS A Stage IA, intervention development study, used qualitative interviews to assess the usability (ease of use) and feasibility (ability to implement) of a take-home methadone app. The Stage IA market research was a two-week test with 96 patient participants from four OTPs. Qualitative interviews were completed with 20 systematically selected individuals who used the take-home app and 20 OTP clinicians (five each from the four OTPs). The Stage IB Small Business Innovation Research (SBIR) study (24 patients and 8 clinicians in a single OTP) included quantitative assessments of the app's usability, acceptability, appropriateness, and feasibility. Thematic analysis coded participant and staff assessments of the take-home app. RESULTS Stage IA patients (mean age = 41 years; 52 % men, 57 % White) and IB patients (mean age = 38 years, 54 % men, 79 % White) described the app as "easy to use." Compared to unsupervised take-homes, some patients preferred using the take-home app. In Stage IB, patients rated the app highly on standardized measures of usability, acceptability, appropriateness, and feasibility. Clinician ratings were more ambivalent. Patients rated in-clinic dosing as more disruptive than unsupervised take-homes and take-homes using the app. DISCUSSION A Stage IA study informed the development and maturation of a Stage IB feasibility pilot study. Overall, the take-home app's usability, acceptability, appropriateness, and feasibility were rated positively. Clinical staff ratings were less positive, but individuals commented that using the app a) enhanced patient quality of life, b) provided new tools for counselors, and c) offered competitive advantages. The SBIR award enhanced market research with more complete and systematic data collection and analysis.
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Affiliation(s)
- Michael Giles
- Sonara Health, Inc., Dallas, TX, United States of America
| | - Lucy Reynales
- Sonara Health, Inc., Dallas, TX, United States of America
| | | | - Omer Kaplan
- Sonara Health, Inc., Dallas, TX, United States of America
| | - Kshitij Verma
- Sonara Health, Inc., Dallas, TX, United States of America
| | | | - Samuel Denney
- Adapt Integrated Health System, Roseburg, OR, United States of America
| | - Cora Hart
- Adapt Integrated Health System, Roseburg, OR, United States of America
| | - Steffani R Bailey
- School of Medicine, Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Dongseok Choi
- OHSU - PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States of America
| | - Kim A Hoffman
- School of Medicine, Department of General and Internal Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Mark P McGovern
- Stanford University School of Medicine, Department of Psychiatry & Behavioral Sciences, Stanford, CA, United States of America
| | - Dennis McCarty
- School of Medicine, Department of General and Internal Medicine, Oregon Health & Science University, Portland, OR, United States of America; OHSU - PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States of America.
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Gustafson DH, Landucci G, Vjorn OJ, Gicquelais RE, Goldberg SB, Johnston DC, Curtin JJ, Bailey GL, Shah DV, Pe-Romashko K, Gustafson DH. Effects of Bundling Medication for Opioid Use Disorder With an mHealth Intervention Targeting Addiction: A Randomized Clinical Trial. Am J Psychiatry 2024; 181:115-124. [PMID: 37789744 PMCID: PMC10843669 DOI: 10.1176/appi.ajp.20230055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Medication for opioid use disorder (MOUD) improves treatment retention and reduces illicit opioid use. A-CHESS is an evidence-based smartphone intervention shown to improve addiction-related behaviors. The authors tested the efficacy of MOUD alone versus MOUD plus A-CHESS to determine whether the combination further improved outcomes. METHODS In an unblinded parallel-group randomized controlled trial, 414 participants recruited from outpatient programs were assigned in a 1:1 ratio to receive either MOUD alone or MOUD+A-CHESS for 16 months and were followed for an additional 8 months. All participants were on methadone, buprenorphine, or injectable naltrexone. The primary outcome was abstinence from illicit opioid use; secondary outcomes were treatment retention, health services use, other substance use, and quality of life; moderators were MOUD type, gender, withdrawal symptom severity, pain severity, and loneliness. Data sources were surveys comprising multiple validated scales, as well as urine screens, every 4 months. RESULTS There was no difference in abstinence between participants in the MOUD+A-CHESS and MOUD-alone arms across time (odds ratio=1.10, 95% CI=0.90-1.33). However, abstinence was moderated by withdrawal symptom severity (odds ratio=0.95, 95% CI=0.91-1.00) and MOUD type (odds ratio=0.57, 95% CI=0.34-0.97). Among participants without withdrawal symptoms, abstinence rates were higher over time for those in the MOUD+A-CHESS arm than for those in the MOUD-alone arm (odds ratio=1.30, 95% CI=1.01-1.67). Among participants taking methadone, those in the MOUD+A-CHESS arm were more likely to be abstinent over time (b=0.28, SE=0.09) than those in the MOUD-alone arm (b=0.06, SE=0.08), although the two groups did not differ significantly from each other (∆b=0.22, SE=0.11). MOUD+A-CHESS was also associated with greater meeting attendance (odds ratio=1.25, 95% CI=1.05-1.49) and decreased emergency department and urgent care use (odds ratio=0.88, 95% CI=0.78-0.99). CONCLUSIONS Overall, MOUD+A-CHESS did not improve abstinence relative to MOUD alone. However, MOUD+A-CHESS may provide benefits for subsets of patients and may impact treatment utilization.
