Opioid Agonist Treatment Research Articles

Associations Between Opioid Agonist Treatment and Withdrawal Symptoms: Exploratory Analyses from the OPTIMA Study

ABSTRACT Objectives: Evidence is scarce on the comparative effectiveness of buprenorphine/naloxone (BUP/NX) and methadone for withdrawal symptoms during the first weeks of treatment in prescription-type opioid use disorder (POUD), in the context of highly potent opioid use. We aim to verify if methadone and BUP/NX may predict withdrawal symptoms during the first 6 weeks of treatment and to explore associations based on fentanyl exposure. Methods: The study uses data from OPTIMA, an open-label, 24-week, 2-arm, parallel (methadone, n=133; BUP/NX, n=138), multicenter, pan-Canadian, randomized controlled trial. Participants were aged 18 to 64 years with DSM-5 prescription-type opioid use disorder. Dependent variables included opioid withdrawal symptoms measured with the Clinical Opiate Withdrawal Scale (COWS) at weeks 2, 4, and 6 after treatment initiation. Adjusted linear mixed models were used to study COWS as a function of assigned treatment. Analyses stratified by baseline fentanyl–positive urine drug screen (UDS) status were reported. Results: COWS scores decreased from 3.13 at week 2 to 2.56 at week 6. Methadone was associated with lower COWS scores compared to BUP/NX (aβ: −1.02; 95% CI: −1.93; −0.12). In stratified analysis, methadone was associated with lower COWS scores compared to BUP/NX in participants with baseline fentanyl–positive UDS (aβ: −2.26; 95% CI: −3.82; −0.67), but not with baseline fentanyl-negative UDS (aβ: 0.03; 95% CI: −0.94; 0.99). Conclusions: Our study showed that methadone is associated with slightly decreased withdrawal symptoms early during treatment compared to BUP/NX only in those exposed to fentanyl. Future studies should verify whether withdrawal symptoms during opioid agonist therapy induction may impact other key outcomes such as opioid use and treatment retention. Objectifs: Les données probantes sont rares sur l’efficacité comparative de la buprénorphine/naloxone (BUP/NX) et de la méthadone pour les symptômes de sevrage au cours des premières semaines de traitement des troubles liés à l’usage d’opioïdes de type sur prescription (TUOP), dans le contexte d’une consommation d’opioïdes très puissants. Nous visons ici à vérifier si la méthadone et la BUP/NX peuvent prédire les symptômes de sevrage au cours des 6 premières semaines de traitement et à explorer ces associations basées sur l’exposition au fentanyl. Méthodes: L'étude utilise les données d’OPTIMA, une étude parallèle ouverte, contrôlée, randomisée et multicentrique pancanadienne de 24 semaines à deux bras (méthadone n=133; BUP/NX n=138). Les participants étaient âgés de 18 à 64 ans et avaient un diagnostic de TUOP selon le DSM-5. Les variables dépendantes comprenaient les symptômes de sevrage aux opioïdes mesurés avec l’Échelle clinique de sevrage des opiacés (COWS) aux semaines 2, 4 et 6 après le début du traitement. Des modèles mixtes linéaires ajustés ont été utilisés pour étudier les scores de COWS en fonction du traitement assigné. Des analyses stratifiées selon les résultats du dépistage urinaire pour le fentanyl en début d’étude ont été menées. Résultats: Les scores COWS ont diminué de 3,13 à la semaine 2 à 2,56 à la semaine 6. La méthadone était associée à des scores COWS inférieurs à ceux de BUP/NX (aβ: −1,02; IC à 95%: −1,93; −0,12). En analyse stratifiée, la methadone était associée à des scores COWS inférieurs à ceux du BUP/NX chez les participants avec un dépistage urinaire positif au fentanyl (aβ: −2,26; IC à 95%: −3,82; −0,67), mais pas parmi ceux avec un dépistage négatif (aβ: 0,03; IC à 95%: −0,94; 0,99). Conclusion: Notre étude a montré que la méthadone est associée à une légère diminution des symptômes de sevrage tôt pendant le traitement par rapport au BUP/NX, et ce uniquement chez les personnes exposées au fentanyl. Les études futures devraient déterminer si les symptômes de sevrage pendant l’induction du traitement par agonistes opioïdes peuvent avoir un impact sur d’autres résultats clés tels que la consommation d’opioïdes et la rétention en traitement.

