Outcomes for Physicians with Opioid Dependence Treated without Agonist Pharmacotherapy in Physician Health Programs

Highlights

• Participants in physician health programs were grouped based on their substance(s) of abuse.
• Opioid users had similar treatment outcomes as alcohol only and non-opioid drug users.
• Abstinence-based PHP care management produces long-term abstinence.AIMS:

To compare treatment outcome among substance dependent physicians enrolled in a physician health program (PHP) who have a history of alcohol use only, any opioid use, or non-opioid drug use, in order to determine whether the distinctive PHP system of care management is as effective for individuals with opioid use disorders as for those with alcohol or other drug use disorders.

METHODS:

A 5-year, retrospective chart review, intent-to-treat analysis was conducted for all physicians admitted to 16 physician health programs (N=702; 85.5% male; age range=24-75). Analyses compared treatment outcomes for participants based upon their substance(s) of abuse [i.e., 1) "Alcohol Only" (n=204), 2) "Any Opioid" with or without alcohol use (n=339), and 3) "Non-Opioid" drug use with or without alcohol use (n=159)].

RESULTS:

In this sample, 75-80% of physicians across the three groups never tested positive for alcohol or drugs during their extended care management period with random drug testing. This included physicians with opioid dependence who did not receive opioid substitution therapy (OST). Of the 22.1% of physicians who had a positive test, two thirds (i.e., 14.5% of the total sample) had just one positive test, and only one third (i.e., 7.6% of the total sample) had more than one positive test. These results were similar in all three groups.

CONCLUSIONS:

These results indicate that individuals with opioid use disorders who are managed by PHPs can achieve long-term abstinence from opioids, alcohol, and other drugs without OST through participation in abstinence-based psychosocial treatment with extended, intensive care management following discharge.

Purchase full article at:  http://goo.gl/LWnuh2

By:  Merlo LJ1, Campbell MD2, Skipper GE3, Shea CL4, DuPont RL5.

• 1University of Florida, Department of Psychiatry, 4001 SW 13th St, Gainesville, FL 32608. Electronic address: lmerlo@UFL.edu.
• 2Institute for Behavior and Health, Inc., 6191 Executive Blvd, Rockville, MD 20852 USA. Electronic address: Campbell.Mike@jeassociates.com.
• 3Promises Treatment Centers, 2515 Wilshire Blvd, Santa Monica, CA 90403. Electronic address: gregory.skipper@gmail.com.
• 4Institute for Behavior and Health, Inc., 6191 Executive Blvd, Rockville, MD 20852 USA. Electronic address: corinne.shea@ibhinc.org.
• 5Institute for Behavior and Health, Inc., 6191 Executive Blvd, Rockville, MD 20852 USA. Electronic address: BobDuPont@aol.com.
• J Subst Abuse Treat. 2016 May;64:47-54. doi: 10.1016/j.jsat.2016.02.004. Epub 2016 Feb 13.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Linkage to Primary Care for Persons First Receiving Injectable Naltrexone During Inpatient Opioid Detoxification

HIGHLIGHTS

• XR-NTX begun during opioid detoxification can be continued in primary care settings.
• 55% of XR-NTX recipients link to primary care for continued treatment.
• We found no predictors of XR-NTX continuation in primary care.

INTRODUCTION:

Opioid use disorders commonly require ongoing medication-assisted treatment to reduce relapse following discharge from inpatient detoxification programs. Naltrexone, an opioid antagonist, is an increasingly popular treatment option in its once-monthly injectable form (XR-NTX). The aim of this study was to examine the follow-up rates of persons who received an initial injection during inpatient detoxification and scheduled for receipt of a first outpatient injection in the primary care setting.

METHODS:

We reviewed the electronic health records of 62 consecutive opioid dependent adults who received an initial injection of XR-NTX during extended inpatient detoxification at Stanley Street Treatment and Resources (SSTAR) in Fall River, Massachusetts, from March 2013 to August 2015, and were referred to the adjacent SSTAR primary care health center for their second injection 1month later. Demographic information, drug use and opioid treatment history, and aftercare planning were assessed.

