Drug Services Research Articles

Health and social characteristics of clients reporting amphetamine type substance use at entry to public alcohol and other drug services in New South Wales, Australia, 2016-2019.

Amphetamine type substances (ATS) are commonly used by Australian alcohol and other drug service entrants. We describe demographic characteristics, patterns of ATS and other substance use, health and social conditions among clients entering New South Wales (NSW) public alcohol and other drug services. Retrospective cohort of 13,864 records across six health districts (2016-2019) for clients seeking substance use treatment. These districts service approximately 44% of the NSW population aged 15 years and over. Multivariate analysis was conducted on a subsample for whom full data were available (N=9981). Data included NSW Minimum Data Set for drug and alcohol treatment services and Australian Treatment Outcomes Profile items. Over the preceding 4 weeks, 77% (n=10,610) of clients (N=13,864) reported no recent ATS use, 15% (n=2109) reported 'low frequency' (1-12 days) and 8% (n=1145) 'high frequency' (13-28 days) use. ATS use was most common among people attending for ATS or opioids as primary drug of concern. A multinomial regression (N=9981) identified that clients reporting recent arrest (aOR 1.74, 95% CI 1.36, 2.24), higher cannabis use frequency (aOR 1.01, 95% CI 1.00, 1.02), lower opioid use frequency (aOR 0.98, 95% CI 0.97, 0.99) and poorer quality of life (aOR 0.91, 95% CI 0.86, 0.97) were more likely to report 'high frequency' rather than 'low frequency' ATS use. People who use ATS experience health and social issues that may require targeted responses. These should be integrated across all services, not only for clients with ATS as principal drug of concern.

Supporting Decisions of the Brazilian Regulatory Agency for Supplementary Healthcare: A Case Study

ObjectivesThis study aimed to report implementation and partial results of the project “Supporting the Brazilian regulatory agency for supplementary healthcare through health technology assessment actions” conducted at Hospital Sírio-Libanês, Brazil, from 2020 to 2023, through Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, a Brazilian Ministry of Health initiative. MethodsThis was a case study conducted at Health Technology Center, Hospital Sírio-Libanês. ResultsFrom its inception, in 2020, to July 2022, the following activities and products were completed: 59 technical-methodological reports assessing the efficacy, safety, cost-effectiveness, and budget impact of technologies received by Agência Nacional de Saúde Suplementar (ANS) to compose its catalog of drugs products and services; 50 analyses of society contributions from public consultation; 34 methodological or clinical tutorial sessions to support ANS team; 2 templates to systematize the update process of ANS catalog; and one training course on systematic reviews and meta-analysis for ANS team. ConclusionThe project has contributed to increasing ANS autonomy in the health technology assessment, collaborating to efficiency in technologies offer to the users. By adopting and fostering evidence-based knowledge construction, the project reinforces its bridging role for supporting the consonance between public and supplementary healthcare sectors in Brazil.

China’s challenge in drug services

WuXi AppTec has had a great year so far. The Shanghai-based company, perhaps the world’s largest contract research and manufacturing firm serving the drug industry, recently reported a 72% increase in sales for the first three quarters of 2022, to just over $4 billion. Sales in its largest business, WuXi Chemistry, more than doubled. The performance at Asymchem and Porton Pharma Solutions, two other publicly traded drug services providers in China, has been similarly robust this year. And WuXi’s third-quarter earnings report predicts that the firm “will maintain strong growth regardless of the environment.” That environment is changing, and tension between China and the West is casting a shadow on Chinese companies like WuXi. In September, Asymchem’s planned acquisition of Snapdragon Chemistry, a Massachusetts-based specialist in flow chemistry, fell through after a review by the Committee on Foreign Investment in the United States, an arm of the US Treasury Department

China’s challenge in the drug services field

China’s challenge in the drug services field

Community perceptions surrounding Lisbon's first mobile drug consumption room.

Portugal's first Mobile Drug Consumption Room (MDCR) has been operating for over three years in two Lisbon neighborhoods. This qualitative study first creates a baseline understanding of community perceptions concerning the acceptability of and expectations surrounding drug consumption rooms in the communities of intervention. Then, at least six months after the initial interviews, it determines how these perceptions changed and what changes participants perceive in the neighborhoods. Findings highlight widespread acceptance of the MDCR among participants. One of the participants' priorities related to the MDCR was to lessen the visibility of public consumption, a change some participants perceived in the neighborhood. While in the first round of data collection participants primarily conceptualized the MDCR as a service for People Who Use Drugs (PWUD), in the follow-up round, they reported changes in the community.