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Affiliation(s)
- David H. Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, University of Wisconsin–Madison
| | - Gina Landucci
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
| | - Olivia J. Vjorn
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
| | | | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin–Madison
- Center for Healthy Minds, University of Wisconsin–Madison
| | - Darcie C. Johnston
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
| | - John J. Curtin
- Department of Psychology, University of Wisconsin–Madison
| | - Genie L. Bailey
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I
- Stanley Street Treatment and Resources (SSTAR), Fall River, Mass
| | - Dhavan V. Shah
- School of Journalism and Mass Communication, University of Wisconsin–Madison
| | - Klaren Pe-Romashko
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
| | - David H. Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
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López-Castro T, Jakubowski A, Masyukova M, Peterson M, Pierz A, Kodali S, Arnsten JH, Starrels JL, Nahvi S. Loss, liberation, and agency: Patient experiences of methadone treatment at opioid treatment programs during the COVID-19 pandemic. J Subst Use Addict Treat 2024; 157:209235. [PMID: 38061636 PMCID: PMC10932891 DOI: 10.1016/j.josat.2023.209235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Despite its safety and effectiveness, methadone treatment for opioid use disorder (OUD) remains highly stigmatized, and stringent opioid treatment program (OTP) attendance requirements create barriers to retention for many patients. The COVID-19 pandemic prompted a shift in federal regulations governing methadone, including a blanket exemption permitting increased take-home doses of methadone. We studied the impact of these changes upon established patients' experiences of OTP care. METHOD We conducted semi-structured qualitative interviews with 18 OTP patients who met our criteria of having established OTP care (i.e., enrolled at the OTP for at least 12 weeks) and were administered methadone three to six days weekly prior to the March 2020 blanket exemption. Interviews centered on how COVID-19 had affected their experiences of receiving treatment at an OTP. RESULTS We identified three interconnected themes relevant to transformation of OTP care by the COVID-19 pandemic. Participants described mourning therapeutic OTP relationships and structure (1. loss), yet feeling more satisfaction with fewer in-person OTP visits (2. liberation), and appreciating more opportunities to self-direct their OUD care (3. agency). DISCUSSION Structural changes made to OTP care early in the COVID-19 pandemic resulted in loss of community and structure. Increasing the availability of take-home methadone also improved patient experience and sense of agency. Our findings join a diverse body of converging evidence in support of policy changes allowing for more flexible dosing and individualized OTP care.
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Affiliation(s)
- Teresa López-Castro
- Department of Psychology, Colin Powell School of Civic and Global Leadership, The City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Andrea Jakubowski
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Mariya Masyukova
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; Project Renwal, Inc. 200 Varick Street, 9th Floor New York, NY 10014
| | - Meghan Peterson
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; Department of Social Medicine, University of North Carolina - Chapel Hill School of Medicine, 321 S Columbia St, Chapel Hill, NC 27599, United States
| | - Amanda Pierz
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States; The City University of New York Graduate School of Public Health and Health Policy, 55 W. 125(th) Street, New York, NY 10027, United States
| | - Sruthi Kodali
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
| | - Shadi Nahvi
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, United States
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Imai S, Aoki N, Ikegami K, Kizaki H, Hori S. A Survey of the Status of Methadone Switching in Japan Using a Hospital-Based Administrative Claims Database. J Clin Pharmacol 2024; 64:189-195. [PMID: 37737471 DOI: 10.1002/jcph.2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
Methadone is generally used for the management of cancer pain in patients who cannot obtain adequate analgesia from other strong opioids; however, it has a complicated and inconsistent conversion ratio from pre-switching opioid dosage to methadone. This issue may be pronounced in Japan because only oral tablets are commercially available. We aimed to elucidate the status of methadone switching in Japan, focusing on its dosage. Using a Japanese hospital-based administrative claims database, we included patients who switched to methadone between April 2008 and January 2021. The proportion of methadone switching completion that required more than the defined conversion ratio in the Japanese package insert (called "high-dose methadone switching") was evaluated as a primary endpoint. Other endpoints included "the duration from initiation to completion of methadone switching" and "factors affecting high-dose methadone switching by using multivariate logistic regression analysis". Of 1585 patients who received methadone, 370 were enrolled. Among those, 130 (35.1%) received high-dose methadone switching. The median duration of methadone switching completion (12 days) was longer in the high-dose methadone switching group than in other patients. Four variables were identified as factors affecting high-dose methadone switching. Younger age and outpatient status increased the risk of requiring high-dose methadone switching, whereas the concomitant use of nonsteroidal anti-inflammatory drugs and fentanyl as a pre-switching opioid decreased the risk. In conclusion, more than 30% of the patients underwent high-dose methadone switching and required long completion periods, suggesting that methadone switching remains challenging in Japan.
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Affiliation(s)
- Shungo Imai
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
| | - Natsumi Aoki
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
| | - Keisuke Ikegami
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
| | - Hayato Kizaki
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
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Bromberg DJ, Machavariani E, Madden LM, Dumchev K, LaMonaca K, Earnshaw VA, Pykalo I, Filippovych M, Haddad MS, Dvoriak S, Altice FL. Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge. J Int AIDS Soc 2024; 27:e26202. [PMID: 38379179 PMCID: PMC10879646 DOI: 10.1002/jia2.26202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma has undermined the scale-up of evidence-based HIV prevention and treatment. Negative beliefs influence clinicians' discriminatory behaviour and ultimately have wide-ranging effects across the HIV prevention and treatment continuum. Stigma among clinicians can be mitigated in several ways, including through interpersonal contact. In this study, we test whether interactions with people who inject drugs (PWID) influence attitudes of both direct and indirect providers of opioid agonist therapies (OATs) within the same primary care clinics (PCCs) where OAT is newly introduced. METHODS In a cluster randomized controlled trial integrating OAT and HIV care into PCCs in Ukraine, clinicians at 24 integrated care sites (two sites in 12 regions) from January 2018 to August 2022 completed a structured survey at baseline, 12 and 24 months. The survey included feeling thermometers and standardized scales related to clinician attitudes towards patients and evidence-based care. Nested linear mixed-effects models were used to examine changes in mean scores over three timepoints for both direct and indirect clinicians. RESULTS There were fewer significant changes in any of the scales for direct providers (n = 87) than for indirect providers (n = 155). Direct providers became less tough-minded about substance use disorders (p = 0.002), had less negative opinions about PWID (p = 0.006) and improved their beliefs regarding OAT maintenance (p<0.001) and medical information (p = 0.004). Indirect providers reported improvements in most stigma constructs, including a significant decrease in prejudice (p<0.001), discrimination (p = 0.001), shame (p = 0.007) and fear (p = 0.001) towards PWID. CONCLUSIONS Integrating OAT services within primary settings was associated with significantly reduced stigma constructs and improved attitudes towards PWID, possibly through increased intergroup contact between PWID and general clinical staff. Unlike most stigma reduction interventions, re-engineering clinical processes so that PWID receive their care in PCCs emerges as a multilevel stigma reduction intervention through the integration of specialized services in PCCs. Integration influences different types of stigma, and has positive effects not only on health outcomes, but also improves clinician attitudes and efficiently reduces clinician stigma.
