Addiction Clinic Research Articles

Brief Report on Outpatient Treatment of Adolescent Opioid Use Disorder.

Adolescents are experiencing an increase in substance-related overdose fatalities, with most attributed to fentanyl and an increase in the prevalence of opioid use disorder (OUD). We know little about the characteristics of adolescents who use fentanyl, develop OUD, and seek addiction treatment. Here, we present demographic data and retention data on adolescent patients (≤18 years) who were treated at a pediatric addiction clinic. We included all patients who presented to an intake appointment at the pediatric addiction clinic between January 3, 2023, and October 17, 2023, and were diagnosed with OUD. We collected data on demographics, decision to start medicine for OUD (MOUD), choice of MOUD, and retention in treatment based on clinic visits at 1 month and 3 months postintake. Patients are consisted of 24 adolescents (Mage at intake = 16.8 ± 1.0 years, 67% Hispanic/Latinx, 75% public insurance) who met the criteria for moderate to severe OUD with known fentanyl use. All were offered MOUD, and 21 patients agreed to MOUD treatment; 16 adolescents selected buprenorphine/naloxone, and 5 selected naltrexone. At 3 months postintake, 14 patients (58%) were retained in treatment. Adolescent and family acceptance of MOUD treatment was high, and most patients were retained in treatment at 3 months postintake. More studies are needed to understand how to retain and support adolescent patients in outpatient treatment for OUD given the emergence of fentanyl.

Screening for compensated advanced chronic liver disease using transient elastography in outpatient addiction clinics.

Patients with substance use disorders present with many risk factors for liver disease-including alcohol, hepatitis C virus infection, and obesity-and should thus be screened for compensated advanced chronic liver disease (cACLD). Such screening could potentially be performed by outpatient addiction clinics. In this study, we aimed to assess the feasibility, acceptability, and results of cACLD screening using transient elastography (TE) among all patients attending routine follow-up visits at addiction clinics, regardless of their liver disease risk factors. Liver fibrosis evaluation using TE was offered to every patient consulting two different addiction clinics in France, between December 2020 and September 2021, during dedicated half-day screening sessions. The screening was proposed during the patient's routine care and was performed immediately after the scheduled consultation. Patients with a liver stiffness measurement over 8 kPa were referred to a hepatology visit in the addiction clinic within 2-4 weeks. Screening was offered to 227 patients and was accepted by 116 (51%) patients. Twelve patients had a liver stiffness over 8 kPa, and nine of these patients attended the recommended specialist hepatology visit. Five patients (4.3% of those screened) were diagnosed with cACLD. Patients' acceptance of the screening was associated with older age, being on one's own or professionally inactive, and presenting with alcohol use disorder. Overall, our results demonstrated that opportunistic cACLD screening using TE in outpatient addiction clinics was feasible and acceptable, with good results.

Drinking refusal self-efficacy- a positive effect of attending de-addiction clinic -survey report of South Indian Union territory hospital.

Introduction: Alcoholism is the most common psychiatric disorder that causes impairment in physical health, mental health,and social functioning. “Alcohol dependence syndrome (ADS) is characterized by a state, psychic, and usually also physical,resulting from drinking alcohol. Self-efficacy is an individual’s belief in his/her innate ability to achieve goals. The prevalenceof current alcohol use in Pondicherry is 9.5% for males and 20 % in total. However, more than 40% of alcohol users drinkalcohol in a dependent pattern in Pondicherry. The current study aimed to assess the self-efficacy of clients to quit alcohol.Methodology: In this descriptive cross-sectional study 97 participants were selected by a convenient sampling technique atde addiction clinic, JIPMER, Puducherry. The tools used for the study include socio-demographic variables, modified versionof drinking refusal self-efficacy questionnaire, which consists of 19 questions to assess their belief about the ability to resistalcohol in the various situation on a six-point Likert scale ranged from 1( I am very sure I would drink) to 6 (I am sure I wouldnot drink)The primary objective was analysed using descriptive and inferential statistics and the secondary objectives were analysedusing the chi-square test and Pearson correlation.Results: The result showed that among 97 study participants, the majority of them could resist (58.8%) alcohol during theirde-addiction follow up visit.Conclusion: Our study concluded that patients who regularly attend de-addiction clinic could resist alcohol consumption.There is still a need for health education and counseling to quit Alcohol.