What does Dame Carol Black’s review of drug and alcohol misuse services mean for probation services?

The Review of Drugs in two parts by Dame Carol Black (2020, 2021) has put new life into the case for properly resourcing substance misuse services in England and Wales. The Black Review has largely been accepted by the UK Government; Dame Carol’s analysis and recommendations have been the catalyst for additional funding and a renewed policy focus upon enforcement, treatment and prevention of drug misuse. Nevertheless, the Review has been criticised for focussing upon low-harm recreational drugs, for lacking consideration of co-occurring alcohol and drug misuse, and for accepting the Government’s restricted remit which excluded from consideration the harms of criminalisation and the ‘war on drugs’ (Transform Drugs, 2021). The following will summarise the Black Review, and the associated research and evidence. The article also attempts to elucidate key implications for probation, and the new opportunities for probation professionals to restore their ‘fractured relationship’ (Ball and Parker, 2022) with substance misuse colleagues.

Primary Health Care System Strengthening Project in Sri Lanka: Status and Challenges with Human Resources, Information Systems, Drugs and Laboratory Services.

A Primary Healthcare-System-Strengthening Project (PSSP) is implemented by the Ministry of Health, Sri Lanka, with funding support from the World Bank for providing quality care through primary medical care institutions (PMCIs). We used an explanatory mixed-methods study to assess progress and challenges in human resources, drug availability, laboratory services and the health management information system (HMIS) at PMCIs. We conducted a checklist-based assessment followed by in-depth interviews of healthcare workers in one PMCI each in all nine provinces. All PMCIs had medical/nursing officers, but data entry operators (44%) and laboratory technicians (33%) were mostly not available. Existing staff were assigned additional responsibilities in PSSP, decreasing their motivation and efficiency. While 11/18 (61%) essential drugs were available in all PMCIs, buffer stocks were not maintained in >50% due to poor supply chain management and storage infrastructure. Only 6/14 (43%) essential laboratory investigations were available in >50% of PMCIs, non-availability was due to shortages of reagents/consumables and lack of sample collection-transportation system. The HMIS was installed in PMCIs but its usage was sub-optimal due to perceived lack of utility, few trained operators and poor internet connectivity. The PSSP needs to address these bottlenecks as a priority to ensure sustainability and successful scale-up.

Analisis Tingkat Kepuasan Pasien Terhadap Pelayanan Kefarmasian Di Puskesmas Terara Tahun 2021

Patient satisfaction with pharmaceutical services is important for every Puskesmas. Patient satisfaction is a determining factor for good or bad services provided by the Puskesmas. This study aims to determine the description of patient satisfaction with pharmaceutical services at the Terara Health Center. This research is a descriptive research, which is a research method that is carried out to make a description of the objective situation. While the form of implementation of this research is a survey. The survey in question is a public opinion survey. The results showed that the level of patient satisfaction with pharmaceutical services was based on 5 dimensions, namely 1) responsiveness 99%, 2) empathy 99%, 3) reliability 100%), 4) assurance 99%, 5) Tangiable 100%. Thus, it can be concluded that of the five dominant dimensions, which are in the good category, it can be said that the respondent's perception of the level of patient satisfaction with drug services at the Terara Health Center is good.

Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination.