RESULTS:

Participants averaged 32.4 (±7.8) years of age, 90.3% were non-Latino Caucasian, 35.5% were homeless, 21.3% reported a drug overdose in the last year, and 53.2% had been in detoxification within the last year. Of the 62 participants referred to primary care, 34 (54.8%) followed up to receive their second XR-NTX injection. Twenty of these persons received at least a third XR-NTX injection. No demographic, treatment history, substance use behaviors, or aftercare plan variables were associated with receipt of a second injection (p<.20).

CONCLUSION:

Predicting, and therefore improving, XR-NTX continuation during the transition from inpatient detoxification to primary care may be difficult in this population.

Purchase full article at:   http://goo.gl/mEBWGY

By:  Stein MD1, Risi MM2, Bailey GL3, Anderson BJ2.

• 1General Medicine Research Unit, Butler Hospital, Providence, RI, 02906; Warren Alpert Medical School of Brown University, Providence, RI, 02912. Electronic address: michael_stein@brown.edu.
• 2General Medicine Research Unit, Butler Hospital, Providence, RI, 02906.
• 3Warren Alpert Medical School of Brown University, Providence, RI, 02912; Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts, 02720. 
• J Subst Abuse Treat. 2016 May;64:44-6. doi: 10.1016/j.jsat.2016.01.007. Epub 2016 Feb 23.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients

IMPORTANCE

Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known.

OBJECTIVE

To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization.

DESIGN, SETTING, AND PARTICIPANTS

From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group.

INTERVENTIONS

Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital’s primary care clinic (linkage).

MAIN OUTCOMES AND MEASURES

Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report).

RESULTS

During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P < .001). At 6 months, 12 linkage participants (16.7%) and 2 detoxification participants (3.0%) were receiving buprenorphine OAT (P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P < .01) in an intent-to-treat analysis.

CONCLUSIONS AND RELEVANCE

Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge.

LEVEL OF EVIDENCE:

Level 3 Prognostic.

Below:  Distribution of Rates of Illicit Opioid Use During Follow-up Assessment by Intervention in 116 Individuals. 

A, Detoxification group; B, linkage group. To facilitate description, rates were calculated as days of illicit opioid use per 30 follow-up days using all available data, including the mean of all assessments for each study participant with multiple follow-up data or any follow-up time point for participants with one time point.

Full article at:   http://goo.gl/zwTQgS

By:  Jane M. Liebschutz, MD, MPH, Denise Crooks, MPH, Debra Herman, PhD, Bradley Anderson, PhD, Judith Tsui, MD, MPH, Lidia Z. Meshesha, BA, Shernaz Dossabhoy, BA, and Michael Stein, MD

Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Liebschutz, Crooks, Tsui, Dossabhoy); Department of Medicine, Boston University School of Medicine, Boston, Massachusetts (Liebschutz, Tsui); Department of General Internal Medicine, Butler Hospital, Providence, Rhode Island (Herman, Anderson, Stein); Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island (Herman, Anderson, Stein); Department of Psychology, The University of Memphis, Memphis, Tennessee (Meshesha).

Corresponding Author: Jane M. Liebschutz, MD, MPH, Boston Medical Center, 801 Massachusetts Ave, Second Floor, Boston, MA 02118 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Correlates of Nine-Month Retention following Interim Buprenorphine-Naloxone Treatment in Opioid Dependence: A Pilot Study