The severity of heroin use disorder in patients at treatment entry and their therapeutic response to opioid agonist treatment

The severity of heroin use disorder in patients at treatment entry and their therapeutic response to opioid agonist treatment

Health utility among people who regularly use opioids in Australia.

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. 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. 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). 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.

Canadian Addiction Treatment Centre (CATC) opioid agonist treatment cohort in Ontario, Canada

PurposeThe Canadian Addiction Treatment Centre (CATC) cohort was established during a period of increased provision of opioid agonist treatment (OAT), to study patient outcomes and trends related to the treatment...

High levels of all-cause mortality among people who inject drugs from 2018 to 2022

BackgroundMortality among people who inject drugs (PWID) is high, with overdose and HIV infection being the main causes of death. In Greece, there have been no data on mortality, and two HIV outbreaks have been recorded in this population in the past decade. In this study, we aim to estimate the all-cause crude mortality rate and the standardised mortality ratio in this population during 2018–2022. MethodsPWID recruited from two community-based programs in Athens and Thessaloniki during 2018–2021 were interviewed and tested for HIV/HCV. Data on vital status (deceased/alive) and date of death were obtained from death registries through December 31, 2022. All-cause crude mortality rates (CMR) and standardised mortality ratios (SMR) were estimated. Determinants of mortality were assessed using Cox proportional-hazards model. ResultsOf 2,530 participants, 301 died over 8,543 person-years (PYs) of follow-up. The CMR (95 % CI) was 3.52 (3.15–3.94) deaths per 100 PYs; 3.10 per 100 PYs (2.68–3.58) in Athens and 4.48 per 100 PYs (3.74–5.37) in Thessaloniki. An increasing trend in CMR was identified over 2018–2022 in Athens (from 2.90 to 4.11 per 100 PYs, 41.5 % increase, p = 0.018). The pooled SMR (95 % CI) was 15.86 (14.17–17.76) for both cities and was particularly increased in younger individuals, females, those injecting daily, not enrolled to opioid agonist treatment and HIV-infected individuals. Older age, living in Thessaloniki, Greek origin, homelessness, history of injection in the past 12 months, and HIV infection were independently associated with higher risk of death. ConclusionMortality among PWID in the two largest cities (Athens and Thessaloniki) in Greece in 2018–2022 was high, with the population in Thessaloniki being particularly affected. The increasing trend in mortality in Athens may reflect the long-term impact of the COVID-19 pandemic. Preventive programs such as take-home naloxone, screening and treatment for HIV, are urgently needed.

Opioid agonist treatment and trust in the community pharmacy setting: a qualitative study of perceptions and experiences

Background Opioid agonist treatment (OAT) in New South Wales Australia involves prescribed consumption of methadone or buprenorphine formulations and is commonly accessed through community pharmacies. People with a history of drug use often feel mistrusted and this can deter them from starting or staying in treatment. This study sought pharmacist and consumer perspectives to understand how treatment engagement can be best supported. Objective To explore consumer and pharmacist experiences of OAT services, identifying the social and structural elements that enhance or impair treatment and professional satisfaction and analyzing how these are influenced by trust. Methods Semi-structured interviews were conducted in 2021–2022 with 10 pharmacists and 15 consumers. Transcripts were analyzed using a realist thematic approach. Results Burdensome fees, pharmacy service problems, and system opportunities were generated as themes of subjection, and socially inclusive care and person-centered approaches as themes of connection. OAT consumers felt more inclusion when pharmacy practices did not differentiate or demean them and when pharmacists communicated in a personable and caring manner, and pharmacists recognized these aspects as contributing to greater professional fulfillment and less service problems. Conclusion OAT delivery in community pharmacies provides opportunities for greater social inclusion, particularly when trust and fairness are demonstrated.