Most high-income countries are not on track to achieve the World Health Organization hepatitis C elimination targets. As elimination programmes assess growing proportions of patients in community-based pathways, rates of treatment uptake may fall. We aimed to identify factors associated with DAA treatment uptake and measure changes in their prevalence over time. We performed a time-to-treatment analysis on 2728 patients approved for hepatitis C Direct-Acting Antiviral treatment in the North Central London region between January 2016 and October 2019. We investigated the association between treatment uptake and factors including assessment/treatment setting (hospital, drug service or prison), patient age, gender, injection drug use, harmful alcohol use, cirrhosis status and previous treatment. The likelihood of treatment uptake was reduced by three independent risk factors. These included assessment setting: prison-based or drug-service pathways (aHR 0.29 or 0.81 vs. hospital outpatient pathway, 95% CI 0.21-0.40 and 0.70-0.94 respectively, p< .001); being UK-born (aHR 0.89 vs. non-UK born, 0.82-0.98, p= .01); and history of harmful alcohol use (aHR 0.84 vs. no history, 0.72-0.99, p= .04). The average number of these risk factors for not starting treatment per patient increased over time (R2 = 0.66 p< .001). Independent of these, there was an additional 5% reduction in rate of treatment initiation in each successive year of the programme (aHR 0.95, 0.91-0.99, p= .02). In conclusion, disengagement from care before treatment uptake was found to be a growing threat to elimination. Despite provision of community-based test-to-cure pathways, there are persistent barriers to treatment uptake and these are increasing over time.

Investigating recovery from problem substance use using digital photovoice.

This study investigates the complex process of recovery from problem substance use using a visual research method known as 'Photovoice'. Seven service users from a harm reduction drug service were given digital cameras and asked to photograph 'people, places, and things' meaningful to them in their recovery. These photographs were then used as a catalyst for discussion during two in-depth interviews. This study demonstrates the nuanced experiences of recovery as some participants expressed feeling isolated while others reflected upon their access to various forms of social capital. These findings recognise the link between social capital and recovery outcomes, while also reflecting upon how services might imbed the need for relationship quality within artificial recovery networks. The use of photographs is a novel way of providing voice to the lived experience of service users and adds to the discussion and debate concerning how recovery services may develop.

REVIEW: FACTORS AFFECTING WAITING TIME FOR OUTPATIENT PRESCRIPTION DRUGS IN HOSPITALS

Waiting is an activity which frequently causes uncomfortable feelings, particularly in health services. Patients who attend to health care facilities such as hospitals, are eager to receive good and quality health care system without having to wait for a long time. The quality of pharmaceutical services in hospitals influences the level of patient satisfaction with the services provided by pharmacy staff in drug services to patients. There are still numerous waiting times for outpatient prescription drug services in Indonesian hospitals which do not fulfill minimum service standards. Thus, the objective of this review articles is to determine the factors affecting the waiting time for outpatient prescription services at the hospital. This review was conducted by employing the literature review method with a sample size of 12 articles. The results acquired are several factors influencing the waiting time for outpatient drugs in hospitals encompassing: receiving prescriptions, providing etiquette, working on prescription drug concoctions, submitting drugs, facilities and infrastructure, human resources, hospital management information systems and standard operating procedures. Based on the complexity of the issue which was found in this review, the most dominant and influencing factors on the waiting time of outpatient drugs at the hospital are prescription reception, providing etiquette, preparation of prescription drugs, and submitting drugs.

Prevalence of blood-borne viral and sexually transmitted infections among homeless people in Berlin

Abstract Background Risk factors associated with precarious living conditions make people experiencing homelessness (PEH) also highly vulnerable for blood-borne viral and sexually transmitted infections (BBVSTI) and tuberculosis (TB). The number of PEH in Germany is rising, yet little data is available on the infectious burden among this population. A pilot study assessed the prevalence of BBVSTI, TB, behaviours and access to medical services among PEH. Methods We recruited PEH from April-June 2021 in five low-threshold medical services in Berlin. Behavioural data was collected via questionnaire-based interviews. Serological/molecular testing from venous blood samples was performed for Hepatitis B (HBV), Hepatitis C (HCV), HIV, syphilis and TB and from urine for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). Results Of 216 participants, 88% (191/216) were male and 73% (158/215) were born abroad. Mean age was 41 years (range 19-68). No health insurance was reported by 57% (123/216) and previous incarceration by 71% (153/214). Of all, 53% (114/216) injected drugs in the last 30 days, and 41% (89/216) reported unprotected sex in the last 12 months. Prevalence of active HBV was 1.9% (4/212), of active HCV 15.9% (34/213), and of HIV 2.8% (6/213). No active TB was diagnosed, while 14.4% (31/216) tested positive for latent TB infection. Active syphilis was found in 1.4% (3/212), NG in 2.0% (4/197), CT in 3.0% (6/197), and serological evidence of HBV vaccination in 26% (56/212). While 44% (96/216) of participants were ever tested for HCV, 71% (36/51) of those with HCV antibodies knew about their infection, 36% (13/36) of them reported previous/current treatment. Conclusions Burden of HCV and HIV was high among PEH in Berlin, and risk behaviours were frequently reported. There is a need to improve access to regular health care, accompanied by low-threshold prevention offers in cooperation with drug and homeless services. A nationwide expansion of the study is planned. Key messages • High burden of Hepatitis C and HIV among people experiencing homelessness in Berlin, Germany. • Access of people experiencing homelessness to regular health care needs improvement, accompanied by low-threshold prevention offers in cooperation with drug and homeless services.

