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Rushton CM, Kelly PJ, Thomas T, Beck AK, Townsend C, Baker AL, Manning V, Argent A, Deane FP, Hides L, Hitsman B, Velleman R, Velleman G, Larance B. SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another's methamphetamine use. J Subst Use Addict Treat 2024; 161:209355. [PMID: 38548059 DOI: 10.1016/j.josat.2024.209355] [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] [Received: 04/18/2023] [Revised: 12/20/2023] [Accepted: 03/23/2024] [Indexed: 05/15/2024]
Abstract
INTRODUCTION Families affected by another's substance use, including methamphetamine, experience harms to their mental and physical health. Yet, research has paid little attention to support and service needs of this population. This pilot study examines the feasibility and outcomes of SMART Family and Friends, a video-conference-delivered mutual-support group targeting families affected by another's methamphetamine use. METHODS Recruitment for this study occurred between March-October 2021 via the SMART Recovery Australia website. Participants were English-speaking Australian residents, ≥18 years, affected by another's methamphetamine use, interested in participating in a manualised eight-module group delivered via video-conferencing. Feasibility was evaluated by attendance rates, participant satisfaction, fidelity ratings, and semi-structured interviews. Measures of distress, quality of life, and family functioning assessed outcomes at baseline and one-month post-treatment conclusion. RESULTS Forty-three participants commenced SMART Family and Friends groups. 84 % (n = 36) completed ≥4 modules, 67 % (n = 29) completed ≥6, and 42 % (n = 18) completed all 8 modules. Participant satisfaction (M = 4.32, SD = 0.66, out of 5) and facilitator fidelity (>94 % for all modules) were high. A within-group analysis, without comparison condition demonstrated significant improvements in psychological distress (d = 0.38), family impact (d = 0.64), family strain symptoms (d = 0.48), and total family burden (d = 0.69) post-treatment. Qualitative findings illustrated the benefits and challenges of the video-conference-delivered group, as well as recommendations for improvement. CONCLUSIONS Results provide initial support for the feasibility and positive outcomes of the SMART Family and Friends program. These findings demonstrate the successful provision of a mutual-support group for affected families delivered via video-conferencing, and merit further sufficiently powered randomised-control-trials to evaluate efficacy.
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Affiliation(s)
- Clare M Rushton
- School of Psychology, University of Wollongong, Wollongong, Australia.
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Tamsin Thomas
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Alison K Beck
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Camilla Townsend
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Brisbane, Australia
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Richard Velleman
- Department of Psychology, University of Bath, Bath, UK; Addictions and Related Research Group, Sangath, Goa, India
| | - Gill Velleman
- Addictions and Related Research Group, Sangath, Goa, India
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Farrell M, Shahbazi J, Chambers M, Byrne M, Gholami J, Zahra E, Grebely J, Lintzeris N, Larance B, Ali R, Nielsen S, Dunlop A, Dore GJ, McDonough M, Montebello M, Weiss R, Rodgers C, Cook J, Degenhardt L. 96-week retention in treatment with extended-release subcutaneous buprenorphine depot injections among people with opioid dependence: Extended follow-up after a single-arm trial. Int J Drug Policy 2024; 127:104390. [PMID: 38522175 DOI: 10.1016/j.drugpo.2024.104390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The most recent formulation of buprenorphine treatment is extended-release depot injections (BUP-XR) that are administered subcutaneously by health care professionals. This study aimed to observe treatment outcomes of BUP-XR delivered in standard practice during a 96-week follow-up period in a community setting. METHODS This study is an extension of the CoLAB study, a prospective single-arm, multicentre, open label trial (N=100, 7 sites in Australia) among people with opioid dependence who received monthly injections of BUP-XR to evaluate the retention in treatment. Participants were followed for 96 weeks, comprising 48 weeks of the CoLAB study followed by a 48-week extension. RESULTS Of 100 participants at baseline, 47 were retained on BUP-XR at 96 weeks. The median time retained on monthly depot was 90 weeks. Heroin use (adjusted OR=0.19, P=0.012) in the month prior to baseline was associated with lower odds of retention on BUP-XR. Older age at first opioid use (adjusted OR= 1.08, P=0.009) and longer duration in OAT at baseline (adjusted OR= 1.12, P=0.001) were associated with increased retention. Prevalence of past four-weeks opioid use was estimated at 4% at 96 weeks of treatment (prevalence 0.04, 95%CI: 0.00-0.11) compared to 15% at baseline. Quality of life and medication treatment satisfaction improved over time for those retained in treatment. CONCLUSION This is one of the few studies to describe long term (96 week) retention in treatment with BUP-XR in a community setting. It displayed retention rates with 47% of participants completing 96 weeks of treatment with BUP-XR. Patient reported outcomes suggest improvements in client wellbeing. FUNDING Indivior.
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Affiliation(s)
| | | | - Mark Chambers
- National Drug and Alcohol Research Centre, UNSW, Australia
| | - Marianne Byrne
- National Drug and Alcohol Research Centre, UNSW, Australia; The Kirby Institute, UNSW, Australia
| | - Jaleh Gholami
- National Drug and Alcohol Research Centre, UNSW, Australia
| | - Emma Zahra
- National Drug and Alcohol Research Centre, UNSW, Australia
| | | | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, NSW, Australia; Drug and Alcohol Services, South East Sydney Local Health District, Surry Hills, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW, Australia; School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, Australia; Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | | | - Michael McDonough
- Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia
| | - Mark Montebello
- National Drug and Alcohol Research Centre, UNSW, Australia; Discipline of Addiction Medicine, University of Sydney, NSW, Australia; Drug and Alcohol Services, North Sydney Local Health District, St Leonards, NSW, Australia
| | - Rob Weiss
- Frankston Healthcare, Frankston, Victoria, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst NSW Australia
| | - Jon Cook
- Drug and Alcohol Clinical Advisory Service, Western Health, Victoria, Australia
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Tran AD, Grebely J, Chambers M, Degenhardt L, Farrell M, Bajis S, Larance B. Health utility among people who regularly use opioids in Australia. Drug Alcohol Rev 2024. [PMID: 38403293 DOI: 10.1111/dar.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Studies of health utilities among people who use opioids have mostly been based on in-treatment populations. We aim to report utility-based quality of life by participants' socio-demographic, drug and treatment characteristics, and to examine the determinants of health utility among people who use opioids regularly. METHODS Cross-sectional study of participants who used opioids regularly, recruited across New South Wales, Victoria and Tasmania in 2018-2019. Differences in European Quality of Life (EQ-5D-5L) heath utility scores between socio-demographic and clinical subgroups were assessed using non-parametric Kruskal-Wallis test by rank. To address the unique distribution of EQ-5D-5L health utility scores in the current sample, a two-part model was applied to assess factors associated with health utility. RESULTS Among 402 participants enrolled in the study, 385 (96%) completed the EQ-5D-5L questionnaire. The mean health utility of the total sample was 0.63 (SD 0.29). Participants who previously received opioid agonist treatment [OAT] (adj marginal effect (ME) -0.11; 95% confidence interval [CI] -0.20 to -0.02) and those currently in OAT (adj ME -0.13; 95% CI -0.22 to -0.06) reported lower health utility than those who had never received OAT. Participants who used both pharmaceutical opioids and benzodiazepines had lower health utility compared to no pharmaceutical opioids and no benzodiazepines use (adj ME -0.17; 95% CI -0.28 to -0.07). DISCUSSION AND CONCLUSIONS Findings provide important health utility data for economic evaluations, useful for guiding allocation of resources for treatment strategies among people who use opioids. Lower health utilities among those using benzodiazepines and pharmaceutical opioids suggests interventions targeting these subgroups may be beneficial.
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Affiliation(s)
- Anh Dam Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | | | - Mark Chambers
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Sahar Bajis
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute University of Wollongong, Wollongong, Australia
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Beck AK, Waks S, Argent A, Deane FP, Larance B, Manning V, Baker AL, Hides L, Kelly PJ. The benefits and challenges of virtual SMART recovery mutual-help groups: Participant and facilitator perspectives. Int J Drug Policy 2023; 120:104174. [PMID: 37659377 DOI: 10.1016/j.drugpo.2023.104174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND COVID-19 prompted widespread transition of face-to-face mutual-help groups to virtual delivery. Current understanding of the experience of virtual mutual-help groups is limited to 12-step approaches or asynchronous groups (e.g., forums). This paper explores participant and facilitator perspectives regarding the benefits and challenges of accessing SMART Recovery mutual-help groups virtually via videoconference. METHODS A self-selected convenience sample of participants (n = 29) and facilitators (n = 15) from SMART Recovery mutual-help groups in Australia were enrolled. Participants and facilitators were sampled to reflect experience of virtual groups delivered via videoconference ('online'), face-to-face groups ('face-to-face') or both types of groups ('both'). Telephone qualitative interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed, and analysed using iterative categorisation. RESULTS Participant and facilitators discussed their experience across eight interconnected themes benefits were typically discussed with regard to the (1) availability, (2) ease of access and (3) value add of the chat feature in online groups. Challenges largely pertained to (1) in-group engagement, (2) group size, (3) non-verbal cues, (4) social interaction and (5) technology problems. The impact of these challenges on participant and facilitator experience varied, and neither modality was consistently identified as superior. CONCLUSIONS SMART Recovery mutual-help groups provided participants with another option for accessing mutual-help and appealed to different people under different circumstances. Depending on the needs and preferences of the individual, online SMART Recovery mutual-help groups may help to mitigate a range of barriers to help seeking and may also engage people otherwise unable or reluctant to engage in treatment. To inform training, practice and policy, improved understanding of the individual and contextual factors that enhance participant engagement, experience and outcomes is needed.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia.
| | - Shifra Waks
- Discipline of Occupational Therapy, The University of Sydney, NSW, Australia
| | | | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, QLD, Australia
| | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
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Degenhardt L, Clark B, Macpherson G, Leppan O, Nielsen S, Zahra E, Larance B, Kimber J, Martino-Burke D, Hickman M, Farrell M. Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies. Lancet Psychiatry 2023; 10:386-402. [PMID: 37167985 DOI: 10.1016/s2215-0366(23)00095-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 01/19/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Opioid dependence is associated with substantial health and social burdens, and opioid agonist treatment (OAT) is highly effective in improving multiple outcomes for people who receive this treatment. Methadone and buprenorphine are common medications provided as OAT. We aimed to examine buprenorphine compared with methadone in the treatment of opioid dependence across a wide range of primary and secondary outcomes. METHODS We did a systematic review and meta-analysis in accordance with GATHER and PRISMA guidelines. We searched Embase, MEDLINE, CENTRAL, and PsycINFO from database inception to Aug 1, 2022; clinical trial registries and previous relevant Cochrane reviews were also reviewed. We included all RCTs and observational studies of adults (aged ≥18 years) with opioid dependence comparing treatment with buprenorphine or methadone. Primary outcomes were retention in treatment at 1, 3, 6, 12, and 24 months, treatment adherence (measured through doses taken as prescribed, dosing visits attended, and biological measures), or extra-medical opioid use (measured by urinalysis and self-report). Secondary outcomes were use of benzodiazepines, cannabis, cocaine, amphetamines, and alcohol; withdrawal; craving; criminal activity and engagement with the criminal justice system; overdose; mental and physical health; sleep; pain; global functioning; suicidality and self-harm; and adverse events. Single-arm cohort studies and RCTs that collected data on buprenorphine retention alone were also reviewed. Data on study, participant, and treatment characteristics were extracted. Study authors were contacted to obtain additional data when required. Comparative estimates were pooled with use of random-effects meta-analyses. The proportion of individuals retained in treatment across multiple timepoints was pooled for each drug. This study is registered with PROSPERO (CRD42020205109). FINDINGS We identified 32 eligible RCTs (N=5808 participants) and 69 observational studies (N=323 340) comparing buprenorphine and methadone, in addition to 51 RCTs (N=11 644) and 124 observational studies (N=700 035) that reported on treatment retention with buprenorphine. Overall, 61 studies were done in western Europe, 162 in North America, 14 in north Africa and the Middle East, 20 in Australasia, five in southeast Asia, seven in south Asia, two in eastern Europe, three in central Europe, one in east Asia, and one in central Asia. 1 040 827 participants were included in these primary studies; however, gender was only reported for 572 111 participants, of whom 377 991 (66·1%) were male and 194 120 (33·9%) were female. Mean age was 37·1 years (SD 6·0). At timepoints beyond 1 month, retention was better for methadone than for buprenorphine: for example, at 6 months, the pooled effect favoured methadone in RCTs (risk ratio 0·76 [95% CI 0·67-0·85]; I·=74·2%; 16 studies, N=3151) and in observational studies (0·77 [0·68-0·86]; I·=98·5%; 21 studies, N=155 111). Retention was generally higher in RCTs than observational studies. There was no evidence suggesting that adherence to treatment differed with buprenorphine compared with methadone. There was some evidence that extra-medical opioid use was lower in those receiving buprenorphine in RCTs that measured this outcome by urinalysis and reported proportion of positive urine samples (over various time frames; standardised mean difference -0·20 [-0·29 to -0·11]; I·=0·0%; three studies, N=841), but no differences were found when using other measures. Some statistically significant differences were found between buprenorphine and methadone among secondary outcomes. There was evidence of reduced cocaine use, cravings, anxiety, and cardiac dysfunction, as well as increased treatment satisfaction among people receiving buprenorphine compared with methadone; and evidence of reduced hospitalisation and alcohol use in people receiving methadone. These differences in secondary outcomes were based on small numbers of studies (maximum five), and were often not consistent across study types or different measures of the same constructs (eg, cocaine use). INTERPRETATION Evidence from trials and observational studies suggest that treatment retention is better for methadone than for sublingual buprenorphine. Comparative evidence on other outcomes examined showed few statistically significant differences and was generally based on small numbers of studies. These findings highlight the imperative for interventions to improve retention, consideration of client-centred factors (such as client preference) when selecting between methadone and buprenorphine, and harmonisation of data collection and reporting to strengthen future syntheses. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Brodie Clark
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Georgina Macpherson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Oscar Leppan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Emma Zahra
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Briony Larance
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jo Kimber
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Daniel Martino-Burke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Beck AK, Larance B, Baker AL, Deane FP, Manning V, Hides L, Kelly PJ. Supporting people affected by problematic alcohol, substance use and other behaviours under pandemic conditions: A pragmatic evaluation of how SMART recovery Australia responded to COVID-19. Addict Behav 2023; 139:107577. [PMID: 36528964 PMCID: PMC9741494 DOI: 10.1016/j.addbeh.2022.107577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic prompted rapid, reflexive transition from face-to-face to online healthcare. For group-based addiction services, evidence for the impact on service delivery and participant experience is limited. METHODS A 12-month (plus 2-month follow-up) pragmatic evaluation of the upscaling of online mutual-help groups by SMART Recovery Australia (SRAU) was conducted using The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Data captured by SRAU between 1st July 2020 and 31st August 2021 included participant questionnaires, Zoom Data Analytics and administrative logs. RESULTS Reach: The number of online groups increased from just 6 pre-COVID-19 to 132. These groups were delivered on 2786 (M = 232.16, SD = 42.34 per month) occasions, to 41,752 (M = 3479.33, SD = 576.34) attendees. EFFECTIVENESS Participants (n = 1052) reported finding the online group meetings highly engaging and a positive, recovery supportive experience. 91 % of people with experience of face-to-face group meetings rated their online experience as equivalent or better. Adoption: Eleven services (including SRAU) and five volunteers delivered group meetings for the entire 12-months. IMPLEMENTATION SRAU surpassed their goal of establishing 100 groups. Maintenance: The average number of meetings delivered [t(11.14) = -1.45, p = 0.1737] and attendees [t(1.95) = -3.28, p = 0.1880] per month were maintained across a two-month follow-up period. CONCLUSIONS SRAU scaled-up the delivery of online mutual-help groups in response to the COVID-19 pandemic. Findings support the accessibility, acceptability and sustainability of delivering SMART Recovery mutual-help groups online. Not only are these findings important in light of the global pandemic and public safety, but they demonstrate the potential for reaching and supporting difficult and under-served populations.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia.