A Study of Clinical and Socio-Demographic Profile of Elderly Patients with Opioid Use Disorder on Agonist Treatment Attending a Tertiary Care Teaching Institute of India

Background: Opioid use is one among the major substance of use in Indian population which is not only seen in younger age group but rather is an upcoming concern in the elderly population as well. Opioid agonist treatment for opioid use disorder is a better way of management, among which buprenorphine is a safer option. Despite, being an important area of health concern, opioid use is poorly studied in the geriatric population. Objective: To study the clinical and socio-demographic profile of elderly patients with opioid use disorder on agonist treatment attending a tertiary care teaching institute of urban Delhi. Method: A retrospective study was done in an OPD based opioid treatment centre of a tertiary care hospital in Delhi to analyze the socio-demographic, clinical profile, pattern of opioid use disorder and opioid agonist treatment (Buprenorphine) in elderly Indian population over a year. The data collected was further analyzed for descriptive and analytic statistics using SPSS version 23.0. Results: A total of 32 subjects of age > 60years, with predominant male population having mean age of 63.6years we seen. They had heroin use by inhalation route as a major opioid use. The main source of referral was by friends and self with significant medical and psychiatric comorbidities that was seen in the elderly group. An average dose of 2.34mg of Buprenorphine was found to effectively manage the geriatric opioid use disorder. Conclusion: Opioid Used Disorder is common in Geriatric population and is often associated with both psychiatric and medical co-morbidities. Opioid agonist treatment is an effective approach in management of elderly cases of opioid use disorder. Declaration of Interest : None

Methadone pharmacokinetics in opioid agonist treatment: Influencing factors and clinical implications.

A considerable inter-individual variability has been reported in the relationship between methadone doses applied and serum concentrations achieved in methadone maintenance treatment. However, the underlying causes for this variability are not fully understood. We investigated the influence of genetic, pathophysiological and pharmacological factors on serum methadone concentration-to-dose ratio (CDR) and discussed the clinical implications of the findings. We used data from two retrospective laboratory databases and a prospective cohort study to investigate the impact on methadone CDR of hepatic cytochrome P450 enzyme system (CYP) genetic polymorphisms, age, sex, concomitant medication, liver fibrosis and body mass index through linear mixed model analyses. A positive association was found between CDR and the homozygous CYP2B6*6 genotype, concurrent treatment with CYP3A4 inhibitors and body mass index. CDR was lower among women and during concomitant use of CYP inducers. CDR was not associated with age or the degree of liver fibrosis in our investigations. This research work supports the need for individually tailored dosage considering the various factors that influence methadone CDR. The gained knowledge can contribute to reducing the risks associated with the treatment and optimizing the desired outcomes.

Medication safety, privacy, and stigma: A qualitative study of pharmacy opioid agonist treatment disruptions and adaptations in the 2022 Northern Rivers floods, Australia

BackgroundOpioid agonist treatment (OAT) involves the daily consumption of long-acting opioid medications to assist in managing health and wellbeing issues related to illicit or high-strength opioid drug use. Flooding events disrupted OAT service systems in the Northern Rivers region (Australia) in 2022. This study describes the experiences of OAT consumers and pharmacists during this time, including how structural stigma may have limited clinician behaviours and influenced consumer experiences. MethodsInterview transcripts from eleven pharmacists and thirteen consumers were collated and thematically analysed. ResultsOpioid agonist treatment consumers experienced disruptions when their prescribing and pharmacy treatment sites were destroyed by flood or where roads were cut off, and faced long delays if they attended the primary public clinic for emergency dosing or prescription re-issuing. Absent prescriptions were the main barrier to enabling emergency dosing. Pharmacists’ efforts in providing advance takeaways or discretionary doses reduced consumer hardships and distress. The treatment access difficulties that consumers experienced were found to be constrained by stigma, and this intensified risks related to medication safety and privacy. ConclusionsTreatment access was enabled when pharmacists operated outside of the restrictive medication safety protocols that opioid agonist treatment is uniquely subject to, and that is informed by structural stigma towards OAT consumers. Potential distress was averted where pharmacists took responsive approaches to protecting and maintaining OAT access. Future emergency planning should aim to protect and transmit OAT dose authorisation records more effectively, while striving to minimise adverse impacts including decreased privacy and accessibility.

Shared decision-making and client-reported dose satisfaction in a longitudinal cohort receiving injectable opioid agonist treatment (iOAT)

BackgroundAcross different types of oral Opioid Agonist Treatment for people with Opioid Use Disorder, receiving a dose that meets their needs is associated with better outcomes. Evidence also shows patients are more likely to receive an “adequate dose” when their prescribers are involving them in decision making. Neither of these findings have been studied in the context of injectable Opioid Agonist Treatment, which is the purpose of this study.MethodsThis study was a retrospective analysis of an 18-month prospective longitudinal cohort study of 131 people receiving injectable Opioid Agonist Treatment. In the 18-month study, observations were collected every two months for one year, and then once more at 18 months. At 6 months, participants were asked whether their dose was satisfactory to them (outcome variable). Generalized Estimating Equations were used, to account for multiple observations from each participant. The final multivariate model was built using a stepwise approach.ResultsFive hundred forty-five participant-observations were included in the analysis. Participant-observations were grouped by “dose is satisfactory” and “wants higher dose”. From unadjusted analyses, participants were less likely to report being satisfied with their dose if they: were Indigenous, had worse psychological or physical health problems, had ever attempted suicide, were younger when they first injected any drug, were a current smoker, felt troubled by drug problems, gave their medication a lower “drug liking” score, and felt that their doctor was not including them in decisions the way they wanted to be. In the final multivariate model, all previously significant associations except for “current smoker” and “troubled by drug problems” were no longer significant after the addition of the “drug liking” score.ConclusionsPatients in injectable Opioid Agonist Treatment who are not satisfied with their dose are more likely to: be troubled by drug problems, be a current smoker, and report liking their medication less than dose-satisfied patients. Prescribers’ practicing shared decision-making can help patients achieve dose-satisfaction and possibly alleviate troubles from drug problems. Additionally, receiving a satisfactory dose may be dependent on patients being able to access an opioid agonist medication (and formulation) that they like.

Barriers and Facilitators to Harm Reduction for Opioid Use Disorder: A Qualitative Study of People With Lived Experience

ObjectiveAlthough an increasing number of emergency departments (ED) offer opioid agonist treatment (OAT), naloxone, and other harm reduction measures, little is known about patient perspectives on harm reduction practices delivered in the ED. The objective of this study was to identify patient-focused barriers and facilitators to harm reduction strategies in the ED. MethodsWe conducted semi-structured interviews with a convenience sample of individuals in Massachusetts diagnosed with opioid use disorder (OUD). We developed an interview guide and interviews were recorded, transcribed, and analyzed in an iterative process using reflexive thematic analysis. After initial interviews and coding, we triangulated the results among a focus group of four individuals with lived experience. ResultsWe interviewed 25 participants with opioid use disorder, 6 recruited from one ED and 19 recruited from OAT clinics. Key themes included accessibility of harm reduction supplies, lack of self-care resulting from withdrawal and hopelessness, the impact of stigma on the likelihood of using harm reduction practices, habit and knowledge, as well as the need for user-centered harm reduction interventions. ConclusionIn this study, people with lived experience discussed the characteristics and need for user-centered harm reduction strategies in the ED that centered on reducing stigma, treatment of withdrawal, and availability of harm reduction materials.

Managing Opioid Addiction in Adolescents in the Community: Experiences from Two Cases

Abstract Introduction: Adolescent opioid use in India has emerged as a critical public health concern, with a 2018 survey revealing 1.8% of adolescents aged 10–17 years as past-year opioid users. We present here the experiences of two cases of adolescent opioid users from a community-based drug treatment clinic in Delhi. Case Description: Case 1 involved a 17-year-old male suffering from opioid and tobacco dependence. His treatment, starting about 3 years back, showcased challenges in withdrawal management, leading to successful opioid agonist treatment (OAT), employment, and positive social reintegration over follow-up. Case 2 was a 15-year-old male with opioid, cannabis, tobacco, and volatile solvent dependence who presented about 2.5 years back to us. Despite treatment initiation in February 2021 and positive strides in OAT, employment, and cessation of injecting drug use, challenges persisted, highlighting the necessity for effective tailored interventions in managing substance use disorder in adolescents. Conclusion: Adolescent opioid use disorder can be managed in the community with OAT, though challenges of dropout do remain.