Prevalence of hepatitis B and C, HIV, and syphilis among people who inject drugs in Germany

Abstract Background We piloted a future monitoring system among people who inject drugs (PWID) in Germany (DRUCK2.0). Monitoring is needed to inform and support the viral hepatitis/HIV/STI elimination process in Germany by providing regular up-to-date prevalence and behavioural data for this key population. Methods PWID aged 16+ years who injected drugs within the last 12 months were recruited by time location sampling via low threshold drug services and opioid substitution treatment (OST) practices during routine services in Berlin and Bavaria between 01/06/2021 and 28/02/2022. All participants filled a questionnaire on sociodemographics, behaviour and access to care and were tested for hepatitis B and C (HBV, HCV), HIV and syphilis using capillary dried blood spots. All received a 10 Euro incentive voucher. Results In total, 495 PWID were included, median age was 39 years [range 18-66], 68% (336/494) were male, and 23% (114/492) born outside Germany, mostly in eastern Europe. Of all participants, 58% (275/477) reported recent use of unsafe needles/syringes and 77% (372/485) detention experience. Current OST was reported by 62% (304/487). Prevalence was 46% (229/495) for cured HCV, 26% (130/495) for active HCV, 17% (80/482) for cured HBV, 1.2% (6/483) for active HBV, 2.7% (13/482) for HIV and 2.1% (10/473) for previous Syphilis. Serological HBV vaccination coverage was 24% (115/475). Of all, 95% (453/475) reported previous HCV testing. Of those with cured/active HCV infection 88% (296/337) knew about their infection and 56% (161/285) of them reported previous/current treatment. Conclusions To decrease the heavy burden of infection among PWID in Germany, targeted measures regarding access to HCV treatment, HBV vaccination, and harm reduction (safer use measures, OST) need to be implemented and rolled out. Nationwide regular monitoring of indicators in this key population is needed to guide the elimination progress of viral hepatitis and HIV in Germany. Key messages • High burden of active Hepatitis C infection and low Hepatitis B vaccination coverage among people who inject drugs in Berlin and Bavaria require improved access to treatment and prevention efforts. • National Monitoring is needed to inform and support the viral hepatitis/HIV/STI elimination process among people who inject drugs in Germany.

Optimization of Online Pharmacy System to Lower the Late Billing for Chronic Disease Drugs

One of the biggest cost control problems among hospitals in the National Health Insurance is chronic disease drug services. Billing fee delays or unpaid billing fees often occur due to patient failure to revisit the doctor according to the requirement of 30 (thirty) days from the last visit. It resulted in the hospital's inability to collect the financing for chronic disease drugs from Social Security Administrative Agency (BPJS). This study aimed to discover the root cause of the pending billing of chronic disease drug costs and executable solutions in hospitals. This research was conducted at X Hospital Malang. This research used mix-method of qualitative and quantitative. The qualitative method were observations of the service flow for chronic disease patients, interviews with all unit coordinators, and focus group discussion with the Pharmacy Unit and Casemix Unit coordinators. The quantitative method was done using CARL scoring to determine the priority of the problem solution. The root of the problem was the lack of adequate systems and resources in chronic disease drug services. The possible solution is to modify the flow in the outpatient pharmacy. It is necessary to apply patient screening through the Online Pharmacy Application at the outpatient pharmacy to prevent patients who visit for less than 30 days. The results of the solution implementation are expected to reduce the amount of money from pending billing for chronic disease drug costs, thereby minimizing hospital financial losses.

Adapting investigational drug services during a pandemic: Recommendations for future preparedness from the Hematology/Oncology Pharmacy Association Investigational Drug Services Special Interest Group.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Geographical variation in implementation of the Pathways to Comorbidity Care program in Australian drug and alcohol services.