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Australia.
| | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Australia.
| | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
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Rushton C, Kelly PJ, Raftery D, Beck A, Larance B. The effectiveness of psychosocial interventions for family members impacted by another's substance use: A systematic review and meta-analysis. Drug Alcohol Rev 2023; 42:960-977. [PMID: 36744608 DOI: 10.1111/dar.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/27/2022] [Accepted: 12/19/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Family members affected by another's substance use disorder experience physical health problems, breakdowns in relationships and reduced psychological wellbeing. This review examines the effectiveness of psychosocial interventions for improving the wellbeing of family members. METHODS A systematic review of randomised-controlled trials (RCT), non-RCTs and pre-post studies examining group or individual interventions for affected families. Five databases were searched (PubMed, PsycINFO, Medline, Web of Science, Cochrane Library). Outcomes included psychological functioning, quality of life, physical health and substance use, family functioning and coping. Outcomes were analysed by study design and mode of delivery (individual or group). Risk of bias was assessed using the Cochrane tools (RoB2, ROBINS-I). The review followed PRISMA reporting guidelines and was prospectively registered with the PROSPERO database (CRD42020200260). RESULTS Nineteen studies were included (k = 10 included in meta-analyses). In k = 3 RCTs, individually administered interventions significantly reduced depression (standardised mean difference [SMD] 0.50, 95% confidence interval [CI] 0.21, 0.79) and distress (SMD 0.28, 95% CI 0.03, 0.54). In k = 2 pre-post studies, individual interventions improved family functioning (d = 0.51, 95% CI 0.28, 0.73) and coping (d = 0.43, 95% CI 0.24, 0.61). In k = 3 non-RCTs and k = 2 pre-post designs group interventions significantly reduced depression (d = 0.50, 95% CI 0.17, 0.82) and distress (d = 0.44, 95% CI 0.13, 0.75), and improved coping (d = 0.81, 95% CI 0.29, 1.33). DISCUSSION AND CONCLUSIONS This review summarises the contemporary literature evaluating interventions for affected families, with both individual and group interventions demonstrating favourable outcomes. However, small sample sizes and methodologically weak-quality studies limit conclusions.
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Affiliation(s)
- Clare Rushton
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Dayle Raftery
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Alison Beck
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Beck AK, Larance B, Manning V, Hides L, Baker AL, Deane FP, Shakeshaft A, Raftery D, Kelly PJ. Online SMART Recovery mutual support groups: Characteristics and experience of adults seeking treatment for methamphetamine compared to those seeking treatment for other addictive behaviours. Drug Alcohol Rev 2023; 42:20-26. [PMID: 36106354 PMCID: PMC10087117 DOI: 10.1111/dar.13544] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The COVID-19 pandemic prompted the transition of Australian Self-Management and Recovery Training (SMART) Recovery mutual support groups to virtual delivery. This study examined the self-reported experience of online SMART Recovery groups for people seeking support for methamphetamine use (alone or in combination with other behaviours) compared to those who did not endorse methamphetamine use as a reason for seeking support. METHODS An online survey invitation was embedded in the post-group exit page. Items assessed participant demographic characteristics, experience, engagement and perceived contribution of the online group to recovery. Unique responses (n = 1414) were analysed using chi-square. RESULTS After alcohol, methamphetamine use was the second most common behaviour to prompt online SMART Recovery group attendance (n = 205, 14.5%). People attending for methamphetamine use were more likely to endorse multiple addictive behaviours (n = 137, 66.8% vs. n = 371, 30.7%, p < 0.001). Irrespective of whether people attended for methamphetamine use or not, participant ratings of experience, engagement and perceived contribution to recovery were positive and largely comparable. People attending for methamphetamine use were significantly less likely to set a 7-day plan (72.7% vs. 81.9%; χ2 = 9.47, p = 0.002). DISCUSSION AND CONCLUSIONS Findings support the acceptability of online SMART Recovery groups for people experiencing addictive behaviours, including methamphetamine use. To maximise the benefits of these groups, further evidence on how best to support people to develop a change plan within a time-limited, online group setting is needed. Online mutual support groups may help to reach and support people who might not otherwise engage in treatment and support, including people who use methamphetamine.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Brisbane, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Dayle Raftery
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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9
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Abstract
BACKGROUND There are ongoing concerns regarding pharmaceutical opioid-related harms, including overdose and dependence, with an associated increase in treatment demand. People dependent on pharmaceutical opioids appear to differ in important ways from people who use heroin, yet most opioid agonist treatment research has been conducted in people who use heroin. OBJECTIVES: To assess the effects of maintenance opioid agonist pharmacotherapy for the treatment of pharmaceutical opioid dependence. SEARCH METHODS We updated our searches of the following databases to January 2022: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, MEDLINE, four other databases, and two trial registers. We checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs with adults and adolescents examining maintenance opioid agonist treatments that made the following two comparisons. 1. Full opioid agonists (methadone, morphine, oxycodone, levo-alpha-acetylmethadol (LAAM), or codeine) versus different full opioid agonists or partial opioid agonists (buprenorphine) for maintenance treatment. 2. Full or partial opioid agonist maintenance versus non-opioid agonist treatments (detoxification, opioid antagonist, or psychological treatment without opioid agonist treatment). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. MAIN RESULTS We identified eight RCTs that met inclusion criteria (709 participants). We found four studies that compared methadone and buprenorphine maintenance treatment, and four studies that compared buprenorphine maintenance to either buprenorphine taper (in addition to psychological treatment) or a non-opioid maintenance treatment comparison. We found low-certainty evidence from three studies of a difference between methadone and buprenorphine in favour of methadone on self-reported opioid use at end of treatment (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.28 to 0.86; 165 participants), and low-certainty evidence from four studies finding a difference in favour of methadone for retention in treatment (RR 1.21, 95% CI 1.02 to 1.43; 379 participants). We found low-certainty evidence from three studies showing no difference between methadone and buprenorphine on substance use measured with urine drug screens at end of treatment (RR 0.81, 95% CI 0.57 to 1.17; 206 participants), and moderate-certainty evidence from one study of no difference in days of self-reported opioid use (mean difference 1.41 days, 95% CI 3.37 lower to 0.55 days higher; 129 participants). There was low-certainty evidence from three studies of no difference between methadone and buprenorphine on adverse events (RR 1.13, 95% CI 0.66 to 1.93; 206 participants). We found low-certainty evidence from four studies favouring maintenance buprenorphine treatment over non-opioid treatments in terms of fewer opioid positive urine drug tests at end of treatment (RR 0.66, 95% CI 0.52 to 0.84; 270 participants), and very low-certainty evidence from four studies finding no difference on self-reported opioid use in the past 30 days at end of treatment (RR 0.63, 95% CI 0.39 to 1.01; 276 participants). There was low-certainty evidence from three studies of no difference in the number of days of unsanctioned opioid use (standardised mean difference (SMD) -0.19, 95% CI -0.47 to 0.09; 205 participants). There was moderate-certainty evidence from four studies favouring buprenorphine maintenance over non-opioid treatments on retention in treatment (RR 3.02, 95% CI 1.73 to 5.27; 333 participants). There was moderate-certainty evidence from three studies of no difference in adverse effects between buprenorphine maintenance and non-opioid treatments (RR 0.50, 95% CI 0.07 to 3.48; 252 participants). The main weaknesses in the quality of the data was the use of open-label study designs, and difference in follow-up rates between treatment arms. AUTHORS' CONCLUSIONS There is very low- to moderate-certainty evidence supporting the use of maintenance agonist pharmacotherapy for pharmaceutical opioid dependence. Methadone or buprenorphine did not differ on some outcomes, although on the outcomes of retention and self-reported substance use some results favoured methadone. Maintenance treatment with buprenorphine appears more effective than non-opioid treatments. Due to the overall very low- to moderate-certainty evidence and small sample sizes, there is the possibility that the further research may change these findings.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, Australia
| | - Wai Chung Tse
- Monash Addiction Research Centre, Monash University, Frankston, Australia
- School of Medicine, Monash University, Melbourne, Australia
| | - Briony Larance
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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10
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Hopkins RE, Campbell G, Degenhardt L, Lintzeris N, Larance B, Nielsen S, Gisev N. Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain. International Journal of Drug Policy 2022; 105:103708. [DOI: 10.1016/j.drugpo.2022.103708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/06/2022] [Accepted: 04/19/2022] [Indexed: 11/24/2022]
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11
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Osborne B, Larance B, Ivers R, Deane FP, Robinson LD, Kelly PJ. Systematic review of guidelines for managing physical health during treatment for substance use disorders: Implications for the alcohol and other drug workforce. Drug Alcohol Rev 2022; 41:1367-1390. [PMID: 35765725 PMCID: PMC9539873 DOI: 10.1111/dar.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
ISSUES Substance use disorders are associated with significant physical health comorbidities, necessitating an integrated treatment response. However, service fragmentation can preclude the management of physical health problems during addiction treatment. The aim of this systematic review was to synthesise the recommendations made by clinical practice guidelines for addressing the physical health of people attending alcohol and other drug (AOD) treatment. APPROACH An iterative search strategy of grey literature sources was conducted from September 2020 to February 2021 to identify clinical practice guidelines. Content pertaining to physical health care during AOD treatment was extracted. Quality of guidelines were appraised using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool. FINDINGS Thirty-three guidelines were included for review. Fourteen guidelines were considered high quality based on AGREE-II scores. Neurological conditions (90.9%) and hepatitis (81.8%) were the most frequent health problems addressed. Most guidelines recommended establishing referral pathways to address physical health comorbidities (90.9%). Guidance on facilitating these referral pathways was less common (42.4%). Guidelines were inconsistent in their recommendations related to oral health, tobacco use, physical activity, nutrition and the use of standardised assessment tools. IMPLICATIONS AND CONCLUSIONS Greater consistency and specificity in the recommendations made for integrating physical health care within addiction treatment is needed. Ensuring that recommendations are applicable to the AOD workforce and to treatment services limited by funding and resource constraints should enhance implementation. Future guideline development groups should consider increased consultation with the AOD workforce and inclusion of clinical tools and decision aids to facilitate referral pathways.
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Affiliation(s)
- Briony Osborne
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Centre for Health Psychology Practice and Research, Wollongong, Australia
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12
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Zahra E, Chen R, Nielsen S, Tran AD, Santo T, Degenhardt L, Farrell M, Byrne J, Ali R, Larance B. Examining the cost and impact of dosing fees among clients in opioid agonist treatment: Results from a cross-sectional survey of Australian treatment clients. Drug Alcohol Rev 2022; 41:841-850. [PMID: 35130368 PMCID: PMC9398207 DOI: 10.1111/dar.13437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 12/12/2021] [Accepted: 01/08/2022] [Indexed: 12/26/2022]
Abstract
Introduction Opioid agonist treatment (OAT) clients frequently bear costs associated with their treatment, including dosing fees. This study aimed to explore the financial and social impact of dosing fees upon clients. Methods Cross‐sectional survey of people who use opioids regularly (N = 402) between December 2017 and March 2018, conducted in Australia. Dosing fees were calculated and expressed as percentage of income, by OAT type. Consequences and strategies for difficulties making payments were examined as proportions. Results A total of N = 360 participants had ever been in OAT and N = 245 participants currently engaged in OAT reported data on dosing fees, of them 53% (n = 129) reported paying dosing fees. Compared to clients with high levels of dosing supervision, those with moderate or low levels of supervision were more likely to pay dosing fees. The median 28‐day dosing fee was AUD$110 (interquartile range AUD$80); median 28‐day income was AUD$1520 (interquartile range AUD$700). For those who paid dosing fees, the fee comprised <10% of total monthly income for 70% of participants; however, 23% of participants paid fees comprising 10% to <20%, and 7% of participants paid fees comprising 20% or more of monthly income. Among those that had ever been in OAT, 72% experienced difficulties in paying treatment costs; 36% left treatment earlier than intended and 25% had been excluded due to payment difficulties. Discussion and Conclusions Negative consequences of treatment costs to clients, particularly dosing fees, are evident. These costs impact treatment access and retention that may negatively impact clients' physical health, mental health and social wellbeing.
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Affiliation(s)
- Emma Zahra
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rory Chen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Anh Dam Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jude Byrne
- Australian Injecting and Illicit Drug Users League, Canberra, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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13
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Kelly PJ, Hatton EL, Hinsley K, Davis E, Larance B. Preliminary psychometric evaluation of the patient reported experience measure for addiction treatment (PREMAT). Addict Behav 2021; 123:107048. [PMID: 34348223 DOI: 10.1016/j.addbeh.2021.107048] [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: 03/10/2021] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patient-reported experience measures (PREMs) are recommended for use in evaluating person-centred care. To date, a PREM has not been validated for residential alcohol and other drug (AOD) treatment. Utilising items developed through a previously published qualitative study informing the development of the PREM for Addiction Treatment (PREMAT), the current study conducted a psychometric evaluation and validation of the PREMAT. DESIGN AND METHODS Cross-sectional survey data were collected from six Australian residential AOD treatment facilities (N = 178). Psychometric evaluation included examining the factor structure, internal consistency, and construct validity of the PREMAT. Test re-test reliability was conducted at one treatment site (n = 24). RESULTS The total PREMAT score demonstrated strong internal consistency (α = 0.91). Principle components analysis identified six factors (all α > 0.72). The PREMAT total score and factor scores were negatively skewed. Concurrent validity was demonstrated by strong positive correlations with measures of satisfaction (ρ = 0.81, Client Satisfaction Questionnaire-8; ρ = 0.78, Treatment Perceptions Questionnaire), and divergent validity was demonstrated with weaker correlations with Drug-Taking Confidence Questionnaire (ρ = 0.25) and Kessler-10 (ρ = -0.20). Test-retest reliability was strong for the total PREMAT (ρ = 0.89). DISCUSSION AND CONCLUSIONS Results support the use of the PREMAT as a valid measure of experience in residential AOD treatment settings. Future research should examine the use of the PREMAT across the course of treatment to examine if experience is related to client characteristics, outcome, dropout or re-engagement in treatment.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Emma L Hatton
- School of Psychology, University of Wollongong, Australia
| | - Kate Hinsley
- School of Psychology, University of Wollongong, Australia
| | - Esther Davis
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia; Australian Health Services Research Institute, University of Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
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14
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Farrell M, Shahbazi J, Byrne M, Grebely J, Lintzeris N, Chambers M, Larance B, Ali R, Nielsen S, Dunlop A, Dore GJ, McDonough M, Montebello M, Nicholas T, Weiss R, Rodgers C, Cook J, Degenhardt L. Outcomes of a single-arm implementation trial of extended-release subcutaneous buprenorphine depot injections in people with opioid dependence. Int J Drug Policy 2021; 100:103492. [PMID: 34736130 DOI: 10.1016/j.drugpo.2021.103492] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Opioid agonist treatment (OAT) is an effective intervention for opioid dependence. Extended-release buprenorphine injections (BUP-XR) may have additional potential benefits over sublingual buprenorphine. This single-arm trial evaluated outcomes among people receiving 48 weeks of BUP-XR in diverse community healthcare settings in Australia, permitting examination of outcomes when BUP-XR is delivered in standard practice. METHODS Participants were recruited from a network of specialist public drug treatment services, primary care and some private practices in three states. Following a minimum 7 days on 8-32 mg of sublingual buprenorphine (±naloxone), participants received monthly subcutaneous BUP-XR injections administered by a healthcare practitioner and completed monthly research interviews. The primary endpoint was retention in treatment at 48 weeks. FINDINGS Participants (n = 100) were 28% women, mean age 44 years with a long history of OAT (median 5.8 years); heroin was the most common opioid of concern (58%). Treatment retention at 24 and 48 weeks was 86% and 75%, respectively. Participants with past-month injecting drug use (OR 0.23; 95%CI: 0.09-0.61) or heroin use (OR 0.23; 95%CI: 0.08-0.65) at baseline had lower odds of being retained in treatment to 48 weeks. Reductions in multiple forms of extra-medical drug use were observed. Improvements in quality of life, participation in employment, and treatment satisfaction measures were also observed. INTERPRETATION This real-world implementation study of BUP-XR demonstrated high retention and treatment satisfaction. This study provides important additional data on the uptake and experience of clients, with relevance for policy makers, health service planners, administrators, and practitioners. FUNDING Indivior. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03809143.
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Affiliation(s)
- Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
| | - Jeyran Shahbazi
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Marianne Byrne
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Surry Hills, NSW, Australia; The Langton Centre, South East Sydney Local Health District, Surry Hills, NSW, Australia
| | - Mark Chambers
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Psychology, University of Wollongong, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Adrian Dunlop
- Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, NSW, Australia; Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Michael McDonough
- Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia
| | - Mark Montebello
- Discipline of Addiction Medicine, University of Sydney, Surry Hills, NSW, Australia; Drug and Alcohol Services, North Sydney Local Health District, Sydney, NSW, Australia
| | - Thomas Nicholas
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Rob Weiss
- Frankston Healthcare, Frankston, Victoria, Australia
| | - Craig Rodgers
- Rankin Court Treatment Centre, The O'Brien Centre, Darlinghurst, NSW, Australia
| | - Jon Cook
- Drug and Alcohol Clinical Advisory Service, Western Health, Victoria, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
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15
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Tran AD, Chen R, Nielsen S, Zahra E, Degenhardt L, Santo T, Farrell M, Larance B. Economic analysis of out-of-pocket costs among people in opioid agonist treatment: A cross-sectional survey in three Australian jurisdictions. Int J Drug Policy 2021; 99:103472. [PMID: 34649203 DOI: 10.1016/j.drugpo.2021.103472] [Citation(s) in RCA: 3] [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: 05/24/2021] [Revised: 09/05/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Out-of-pocket costs for opioid agonist treatment (OAT) constitute a barrier to treatment entry and retention.This study examines OAT clients' total out-of-pocket costs (including dispensing fees, travel costs and OAT-related appointment costs) in different treatment settings (public clinics, community pharmacies, and private clinics). METHODS Cross-sectional survey of 402 people with opioid drug use (OUD) in New South Wales (NSW), Victoria (VIC), Tasmania (TAS), Australia; 266 clients (66%) currently receiving methadone, buprenorphine or buprenorphine-naloxone treatment were asked about dispensing fees, travel costs and OAT-related appointment costs in the past 28 days. A two-part regression model was used to deal with non-normal distributions of costing data (right skew and excess zeros). RESULTS Among clients currently receiving OAT, 87% paid out-of-pocket costs. Among those who paid out-of-pocket costs (N=194), travel costs accounted for more than half of total costs (52%), followed by dispensing fees (44%). The mean monthly total out-of-pocket costs were AU$135 (SD: AU$121) for public clinics, AU$161 (SD: AU$110) to AU$214 (SD: AU$166) for community pharmacies and AU$355 (SD: AU$159) for private clinics. Compared to participants in NSW private clinics, those at public clinics paid one third the total out-of-pocket costs (coefficient = 0.33; 95%CI = 0.23-0.48) and those at NSW, TAS, VIC pharmacies paid approximately half the costs (coefficient = 0.58; 95%CI = 0.42-0.79; coefficient = 0.51; 95%CI = 0.36-0.72; coefficient = 0.47; 95%CI = 0.34-0.66, respectively). People in OAT for more than a year paid half the total out-of-pocket costs, compared with those in OAT less than a year (coefficient = 0.49, 95%CI = 0.31-0.77). CONCLUSIONS Participants in the current study spent one-eighth of their income on out-of-pocket costs associated with OAT representing a substantial financial burden. Total out-of-pocket costs disproportionately affects those who are newer in treatment and receiving fewer unsupervised doses. Considering and addressing total out-of-pocket costs, especially travel costs and dispensing fees, to clients is critical to prevent cost from being a barrier from receiving effective care.
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Affiliation(s)
- Anh Dam Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Rory Chen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Emma Zahra
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute University of Wollongong, Wollongong, Australia
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16
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Kelly PJ, Beck AK, Deane FP, Larance B, Baker AL, Hides L, Manning V, Shakeshaft A, Neale J, Kelly JF, Oldmeadow C, Searles A, Palazzi K, Lawson K, Treloar C, Gray RM, Argent A, McGlaughlin R. Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study. J Med Internet Res 2021; 23:e25217. [PMID: 34612829 PMCID: PMC8529481 DOI: 10.2196/25217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/25/2021] [Accepted: 04/25/2021] [Indexed: 01/19/2023] Open
Abstract
Background Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. Objective The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. Methods SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8). Results Of the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI –2.02 to 2.24) was reported. Conclusions Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336 International Registered Report Identifier (IRRID) RR2-10.2196/15113
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Affiliation(s)
- Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Brisbane St Lucia, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Joanne Neale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - John F Kelly
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, Australia
| | - Andrew Searles
- Hunter Medical Research Institute Health Research Economics, Hunter Medical Research Institute, New Lambton, Australia
| | - Kerrin Palazzi
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, Australia
| | - Kenny Lawson
- Hunter Medical Research Institute Health Research Economics, Hunter Medical Research Institute, New Lambton, Australia
| | - Carla Treloar
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Rebecca M Gray
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
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Beck AK, Larance B, Deane FP, Baker AL, Manning V, Hides L, Shakeshaft A, Argent A, Kelly PJ. The use of Australian SMART Recovery groups by people who use methamphetamine: Analysis of routinely-collected nationwide data. Drug Alcohol Depend 2021; 225:108814. [PMID: 34174775 DOI: 10.1016/j.drugalcdep.2021.108814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Mutual support groups (e.g. SMART Recovery) are an important source of support for people experiencing addictive behaviours. Little is known about the use of mutual support groups by people who use methamphetamine, or the factors that may influence group cohesion. METHODS This study uses post-group data reported by SMART Recovery facilitators in Australia between 2018 and 2020. Group cohesion was indexed by facilitator ratings of The Group Entitativity measure (GEM-GP). Participant characteristics (gender, age, new or returning group member, voluntary or mandated attendance) and group location (major city vs. regional/remote vs. online) were used to (a) compare methamphetamine and non-methamphetamine related attendances; and (b) explore relationships to group cohesion within groups where the majority attended for methamphetamine. RESULTS Methamphetamine use was the second most common reason for attending SMART Recovery groups (n = 4929; 22.2 % service occasions). Methamphetamine-related service occasions were more likely amongst men, people aged <45 years, returning attendees and regional/rural groups (allp < .05). GEM-GP scores were high (signalling strong cohesion), and did not significantly differ according to proportion of participants attending for methamphetamine (F(1,2) = 0.482, p = .618). Group cohesion increased with larger group size, proportion of women and proportion of younger people (F(4, 504) = 11.058, p < .001)). DISCUSSION AND CONCLUSIONS This study improves current understanding of service utilisation by people who use methamphetamine. SMART Recovery groups offer an avenue for supporting a diverse range of people who use methamphetamine, outside the formal treatment system. This provides an important foundation for improving community support options for people who use methamphetamine.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia.
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Victoria Manning
- Monash Addiction Research Centre (MARC), Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | | | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
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Kelly PJ, McCreanor K, Beck AK, Ingram I, O'Brien D, King A, McGlaughlin R, Argent A, Ruth M, Hansen BS, Andersen D, Manning V, Shakeshaft A, Hides L, Larance B. SMART Recovery International and COVID-19: Expanding the reach of mutual support through online groups. J Subst Abuse Treat 2021; 131:108568. [PMID: 34446323 PMCID: PMC8639485 DOI: 10.1016/j.jsat.2021.108568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Abstract
Background Mutual support groups play an extremely important role in providing opportunities for people to engage in alcohol and other drug (AOD) treatment and support. SMART Recovery groups employ cognitive, behavioural and motivational principles and strategies to offer support for a range of addictive behaviours. COVID-19 fundamentally changed the way that these groups could be delivered. Methods A series of online meetings were conducted by the lead author (PK) and the SMART Recovery International Executive Officer (KM), with representatives from the SMART Recovery National Offices in the Ireland (DO), United States (MR), Australia (RM), and Denmark (BSH, DA), and the United Kingdom (AK). The meetings focused on discussing the impacts of COVID-19 on SMART Recovery in each of the regions. Results As a result of restrictions to prevent the transmission of COVID-19, the vast majority of SMART Recovery face-to-face meetings were required to cease globally. To ensure people still had access to AOD mutual support, SMART Recovery rapidly scaled up the provision of online groups. This upscaling has increased the number of groups in countries that had previously provided a limited number of online meetings (i.e., United States, England, Australia), and has meant that online groups are available for the first time in Denmark, Ireland, Hong Kong, Spain, Malaysia and Brazil. Discussion Whilst the urgent and rapid expansion of online groups was required to support people during the pandemic, it has also created an opportunity for the ongoing availability of online mutual support post-pandemic. The challenge for the research community is to critically evaluate the online delivery of mutual support groups, to better understand the mechanisms through which they may work, and to help understand the experience of people accessing the groups.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, Australia.
| | - Kim McCreanor
- SMART Recovery International, United States of America
| | - Alison K Beck
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, Australia
| | - Isabella Ingram
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, Australia
| | | | - Angie King
- SMART Recovery United Kingdom, United Kingdom of Great Britain
| | | | | | - Mark Ruth
- SMART Recovery United States of America, United States of America
| | | | | | - Victoria Manning
- Monash Addiction Research Centre Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Leanne Hides
- School of Psychology, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, Australia
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Nielsen S, Sanfilippo P, Belackova V, Day C, Silins E, Lintzeris N, Bruno R, Grebely J, Lancaster K, Ali R, Bell J, Dietze P, Degenhardt L, Farrell M, Larance B. Perceptions of injectable opioid agonist treatment (iOAT) among people who regularly use opioids in Australia: findings from a cross-sectional study in three Australian cities. Addiction 2021; 116:1482-1494. [PMID: 33067836 DOI: 10.1111/add.15297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/03/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Not all people experiencing opioid dependence benefit from oral opioid agonist treatment. The aim of this study was to examine perceptions of (supervised) injectable opioid agonist treatment (iOAT) (described as 'an opioid similar to heroin self-injected at a clinic several times a day') among people who regularly use opioids and determine how common iOAT eligibility criteria accord with interest in iOAT. DESIGN Cross-sectional survey SETTING: Sydney, Melbourne and Hobart, Australia PARTICIPANTS: A total of 344 people (63% male) who use opioids regularly and had ever injected opioids, interviewed December 2017-March 2018. The mean age of participants was 41.5 years [standard deviation (SD) = 8.5]. MEASUREMENTS Primary outcome measures were interest in iOAT, factors associated with interest and the proportion of participants who would be eligible using common criteria from trials and guidelines. We examined willingness to travel for iOAT, medication preferences and perspectives on whom should receive iOAT. FINDINGS Overall, 53% of participants (n = 182) believed that iOAT would be a good treatment option for them. Participants who believed that iOAT was a good treatment option for them were more likely to be male [adjusted odds ratio (aOR) = 1.76, 95% confidence interval (CI) = 1.10-2.82], have used heroin in the past month (aOR = 6.03, 95% CI = 2.86-12.71), currently regularly inject opioids (aOR = 1.84, 95% CI = 1.16-2.91) and have met ICD-10 criteria for opioid dependence (aOR = 3.46, 95% CI = 1.65-7.24). Those interested in iOAT had commenced more treatment episodes (aOR =1.06, 95% CI = 1.00-1.12). Among those interested in iOAT (n = 182), 26% (n = 48) met common eligibility criteria for iOAT. CONCLUSIONS Interest in injectable opioid agonist treatment does not appear to be universal among people who regularly use opioids. Among study participants who expressed interest in injectable opioid agonist treatment, most did not meet common eligibility criteria.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Paul Sanfilippo
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Vendula Belackova
- Medically Supervised Injecting Centre, Sydney, Australia.,Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carolyn Day
- Medically Supervised Injecting Centre, Sydney, Australia.,Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Ed Silins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Medically Supervised Injecting Centre, Sydney, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Sydney, Australia.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Raimondo Bruno
- School of Medicines (Psychology), University of Tasmania, Hobart, Australia
| | | | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Robert Ali
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - James Bell
- Medically Supervised Injecting Centre, Sydney, Australia.,Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
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Degenhardt L, Hungerford P, Nielsen S, Bruno R, Larance B, Clare PJ, Dobbins T, Hall W, Cohen M, Blyth F, Lintzeris N, Farrell M, Campbell G. Pharmaceutical Opioid Use Patterns and Indicators of Extramedical Use and Harm in Adults With Chronic Noncancer Pain, 2012-2018. JAMA Netw Open 2021; 4:e213059. [PMID: 33835176 PMCID: PMC8035647 DOI: 10.1001/jamanetworkopen.2021.3059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Despite concern about harms related to long-term prescribed opioid use among individuals with chronic noncancer pain (CNCP), no study has examined whether the same patients engage in a risky pattern of use consistently for the long term. OBJECTIVE To examine the prevalence, incidence, persistence, and cessation of a range of opioid behaviors, indicators of extramedical use, and harm among individuals who are prescribed opioids. DESIGN, SETTING, AND PARTICIPANTS This 5-year prospective cohort study in communities across Australia included 1514 adults who were prescribed opioids for CNCP. Data collection took place from August 2012 to December 2018, and data analysis took place from February to November 2020. EXPOSURE Prescription opioid use. MAIN OUTCOMES AND MEASURES High-dose opioid use (≥200 oral morphine equivalent [OME] mg/d); requesting an increase in opioid dose; requesting an early prescription renewal; tampering with opioid medication; diversion of medication to others; and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision opioid dependence. Cessation of opioid use was also assessed. RESULTS Of the 1514 participants, 672 (44.39%) were men, the mean (SD) age was 58 (19) years, and 737 (48.68%) were unemployed. At each annual interview, approximately 1 in 8 people (10.98% [95% CI, 10.33%-11.63%] to 14.73% [95% CI, 13.98%-15.48%] at any given interview) were taking more than 200 OME mg/d; comparatively more had requested an increased dosage in the previous 3 months (8.46% [95% CI, 7.89%-9.03%] to 23.77% [95% CI, 22.82%-24.73%]); and fewer asked for an early prescription renewal (4.61% [95% CI, 4.19%-5.03%] to 13.97% [95% CI, 13.24%-14.70%]). In any given interview, between 3.06% (95% CI, 2.72%-3.40%) and 7.86% (95% CI, 7.31%-8.41%) of respondents reported tampering and between 0.47% (95% CI, 0.33%-0.60%) and 1.39% (95% CI, 1.16%-1.62%) reported diversion to others. Between 8.28% (95% CI, 7.71%-8.84%) and 13.06% (95% CI, 12.35%-13.77%) met criteria for opioid dependence at each interview. Opioid cessation increased across interviews, from year 1 (9.15% [95% CI, 8.55%-9.74%]) to year 5 (20.02% [19.14%-20.89%]). There was considerable incidence and cessation in all behaviors from 1 interview to the next: most who engaged in any of these behaviors only did so at only 1 interview. For pharmaceutical opioid dependence, between 55.26% (95% CI, 53.81%-56.71%) and 64.44% (95% CI, 62.87%-66.00%) of cases in 1 interview did not meet dependence criteria in the following interview. CONCLUSIONS AND RELEVANCE These findings suggest considerable fluidity in opioid use, extramedical behaviors, and opioid dependence among people with CNCP. This reinforces the need for reassessment of the effectiveness and safety of prescription opioid use over time.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Phillip Hungerford
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Monash University, Melbourne, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- School of Psychological Sciences, University of Tasmania, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Philip J. Clare
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, Australia
| | - Timothy Dobbins
- School of Population Health, University of New South Wales Medicine, Sydney, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Queensland, Australia
- National Addiction Centre, Kings College, London, England
| | - Milton Cohen
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Sydney, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Australia
- The Langton Centre, South East Sydney Local Health District Drug and Alcohol Services, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Queensland, Australia
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Nielsen S, Gisev N, Leung J, Clare P, Bruno R, Lintzeris N, Larance B, Blyth F, Hall W, Cohen M, Degenhardt L, Farrell M, Campbell G. Clinical correlates and outcomes associated with pregabalin use among people prescribed opioids for chronic non-cancer pain: A five-year prospective cohort study. Br J Clin Pharmacol 2021; 87:3092-3104. [PMID: 33368473 DOI: 10.1111/bcp.14715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Pregabalin has become widely used as an alternative to opioids in treating certain types of chronic non-cancer pain, but few studies have examined its clinical efficacy outside trials. We address this gap by examining the utilization, correlates and clinical outcomes of pregabalin use among an Australian community-based cohort of people prescribed opioids for chronic non-cancer pain. METHODS Through a five-year prospective cohort study (n = 1514) we examined associations between pregabalin use and pain severity and interference, mental health, opioid dose and past month use of ambulance and emergency department services. We used fixed-effects regression models to examine within-participant differences, and random-effects regression models to examine within- and between-participant differences in clinical outcomes. RESULTS In an analysis of cases with complete data over five-years (n = 896), the prevalence of pregabalin use ranged from 16% at cohort entry to 29% at 36- and 48-months, and 46% reported pregabalin use at any time during the five years. Pregabalin use was associated with greater pain severity and interference and greater use of high-risk opioid doses (>90 oral morphine equivalents/day). Pregabalin use was not associated with changes in mental health symptoms, ambulance or emergency department attendance in the fixed or random effects models. CONCLUSIONS Pregabalin use was common, but for most people use was not associated with clinically meaningful improvements in pain or functioning.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Janni Leung
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,School of Psychology, University of Queensland, Brisbane, Australia.,Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Sydney, Australia
| | - Philip Clare
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,School of Medicine, University of Tasmania, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, Australia.,Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Sydney, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia
| | - Milton Cohen
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | | | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
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Darke S, Duflou J, Larance B, Farrell M, Lappin J. Characteristics and circumstances of death related to buprenorphine toxicity in Australia. Drug Alcohol Depend 2021; 218:108360. [PMID: 33268226 DOI: 10.1016/j.drugalcdep.2020.108360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/25/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Buprenorphine is a semi-synthetic opioid used in the treatment of opioid dependence and chronic pain. The current study aimed to determine the characteristics and circumstances of all recorded cases of buprenorphine-related toxicity death in Australia; determine toxicology and organ pathology; and compare these profiles to cases of death due to buprenorphine-related traumatic injury. METHODS All cases of buprenorphine-related drug toxicity death were retrieved from the National Coronial Information System (2000-2019), as were all cases of buprenorphine-related traumatic injury. Information was collected on cause of death, case characteristics, toxicology and major organ pathology. RESULTS A total of 314 cases of drug toxicity and 55 of traumatic injury were identified. Toxicity cases were significantly older (40.5 v 36.1 years), more likely to have a history of chronic pain (OR 2.95), less likely to have a history of injecting drug use (OR 0.09), but more likely to have injected buprenorphine proximal to death (OR 4.90). There were no group differences in buprenorphine or norbuprenorphine toxicology. Toxicity cases were more likely to have hypnosedatives (OR 2.08) and other opioids (OR 4.69) present, but less likely to have psychostimulants (OR 0.26) and THC (OR 0.45). Toxicity cases were more likely to be obese (OR 4.05), have pre-existing cardiovascular disease (OR 4.02) and heavier hearts (412.1 v 355.2 g). CONCLUSIONS Buprenorphine-related toxicity death cases differed from trauma deaths in their characteristics, toxicology and disease. Fatal buprenorphine toxicity is associated with older age, concurrent use of depressants and cardiovascular disease.
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Affiliation(s)
- Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia.
| | - Johan Duflou
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Briony Larance
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Psychology, University of Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Julia Lappin
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Psychiatry, University of New South Wales, NSW, Australia
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Kelly PJ, Deane FP, Davis EL, Hudson S, Robinson LD, Keane CA, Hatton EL, Larance B. Routine outcome measurement in specialist non-government alcohol and other drug treatment services: Establishing effectiveness indicators for the NADAbase. Drug Alcohol Rev 2020; 40:540-552. [PMID: 33155315 DOI: 10.1111/dar.13191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector. DESIGN AND METHODS ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale). RESULTS Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach. DISCUSSION AND CONCLUSIONS The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Esther L Davis
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Suzie Hudson
- Network of Alcohol and other Drug Agencies, Sydney, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Carol A Keane
- School of Psychology, University of Wollongong, Wollongong, Australia.,School of Health, Medical and Applied Science, Central Queensland University, Rockhampton, Australia
| | - Emma L Hatton
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
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Campbell G, Noghrehchi F, Nielsen S, Clare P, Bruno R, Lintzeris N, Cohen M, Blyth F, Hall W, Larance B, Hungerford P, Dobbins T, Farrell M, Degenhardt L. Risk factors for indicators of opioid-related harms amongst people living with chronic non-cancer pain: Findings from a 5-year prospective cohort study. EClinicalMedicine 2020; 28:100592. [PMID: 33294810 PMCID: PMC7700907 DOI: 10.1016/j.eclinm.2020.100592] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The literature suggests patient characteristics and higher opioid doses and long-term duration are associated with problematic opioid behaviours but no one study has examined the role of all these factors simultaneously in a long-term prospective cohort study. METHODS Five-year, community-based, prospective cohort of people prescribed opioids for chronic non-cancer pain (CNCP). Logistic mixed effect models with multiple imputation were used to address missing data. Oral morphine equivalent (OME) mg per day was categorised as: 0 mg OME/day, 1-49 mg OME/day (reference), 50-89 mg OME/day, 90-199 mg OME/day and 200mg+ OME/day. Patient risk factors included: age, gender, substance use, mental health history and pain-related factors. Main outcomes included: Prescribed Opioids Difficulties Scale (PODS), Opioid-Related Behaviours In Treatment (ORBIT) scale, and ICD-10 opioid dependence. Multiple confounders for problematic opioid behaviours were assessed. FINDINGS Of 1,514 participants 44.4% were male (95%CI 41.9-46.9) and their mean age was 58 years (IQR 48-67). Participants had a mean duration of pain of 10 years (IQR 4.5-20.0) and had been taking strong opioids for a median of four years (IQR 1.0-10.0). At baseline, median OME/day was 73 (IQR 35-148). At 5-years, 85% were still taking strong opioids. PODS moderate-high scores reduced from 59.9% (95%CI 58.8-61.0) at baseline to 51.5% (95%CI 50.0-53.0) at 5-years. Around 9% met criteria for ICD-10 opioid dependence at each wave. In adjusted mixed effect models, the risk factors most consistently associated with problematic opioid use were: younger age, substance dependence, mental health histories and higher opioid doses. INTERPRETATION Both patient risk factors and opioid dose are associated with problematic opioid use behaviours.
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Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
- School of Health and Sport Sciences, University of the Sunshine Coast, USC, Locked Bag 4, Maroochydore, DC QLD 4558, Australia
| | - Firouzeh Noghrehchi
- School of Medical Sciences-Pharmacology, University of Sydney, NSW, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Phillip Clare
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
- School of Medicine, University of Tasmania, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Australia
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Australia
| | - Milton Cohen
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Sydney, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, QLD, Australia
- National Addiction Centre, Kings College, London United Kingdom
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Timothy Dobbins
- School of Public Health and Community Medicine, UNSW, NSW Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
- School of Population and Global Health, University of Melbourne, Australia
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Osborne B, Kelly PJ, Robinson LD, Ivers R, Deane FP, Larance B. Facilitators and barriers to integrating physical health care during treatment for substance use: A socio-ecological analysis. Drug Alcohol Rev 2020; 40:607-616. [PMID: 33094870 DOI: 10.1111/dar.13197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Clinical practice guidelines recommend physical health be addressed when treating substance use disorders. Yet, the integration of alcohol and other drug (AOD) treatment and physical health care is seldom actualised. This is particularly the case in the non-government sector. Using the socio-ecological model as a framework, this study aimed to examine the facilitators and barriers to integrating physical health in non-government AOD services. DESIGN AND METHODS Interviews were conducted with residential and outpatient AOD services across New South Wales, Australia. Qualitative data were collected from service users (n = 20) and clinicians (n = 13). Interview data were transcribed then systematically coded and analysed using iterative categorisation. RESULTS Most staff recognised physical health care as a fundamental component of treatment for substance use even when there were personal, professional and structural barriers for doing so. Service users reported a diverse range of health and social benefits when physical health care was incorporated in to AOD treatment. An exception to this was some negative experiences with health-care providers that were not identified by staff. DISCUSSION AND CONCLUSIONS Findings highlight the importance of developing resources to enhance the health literacy and capacity of non-government AOD services to address the physical health of clients. Given some clients reported negative experiences with health-care providers that were not identified by staff, services should seek regular feedback from clients regarding their experiences with external providers. The effectiveness of existing and new physical health initiatives within non-government organisation AOD services needs more formal evaluation.
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Affiliation(s)
- Briony Osborne
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
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26
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Gisev N, Nielsen S, Campbell G, Santo T, Mant A, Bruno R, Cohen M, Hall WD, Larance B, Lintzeris N, Farrell M, Degenhardt L. Antidepressant Use Among People Prescribed Opioids for Chronic Noncancer Pain. Pain Med 2020; 20:2450-2458. [PMID: 30861530 DOI: 10.1093/pm/pnz009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Although depression and chronic pain often coexist, few studies have examined antidepressant use among people with pain. This study examines the prevalence and characteristics associated with antidepressant use among people prescribed opioids for chronic noncancer pain (CNCP). DESIGN Baseline data from a prospective cohort study. SETTING Australian community. SUBJECTS A total of 1166 people prescribed opioids for CNCP. METHODS Baseline data collection consisted of a self-completed seven-day medication diary and telephone interview to collect information on sociodemographic characteristics and mental/physical health using validated questionnaires. Logistic regression was used to examine characteristics associated with antidepressant use, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS Of the 1166 participants, 668 (57.3%) were female, and the median (interquartile range) age was 59 (49-68) years. About half the cohort (N = 637, 54.6%) used antidepressants. Of these, 329 (51.7%) reported moderate to severe depression. Amitriptyline was the most commonly used antidepressant (17.3%). Factors independently associated with antidepressant use were being female (AOR = 1.47, 95% CI = 1.13-1.92), more years lived in pain (AOR = 1.01, 95% CI = 1.00-1.02), and use of nonopioid analgesics (AOR = 1.34, 95% CI = 1.01-1.78), benzodiazepines and related drugs (AOR = 1.84, 95% CI = 1.36-2.49), antiepileptics (AOR = 1.86, 95% CI = 1.38-2.51), and antipsychotics (AOR = 2.15, 95% CI = 1.22-3.77). CONCLUSIONS Antidepressant use is common among people with CNCP prescribed opioids. Those using antidepressants were more likely to use other psychotropic medicines concurrently, highlighting that they are a high-risk population requiring comprehensive assessment to optimize outcomes and reduce potential harms from polypharmacy.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrea Mant
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Milton Cohen
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia.,National Addiction Centre, Kings College London, London, UK
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia.,The Langton Centre, South East Sydney Local Health District Drug and Alcohol Services, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Larance B, Byrne M, Lintzeris N, Nielsen S, Grebely J, Degenhardt L, Shahbazi J, Shanahan M, Lancaster K, Dore G, Ali R, Farrell M. Open-label, multicentre, single-arm trial of monthly injections of depot buprenorphine in people with opioid dependence: protocol for the CoLAB study. BMJ Open 2020; 10:e034389. [PMID: 32737087 PMCID: PMC7398105 DOI: 10.1136/bmjopen-2019-034389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Opioid agonist treatment is effective for opioid dependence and newer extended-release buprenorphine (BUP-XR) injections represent a significant development. The Community Long-Acting Buprenorphine (CoLAB) study aims to evaluate client outcomes among people with opioid dependence receiving 48 weeks of BUP-XR treatment, and examines the implementation of BUP-XR in diverse community healthcare settings in Australia. METHODS AND ANALYSIS The CoLAB study is a prospective single-arm, multicentre, open-label trial of monthly BUP-XR injections in people with opioid dependence. Participants are being recruited from a network of general practitioner and specialist drug treatment services located in the states of New South Wales, Victoria and South Australia in Australia. Following a minimum 7 days on 8-32 mg of sublingual buprenorphine (±naloxone), participants will receive monthly subcutaneous BUP-XR injections administered by a healthcare practitioner at intervals of 28 days (-2/+14 days). The primary endpoint is participant retention in treatment at 48 weeks after treatment initiation. Secondary endpoints will evaluate dosing schedule variations, craving, withdrawal, substance use, health and well-being, and client-reported treatment experience. Qualitative and costing substudies will examine implementation barriers and facilitators at the client and provider level. ETHICS AND DISSEMINATION The study has received ethics approval from the St Vincent's Hospital Sydney Human Research Ethics Committee (Ref. HREC/18/SVH/221). The findings will be disseminated via publication in peer-reviewed journals, presentations at national and international scientific conferences, and in relevant community organisation publications and forums. TRIAL REGISTRATION NUMBER NCT03809143 PROTOCOL IDENTIFIER: CoLAB1801, V.4.0 dated 01 August 2019.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- School of Psychology, University of Wollongong, Sydney, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marianne Byrne
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Surry Hills, New South Wales, Australia
- The Langton Centre, South East Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeyran Shahbazi
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gregory Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
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28
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Kelly PJ, Beck AK, Baker AL, Deane FP, Hides L, Manning V, Shakeshaft A, Larance B, Neale J, Kelly J, Oldmeadow C, Searles A, Treloar C, Gray RM, Argent A, McGlaughlin R. Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in Mutual Support Groups Coordinated by SMART Recovery Australia: Protocol for a Pilot Study. JMIR Res Protoc 2020; 9:e15113. [PMID: 32673272 PMCID: PMC7380906 DOI: 10.2196/15113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the importance and popularity of mutual support groups, there have been no systematic attempts to implement and evaluate routine outcome monitoring (ROM) in these settings. Unlike other mutual support groups for addiction, trained facilitators lead all Self-Management and Recovery Training (SMART Recovery) groups, thereby providing an opportunity to implement ROM as a routine component of SMART Recovery groups. OBJECTIVE This study protocol aims to describe a stage 1 pilot study designed to explore the feasibility and acceptability of a novel, purpose-built mobile health (mHealth) ROM and feedback app (Smart Track) in SMART Recovery groups coordinated by SMART Recovery Australia (SRAU) The secondary objectives are to describe Smart Track usage patterns, explore psychometric properties of the ROM items (ie, internal reliability and convergent and divergent validity), and provide preliminary evidence for participant reported outcomes (such as alcohol and other drug use, self-reported recovery, and mental health). METHODS Participants (n=100) from the SMART Recovery groups across New South Wales, Australia, will be recruited to a nonrandomized, prospective, single-arm trial of the Smart Track app. There are 4 modes of data collection: (1) ROM data collected from group participants via the Smart Track app, (2) data analytics summarizing user interactions with Smart Track, (3) quantitative interview and survey data of group participants (baseline, 2-week follow-up, and 2-month follow-up), and (4) qualitative interviews with group participants (n=20) and facilitators (n=10). Feasibility and acceptability (primary objectives) will be analyzed using descriptive statistics, a cost analysis, and a qualitative evaluation. RESULTS At the time of submission, 13 sites (25 groups per week) had agreed to be involved. Funding was awarded on August 14, 2017, and ethics approval was granted on April 26, 2018 (HREC/18/WGONG/34; 2018/099). Enrollment is due to commence in July 2019. Data collection is due to be finalized in October 2019. CONCLUSIONS To the best of our knowledge, this study is the first to use ROM and tailored feedback within a mutual support group setting for addictive behaviors. Our study design will provide an opportunity to identify the acceptability of a novel mHealth ROM and feedback app within this setting and provide detailed information on what factors promote or hinder ROM usage within this context. This project aims to offer a new tool, should Smart Track prove feasible and acceptable, that service providers, policy makers, and researchers could use in the future to understand the impact of SMART Recovery groups. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/15113.
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Affiliation(s)
- Peter J Kelly
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Alison K Beck
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Frank P Deane
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Brisbane St Lucia, Australia
| | - Victoria Manning
- Faculty of Medicine, Nursing and Health Sciences, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Anthony Shakeshaft
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Briony Larance
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Joanne Neale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - John Kelly
- Centre for Addiction Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, Australia
| | - Andrew Searles
- Health Research Economics Unit, Hunter Medical Research Institute, New Lambton, Australia
| | - Carla Treloar
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Rebecca M Gray
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, Australia
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29
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Larance B, Degenhardt L, Grebely J, Nielsen S, Bruno R, Dietze P, Lancaster K, Larney S, Santo T, Shanahan M, Memedovic S, Ali R, Farrell M. Perceptions of extended-release buprenorphine injections for opioid use disorder among people who regularly use opioids in Australia. Addiction 2020; 115:1295-1305. [PMID: 31860767 PMCID: PMC7292758 DOI: 10.1111/add.14941] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/11/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
AIMS To examine perceptions of extended-release (XR) buprenorphine injections among people who regularly use opioids in Australia. DESIGN Cross-sectional survey prior to implementation. XR-buprenorphine was registered in Australia in November 2018. SETTING Sydney, Melbourne and Hobart. Participants A total of 402 people who regularly use opioids interviewed December 2017 to March 2018. MEASUREMENTS Primary outcome concerned the proportion of participants who believed XR-buprenorphine would be a good treatment option for them, preferred weekly versus monthly injections and perceived advantages/disadvantages of XR-buprenorphine. Independent variables concerned the demographic characteristics and features of current opioid agonist treatment (OAT; medication-type, dose, prescriber/dosing setting, unsupervised doses, out-of-pocket expenses and travel distance). FINDINGS Sixty-eight per cent [95% confidence interval (CI) = 63-73%] believed XR-buprenorphine was a good treatment option for them. They were more likely to report being younger [26-35 versus > 55 years; odds ratio (OR) = 3.16, 95% CI = 1.12-8.89; P = 0.029], being female (OR = 1.67, 95% CI = 1.04-2.69; P = 0.034), < 10 years school education (OR = 1.87, 95% CI = 1.12-3.12; P = 0.016) and past-month heroin (OR = 1.81, 95% CI = 1.15-2.85; P = 0.006) and methamphetamine use (OR = 1.90, 95% CI = 1.20-3.01; P = 0.006). Fifty-four per cent reported no preference for weekly versus monthly injections, 7% preferred weekly and 39% preferred monthly. Among OAT recipients (n = 255), believing XR-buprenorphine was a good treatment option was associated with shorter treatment episodes (1-2 versus ≥ 2 years; OR = 3.93, 95% CI = 1.26-12.22; P = 0.018), fewer unsupervised doses (≤ 8 doses past-month versus no take-aways; OR = 0.50; 95% CI = 0.27-0.93; P = 0.028) and longer travel distance (≥ 5 versus < 5 km; OR = 2.10, 95% CI = 1.20-3.65; P = 0.009). Sixty-nine per cent reported 'no problems or concerns' with potential differences in availability, flexibility and location of XR-buprenorphine. CONCLUSIONS Among regular opioid users in Australia, perceptions of extended-release buprenorphine as a good treatment option are associated with being female, recent illicit drug use and factors relating to the (in)convenience of current opioid agonist treatment.
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Affiliation(s)
- Briony Larance
- School of PsychologyUniversity of WollongongWollongongNSWAustralia,National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | | | - Suzanne Nielsen
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia,Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Raimondo Bruno
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia,School of MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | | | - Kari Lancaster
- Centre for Social Research in HealthUNSW SydneySydneyNSWAustralia
| | - Sarah Larney
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Thomas Santo
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Marian Shanahan
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Sonja Memedovic
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Robert Ali
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia,Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Michael Farrell
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
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30
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Osborne B, Kelly PJ, Larance B, Robinson LD, Ivers R, Deane FP, Webber A, Kelly D. Substance Use and Co-occurring Physical Health Problems: File Review of a Residential Drug and Alcohol Treatment Service. J Dual Diagn 2020; 16:250-259. [PMID: 31877110 DOI: 10.1080/15504263.2019.1704960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives: Physical health conditions cause significant disability and mortality among people living with alcohol and other drug problems. There has been limited research on the prevalence of health problems among clinical samples of people with substance use disorders, particularly among those in residential treatment. Yet residential settings provide unique opportunity for responding to health needs. To better understand the health of people attending treatment for substance use disorders, this study conducted a file review to examine the prevalence of physical health problems as identified during routine residential care. Methods: A retrospective review of client files collected between 2013 and 2017 (N = 172) was completed at a residential treatment service in NSW, Australia. Data were extracted to examine the prevalence of physical health problems recorded at entry into treatment. Correlates of health problems were estimated using bivariate descriptive analyses and logistic regression. Results: The majority of clients in treatment for substance use had a comorbid physical health problem (80.7%). Musculoskeletal problems were the most frequently reported medical issue (38.6%). Odds for some physical health problems were related to client gender, age, and primary substance of concern. Male gender remained the strongest predictor of dental health problems when controlling for age and substance type (odds ratio [OR] = 3.60). Primary alcohol use remained the strongest predictor of nutritional deficiencies when controlling for client age (OR = 4.43). Among clients with a physical health problem and who had a treatment episode of at least 14 days (n = 110), just over half (55.5%) were referred to a health-related practitioner or service during their treatment episode. Conclusions: This study contributes to the literature by reporting on the incidence of physical health problems among people in residential treatment for substance use disorders. The high prevalence of physical health morbidity iterates the role of non-medical staff working within drug and alcohol services in the identification of client health needs. The findings support calls for systematic screening of physical health as part of routine care for substance use disorders improved integration of substance treatment and the broader primary health care system.
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Affiliation(s)
- Briony Osborne
- Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
| | - Briony Larance
- Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
| | - Laura D Robinson
- Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
| | - Rowena Ivers
- School of Public Health, University of Sydney, Sydney, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
| | - Adrian Webber
- St Vincent de Paul Services, Lewisham, New South Wales, Australia
| | - David Kelly
- St Vincent de Paul Services, Lewisham, New South Wales, Australia
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31
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Nielsen S, Picco L, Campbell G, Lintzeris N, Larance B, Farrell M, Degenhardt L, Bruno R. Development of a Brief Patient-Administered Screening Tool for Prescription Opioid Dependence for Primary Care Settings. Pain Med 2020; 21:e79-e88. [PMID: 31591644 PMCID: PMC8204889 DOI: 10.1093/pm/pnz213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To develop a short, patient-administered screening tool that will allow for earlier assessment of prescription opioid dependence (often referred to as addiction) in primary care settings. DESIGN AND SETTING Cross-sectional analysis (N = 1,134) from the two-year time point of the Pain and Opioids IN Treatment (POINT) cohort was used in the scale development. SUBJECTS Participants who completed two-year interviews in the POINT study, a prospective cohort study that followed people with chronic noncancer pain over a five-year period, and who were prescribed strong opioids for a minimum of six weeks at baseline. METHODS An advisory committee provided advice on wording and content for screening in primary care settings. Univariate logistic regression identified individual items that were significantly associated with meeting ICD-11 criteria for prescription opioid dependence. Exploratory and confirmatory factor analysis (EFA and CFA) were conducted, and items were reduced to identify a small item set that were discriminative and shared a simple underlying structure. RESULTS Sixty-four variables associated with ICD-11 criteria for prescription opioid dependence were initially identified. Four rounds of EFA were performed, resulting in five items remaining. CFA identified two possible four-item combinations, with the final combination chosen based on greater item endorsement and the results of goodness-of-fit indices. CONCLUSIONS Addressing prescription opioid dependence is an important part of the global public health challenge surrounding rising opioid-related harm. This study addresses an important initial requisite step to develop a brief screening tool. Further studies are required to validate the tool in clinical settings.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, New South Wales, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Peacock A, Gisev N, Memedovic S, Larance B, Brown J, Cairns R, Buckley N, Farrell M, Degenhardt L. Opioid use and harms associated with a sustained-release tapentadol formulation: A post-marketing surveillance study. Drug Alcohol Depend 2020; 206:107697. [PMID: 31869601 DOI: 10.1016/j.drugalcdep.2019.107697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
AIMS A sustained-release formulation (SRF) of tapentadol has been marketed in Australia since February 2013. This study examined tapentadol SRF extra-medical use, attractiveness for extra-medical use, and associated harms in Australia. METHODS This post-marketing study comprises analyses of Australian community sales data (2011-2017) for eleven pharmaceutical opioids (prescription and over-the-counter codeine disaggregated); calls to three poisons information centres (covering five of the eight jurisdictions in Australia) related to pharmaceutical opioids and coded by the centres as 'misuse' or 'abuse' (2011-2017); and interviews with people who inject drugs (n = 888) recruited as part of the Illicit Drug Reporting System (IDRS) from all Australian capital cities (2017). RESULTS Population-level availability of tapentadol SRF increased from market launch, comprising the sixth largest market share of all opioid unit sales, and third greatest share in oral morphine equivalent milligrams sold, in December 2017. Lifetime tapentadol SRF use among the IDRS sample (n = 888) was low (1.5%; 95%CI 0.9-2.5), with few reporting past-6 month non-prescribed use or injection. Non-fatal overdose following tapentadol use was self-reported by less than 1% (95%CI 0.1-0.8). Between 2013-2017, 1.1% (n = 25) of pharmaceutical opioid 'misuse/abuse' calls were related to tapentadol, and predominantly the SRF. CONCLUSIONS Increasing utilisation of tapentadol sustained-release formulation was observed, along with indications of extra-medical use and harms associated with use, although on a smaller scale relative to other opioids. These findings need to be interpreted in the context of the low level of exposure to tapentadol sustained-release formulation among the sentinel population of people who inject drugs.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Medicine, University of Tasmania, TAS, Australia.
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Sonja Memedovic
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Psychology, University of Wollongong, NSW, Australia
| | - Jared Brown
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia; School of Medical Sciences, University of Sydney, NSW, Australia
| | - Nicholas Buckley
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia; School of Medical Sciences, University of Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
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Santo T, Larance B, Bruno R, Gisev N, Nielsen S, Degenhardt L, Campbell G. Correlates of indicators of potential extra-medical opioid use in people prescribed opioids for chronic non-cancer pain. Drug Alcohol Rev 2019; 39:128-134. [PMID: 31841260 DOI: 10.1111/dar.13021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND AIMS The opioid-related behaviours in treatment (ORBIT) scale are a measure of recent indicators of potential extra-medical opioid use. Indicators of potential extra-medical opioid use are divergent practices among people prescribed opioids that may place them at risk of harm. This study aimed to examine the correlates of indicators of potential extra-medical opioid use in people prescribed opioids for chronic non-cancer pain (CNCP). DESIGN AND METHODS The Pain and Opioids IN Treatment (POINT) study is a prospective cohort study of people prescribed opioids for CNCP in Australia. People prescribed opioids solely for opioid dependence were excluded. This cross-sectional study utilised logistic regression to determine the characteristics associated with reporting any indicators of potential extra-medical opioid use. RESULTS Of the 1505 participants, 38% reported at least one indicator of potential extra-medical opioid use, most commonly asking for an increase in prescribed opioid dose (21%) and early prescription renewal (12%). Indicators of potential extra-medical opioid use were associated with younger age (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI] = 0.92, 0.99), male sex (AOR = 1.53; 95% CI = 1.15, 2.04), lifetime pharmaceutical opioid use disorder (AOR = 1.87; 95% CI = 1.31, 2.66) and lifetime illicit drug use disorder (AOR = 1.72; 95% CI = 1.18, 2.52). DISCUSSION AND CONCLUSIONS Over one-third of the POINT cohort reported one or more indicators of potential extra-medical opioid use. Lifetime substance use disorders were associated these divergent practices, highlighting the importance of clinical monitoring and patient education for this patient group. Longitudinal studies are needed to investigate whether indicators of potential extra-medical opioid use predict opioid use disorders in this population.
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Affiliation(s)
- Thomas Santo
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Medicine, University of Tasmania, Hobart, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Darke S, Farrell M, Duflou J, Larance B, Lappin J. Circumstances of death of opioid users being treated with naltrexone. Addiction 2019; 114:2000-2007. [PMID: 31278812 DOI: 10.1111/add.14729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/16/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Naltrexone is an opioid antagonist used as a maintenance drug for the treatment of opioid dependence and in opioid withdrawal regimens. The current study aimed to: (1) determine the clinical characteristics and circumstances of death of people undergoing naltrexone treatment for opioid dependence; and (2) determine the blood toxicology of cases including naltrexone concentrations, the presence of other drugs and a comparison of morphine concentrations in the presence and absence of naltrexone. DESIGN Retrospective study of all deaths among people undergoing naltrexone treatment for opioid dependence retrieved from the National Coronial Information System, 2000-17. SETTING Australia-wide. CASES Seventy-four cases, with a mean age of 32.5 years; 81.1% male. MEASUREMENTS Information was collected on demographics, manner of death, naltrexone treatment history, toxicology and major organ pathology. FINDINGS Death was attributed to opioid toxicity in 86.5% of cases: accidental (79.7%), deliberate (6.8%). In 55.4% of all cases the decedent was maintained on oral naltrexone and 32.4% had a recent naltrexone implant. In five cases the decedent was undergoing opioid detoxification. Among those screened for naltrexone, naltrexone was present in the blood or urine of 52.5% (15.8% of oral maintenance cases, 85.7% of implant cases). Fourteen cases were known to have died from opioid toxicity with naltrexone present in their blood or urine. The median blood naltrexone concentrations were within the reported therapeutic range. CONCLUSIONS The primary cause of death among people undergoing naltrexone treatment for opioid dependence in Australia from 2000 to 2017 was opioid toxicity, the majority of cases having been maintained on oral naltrexone. Cases in which naltrexone was not detected indicate the importance of treatment compliance. Deaths due to opioid toxicity where naltrexone was present indicates the possibility of overdose while naltrexone medication is maintained.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,School of Psychology, University of Wollongong, NSW, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,School of Psychiatry, University of New South Wales, NSW, Australia
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Jacka B, Larance B, Copeland J, Burns L, Farrell M, Jackson E, Degenhardt L. Health care engagement behaviors of men who use performance- and image-enhancing drugs in Australia. Subst Abus 2019; 41:139-145. [PMID: 31545138 DOI: 10.1080/08897077.2019.1635954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Although people who inject performance- and image-enhancing drugs (PIEDs) report fewer unsafe injecting practices, stigma and discrimination may negatively impact their access to help and information. Engagement with health care services, compared with social networks (friends, relatives, and gym associates) and the Internet and media (steroid user forums, information sites, and magazines), may be important for harm minimization. Methods: A cross-sectional Internet or in-person survey of men who use PIEDs in Australia in 2014-2015 examined differences in sources for PIEDs, injecting equipment, and anabolic-androgenic steroids (AAS) information and factors associated with having periodical medical checks related to PIEDs issues using multivariate logistic regression. Results: In total, 267 men (mean age: 25 years, SD: 8.7 years; 246 of 267 [92%] reported recent AAS injection) were recruited. Most participants sourced injecting equipment from health professionals, PIEDs from their social networks, and AAS information from the Internet and media. Self-reported AAS knowledge was high and frequent. Higher income (adjusted odds ratio [AOR]: 2.04, 95% confidence interval [CI]: 1.03, 4.00), ≥2 different PIEDs used in addition to AAS (AOR: 1.94, 95% CI: 1.08, 3.49), and sourcing AAS information from health care professionals (AOR: 3.14, 95% CI: 1.81, 5.46) were independently associated with periodical medical checks. Participants nominated preference for improved health services through needle-syringe programs, primary care services, and peer educator support groups. Conclusion: Men who use PIEDs in Australia consider themselves well informed but tend to use Internet and media sources, providing potentially misleading or inaccurate information. Increasing trust between men who use PIEDs and health care providers may enable delivery of PIEDs-specific information to those at greatest need.
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Affiliation(s)
- B Jacka
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - B Larance
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J Copeland
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - L Burns
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M Farrell
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - E Jackson
- Nepean/Blue Mountains Sexual Health & HIV Clinics, Nepean Hospital, Kingswood, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
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36
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Larance B, Campbell G, Moore T, Nielsen S, Bruno R, Lintzeris N, Cohen M, Hall W, Mattick R, O'Donnell C, Degenhardt L. Concerns and Help-Seeking Among Patients Using Opioids for Management of Chronic Noncancer Pain. Pain Med 2019; 20:758-769. [PMID: 29762767 DOI: 10.1093/pm/pny078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The safety and efficacy of long-term opioid treatment for chronic noncancer pain (CNCP) remains controversial. This study examined whether patients who report problematic opioid use sought help and/or perceived barriers to help-seeking. METHODS Data were collected from 1,086 people prescribed opioids for CNCP via a large prospective cohort called the Pain and Opioids IN Treatment (POINT) study. Patients' characteristics and help-seeking were examined according to scores on the Prescribed Opioids Difficulties Scale (PODS). RESULTS Participants scoring "intermediate" (17%) or "high" (30%) on the PODS were younger and reported more complex pain presentations, higher opioid doses, poorer physical health, moderate to severe anxiety and depression, aberrant behavior, past month opioid use disorder and help-seeking (compared with the "low" PODS group, 53%). One-quarter (26%) had sought help, most commonly from a primary care physician, specialist pain clinic, family member/partner, counselor/psychologist, and the Internet. Participants in the "high" PODS group were more likely to have sought help from an alcohol or other drug service, addiction specialist, or drug information helpline. Common barriers to help-seeking were desire for self-management and concern that their opioid treatment may be discontinued. Although 35% met criteria for likely opioid use disorder, only 4.8% reported lifetime treatment with methadone or buprenorphine; participants' ratings indicated significant perceived stigma associated with these medications. CONCLUSIONS The PODS is effective in identifying patients who are concerned about their opioid use. Strategies to address stigma related to drug treatment, including better integration of primary health, specialist pain, and addiction services, are important in reducing opioid-related harm.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Teleri Moore
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.,The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney New South Wales, Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney New South Wales, Australia.,Addiction Medicine, Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Milton Cohen
- St Vincent's Clinical School, UNSW Australia, Sydney, New South Wales, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse, University of Queensland, Queensland, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Courtney O'Donnell
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
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Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.,University of Wollongong, Wollongong, NSW
| | - Nicholas Lintzeris
- University of Sydney, Sydney, NSW.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
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Shanahan M, Larance B, Nielsen S, Cohen M, Schaffer M, Campbell G. A protocol for a discrete choice experiment: understanding patient medicine preferences for managing chronic non-cancer pain. BMJ Open 2019; 9:e027153. [PMID: 31377695 PMCID: PMC6687015 DOI: 10.1136/bmjopen-2018-027153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION High rates of chronic non-cancer pain (CNCP), concerns about adverse effects including dependence among those prescribed potent pain medicines, the recent evidence supporting active rather than passive management strategies and a lack of funding for holistic programme have resulted in challenges around decision making for treatment among clinicians and their patients. Discrete choice experiments (DCEs) are one way of assessing and valuing treatment preferences. Here, we outline a protocol for a study that assesses patient preferences for CNCP treatment. METHODS AND ANALYSIS A final list of attributes (and their levels) for the DCE was generated using a detailed iterative process. This included a literature review, a focus group and individual interviews with those with CNCP and clinicians who treat people with CNCP. From this process a list of attributes was obtained. Following a review by study investigators including pain and addiction specialists, pharmacists and epidemiologists, the final list of attributes was selected (number of medications, risk of addiction, side effects, pain interference, activity goals, source of information on pain, provider of pain care and out-of-pocket costs). Specialised software was used to construct an experimental design for the survey. The survey will be administered to two groups of participants, those from a longitudinal cohort of patients receiving opioids for CNCP and a convenience sample of patients recruited through Australia's leading pain advocacy body (Painaustralia) and their social media and website. The data from the two participant groups will be initially analysed separately, as their demographic and clinical characteristics may differ substantially (in terms of age, duration of pain and current treatment modality). Mixed logit and latent class analysis will be used to explore heterogeneity of responses. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of New South Wales Sydney Human Ethics committee HC16511 (for the focus group discussions, the one-on-one interviews and online survey) and HC16916 (for the cohort). A lay summary will be made available on the National Drug and Alcohol Research Centre website and Painaustralia's website. Peer review papers will be submitted, and it is expected the results will be presented at relevant pain management conferences nationally and internationally. These results will also be used to improve understanding of treatment goals between clinicians and those with CNCP.
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Affiliation(s)
- Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Milton Cohen
- Vincent's Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Schaffer
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
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Schaffer AL, Buckley NA, Degenhardt L, Larance B, Cairns R, Dobbins TA, Pearson SA. Person-level changes in oxycodone use after the introduction of a tamper-resistant formulation in Australia. CMAJ 2019; 190:E355-E362. [PMID: 29581162 DOI: 10.1503/cmaj.170666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Australia introduced tamper-resistant controlled-release (CR) oxycodone in April 2014. We quantified the impact of the reformulation on dispensing, switching and poisonings. METHODS We performed interrupted time-series analyses using population-representative national dispensing data from 2012 to 2016. We measured dispensing of oxycodone CR (≥ 10 mg), discontinuation of use of strong opioids and switching to other strong opioids after the reformulation compared with a historical control period. Similarly, we compared calls about intentional opioid poisoning using data from a regional poisons information centre. RESULTS After the reformulation, dispensing decreased for 10-30 mg (total level shift -11.1%, 95% confidence interval [CI], -17.2% to -4.6%) and 40-80 mg oxycodone CR (total level shift -31.5%, 95% CI -37.5% to -24.9%) in participants less than 65 years of age but was unchanged in people 65 years of age or older. Compared with the previous year, discontinuation of use of strong opioids did not increase (adjusted hazard ratio [HR] 0.95, 95% CI 0.91 to 1.00), but switching to oxycodone/naloxone did increase (adjusted HR 1.54, 95% CI 1.32 to 1.79). Switching to morphine varied by age (p < 0.001), and the greatest increase was in participants less than 45 years of age (adjusted HR 4.33, 95% CI 2.13 to 8.80). Participants switching after the reformulation were more likely to be dispensed a tablet strength of 40 mg or more (adjusted odds ratio [OR] 1.40, 95% CI 1.09 to 1.79). Calls for intentional poisoning that involved oxycodone taken orally increased immediately after the reformulation (incidence rate ratio (IRR) 1.31, 95% CI 1.05-1.64), but there was no change for injected oxycodone. INTERPRETATION The reformulation had a greater impact on opioid access patterns of people less than 65 years of age who were using higher strengths of oxycodone CR. This group has been identified as having an increased risk of problematic opioid use and warrants closer monitoring in clinical practice.
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Affiliation(s)
- Andrea L Schaffer
- Centre for Big Data Research in Health (Schaffer, Pearson), University of New South Wales; School of Medical Sciences (Buckley), University of Sydney; National Drug and Alcohol Research Centre (Degenhardt, Larance, Dobbins), University of New South Wales, Sydney, AU; New South Wales Poisons Information Centre (Cairns), Children's Hospital at Westmead, Westmead, AU
| | - Nicholas A Buckley
- Centre for Big Data Research in Health (Schaffer, Pearson), University of New South Wales; School of Medical Sciences (Buckley), University of Sydney; National Drug and Alcohol Research Centre (Degenhardt, Larance, Dobbins), University of New South Wales, Sydney, AU; New South Wales Poisons Information Centre (Cairns), Children's Hospital at Westmead, Westmead, AU
| | - Louisa Degenhardt
- Centre for Big Data Research in Health (Schaffer, Pearson), University of New South Wales; School of Medical Sciences (Buckley), University of Sydney; National Drug and Alcohol Research Centre (Degenhardt, Larance, Dobbins), University of New South Wales, Sydney, AU; New South Wales Poisons Information Centre (Cairns), Children's Hospital at Westmead, Westmead, AU
| | - Briony Larance
- Centre for Big Data Research in Health (Schaffer, Pearson), University of New South Wales; School of Medical Sciences (Buckley), University of Sydney; National Drug and Alcohol Research Centre (Degenhardt, Larance, Dobbins), University of New South Wales, Sydney, AU; New South Wales Poisons Information Centre (Cairns), Children's Hospital at Westmead, Westmead, AU
| | - Rose Cairns
- Centre for Big Data Research in Health (Schaffer, Pearson), University of New South Wales; School of Medical Sciences (Buckley), University of Sydney; National Drug and Alcohol Research Centre (Degenhardt, Larance, Dobbins), University of New South Wales, Sydney, AU; New South Wales Poisons Information Centre (Cairns), Children's Hospital at Westmead, Westmead, AU
| | - Timothy A Dobbins
- Centre for Big Data Research in Health (Schaffer, Pearson), University of New South Wales; School of Medical Sciences (Buckley), University of Sydney; National Drug and Alcohol Research Centre (Degenhardt, Larance, Dobbins), University of New South Wales, Sydney, AU; New South Wales Poisons Information Centre (Cairns), Children's Hospital at Westmead, Westmead, AU
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health (Schaffer, Pearson), University of New South Wales; School of Medical Sciences (Buckley), University of Sydney; National Drug and Alcohol Research Centre (Degenhardt, Larance, Dobbins), University of New South Wales, Sydney, AU; New South Wales Poisons Information Centre (Cairns), Children's Hospital at Westmead, Westmead, AU
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Campbell G, Hall WD, Peacock A, Lintzeris N, Bruno R, Larance B, Nielsen S, Cohen M, Chan G, Mattick RP, Blyth F, Shanahan M, Dobbins T, Farrell M, Degenhardt L. Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study. Lancet Public Health 2019; 3:e341-e350. [PMID: 29976328 DOI: 10.1016/s2468-2667(18)30110-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Interest in the use of cannabis and cannabinoids to treat chronic non-cancer pain is increasing, because of their potential to reduce opioid dose requirements. We aimed to investigate cannabis use in people living with chronic non-cancer pain who had been prescribed opioids, including their reasons for use and perceived effectiveness of cannabis; associations between amount of cannabis use and pain, mental health, and opioid use; the effect of cannabis use on pain severity and interference over time; and potential opioid-sparing effects of cannabis. METHODS The Pain and Opioids IN Treatment study is a prospective, national, observational cohort of people with chronic non-cancer pain prescribed opioids. Participants were recruited through community pharmacies across Australia, completed baseline interviews, and were followed up with phone interviews or self-complete questionnaires yearly for 4 years. Recruitment took place from August 13, 2012, to April 8, 2014. Participants were asked about lifetime and past year chronic pain conditions, duration of chronic non-cancer pain, pain self-efficacy, whether pain was neuropathic, lifetime and past 12-month cannabis use, number of days cannabis was used in the past month, and current depression and generalised anxiety disorder. We also estimated daily oral morphine equivalent doses of opioids. We used logistic regression to investigate cross-sectional associations with frequency of cannabis use, and lagged mixed-effects models to examine temporal associations between cannabis use and outcomes. FINDINGS 1514 participants completed the baseline interview and were included in the study from Aug 20, 2012, to April 14, 2014. Cannabis use was common, and by 4-year follow-up, 295 (24%) participants had used cannabis for pain. Interest in using cannabis for pain increased from 364 (33%) participants (at baseline) to 723 (60%) participants (at 4 years). At 4-year follow-up, compared with people with no cannabis use, we found that participants who used cannabis had a greater pain severity score (risk ratio 1·14, 95% CI 1·01-1·29, for less frequent cannabis use; and 1·17, 1·03-1·32, for daily or near-daily cannabis use), greater pain interference score (1·21, 1·09-1·35; and 1·14, 1·03-1·26), lower pain self-efficacy scores (0·97, 0·96-1·00; and 0·98, 0·96-1·00), and greater generalised anxiety disorder severity scores (1·07, 1·03-1·12; and 1·10, 1·06-1·15). We found no evidence of a temporal relationship between cannabis use and pain severity or pain interference, and no evidence that cannabis use reduced prescribed opioid use or increased rates of opioid discontinuation. INTERPRETATION Cannabis use was common in people with chronic non-cancer pain who had been prescribed opioids, but we found no evidence that cannabis use improved patient outcomes. People who used cannabis had greater pain and lower self-efficacy in managing pain, and there was no evidence that cannabis use reduced pain severity or interference or exerted an opioid-sparing effect. As cannabis use for medicinal purposes increases globally, it is important that large well designed clinical trials, which include people with complex comorbidities, are conducted to determine the efficacy of cannabis for chronic non-cancer pain. FUNDING National Health and Medical Research Council and the Australian Government.
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Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia; National Addiction Centre, Kings College London, London, UK
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Sydney, NSW, Australia; The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, NSW, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Milton Cohen
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Gary Chan
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Peacock A, Larance B, Bruno R, Pearson SA, Buckley NA, Farrell M, Degenhardt L. Effectiveness and framing of pharmaceutical opioid abuse-deterrent formulations. Addiction 2019; 114:404-405. [PMID: 30767388 PMCID: PMC6656581 DOI: 10.1111/add.14556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 12/17/2022]
Abstract
Abuse-deterrent formulations (ADFs) of pharmaceutical opioids have limited capacity to reduce extra-medical use and harm; their impact is likely restricted to prevention of specific practices among population sub-groups. This debate highlights the importance of viewing ADFs as one component in a range of public health responses. Greater involvement of invested parties (e.g., prescribers, consumers) and reframing terminology will reduce discrimination and stigma.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia,School of Psychology, University of Wollongong, NSW,
Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia,School of Psychology, University of Wollongong, NSW,
Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia,School of Medicine, University of Tasmania, TAS,
Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New
South Wales Sydney, NSW, Australia
| | | | - Michael Farrell
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia
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42
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Peacock A, Larance B, Bruno R, Pearson SA, Buckley NA, Farrell M, Degenhardt L. Post-marketing studies of pharmaceutical opioid abuse-deterrent formulations: a framework for research design and reporting. Addiction 2019; 114:389-399. [PMID: 29989247 PMCID: PMC6599581 DOI: 10.1111/add.14380] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/12/2018] [Accepted: 07/04/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Opioid formulations with properties to deter abuse (abuse-deterrent formulations; ADFs) have been developed as one response to the prescription opioid 'epidemic'. As for all medicines, ADFs undergo evaluation of safety and efficacy prior to registration for marketing. However, reduced extra-medical use (the primary intended outcome of ADFs and reason for their introduction) can only be established in post-marketing observational studies, comparing them to opioid formulations without abuse-deterrent properties. This has implications for various features of study design and analysis. We discuss proposals for the design, conduct, governance and reporting of post-marketing studies on the effectiveness of pharmaceutical and opioid ADFs. METHODS A review of current guidance documents, public work-shops and forums and our own experience with post-marketing studies of ADFs. RESULTS AND CONCLUSIONS Research questions for post-marketing studies on ADFs of opioids should reasonably be framed around detecting any probable intended or unintended clinical and/or meaningful changes in specific aspects of extra-medical use (e.g. injection use) and harms. Outcomes reported by prevalence and frequency of occurrence and disaggregated by specific product and route of administration can illustrate the magnitude of ADF impact. We argue that a multi-faceted approach is required, using data from both general population and sentinel high-risk cohorts and from primary and secondary data sources. The comparator (historical non-ADF formulation of that opioid, equivalent current generic or similar opioid product), duration of monitoring and analytical approach require justification and should be sufficient to add weight to conclusions of causality. To maximize transparency, we recommend explicit declarations of funding and conflict of interest, establishment of an advisory committee, publication of study protocol and access to study results.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia,School of Medicine, University of Tasmania, TAS 7001, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia,School of Medicine, University of Tasmania, TAS 7001, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Australia
| | | | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia
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43
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Jacka B, Kemp R, Degenhardt L, Peacock A, Clare P, Bruno R, Dev A, Sotade O, Larance B. Trends in methamphetamine and opioid use among clients of needle-syringe programs in Queensland, Australia: 2007-2015. Drug Alcohol Rev 2019; 38:159-168. [PMID: 30761653 DOI: 10.1111/dar.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Needle-syringe programs (NSP) are an underutilized source of data on drug injection trends; these data are essential for informing public health interventions. We examine trends in NSP service occasions from 2007-2015. DESIGN AND METHODS Using standardised data from 26 NSP outlets through the Queensland NSP Minimum Data Set (QNSPMDS), trends in service occasions among clients intending to inject methamphetamine, heroin, opioid substitution therapy (OST) medications and other pharmaceutical opioids were assessed using multilevel mixed-effects negative binomial regression, adjusting for month, year, age and clustering by site. RESULTS Over 1.5 million service occasions were recorded in 2007-2015. Methamphetamine was the main 'drug intended to inject' (33.7%), however cf. 2007, the incidence rate ratio decreased to 0.64 (95% CI: 0.62, 0.66) in 2009, remaining low until 2015. Among clients reporting methamphetamine injection, there was a shift in the form from base to the higher-potency crystal methamphetamine since 2012. Heroin injection (22.5% service occasions) initially increased (cf. 2007), followed by a decline to 0.77 (95% CI: 0.75, 0.79) in 2015. Significant and sustained increases in OST and other pharmaceutical opioids injection were observed throughout the study period, accounting for 7.2% and 19.8% of total visits, respectively. DISCUSSION AND CONCLUSIONS The QNSPMDS provides unique, routinely collected, jurisdiction-wide and standardised data on the demographics of people who inject drugs, types of drugs injected and regional variations; these data are essential in informing policy, planning and program implementation. There remains significant opportunity to enhance engagement and linkage to care alongside needle-syringe provision.
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Affiliation(s)
- Brendan Jacka
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Robert Kemp
- Communicable Diseases Branch, Queensland Health, Brisbane, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Philip Clare
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Abhilash Dev
- Chief Medical Officer and Healthcare Regulation Branch, Queensland Health, Brisbane, Australia
| | | | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
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44
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Campbell G, Lintzeris N, Gisev N, Larance B, Pearson S, Degenhardt L. Regulatory and other responses to the pharmaceutical opioid problem. Med J Aust 2018; 210:6-8.e1. [PMID: 30636303 DOI: 10.5694/mja2.12047] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Nicholas Lintzeris
- University of Sydney, Sydney, NSW.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.,University of Wollongong, Wollongong, NSW
| | - Sallie Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.,Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
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45
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Schaffer AL, Karanges EA, Buckley NA, Wilson A, Degenhardt L, Larance B, Pearson SA. Increases in controlled-release oxycodone utilisation following the subsidy of oxycodone with naloxone formulations: An Australian population-based study. Pharmacoepidemiol Drug Saf 2018; 28:97-105. [PMID: 30421838 DOI: 10.1002/pds.4683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/21/2018] [Accepted: 09/03/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Despite increasing use of oxycodone/naloxone controlled-release (CR) in Australia, little is known about how it has affected the overall oxycodone CR market since its subsidy in 2011. METHODS We used Pharmaceutical Benefits Scheme dispensing claims (2006-2016) and interrupted time series analysis to examine changes in the quarterly rates of dispensing of oral oxycodone CR formulations (oxycodone/naloxone CR and single-ingredient oxycodone CR) and new oxycodone CR treatment episodes. We also performed a retrospective cohort study in a sample of people initiating a new oxycodone CR treatment episode in 2009, 2012/2013, and 2016 to compare opioid utilisation patterns over time. RESULTS The subsidy of oxycodone/naloxone CR was associated with a 1.6-fold increase in the growth rate of oxycodone CR dispensing, resulting from rapid uptake of low strength (≤5 mg) oxycodone/naloxone CR. In our cohort of initiators, the number of new oxycodone CR treatment episodes increased 2.1-fold between 2009 and 2016; in 2016, 91.4% of new treatment episodes involved oxycodone/naloxone CR. Comparing 2016 with 2009, we observed an increase in people initiating with a tablet strength less than or equal to 5-mg (risk difference [RD] = 21.1%, 95% CI, 19.9%-22.4%) in people initiating with no other opioid dispensing 90 days prior to initiation (RD = 5.2%, 3.8%-6.6%) and with no further opioid dispensing 90 days after initiation (RD = 8.8%, 7.4%-10.2%). CONCLUSIONS After its subsidy, the uptake of low-dose oxycodone/naloxone CR was greater than expected if it were substituting the single-ingredient oxycodone CR, resulting in an expansion of the oxycodone CR market.
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Affiliation(s)
- Andrea L Schaffer
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Emily A Karanges
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | | | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
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46
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Gisev N, Pearson SA, Larance B, Larney S, Blanch B, Degenhardt L. A population-based study of transdermal fentanyl initiation in Australian clinical practice. Eur J Clin Pharmacol 2018; 75:401-408. [PMID: 30392109 DOI: 10.1007/s00228-018-2588-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Although guidelines caution against initiation of transdermal (TD) fentanyl among those who are opioid naïve, there is concern that not all people receive adequate prior opioid exposure. This study examined the percentage of people who are opioid naïve at the time of TD fentanyl initiation in Australia; strengths initiated; and characteristics associated with being opioid naïve. METHODS This is a national retrospective cohort study derived from a 10% sample of Pharmaceutical Benefits Scheme concessional beneficiaries initiating TD fentanyl between 29 September 2009-31 December 2013. Individuals were deemed opioid naïve if they had no opioid dispensings in the previous 90 days. Logistic regression was used to determine characteristics associated with being opioid naïve, including socio-demographics, likely comorbidities and previous analgesic use. RESULTS A total of 13,166 people initiated TD fentanyl; 60.4% were female and 76.2% were aged ≥ 65 years. Three in ten (30.4%) were opioid naïve and 63.2% initiated the 12 mcg/h patch. Those who were opioid naïve were more likely to be female (adjusted odds ratio (aOR) 1.35; 95% CI 1.25-1.46), older (aOR 1.85; 95% CI 1.54-2.28 for those ≥ 85 years) and previously dispensed medicines for dementia (aOR 1.37; 95% CI 1.04-1.80). People previously dispensed medicines for cancer were less likely to be opioid naïve (aOR 0.57; 95% CI 0.48-0.67). CONCLUSIONS Three in ten Australians initiating TD fentanyl are opioid naïve. Our findings suggest that specific patient sub-populations already at increased risk of opioid-related adverse events are not receiving prior opioid treatment before initiation, highlighting the need for greater adherence to current treatment guidelines.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia
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Nielsen S, Lintzeris N, Murnion B, Degenhardt L, Bruno R, Haber P, Johnson J, Hardy M, Ling S, Saddler C, Dunlop A, Demirkol A, Silsbury C, Phung N, Houseman J, Larance B. Understanding an emerging treatment population: Protocol for and baseline characteristics of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence. Drug Alcohol Rev 2018; 37:887-896. [PMID: 30280448 DOI: 10.1111/dar.12859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/04/2018] [Accepted: 08/10/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND AIMS Despite large increases in pharmaceutical opioid dependence and related mortality, few studies have focused on the characteristics and treatment experiences of those with pharmaceutical opioid dependence. We describe the formation of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence and describe their baseline characteristics. DESIGN AND METHODS People who had entered treatment for pharmaceutical opioid dependence (n = 108) were recruited through drug treatment services in New South Wales, Australia. We describe baseline characteristics of those that commenced pharmaceutical opioids for pain or other reasons and conducted a thematic analysis of responses regarding their treatment experience. RESULTS Mean age was 41 years (SD 11), half were male (48%). Just over half reported lifetime heroin use (57%). Oxycodone (49%) and codeine (29%) were the most common opioids reported. Most (85%) reported past-year problematic pain, 38% reported chronic pain. Half (52%) reported moderate to severe depression symptoms. Most (66%) commenced opioids for pain, and this group were older, less likely to report a previous overdose and less likely to report use of illicit drugs compared to those commencing for other reasons. Five themes related to treatment expectations: (i) stigma; (ii) the restrictive nature of treatment; (iii) knowledge; (iv) pain; and (v) positive experience with buprenorphine. DISCUSSION AND CONCLUSIONS This study describes the complexities in an important emerging treatment population of pharmaceutical opioid-dependent people. Findings highlights that addressing knowledge and perceptions around treatment may be critical to address the rising mortality associated with pharmaceutical opioid dependence.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,South East Sydney Local Health District Drug and Alcohol Services, Sydney, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Nicholas Lintzeris
- South East Sydney Local Health District Drug and Alcohol Services, Sydney, Australia
| | - Bridin Murnion
- Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Raimondo Bruno
- School of Psychology, University of Tasmania, Hobart, Australia
| | - Paul Haber
- Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Jennifer Johnson
- University Centre for Rural Health - North Coast, University of Sydney, Lismore, Australia
| | - Mark Hardy
- Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, Australia
| | - Stephen Ling
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Craig Saddler
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Cavalry Mater Hospital, Newcastle, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Apo Demirkol
- South East Sydney Local Health District Drug and Alcohol Services, Sydney, Australia
| | - Catherine Silsbury
- Drug Health Services, Western Sydney Local Health District Sydney, Australia
| | - Nghi Phung
- Drug Health Services, Western Sydney Local Health District Sydney, Australia
| | - Jennie Houseman
- Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Larance B, Gisev N, Cama E, Nelson EC, Darke S, Larney S, Degenhardt L. Predictors of transitions across stages of heroin use and dependence prior to treatment-seeking among people in treatment for opioid dependence. Drug Alcohol Depend 2018; 191:145-151. [PMID: 30107320 PMCID: PMC6698181 DOI: 10.1016/j.drugalcdep.2018.03.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Little is known about transition pathways among heroin users prior to treatment. This study examined the demographic and clinical predictors of transition speed from heroin use, to dependence, to first treatment episode. METHODS 1149 heroin-dependent participants recruited from opioid agonist treatment clinics in Sydney, Australia, underwent a structured interview. Age of onset (AOO) was collected for heroin use, dependence and treatment-seeking, childhood maltreatment, psychiatric history and other substance dependence. Discrete-time survival analyses modelled years from onset of use to dependence, and from dependence to treatment-seeking, including demographic and clinical covariates. FINDINGS Median AOO for first heroin use, dependence and treatment-seeking was 18 years (inter-quartile range, or IQR = 6), 21 years (IQR = 7), and 24 years (IQR = 10) respectively. In adjusted models, younger birth cohorts (vs. born <1960), greater childhood maltreatment and later AAO of first heroin use were associated with more rapid transitions from heroin use to dependence. Living independently, parental violence, and alcohol dependence were associated with slower transitions. Earlier treatment-seeking was associated with younger birth cohorts, having dependent children and later AOO of dependence. Delayed treatment-seeking was associated with <10 years school education, living independently, depression and alcohol dependence. CONCLUSIONS In this treatment sample, onset of heroin use occurred during late adolescence, suggesting the need for targeted interventions in mid-adolescence. Transitions to heroin dependence, then treatment-seeking, occurred during early adulthood. Rapid transitions from use to dependence were associated with younger birth cohorts, greater exposure to childhood maltreatment, and later onset of use.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia.
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW 2052, Australia
| | - Elena Cama
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW 2052, Australia
| | - Elliot C. Nelson
- Washington University, School of Medicine, Department of Psychiatry, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW 2052, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW 2052, Australia
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49
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Holliday S, Hayes C, Dunlop A, Morgan S, Tapley A, Henderson K, Larance B, Magin P. Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention. Pain Med 2018; 18:2306-2315. [PMID: 28340143 DOI: 10.1093/pm/pnx018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Advocacy and commercially funded education successfully reduced barriers to the provision of long-term opioid analgesia. The subsequent escalation of opioid prescribing for chronic noncancer pain has seen increasing harms without improved pain outcomes. Methods This was a one-group pretest-posttest design study. A multidisciplinary team developed a chronic pain educational package for general practitioner trainees emphasizing limitations, risk-mitigation, and deprescribing of opioids with transition to active self-care. This educational intervention incorporated prereadings, a resource kit, and a 90-minute interactional video case-based workshop incorporated into an education day. Evaluation was via pre- and postintervention (two months) questionnaires. Differences in management of two clinical vignettes were tested using McNemar's test. Results Of 58 eligible trainees, 47 (response rate = 81.0%) completed both questionnaires (36 of whom attended the workshop). In a primary analysis including these 47 trainees, therapeutic intentions of tapering opioid maintenance for pain (in a paper-based clinical vignette) increased from 37 (80.4%) pre-intervention to 44 (95.7%) postintervention (P = 0.039). In a sensitivity analysis including only trainees attending the workshop, 80.0% pre-intervention and 97.1% postintervention tapered opioids (P = 0.070). Anticipated initiation of any opioids for a chronic osteoarthritic knee pain clinical vignette reduced from 35 (74.5%) to 24 (51.1%; P = 0.012) in the primary analysis and from 80.0% to 41.7% in the sensitivity analysis (P = 0.001). Conclusions Necessary improvements in pain management and opioid harm avoidance are predicated on primary care education being of demonstrable efficacy. This brief educational intervention improved hypothetical management approaches two months subsequently. Further research measuring objective changes in physician behavior, especially opioid prescribing, is indicated.
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Affiliation(s)
- Simon Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, New South Wales, Australia
| | - Chris Hayes
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Integrated Pain Service, New Lambton Heights, New South Wales, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, New South Wales, Australia
| | - Simon Morgan
- General Practice Training Valley to Coast, Mayfield, New South Wales, Australia
| | - Amanda Tapley
- General Practice Training Valley to Coast, Mayfield, New South Wales, Australia
| | - Kim Henderson
- General Practice Training Valley to Coast, Mayfield, New South Wales, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,General Practice Training Valley to Coast, Mayfield, New South Wales, Australia
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Abstract
INTRODUCTION It has been argued that tapentadol may pharmacologically have lower abuse potential than other pharmaceutical opioids currently available. However, there has been no comprehensive triangulation of data regarding use and harms associated with this formulation. A sustained-release formulation (SRF) of tapentadol (Palexia) was released in Australia in 2011 and listed for public subsidy in 2013. We summarise here the methods of a postmarketing study which will measure postintroduction: (1) population level availability, (2) extramedical use and diversion, (3) attractiveness for extramedical use and (4) associated harms, of tapentadol compared against other pharmaceutical opioids. METHODS AND ANALYSIS We evaluated key sources on pharmaceutical use and harms in Australia. This review indicateddata from four sources that disaggregate pharmaceutical opioid formulations and capture tapentadol SRF could be triangulated. These data sources comprised: (1) national pharmaceutical opioid community sales data from 2011 to 2017, (2) national pharmaceutical opioid poisonings reported to Poison Information Centres (PICs) from 2011 to 2017, (3) number of vendors on online marketplaces listing pharmaceutical opioids for sale and (4) data on pharmaceutical opioid extramedical use, attractiveness and harms from interviews with people who regularly inject drugs in Australia. ETHICS AND DISSEMINATION Ethics approval is not required for use of pharmaceutical sales data. Ethics approval has been obtained for use of national pharmaceutical opioid poisonings reported to PICs (LNR/16/SCHN/44) and for use of online marketplace data and interview data from people who inject drugs (HC12086). Key findings will be published mid-2018 in a peer-reviewed academic journal, and presented at various conferences and professional meetings.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Buckley
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA
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