Buprenorphine Induction in Trauma Patients With Opioid Use Disorder — A Single Center Experience?

IntroductionBuprenorphine is a Food and Drug Administration-approved therapy for opioid use disorder, with proven efficacy in treatment retention and reduction in opioid use and mortality. Low-dose buprenorphine initiation or microinduction is a novel means of initiation that may allow for an easier transition in patients. Trauma patients have high rates of opioid use disorder and patient directed discharges (PDD). We hypothesized that patients initiated on a buprenorphine microinduction program would have increased protocol completion and fewer PDD compared with patients initiated historically on a traditional induction. MethodsOur retrospective cohort study compared buprenorphine microinduction and traditional induction in trauma patients at an urban level one trauma center between December 2020 and June 2022. Patients aged 18-89 y with traumatic injuries who received buprenorphine were included. Our primary outcome was in-hospital protocol completion, defined as reaching 16 mg of buprenorphine within 24 h or a documented stable dose. Statistical analysis was performed using chi-square for categorical variables and two sample t-tests for continuous variables. ResultsNinety-eight patients were included, with 46 initiating with microinduction and 52 initiating with traditional induction. There was no difference in protocol completion, (P = 0.29) and 83% of subjects who started an induction protocol completed it. Those who completed a protocol were more likely to be discharged home (P = 0.0002), had less PDD (P = 0.001), and had an increased likelihood of attending outpatient addiction clinic follow-up (P = 0.038). ConclusionsRegardless of the protocol type, buprenorphine induction can be implemented in trauma patients with high protocol completion rates. In our population, those who complete a protocol had a higher likelihood of discharge home and postdischarge follow-up in addiction medicine clinic.

Initiation of Buprenorphine Treatment of Opioid Use Disorder in Pediatric Emergency Departments.

Pediatric emergency departments (EDs) in the United States are facing a rise in the number of children and adolescents who present with opioid use disorder (OUD), often driven by illicitly manufactured fentanyl. Medication treatment of pediatric OUD in the ED setting is often limited to symptomatic treatment of opioid withdrawal. Pediatric patients are rarely offered medications for OUD, especially in the ED setting. Buprenorphine is a partial opioid agonist that is Food and Drug Administration-approved for the treatment of OUD in patients aged 16 years and older. Adult studies have demonstrated that ED initiation of medication for OUD such as buprenorphine is feasible, safely treats withdrawal symptoms, and can improve patient compliance with outpatient follow-up. However, initiation of buprenorphine in the ED has not been well-studied in the pediatric population. We present 2 cases of adolescent patients, a 16-year-old male and 17-year-old female, who presented to the ED with opioid withdrawal. They were both diagnosed with severe OUD because of their use of counterfeit pills containing fentanyl. Both patients were successfully started on buprenorphine/naloxone in the pediatric ED before transitioning to an outpatient addiction clinic for continued treatment. The case series demonstrates the feasibility of ED-based buprenorphine initiation for adolescents, an important and timely intervention for adolescents with OUD.

Gaining Recovery in Addiction for Community Elders (GRACE) Project: The Impact of Age-Specific Care on Clinical Outcomes and Health Care Resource Utilization in Older Adults With Substance Use Disorder in an Interprofessional Addiction Clinic.