Comorbid drug and alcohol and mental health disorders are highly prevalent. Significant gaps in service provision make this problem particularly difficult to address in regional Australia. The Pathways to Comorbidity Care (PCC) program was designed to improve management of comorbidity by outpatient drug and alcohol clinicians in New South Wales, Australia. This paper uses the Consolidated Framework for Implementation Research (CFIR) to evaluate variations in implementation outcomes across geographically diverse services. Twenty clinicians across three drug and alcohol services from metropolitan, outer metropolitan and regional geographic locations were engaged at multiple levels of influence (directors, managers, clinicians) during the implementation of the multimodal PCC training package. The CFIR guided the development of self-report measures and semi-structured interviews evaluating implementation of the PCC training, and disparities in implementation barriers and facilitators were determined. Metropolitan clinicians identified less barriers than regional clinicians on several intervention characteristics (adaptability, complexity, design quality and packaging), as well as outer setting (peer pressure), inner setting (implementation climate, staff incentives, leadership engagement, available resources) and process (planning, opinion leaders, executing) domains. Regional clinicians evaluated the networks and communications construct more favourably. Specific barriers identified more strongly by regional clinicians included the importance of communication with local clinicians and leadership about the practicalities of incorporating the approach into routine practice (allocation of time, increased accessibility of implementation team). Metropolitan clinicians provided more favourable evaluations of the package design, implementation climate and specific implementation processes such as a clear and informative implementation plan.

Critical Evaluation of Permanently Listed Psychosocial Digital Health Applications into the Directory for Reimbursable Digital Health Applications of the BfArM

Digital health applications (DiGA) delivered as psychosocial therapeutic interventions entail a huge potential through their proven medical benefit or patient-relevant structure and process improvements. Their usage as first-line or concomitant therapy is refunded by the German health insurances. Therefore, the digital health applications have to pass a complex evidence process as requested by the Federal Institute for Drugs and Medical Services. The present article aimed at critically evaluating the available evidence of the permanently registered DiGA using the Critically Appraised Topic method. In conclusion, all studies fulfil at least two thirds of the evaluation criteria, implying that the overall evidence is of sufficient quality.

Putting out the welcome mat-A qualitative exploration of service delivery processes and procedures as barriers to treatment-seeking for people who use alcohol and other drugs.

There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking. Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking. Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.

Evotec to develop plague antibodies

The US Department of Defense has awarded Evotec a contract of up to $49.9 million to quickly develop monoclonal antibodies against plague. Plague is a bacterial disease that still infects people in parts of Africa, Asia, and the western US, according to the US Centers for Disease Control and Prevention. The firm’s drug services Just–Evotec Biologics unit will be responsible for development through Phase 1 first-in-human trials.

The emerging issue of Kamini: A new source of opioid dependence.

Drug and Alcohol ReviewEarly View COMMENTARY The emerging issue of Kamini: A new source of opioid dependence Chris Tremonti, Corresponding Author Chris Tremonti chris.tremonti@health.nsw.gov.au orcid.org/0000-0003-3568-3342 Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia St. Vincent's Hospital Alcohol & Drug Service, Sydney, Australia Faculty of Medicine and Health, The University of Sydney, Sydney, Australia Correspondence Dr Chris Tremonti, Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia. Email: chris.tremonti@health.nsw.gov.auSearch for more papers by this authorSuzanne Nielsen, Suzanne Nielsen orcid.org/0000-0001-5341-1055 Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, AustraliaSearch for more papers by this author Chris Tremonti, Corresponding Author Chris Tremonti chris.tremonti@health.nsw.gov.au orcid.org/0000-0003-3568-3342 Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia St. Vincent's Hospital Alcohol & Drug Service, Sydney, Australia Faculty of Medicine and Health, The University of Sydney, Sydney, Australia Correspondence Dr Chris Tremonti, Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia. Email: chris.tremonti@health.nsw.gov.auSearch for more papers by this authorSuzanne Nielsen, Suzanne Nielsen orcid.org/0000-0001-5341-1055 Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, AustraliaSearch for more papers by this author First published: 25 September 2022 https://doi.org/10.1111/dar.13552Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation