Use Of Opioid Substitution Therapy Research Articles

Methadone use for acute opioid withdrawal in Tshwane shelters during the COVID-19 lockdown.

Temporary shelters were established for street-based people during the national level 5 coronavirus disease 2019 (COVID-19) lockdown. However, street-based substance users' need to access substances was not addressed, resulting in large numbers of people experiencing withdrawal. The Community Oriented Substance Use Programme (COSUP) in Tshwane provided methadone to manage opioid withdrawal. A cross-sectional, descriptive study was conducted using the daily methadone dosing records from shelters in Tshwane between March 2020 and September 2020. The final analysis included 495 participants, of which 64 (12.9%) were initiated on 20 mg - 30 mg of methadone, 397 (80.2%) on 40 mg - 50 mg, and 34 (6.9%) on 60 mg - 70 mg. A total of 194 (39.2%) participants continued their initiation dose for 1-2 months, after which 126 (64.9%) had their doses increased, and 68 (35.1%) had their doses decreased. Approximately 12 (2.4%) participants were weaned off methadone after 1-3 months and 46 (9.3%) after 4-6 months. In all, 100 (20.2%) participants left the shelter prematurely and did not continue with methadone. A total of 126 (25.5%) participants continued to stay in the shelters and received methadone for 6 months, with 125 (25.3%) participants leaving the shelter with continued follow-up at a COSUP site. This study demonstrates variability in methadone dosing regimens among shelter residents. As the lockdown measures eased, many chose to leave the shelters, while others remained to receive methadone and other services. The COSUP appears to be effective during periods of increased vulnerability, since a large number of participants were successfully followed up.Contribution:Opioid dependence is a persistent, lifelong disease. It is multifaceted with complex environmental and individual determinants. This study highlighted the use of opioid substitution therapy during a period of increased vulnerability.

Comparative benefits of social housing and buprenorphine on wheel running depressed by morphine withdrawal in rats.

Social support and opioid replacement therapy are commonly used to treat opioid withdrawal. The present study tested the hypothesis that social housing and buprenorphine administration can restore wheel running depressed by morphine withdrawal in rats. Experiment 1 assessed disruptive side effects of buprenorphine and found that administration of low doses (3.2, 10, & 32µg/kg, s.c.) had no impact on voluntary wheel running. Experiment 2 assessed the impact of social housing and acute buprenorphine administration (10µg/kg) on morphine withdrawal. Two 75mg morphine pellets were implanted for 3days to induce dependence. Removal of the morphine pellets caused a decrease in body weight, increase in wet dog shakes, and depression of wheel running during the normally active dark phase of the circadian cycle. Social housing restored wheel running and reduced the number of wet dog shakes but did not affect body weight. Administration of buprenorphine restored wheel running depressed by morphine withdrawal for 2days in individually housed rats and produced time-dependent changes in socially housed rats: Depression of wheel running in the 3h following administration and restoration of running subsequently compared to saline-treated controls. The impact of buprenorphine and social housing to reduce the effect of morphine withdrawal in rats is consistent with the use of opioid substitution therapy and psychotherapy/social support to treat opioid withdrawal in humans. These data provide further validation for the clinical relevance for the use of wheel running to assess spontaneous opioid withdrawal.

Treatment of substance use disorders with co-occurring severe mental health disorders.

To provide an update of treatment for substance use in patients with co-occurring substance use disorders (SUD) and mental health disorders (dual diagnosis) with a focus on both pharmacological and psychosocial interventions. A total of 1435 abstracts were identified, of which we selectively reviewed 43 for this narrative review. There is emerging evidence, both clinical and neurobiological, that clozapine is a more efficacious antipsychotic in treatment of individuals with schizophrenia and SUD. The use of depot atypical antipsychotic paliperidone palmitate in this population is also promising. Although valproate remains the treatment of choice in individuals with bipolar disorder and SUD, present evidence suggests that lithium and quetiapine may not be effective in this population. Naltrexone is the most effective anticraving agent in individuals with severe mental illness (SMI) and comorbid alcohol use disorders. The use of opioid substitution therapy in individuals with SMI and comorbid opioid use disorders is also associated with favorable outcomes. Varenicline shows promise in patients with SMI who smoke tobacco. Psychosocial interventions should be instituted early in the course of treatment. They should ideally be high intensity and based on established therapies used for SUD. The paucity of systematic studies in individuals with co-occurring mental health disorders and SUD remains a concern, given the enormous burden that they pose. However, there are a number of studies which have evaluated interventions, both psychosocial and pharmacological, which show promise and can guide clinical practice. VIDEO ABSTRACT: http://links.lww.com/YCO/A49.

PMH50 - TREATMENT OF OPIOID USE DISORDER IN ITALY: IS THERE SCOPE FOR POLICY CHANGE?

Opioid use disorder (OUD) is a widespread global public health crisis. An estimated 8,441 overdose deaths were attributed to the abuse of heroin and other opioids in Europe alone in 2015. Opioid dependence is still undertreated throughout Europe with significant limitations associated with current treatment. This research aims to assess the receptivity to a shift in policy in Italy regarding the use of opioid substitution therapy. Primary research with prescribing KOLs, national government stakeholders, regional representatives and NGO representatives in Italy was conducted to probe on evolving policy influencing opioid substitution therapy (OST) prescribing at the national, regional and local level. At present, several trends in Italian OST policy influence prescribing behaviour in Italy. Presidential Decree no 309/90 currently restricts the prescribing and administration of OST to SerDs. This, together with the lack of patient-centred care is a significant barrier to improving treatment outcomes and significantly restricts the access to treatment within the OUD population. Focused, policy-related initiatives in regions such as Lombardy and Emilia-Romagna with higher receptivity to changes in clinical practice may expand the provision of OST outside of SerDs. Undertaking studies that demonstrate the economic value of newer, long-acting buprenorphine products can be used to highlight reductions in healthcare utilisation and consequent improvement in SerD efficiency.

The effects of needle-sharing and opioid substitution therapy on incidence of hepatitis C virus infection and reinfection in people who inject drugs.

Although high hepatitis C virus (HCV) prevalence has been observed in people who inject drugs (PWID) for decades, research suggests incidence is falling. We examined whether PWIDs' use of opioid substitution therapy (OST) and their needle-and-syringe sharing behaviour explained HCV incidence. We assessed HCV incidence in 235 PWID in Melbourne, Australia, and performed discrete-time survival with needle-sharing and OST status as independent variables. HCV infection, reinfection and combined infection/reinfection incidences were 7·6 [95% confidence interval (CI) 4·8-11·9], 12·4 (95% CI 9·1-17·0) and 9·7 (95% CI 7·4-12·6) per 100 person-years, respectively. Needle-sharing was significantly associated with higher incidence of naive HCV infection [hazard ratio (HR) 4·9, 95% CI 1·3-17·7] but not reinfection (HR 1·85, 95% CI 0·79-4·32); however, a cross-model test suggested this difference was sample specific. Past month use of OST had non-significant protective effects against naive HCV infection and reinfection. Our data confirm previous evidence of greatly reduced HCV incidence in PWID, but not the significant protective effect of OST on HCV incidence detected in recent studies. Our findings reinforce the need for greater access to HCV testing and prevention services to accelerate the decline in incidence, and HCV treatment, management and support to limit reinfection.

A urinalysis-based study of buprenorphine and non-prescription opioid use among patients on buprenorphine maintenance

Objectives:To understand the pattern of use of opioid-substitution therapy (OST) and opioid abuse among patients on buprenorphine maintenance using urinalysis.Materials and Methods:The study was conducted at a tertiary care de-addiction center. We reviewed the laboratory record of all consecutive urine samples sent for drug analysis over a period of 1 year. In all, 179 consecutive urine samples were included in the analysis. The chi-square test was used to compare opioid abuse among those testing positive and negative for buprenorphine on urinalysis. Additionally, in order to assess the potential impact of the prescribed induction and maximum dose of buprenorphine on the findings, we carried out the independent-samples t test. Level of statistical significance was kept at P<0.05 for all the tests.Results:Urinalysis failed to detect buprenorphine in 44.7% of the samples. Rate of detection of dextropropoxyphene was significantly higher among buprenorphine-negative samples (P<0.005). The prescribed induction dose of buprenorphine was significantly lower among those testing positive for heroin. This was found for both buprenorphine-positive (P<0.005) as well as buprenorphine-negative samples (P<0.005).Conclusions:These findings support the routine use of urine drug screening among individuals on OST.