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Affiliation(s)
- Daniel J. Bromberg
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
| | | | - Lynn M. Madden
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- APT FoundationNew HavenConnecticutUSA
| | | | | | | | - Iryna Pykalo
- Ukrainian Institute on Public Health PolicyKyivUkraine
| | | | - Marwan S. Haddad
- Center for Key Populations, Community Health Center, Inc.MiddletownConnecticutUSA
| | | | - Frederick L. Altice
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- University of DelawareNewarkDelawareUSA
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Clark SA, Green TC, Rich JD. Pharmacy-based expansion of buprenorphine access. J Subst Use Addict Treat 2024; 157:209195. [PMID: 37858795 DOI: 10.1016/j.josat.2023.209195] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/28/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Access to evidence-based medication treatment is a challenge for most Americans with opioid use disorder. New models of collaborative care that actively incorporate pharmacists are being trialed. METHODS We author a commentary based on our experiences providing clinical care as part of a randomized controlled trial of pharmacy-based addiction care. RESULTS This commentary describes some of the experiences of working with a Collaborative Practice Agreement between pharmacists and physicians to provide pharmacy-based, low-threshold buprenorphine access. CONCLUSION Given that 87 % of Americans with opioid use disorder are not getting access to buprenorphine or methadone, establishing a pharmacy-based buprenorphine treatment program is a promising strategy to address that gap and should be explored promptly.
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Affiliation(s)
- Seth A Clark
- Psychiatry and Human Behavior and Medicine, Brown University, United States of America; The Miriam and Rhode Island Hospitals, United States of America
| | - Traci C Green
- Opioid Policy Research Collaborative, United States of America; The Heller School of Policy and Management, Brandeis University, United States of America
| | - Josiah D Rich
- Medicine and Epidemiology, Brown University, United States of America; The Miriam and Rhode Island Hospitals, 164 Summit Ave, Providence, RI 02906, United States of America.
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Roy V, Buonora M, Simon C, Dooling B, Joudrey P. Adoption of methadone take home policy by U.S. state opioid treatment authorities during COVID-19. Int J Drug Policy 2024; 124:104302. [PMID: 38183861 DOI: 10.1016/j.drugpo.2023.104302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Patients face well documented problems accessing methadone from opioid treatment programs (OTPs) in the U.S., yet addressing these barriers has proven difficult due in part to the sheer number of actors governing treatment, including state authorities. Changes in federal methadone regulations during COVID-19 offer an opportunity to study the timing and extent of U.S. state opioid treatment authority (SOTA) adoption of policies expanding take home dosing for methadone treatment since March 2020. METHODS We completed a policy scan between February 23 and May 2, 2023 on state adoption and subsequent rescinding of federal regulatory exemptions for expanded take-home dosing. This scan involved three components: a policy survey of SOTAs, a freedom of information act (FOIA) request of SAMHSA, and outreach to members of National Survivors Union (NSU)'s methadone work group. RESULTS Of the 39 of 50 (78 %) SOTAs that responded, only 2 states (HI and MT) indicated that they never adopted federal exemptions for expanded take-home dosing. Of the 37 adopting states, all adopted the exemptions within the first month after the agency's announcement. Additionally, four SOTAs (OH, IN, FL, MS) indicated that their state subsequently rescinded expanded take-home dosing for methadone. CONCLUSIONS Among responding states, regulations expanding take-home dosing appear to have been adopted by U.S. SOTAs in a widespread and rapid manner at the start of the COVID-19 pandemic, but some states have begun to rescind such policies. Our findings suggest that state regulators can rapidly modify OTP regulations in response to federal policy changes. SOTA policies are likely to become critical factors in the adoption of methadone treatment innovations if new federal regulatory flexibilities become permanent.
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Affiliation(s)
- Victor Roy
- Yale National Clinician Scholars Program, Yale University School of Medicine. Sterling Hall of Medicine Room 1E-61, 333 Cedar Street, New Haven, CT 06510, United States; West Haven Veterans Affairs Medical Center, West Haven, CT 06516, United States.
| | - Michele Buonora
- Yale National Clinician Scholars Program, Yale University School of Medicine. Sterling Hall of Medicine Room 1E-61, 333 Cedar Street, New Haven, CT 06510, United States; West Haven Veterans Affairs Medical Center, West Haven, CT 06516, United States; Department of Internal Medicine and Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Caty Simon
- Whose Corner Is It Anyway. 1187 Northhampton St, Floor 1, Holyoke MA, 01040, United States; National Survivors Union, NC, United States; NC Survivors Union, NC, United States
| | - Bridget Dooling
- Moritz College of Law, The Ohio State University. 55 West 12th Avenue, Drinko Hall. Colombus, OH 43210-1391. United States
| | - Paul Joudrey
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh. 230 McKee Place. Suite 600. Pittsburgh, PA 15213. United States
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Burruss-Cousins K, Mitchell SG, Gryczynski J, Whitter M, Fuller D, Ibrahim A, Schwartz RP. Opioid treatment program culture and philosophy: Views of OTP staff and state officials on implementing interim methadone treatment. J Subst Use Addict Treat 2024; 157:209265. [PMID: 38103832 PMCID: PMC10922701 DOI: 10.1016/j.josat.2023.209265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/23/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION People seeking treatment at opioid treatment programs (OTPs) can face admission delays. Interim methadone (IM) treatment, an effective approach to expedite admissions when programs lack sufficient counseling staff, has been seldom implemented. A study of implementation facilitation to spur the use of IM was conducted among six OTPs and their state opioid treatment authorities (SOTAs) in four US states. Between study recruitment and launch, organizational changes at three OTPs eliminated their need for IM. Two OTPs' requests to their states to provide IM (one prior to study launch and one following launch) were deferred by the states due to internal issues that required resolution to comply with federal IM regulations. During the study, another OTP's delays resolved, and one OTP streamlined its admissions procedures. METHODS Virtual interviews were conducted with 16 OTP staff and SOTAs from six OTPs in four US states following their participation in the parent study. Interviews focused on the feasibility and acceptability of the implementation intervention for IM. We analyzed data using a constant comparative approach. RESULTS Two overarching themes emerged from the qualitative data with respect to the role that organizational culture plays in OTP staff views of efforts to implement interim methadone: (1) the contrasting views of interim methadone based on whether staff adopt a traditional treatment vs. harm reduction philosophy and (2) the importance of reconciling these philosophies in addressing the culture shift that would accompany the process of implementing IM. CONCLUSIONS Organizational treatment philosophy and program culture emerged as important factors determining the OTPs' staff's willingness to adopt new approaches to expedite admissions. Participants noted a tension between traditional treatment and harm reduction philosophies that impacted their views of IM, in part based on when they entered the drug treatment field. While understanding and addressing treatment philosophy and organizational culture and willingness to change is of importance when implementing new approaches in OTPs, leadership at the state and OTP level are powerful drivers of change.
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Affiliation(s)
| | | | - Jan Gryczynski
- Friends Research Institute, Inc., Baltimore, MD, United States of America
| | - Melanie Whitter
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, DC, United States of America
| | - Douglas Fuller
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, DC, United States of America
| | - Adila Ibrahim
- Friends Research Institute, Inc., Baltimore, MD, United States of America
| | - Robert P Schwartz
- Friends Research Institute, Inc., Baltimore, MD, United States of America
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Erstad BL, Glenn MJ. Management of Critically Ill Patients Receiving Medications for Opioid Use Disorder. Chest 2024; 165:356-367. [PMID: 37898187 DOI: 10.1016/j.chest.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023] Open
Abstract
TOPIC IMPORTANCE Critical care clinicians are likely to see an increasing number of patients admitted to the ICU who are receiving US Food and Drug Administration-approved medications for opioid use disorder (MOUDs) given the well-documented benefits of these agents. Oral methadone, multiple formulations of buprenorphine, and extended-release naltrexone are the three types of MOUD most likely to be encountered by ICU clinicians; however, these drugs vary with respect to formulations, pharmacokinetics, and adverse effects. REVIEW FINDINGS No published clinical practice guidelines or consensus statements are available to guide decision-making in patients admitted to the ICU setting who are receiving MOUDs before admission. Additionally, no randomized trials and limited observational studies have evaluated issues related to MOUD use in the ICU. Therefore, ICU clinicians caring for patients admitted who are taking MOUDs must base their decision-making on data extrapolation from pharmacokinetic, pharmacologic, and clinical studies performed in non-ICU settings. SUMMARY Despite the challenges in administering MOUDs in critically ill patients, extrapolation of data from other hospital settings suggests that the benefits of continuing MOUD therapy outweigh the risks in patients able to continue therapy. This article provides guidance for critical care clinicians caring for patients admitted to the ICU already receiving methadone, buprenorphine, or extended-release naltrexone. The guidance includes algorithms to aid clinicians in the clinical decision-making process, recognizing the inherent limitations of the existing evidence on which the algorithms are based and the need to account for patient-specific considerations.
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Affiliation(s)
- Brian L Erstad
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ.
| | - Melody J Glenn
- Departments of Emergency Medicine and Psychiatry, University of Arizona College of Medicine/Banner University Medical Center, Tucson, AZ
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