Integrated biobehavioral surveillance among people who inject drugs in Ukraine, 2007-2020

BackgroundRepeated integrated biobehavioral surveys (IBBS) have been implemented among people who inject drugs (PWID) in Ukraine to monitor the trends in key epidemiologic and programmatic indicators. MethodsThe study analyzed seven PWID IBBS rounds from 2007 to 2020 in seven Ukrainian cities. Participants were recruited using respondent-driven sampling, tested for HIV and anti-HCV antibodies, and completed a structured questionnaire. Composite weights (based on individual sampling probability and population size) were applied to generate point estimates and confidence intervals for HIV and HCV prevalence, injection risk behaviors, prevention service coverage, and HIV treatment cascade. Multi-level regression assessed temporal trends in these indicators in 2007-2020. ResultsThe samples consisted of 1587 participants in 2007, 1905 in 2008/9, 3066 in 2011, 2846 in 2013, 2699 in 2015, 2798 in 2017, and 3651 in the 2020 rounds. HIV prevalence decreased from 27% to 19% overall, and among PWID younger than 25 from 10.5% to 5.5%. Anti-HCV prevalence increased from 50% to 73% overall but decreased from 58% to 27% in the younger subgroup. Past-30-days injection risk behaviors consistently decreased, reaching a minimum of 38% for any risk in 2020. HIV treatment cascade indicators and coverage with opioid agonist treatment substantially improved in the last three rounds. Harm reduction services coverage fluctuated, declining from 52% to 33% in the last three rounds. ConclusionsThis analysis demonstrates the potential of repeated IBBS for monitoring the HIV epidemic and program coverage. We confirmed a sustained decline in overall HIV and HCV transmission, likely driven by reduced risky injection practices among PWID. The impact of harm reduction services requires further study. HIV status awareness and treatment coverage among PWID markedly increased, reaching the national average, possibly indicating the success of case-finding and linkage-to-care interventions. The upcoming IBBS round in Ukraine will also assess the impact of the war on service provision, risk behavior, and HIV transmission among PWID.

High Interest in Injectable Opioid Agonist Treatment With Hydromorphone Among Urban Syringe Service Program Participants.

Injectable opioid agonist treatment with hydromorphone (iOAT-H) is effective for persons who inject drugs (PWID) with opioid use disorder (OUD) but remains unavailable in the United States. Our objective was to determine interest in iOAT-H among syringe services program (SSP) participants. We recruited PWID with OUD from SSPs in New York City. Interest in iOAT-H was assessed on a 4-point scale. We compared participants who were and were not interested in iOAT-H regarding sociodemographic characteristics and self-reported variables (past 30 days): heroin use, public injection practices, and participation in illegal activity other than drug possession. Participants reported their preferred OUD treatment and reasons for these preferences. Of 108 participants, most were male (69%), Hispanic (68%), and median age was 42 years. The median number of prior OUD treatment episodes was 6 (interquartile range: 2-12). Most (65%) were interested in iOAT-H. Interested participants (vs not interested) reported, over the prior 30 days, greater heroin use days (mean, 26.4 vs 22.3), injecting in public more times (median, 15 vs 6), and a higher percentage having participated in illegal activity (40% vs 16%). Preferences for OUD treatment were: iOAT-H (43%), methadone (39%), and buprenorphine (9%). Participants who preferred iOAT-H to conventional OUD treatments reported preferring injection as a route of administration and that available OUD treatments helped them insufficiently. SSP participants with OUD reported high interest in iOAT-H. Participants had attempted conventional treatments but still used heroin almost daily. We identified PWID at risk for opioid-related harms who potentially could benefit from iOAT-H.

Accessing opioid agonist treatment in prison in England and Scotland remains problematic – the views of people with lived experience

PurposeThe purpose of this paper is to examine lived experiences of opioid agonist treatment (OAT) during and immediately following release from detention in prisons in England and Scotland.Design/methodology/approachSurveys were completed by serving prisoners in both countries and by those recently released from prison (England only). The survey findings were discussed in focus groups of people with lived experience. The combined findings from the surveys and focus groups were shared with an expert group of prison OAT providers and people with lived experience with the purpose of making recommendations for more accessible and effective OAT in custodial environments and continuity of OAT on releaseFindingsThe quality and accessibility of OAT varied considerably between establishments. It was reported to be harder to access OAT in Scottish prisons. It was often hard for people in prison to get the dosage of OAT they felt they needed and it was generally harder to access buprenorphine than methadone in English prisons. Only Scottish people in prison were aware of long-lasting forms of buprenorphine. People in English prisons had mixed experiences of the help available in prison, with no improvement recorded since a 2016 study. People in Scottish prisons were more likely to rate the help available as poor.Research limitations/implicationsThe number of people accessed while actually in prison (73) was reduced by the impact of the pandemic, making it more difficult to access people in prison and because some were resistant to participating on the basis that they had already been consulted for a wide variety of research projects focused on the impact of COVID. The Scottish cohort (a total of 19 individuals comprising 14 survey respondents and five focus group members) is clearly too small a number on which to base robust claims about differences in OAT provision between the English and Scottish prison systems..Practical implicationsThe study identifies key barriers to accessing OAT in prisons and suggests key components of more user-friendly approaches.Social implicationsThis study provides an overview of the recent lived experiences of people accessing OAT in prison and on release and offers valuable recommendations on how to make service provision more effective and consistent.Originality/valueThis study provides an overview of the recent lived experiences of people accessing OAT in prison and on release in England and Scotland and offers valuable recommendations on how to make service provision more effective and consistent.

Blood Oxygenation and Heart Rate Changes After Diamorphine Intravenous Injection During Opioid Agonist Treatment for Outpatients With Heroin Dependence.

More than 60 million people use opioids each year, and many countries have declared an opioid overdose crisis. Heroin, one of the most commonly used opioids, has depressant effects on autonomic functioning; however, few studies have been able to examine the effects of heroin or its pharmaceutically prepared equivalent, diamorphine, in human clinical populations. The present study examined heart rate and oxygen saturation in the minutes immediately after acute diamorphine administration in outpatients with heroin dependence. The sample was a subset of participants (N = 36) in the German Project of Heroin Assisted Treatment of Opiate Dependent Patients Trial in Bonn, Germany. Patients were given 3 daily doses of intravenous diamorphine. Doses were determined on an individual basis by study physicians. Pulse oximetry was recorded at baseline and at 30-second intervals from 0 to 450 seconds after diamorphine administration. Heart rate was significantly higher than baseline at 30 seconds after diamorphine administration and significantly lower than baseline at 270 seconds onward. Oxygen saturation was significantly lower than baseline at 60 seconds onward. Results are consistent with other studies in which depressant effects of opioids were observed. Our findings suggest that even therapeutic doses of diamorphine may have rapid and significant-predominantly depressant-effects on oxygenation and heart rate in populations that frequently use opioids. Monitoring of potential adverse opioid effects would be beneficial even in populations presumed to have developed physiological tolerance.

Exploring Patients’ Perceptions on Injectable Opioid Agonist Treatment: Influences on Treatment Initiation and Implications for Practice

Introduction: Injectable opioid agonist treatment (iOAT) with diacetylmorphine is an effective option for individuals previously considered non-responsive to opioid substitution treatment. Despite implementation in Canada and several European countries, relatively few eligible people choose to initiate iOAT. To better understand what encourages or deters prospective patients from initiating iOAT, the current study explores patients’ perceptions on iOAT and how these influence therapy initiation in practice. Methods: We conducted 34 semi-structured interviews with individuals currently in or eligible for iOAT in two German outpatient iOAT clinics. Transcripts were analysed following qualitative content analysis, with development of inductive categories and use of consensual coding. For member checking, we consulted individuals with lived experiences prior to data collection and publication. Results: Participants based their choice to initiate iOAT on the perceived implications of the treatment on one’s daily life and individual recovery. Participants were encouraged to initiate iOAT due to the therapy’s perceived potential in reducing cravings and substance use, its positive health consequences, and due to the image of iOAT as a path towards abstinence. Regarding deterring perceptions, participants feared a profound impairment of daily life due to factors such as the daily visits to the clinic, were concerned about whether iOAT would sufficiently promote or even impede one’s recovery, and described negative health effects. Conclusion: Perceptions found in this study profoundly influenced participants’ decisions on iOAT enrolment and contextualize the previous literature. The study reveals the dynamic coexistence of different perceptions about iOAT and sheds light on the inner-group stigmatization of iOAT. Practitioners and future research should acknowledge the complexities found in the current study in order to exploit the full potential of effective treatment modalities such as iOAT.

An environmental scan of residential treatment service provision in Ontario

BackgroundOntario has one of the highest rates of substance-related harms in Canada. Residential treatment programs in the province provide a variety of in-house treatment services to support the needs of individuals with substance use disorders (SUD). However, these programs are not standardized, often varying in the type, quality, and availability of services offered, including evidence-based interventions such as Opioid Agonist Treatment (OAT). Local treatment systems are also rather fragmented and complex to navigate, creating barriers for potential services users to identify and make informed choices on available treatment options.MethodsBetween May to August 2023, we conducted an environmental scan to capture available information on all publicly-funded residential treatment programs in Ontario using the ConnexOntario service portal, a government-funded, health services information platform. Data were captured on organization name, geographical location, program description, program type (residential addictions treatment or supportive recovery programs), eligibility criteria, target population, the program’s OAT policies, number of available beds, minimum and maximum length of stay, projected wait times, funding source, and associated fees for program admission. Data were extracted and organized by geographic region, and findings were presented descriptively.ResultsA total of 102 residential addiction treatment programs and 36 residential supportive recovery programs in Ontario were identified. The scan noted substantial regional variations in program availability and wait times, along with a lack of programs tailored to unique populations such as women, youth, and Indigenous peoples. There is also a paucity of publicly-available information on program offerings, including detailed specifics on OAT policies within residential treatment programs that are crucial to ensuring that the services being offered are safe and grounded in evidence-based practice.ConclusionsFindings from the scan highlight notable gaps in program types, offerings, and availability among residential treatment programs in the province, including a lack of standardization on OAT policies across programs. Efforts should be made to ensure access to treatment-specific program information relevant to potential service users and to enhance coordinated access to residential treatment services in the province.

Letter from America: A British addiction psychiatrist's experience of opioid agonist treatment in the United States

Letter from America: A British addiction psychiatrist's experience of opioid agonist treatment in the United States

Experiences of serious depression and serious anxiety among individuals receiving injectable opioid agonist treatment (iOAT)

BackgroundThis study aims to provide evidence of factors that impact participant reported serious depression and serious anxiety among individuals receiving injectable opioid agonist treatment (iOAT). MethodsData from an 18-month longitudinal retrospective cohort of individuals receiving iOAT was utilized. The outcomes of serious depression and serious anxiety were ascertained via self-report in the European Addiction Severity Index. Two Generalized Linear Mixed Models were formulated using Penalized Quasi-Likelihood method. ResultsAnalyses included 131 participants. Average age was 49.04 years, 31 % self-identified as female, and 30 % self-identified as Indigenous. Adjusted analysis identified the importance of poorer physical health (AOR:1.06; 95 % CI: 1.03, 1.08), illicit opioid use (AOR: 1.03; 95 %CI: 1.01, 1.06), emotional abuse (AOR: 2.01; 95 % CI: 1.17, 3.44), and social isolation (AOR: 1.95; 95 % CI: 1.06, 3.58) with serious depression. Adjusted analysis of serious anxiety identified associations with age (AOR: 0.95; 95 % CI: 0.92, 0.98), illicit benzodiazepine use (AOR:1.31 95 % CI: 1.06, 1.61), poorer physical health (AOR: 1.05; 95 % CI: 1.03, 1.07), and social problems (AOR: 2.09; 95 % CI: 1.18, 3.71). LimitationsGeneralizability of study findings may be limited given the criteria used to enroll participants and to define depression and anxiety. ConclusionDepression and anxiety are highly prevalent among clients receiving iOAT. While both disorders share several factors, there are distinct characteristics associated with each outcome. These include poorer physical health, experiences of abuse, illicit substance use, and social problems. Understanding factors that influence depression and anxiety in iOAT can assist providers in supporting iOAT clients' mental health and developing individualized care plans.