States Pursue Elusive Savings by Limiting Buprenorphine

Back to table of contents Previous article Next article Professional NewsFull AccessStates Pursue Elusive Savings by Limiting BuprenorphineLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:16 Sep 2011https://doi.org/10.1176/pn.46.18.psychnews_46_18_7_1AbstractMisplaced concerns about cost and safety may be leading many state Medicaid programs to mistakenly restrict the use of buprenorphine for the treatment of opioid addiction, despite the drug's approval by the Food and Drug Administration for that purpose in 2002. Buprenorphine may offer a better option for those seeking treatment for opiate addiction, without the stigma and access issues of methadone injections.Credit: Beneda Miroslav/ShutterstockMost Medicaid programs limit buprenorphine use by requiring prior authorization to fill prescriptions, limiting treatment duration, or imposing other requirements, such as drug screening before prescription can be reauthorized. A group of Massachusetts researchers recently sought to determine whether such restrictions are justified. "The evidence does not support rationing buprenorphine to save money or ensure safety," wrote Robin Clark, Ph.D., a senior director with the Center for Health Policy and Research and an associate professor of family medicine and community health and quantitative health sciences at the University of Massachusetts Medical School, and his colleagues in the August Health Affairs.The researchers came to that conclusion after they compared spending, the use of services related to drug-use relapses, and mortality for 33,923 Massachusetts Medicaid beneficiaries receiving either buprenorphine, methadone, drug-free treatment, or no treatment during the period 2003 to 2007. They found that buprenorphine offered several attractive features as an opioid-dependence treatment. For example, buprenorphine can be prescribed by a physician and taken at home without the stigma and daily demands of acquiring methadone injections, which must by law be administered at an approved clinic. "Enrollment patterns suggest that buprenorphine has expanded treatment access," they said. Despite concerns about safety, mortality rates were similar for buprenorphine and methadone. In contrast, mortality rates were 75 percent higher among those receiving drug-free treatment, and more than twice as high among those receiving no treatment, compared with those receiving buprenorphine. Buprenorphine carries a lower risk of overdose than the stronger opioid methadone and is formulated with naloxone to prevent the practice of crushing and injecting the drug to achieve a greater opioid effect. "Buprenorphine is also more tightly bound to the opioid receptor than other opioids and therefore may protect patients by blocking out other drugs," said Clark and colleagues. But the idea among some health officials that buprenorphine is more costly than methadone turns out to be mistaken: "After adjustments for confounding factors, total health care spending for patients using buprenorphine treatment were slightly lower than for methadone, despite more frequent relapse events for buprenorphine. Longer and more expensive hospital stays among methadone patients accounted for the largest portion of the difference," the researchers pointed out. They expressed their concern that significant reductions in buprenorphine use could have the unintended effect of increasing costs and reducing the overall use of opioid substitution therapy, perhaps even contributing to "higher mortality among Medicaid beneficiaries with opioid addiction." "This analysis shows the importance of considering a broad range of costs and outcomes when attempting to implement targeted cost reductions," they said. "Failing to consider the impact of medications or other expensive treatments on total health care spending and outcomes could have the unintended effect of increasing costs and placing patients at greater risk." Funding for this study was provided by the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program.An abstract of "The Evidence Doesn't Justify Steps by State Medicaid Programs to Restrict Opioid Addiction Treatment With Buprenorphine" is posted at <http://content.healthaffairs.org/content/30/8/1425.abstract#xref-corresp-1-1>. ISSUES NewArchived

P2-354 Effectiveness of opioid substitution therapy among prisoners with drug dependence: a meta analysis

BackgroundIllicit drug use is widespread in penal institutions worldwide. Despite this, the use of opioid substitution therapy (OST) in prisons is low. This study evaluates the effectiveness of OST in...

Methadone and buprenorphine prescribing patterns of Victorian general practitioners: Their first 5 years after authorisation

The use of opioid substitution therapy (OST) is a widely used and effective treatment for opioid dependence, yet many Australian general practitioners (GPs) authorised to administer OST, prescribe to very few or no patients. This is a particular issue within Victoria that places greater reliance on a small number of active OST prescribing GPs, compared with other jurisdictions. Given the unmet demand for treatment, the provision of accurate figures on the OST prescribing practices of Victorian GPs is necessary for workforce planning. This study aimed to ascertain information on the prescribing patterns of Victorian GPs in their first 5 years after training, and elicit any trends that may explain their reluctance to prescribe OST. The prescribing patterns over a 5 year period of 168 Victorian GPs who became first authorised to prescribe OST during the years 2001-2004 were examined by accessing the Victorian Department of Human Services OST individual patient treatment permit data. Forty-six per cent of these GPs never held a patient permit, and at any one time, approximately two-thirds did not hold a permit. The majority of active prescribers were treating fewer than 10 patients and only 12.5% ever prescribed to more than 50 patients. The study suggests the Victorian GP workforce is inadequate to address the demand for OST. Many more GPs will need to be recruited, and encouraged to prescribe for more patients. Further research is required to identify barriers to GP OST prescribing.

Access to highly active antiretroviral therapy (HAART) for injecting drug users in the WHO European Region 2002–2004

Providing equitable access to highly active antiretroviral treatment (HAART) to injecting drug users (IDUs) is both feasible and desirable. Given the evidence that IDUs can adhere to HAART as well as non-IDUs and the imperative to provide universal and equitable access to HIV/AIDS treatment for all who need it, here we examine whether IDUs in the 52 countries in the WHO European Region have equitable access to HAART and whether that access has changed over time between 2002 and 2004. We consider regional and country differences in IDU HAART access; examine preliminary data regarding the injecting status of those initiating HAART and the use of opioid substitution therapy among HAART patients, and discuss how HAART might be better delivered to injecting drug users. Our data adds to the evidence that IDUs in Europe have poor and inequitable access to HAART, with only a relatively small improvement in access between 2002 and 2004. Regional and country comparisons reveal that inequities in IDU access to HAART are worst in eastern European countries.