The prevalence of substance use disorders (SUDs) in older adults has been increasing, necessitating tailored and effective addiction care for this aging demographic. The purpose of this study was to assess the impact of age-specific, interprofessional addiction care on clinical outcomes and health care resource utilization in older adults with SUD. This quasi-experimental study directly compares patients enrolled in the Gaining Recovery in Addiction for Community Elders (GRACE) Project, an interprofessional age-specific addictions treatment program, with age-matched older adults who received conventional "treatment as usual" (TAU). Through retrospective comparative analysis, substance use outcomes, mental and physical health improvements, and inappropriate use of emergency services were examined among 78 older adults with SUD. Clinical outcomes and health care resource utilization were superior for older adults who received age-specific addictions care through the GRACE Project, as compared to mixed-age conventional "TAU." GRACE patients had improved treatment adherence, fewer relapses, and longer treatment engagement. While both groups exhibited significant reductions in depression and anxiety scores, GRACE patients showed greater improvements. This group demonstrated superior control of both hypertension and diabetes. Importantly, they had fewer inappropriate emergency department visits and avoidable hospitalizations than conventional "TAU." Addiction treatment delivered by an interprofessional team to meet the unique strengths and needs of older adults has the potential to improve treatment adherence and more favorable long-term outcomes in substance use, mental health, and chronic medical conditions. Nurses are poised to lead interprofessional teams to meet the growing demand for specialized addiction treatment and integrated care for older adults.

Monitoring the development of mental health in clients of the Addiction Clinic for Children and Adolescents

Monitoring the development of mental health in clients of the Addiction Clinic for Children and Adolescents

Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis

BackgroundPatients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma.MethodsIn this qualitative study, we interviewed patients with OUD at a single urban academic medical center consisting of multiple primary care and addiction clinics in Oregon, USA. Participants were eligible if they had (1) at least one virtual visit for OUD between March 2020 and December 2021, and (2) a prescription for buprenorphine not exclusively used for chronic pain. We conducted phone interviews between October and December 2022, then recorded, transcribed, dual-coded, and analyzed using reflexive thematic analysis.ResultsThe mean age of participants (n = 30) was 40.5 years (range 20–63); 14 were women, 15 were men, and two were transgender, non-binary, or gender-diverse. Participants were 77% white, and 33% had experienced homelessness in the prior six months. We identified four themes regarding how telehealth for OUD treatment shaped patient perceptions of and experiences with stigma at the individual (1), public (2–3), and structural levels (4): (1) Telehealth offers wanted space and improved control over treatment setting; (2) Public stigma and privacy concerns can impact both telehealth and in-person encounters, depending on clinical and personal circumstances; (3) The social distance of telehealth could mitigate or exacerbate perceptions of clinician stigma, depending on both patient and clinician expectations; (4) The increased flexibility of telehealth translated to perceptions of increased clinician trust and respect.ConclusionsThe forms of stigma experienced by individuals with OUD are complex and multifaceted, as are the ways in which those experiences interact with telehealth-based care. The mixed results of this study support policies allowing for a more individualized, patient-centered approach to care delivery that allows patients a choice over how they receive OUD treatment services.

Provider Perceptions Toward Extended-Release Buprenorphine for Treatment of Opioid Use Disorder.

The persistence of the opioid crisis and the proliferation of synthetic fentanyl have heightened the demand for the implementation of novel delivery mechanisms of pharmacotherapy for the treatment of opioid use disorder, including injectable extended-release buprenorphine (buprenorphine-ER). The purpose of this study was to understand provider-level barriers to prescribing buprenorphine in order to facilitate targeted strategies to improve implementation for patients who would benefit from this novel formulation. Using an interview template adapted from the Consolidated Framework for Implementation Research (CFIR), we conducted structured focus group interviews with 20 providers in an outpatient addiction clinic across 4 sessions to assess providers' perceptions of buprenorphine-ER. Ninety-four unique comments were identified and deductively coded using standardized CFIR constructs. Providers expressed mixed receptivity and confidence in using buprenorphine-ER. Although providers could identify a number of theoretical advantages to the injectable formulation over sublingual buprenorphine, many expressed reservations about using it due to inexperience, negative patient experiences, uncertainties about patient candidacy, cost, and logistical constraints. Provider concerns about buprenorphine-ER may limit utilization. Some concerns may be mitigated through improved education, research, and logistical support. Given the putative benefits of buprenorphine-ER, future research should target barriers to implementation, in part based on hypotheses generated by these findings.

Methods for pragmatic randomized clinical trials of pain therapies: IMMPACT statement.

Pragmatic, randomized, controlled trials hold the potential to directly inform clinical decision making and health policy regarding the treatment of people experiencing pain. Pragmatic trials are designed to replicate or are embedded within routine clinical care and are increasingly valued to bridge the gap between trial research and clinical practice, especially in multidimensional conditions, such as pain and in nonpharmacological intervention research. To maximize the potential of pragmatic trials in pain research, the careful consideration of each methodological decision is required. Trials aligned with routine practice pose several challenges, such as determining and enrolling appropriate study participants, deciding on the appropriate level of flexibility in treatment delivery, integrating information on concomitant treatments and adherence, and choosing comparator conditions and outcome measures. Ensuring data quality in real-world clinical settings is another challenging goal. Furthermore, current trials in the field would benefit from analysis methods that allow for a differentiated understanding of effects across patient subgroups and improved reporting of methods and context, which is required to assess the generalizability of findings. At the same time, a range of novel methodological approaches provide opportunities for enhanced efficiency and relevance of pragmatic trials to stakeholders and clinical decision making. In this study, best-practice considerations for these and other concerns in pragmatic trials of pain treatments are offered and a number of promising solutions discussed. The basis of these recommendations was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks.

The role of the occupational therapist in treatment of patients with prescription medicine dependence

Introduction The abuse of prescription drugs (especially sedatives, hypnotics and opioid analgesics) is a serious and increasingly common phenomenon occurring across addiction clinics. Medications are prescribed for the treatment of chronic pain, sleep difficulties or as mood stabilisers in response to the rush of time and demands of performance. The onset of addiction is often protracted and subtle, but has a major impact on the quality of life and the health, economic or social status of the user. Patients may experience, among other things, cognitive impairment, fatigue, sleep disturbances, irritability, loss of motivation, headaches or impaired coordination of movements. This study is focused on cognitive impairment due to prescription drug dependence and how this impairment affects patients in everyday life.ObjectivesThis poster aims to introduce the audience to the possibilities of occupational therapy intervention in the context of addiction medicine.MethodsData will be taken using standardized tests and questionnaires dealing with cognitive function. It will be conducted upon the patient’s admission to addiction treatment and again after six months of cognitive rehabilitation following the initial survey. Data are collected at the General University Hospital in Prague, Department of Addictology, Prague, Czech Republic.ResultsData are being collected.ConclusionsThe case study manifests multidisciplinary approach in care of patients addicted of prescription medicine. The aim is a comprehensive view of all aspects of the patient’s life affected by prescription drug abuse with cognitive impairment.Grant affiliation: This paper was made possible by the institutional support programme Cooperatio, research area Health Sciences and Grant No. 260632 within the Specific Academic Research.Disclosure of InterestNone Declared

The Role of Personalization in Virtual Reality Exposure Therapy During the Treatment of Alcohol Use Disorder

IntroductionIn Cue-Exposure-Therapy (CET), clients are exposed to triggers through objects, people and environments that arouse craving (Sinha et al. Neuropsychopharmacol. 2009;34 1198–1208). Virtual Reality Exposure therapy (VRET) is used to experience these triggers in a realistic, safe, and personalized way. VR has been used successfully in the treatment of psychiatric disorders. It has not yet been developed and sufficiently tested as an adjuvant in the clinical post-detoxification phase of treatment of alcohol use disorders (AUD) (e.g. Bordnick et al. Addict.Behav 2008;33 743-756; Hone-Blanchet et al. Front.Hum.Neurosci. 2014; 8(844) 1-15). Additionally, these treatment methods have been tested for effect, but not for effectiveness around different VR technologies (Ghita & Gutierrez-Maldonado. Addict.Behav 2018; 81 1-11; ). This study focuses on VRET-Recovry to examine to what extent VR worlds could be personalized in an effective manner to help treat AUD as well as clarifying on the ways in which the VR worlds could be optimized to achieve its goal.ObjectivesThe primary objectives of this study are to assess the necessity of personalization in VR environments for AUD treatment, identify the critical elements for personalization, and examine their impact on craving in AUD patients.MethodsThe study included 10 AUD patients diagnosed according to DSM-V criteria, aged between 18 and 65, who were in the final week of clinical detoxification at a large addiction clinic in The Netherlands. A controlled experiment was conducted using the Recovry 1.0 VR system on Samsung Gear VR and Samsung Galaxy S9. The experiment involved exposure to various VR scenes (CG and 360o), including a neutral setting, a bar scene, and a home situation, with the duration and sequence controlled by a therapist. Data collection consisted of pre- and post-exposure questionnaires, heart rate and blood pressure measurements, and interviews.ResultsCraving was remarkably low in the VR bar scene, primarily due to its unsociable context, limited alcohol visibility, and absence of peer pressure. Technical limitations, such as suboptimal resolution, also affected the feeling of presence. Positive results were shown that craving was predominantly stimulated in the apartment scene, driven by the presence of alcohol-related visual cues and social elements, resembling relaxed drinking with others.ConclusionsThis study underscores that some degree of personalization is needed on all craving dimensions with clear preference was given to CG or 360°. The environments were dependent on the personal history and associations they represent to different levels of alcohol visibility (messy or clean), and types of drink (based on past drinking behavior), and different emotional contexts are needed (positive and negative).Disclosure of InterestNone Declared

Innovation in practice: A deviant case analysis of a locally developed assessment tool used in a psychiatric and addiction clinic in Sweden

AbstractThis article analyses the use of a locally developed assessment tool designed to generate aggregated data to evaluate the work of a psychiatric and addiction clinic. The use of tools, methods and interventions in the Swedish social services is usually based on recommendations in national guidelines established by the National Board of Health and Welfare (NBHW). Thus, a locally produced and systematically used assessment tool provides an interesting deviant case for discussing knowledge production and use from the perspective of evidence‐based practice. The assessment tool was characterised by the specific psychiatric and addiction clinic context, where local needs and prerequisites were prioritised over the recommendations found in NBHW guidelines. The empirics comprise interviews with 12 professionals who used the tool, where experience of using the tool was analysed using a thematic analysis. The findings can be summarised in three main conclusions. First, tinkering of tools and methods is not necessarily associated with limited practice applicability or relevance. Second, professionals are more likely to appreciate a tool if that tool is designed with a treatment and conversation rationality in mind. Third, rather than perceived as more valid than other types of knowledge, NBHW‐recommended tools are associated with a certain shape or style – but a shape or style that is permeated by legitimacy.

Shared Medical Appointment: A Novel Model for Incorporating Group Visits Into Residency Training for Substance Use Disorders.

Shared medical appointments (SMAs) are a novel modality for treating patients with similar conditions, together, by a team of interdisciplinary providers. SMAs benefit patients with substance use disorder (SUD), but no research has focused on the feasibility of implementation of SMAs in a teaching clinic. Primary care residents rotated in a half-day ambulatory addiction clinic for 4 weeks where a third-year resident co-facilitated 4 SMAs. Confidence, knowledge, and attitudes about SUD care were assessed using web-based surveys at weeks 0, 4, and 8. Pre- and post-intervention scores were compared using a t test for paired samples. Ten residents were included in the analyses. Using a 10-point Likert scale, confidence in SUD knowledge (7.0-8.3, P = .003), confidence in counseling patients with SUD (7.1-8.2, P = .023), and confidence in facilitating an SMA (5.7-8.3, P = .007) showed statistically significant increases from baseline following exposure to the SMAs. Confidence that counseling and other treatments will make a difference for patients with illicit drug use increased (7.1-8.0, P = .142), but did not differ statistically. Furthermore, on a 4-point Likert scale, understanding of behavioral therapies for treating and preventing the relapse of SUD (2.9-3.2, P = .180) showed a similar increase. Attitudes toward patients with SUD (42.4-42.1, P = .303) and physician empathy (119.3-119.2, P = .963) did not change from pre- to post-intervention. SMAs are a feasible training tool in the education of primary care residents on an addiction medicine rotation. Residents develop confidence co-facilitating SMAs after 4 weeks. Overall, exposure to SMAs during residency can provide an opportunity to increase confidence in treating patients with SUD, as well as provide a training modality that may shift the way residents interact with patients receiving SUD treatment.

Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking

BackgroundResearch is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD.MethodsThis study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses.ResultsBSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption.ConclusionsBSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking.Trial registration: The original study was registered retrospectively at isrtcn.com (14539251).

Preparing Physicians to Treat Addiction: Inclusion of Dedicated Addiction Training During Internal Medicine Residency.

Physicians in internal medicine lack comfort and skills required to diagnose and treat substance use disorder (SUD). Formal training in substance use treatment within primary care training has traditionally been inconsistent and sparse. The purpose of this study is to assess the impact of a longitudinal experiential addiction curriculum on the attitudes and experiences of graduates from a primary care/internal medicine residency program that included formal addiction didactics, rotations in an outpatient addiction clinic embedded within the resident primary care clinic, and exposure to addiction medicine faculty across treatment settings. A survey was emailed to all graduates from a single academic primary care residency program who graduated between 2016 and 2018 (n = 53). The survey assessed pharmacotherapy for SUD prescribing patterns, comfort with SUD pharmacotherapy, overall comfort treating SUD, experience correcting stigmatizing language, and providing guidance to colleagues on the care of patients with SUD. A subset of respondents (n = 14) were interviewed regarding their experience with the residency program's addiction medicine curriculum and its impact on their current clinical practice. Sixty percent (n = 28) of graduates responded to the survey. All respondents felt comfortable using medications to treat SUD. Eighty-four percent perceived themselves as more comfortable using pharmacotherapy to treat SUD than their colleagues. Qualitative interviews revealed that this addiction medicine training shaped participants' attitudes toward patients with SUD and imparted them with the skills to address stigmatizing language. Participants described how they have become ambassadors of addiction medicine in their workplace and a resource to colleagues with less comfort in the management of SUD. Graduates of a primary care/internal medicine residency with a dedicated addiction medicine curriculum are comfortable prescribing pharmacotherapy for SUD, taking an active role in reducing SUD-related stigma, and serving as a resource for colleagues.

Цифровая грамотность пациентов наркологического профиля: факторы, влияющие на использование компьютеров и ноутбуков

Background. Studying the user experience of eventual target groups for digital services is important both for assessing the feasibility of using information and communication technologies in the case and for involving patients in the activities of therapeutic groups and communities in social media. Study aim. To study the influence of socio-demographic characteristics of patients undergoing inpatient treatment in a drug treatment facility on their use of personal computers/laptops. Materials and methods. Cross-sectional study using a specially designed questionnaire of a non-deterministic sample of addiction patients (n = 1168) hospitalized at the Moscow Scientific and Practical Center for Addictions. Statistical analysis was conducted in IBM SPSS 25.0. Study results. Statistically significant differences were noted in the use of personal computers and laptops depending on the age, level of education and economic activity of respondents. Conclusions. Predictors of active use of computers and laptops by patients are: young age; employment; higher education. The results of the study can be used to target addiction clinic patients according to socio-demographic parameters in order to implement telemedicine approaches in the process of their outpatient support.

Use and attitudes towards digital technologies in addiction rehabilitation in the SARS-CoV-2 pandemic

Abstract Background Before the start of the pandemic, digital technologies were hardly used in addiction rehabilitation in Germany - also due to the lack of a legal framework. During the SARS-CoV-2 pandemic, the funding agencies enabled their use. The aim of the study is to describe the use of and attitudes towards digital technologies in addiction rehabilitation from the perspective of both clinic management and rehabilitation patients. Methods Clinic management of all 1044 outpatient and inpatient addiction rehabilitation clinics in Germany were asked in summer 2022 to complete an online questionnaire on the use of and attitudes towards digital technologies in addiction treatment. 415 clinics provided answers (response rate 40%). In addition, 460 rehabilitation patients from 34 different clinics were questioned in written form (mean age 46.0 years (SD: 13.3), 73% male; 81% alcohol addiction). Results According to the clinic management, digitally conducted therapies were carried out in individual therapy (inpatient: 22% vs. outpatient 62%), group therapy (4% vs. 37%), family-oriented interventions (55% vs. 51%), and pre-admission interviews (45% vs. 45%). Among the rehabilitation patients, 10% in inpatient and 37% in outpatient rehabilitation stated that they had used digitally conducted therapies. 87% of the clinic management felt that digital therapy offers were useful during the pandemic, and 84% were in favour of using them beyond the pandemic. Among rehabilitation patients, the approval rate was 85% and 59% respectively. Conclusions Digital technologies were used for different therapy services in addiction rehabilitation. The majority of both clinic management and rehabilitation patients were in favour of this, even beyond the pandemic. For further use after the pandemic, the establishment of a legal, financial and organisational framework is required. Non-inferiority studies (comparing digital to face-to-face) could add to the evidence. Key messages • Digital technologies were used for therapeutic purposes (e.g. individual therapy, group therapy, family-oriented interventions) by a large proportion of addiction clinics during the pandemic. • The majority of clinic management and rehabilitation patients are in favour of the use of digital technologies in addiction rehabilitation even beyond the pandemic.

Risk of relapse to non-opioid addictive substances among opioid dependent patients treated with an opioid receptor antagonist or a partial agonist: A randomized clinical trial

Background and objectiveFirst study to assess any compensatory increase in use of non-opioid illicit substances and alcohol in opioid dependent patients randomized to treatment with extended-release naltrexone (XR-NTX) or buprenorphine-naloxone (BP-NLX) and in longer term treatment with extended-release naltrexone. MethodA multicenter, outpatient, open-label randomized clinical trial where patients received intramuscular extended-release naltrexone hydrochloride, 380 mg/month, or daily sublingual buprenorphine-naloxone 8–24/2–6 mg for 12 weeks, and an option to continue with extended-release naltrexone for an additional 36 week follow-up. The study was conducted at five urban addiction clinics and detoxification units in Norway between November 2012, and July 2016. ResultsAmong the 143 patients, 106 men and 37 women, there were no significant differences between those randomized to XR-NTX or BP-NLX in the risk of first relapse to alcohol (HR 1.31; 0.68–2.53), amphetamines (HR 0.88; 0.43–1.80), benzodiazepines (HR 1.24; 0.74–2.09) or cannabis (HR 1.55; 0.83–2.89). Also in the 36-week (12–48 weeks) follow-up period we found no significant differences between patients continuing with XR-NTX compared to those switching to XR-NTX after the randomized period in risk of first relapse to any non-opioid substance. In both study periods, the mean time in the study were longer among those relapsing to non-opioid addictive substances than those who did not. There was no significant association between first relapse to illicit opioids and first relapse to non-opioid addictive substances. ConclusionThere was no increase in the risk of relapse to non-opioid addictive substances neither in short term nor longer-term treatment with extended-release naltrexone.Trial registrationclinicaltrials.gov Identifier: NCT01717963

Blood-lead level in humans and drug addiction: a comprehensive study in Iran.

Drug abuse has a high prevalence worldwide and causes many health-related disorders. There are limited human exposure studies on establishing lead exposure levels and their propensity for drug addiction. In the present study, blood samples were tested for lead (Pb) concentrations in illicit drug users together with the related symptoms in comparison with control group of non-drug users. The study was performed on 250 volunteers divided equally in four drug groups, namely, opioids, hashish, methadone, and methamphetamine, and one control group of non-drug users. Participants were recruited from drug addiction clinics and camps in Kashan city, Iran, who were using drugs continuously for more than 1 year. Control group was recruited from companions of the patients with no drug use history. In the investigated groups of drug users, the highest blood-lead level (BLL) concentrations were observed in the opioid group (mean 37.57 µg/dL) with almost 3.7times higher than in the control group (mean 3.39µg/dL). In the methamphetamine group, type of occupation had the significant association with BLL concentrations. The positive correlation was revealed in the opioid and methadone groups for BLL concentrations and the duration of drug usage. In the opioid group, the highest BLL concentrations were observed among users who used both methods of drug use: smoking and eating. Also, several behavioral and life-style factors were identified which influence the blood-lead concentration in the drug users. The results of our study revealed that the BLL concentrations in investigated drug users' groups were significantly higher than in the control group (P < 0.001). That can be related with the Pb contents in illicitly used drugs. Apart other adverse health effects, long-term illicit drug use might cause to lead poisoning.