Interim medication-only treatment has been suggested for the initiation of opioid maintenance treatment (OMT) in opioid-dependent subjects, but this rarely has been studied using buprenorphine instead of methadone. Following a pilot trial assessing interim buprenorphine-naloxone treatment in order to facilitate transfer into OMT, we here aimed to study retention, and potential correlates of retention, in full-scale treatment. Thirty-six patients successfully referred from a waiting list through an interim treatment phase were followed for nine months in OMT. Baseline characteristics, as well as urine analyses during the interim phase and during full-scale OMT, were studied as potential correlates of retention. The nine-month retention in OMT was 83 percent (n = 30). While interim-phase urine samples positive for benzodiazepines did not significantly predict dropout from full-scale OMT (p = 0.09), urine samples positive for benzodiazepines within full-scale OMT were significantly associated with dropout (p < 0.01), in contrast to other substances and baseline characteristics. Retention remained high through nine months in this pilot study sample of patients referred through buprenorphine-naloxone interim treatment, but use of benzodiazepines is problematic, and the present data suggest that it may be associated with treatment dropout.

…The use of benzodiazepines during interim treatment and during full-scale OMT was the only variable associated with dropout in the present study. Although the number of dropouts in this pilot study was low, urines positive for benzodiazepines in the interim condition tended to be associated with a negative outcome once referred to the full-scale program but did not reach statistical significance (p = 0.09). However, significantly, a negative outcome in full-scale OMT was associated with the use of benzodiazepines within that OMT treatment setting, which was not the case for any other substance, suggesting that benzodiazepines may play a major role in the clinical picture of patients with a negative treatment course in opioid dependence.

The seemingly negative association between retention and benzodiazepine use during treatment of opioid dependence may require further attention in research and in clinical practice. In the present study, at baseline, the frequency of use of benzodiazepines was comparable to that of the main drug of these primarily opioid-dependent subjects. In contrast to the high rates of continued benzodiazepine use, urine samples positive for opiates were very infrequent in the full-scale OMT phase, markedly lower than in many other studies [35,36], and opioid-positive urines were not associated with dropout in OMT. The role of benzodiazepines in the present results, compared to the role of opioids, strengthens the impression that polydrug use, particularly including the use of benzodiazepines, may present a potentially even larger challenge in the treatment of severe opioid dependence than the actual primary opioid-related disorder.

Patients with a high level of benzodiazepine use could represent a group with more complicated psychiatric problems and more severe substance-related problems [29, 37]. In the present study, patients dropping out of treatment did not report more use of benzodiazepines during the last 30 days prior to study start, but still, this type of substance use was associated with a negative outcome once in full-scale treatment. It cannot be excluded that intake of benzodiazepines actually increases when the intake of illicit opioids decreases in treatment, at least in a subset of individuals…

Full article at:   http://goo.gl/7QXGbu

By:  A. Håkansson, 1 , 2 , * C. Widinghoff, 1 , 2 T. Abrahamsson, 1 , 2 and C. Gedeon 1 , 3

¹Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, 221 85 Lund, Sweden

²Malmö Addiction Center, Department of Psychiatry, 205 02 Malmö, Skane Region, Sweden

³Solstenen Outpatient Unit for Opiate Maintenance Treatment, Östra Mårtensgatan 15, 223 61 Lund, Sweden

*A. Håkansson: Email: es.ul.dem@nossnakah.c_sredna

Academic Editor: Dennis M. Donovan

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Relapse Prevention Medications in Community Treatment for Young Adults with Opioid Addiction

BACKGROUND:

Despite the well-known effectiveness and widespread use of relapse prevention medications such as extended release naltrexone (XR-NTX) and buprenorphine for opioid addiction in adults, less is known about their use in younger populations.

METHODS:

This was a naturalistic study using retrospective chart review of N = 56 serial admissions into a specialty community treatment program that featured the use of relapse prevention medications for young adults with opioid use disorders (19-26). Treatment outcomes over 24 weeks included retention, and weekly opioid negative urine tests.

RESULTS:

Patients were mean age 23.1, 70% male, 86% Caucasian, 82% with history of injection heroin use, and treated with either buprenorphine (77%) or XR-NTX (23%). The mean number of XR-NTX doses received was 4.1. Retention was approximately 65% at 12 weeks and 40% at 24 weeks, and rates of opioid negative urine were 50% at 12 weeks and 39% at 24 weeks, with missing samples imputed as positive. There were no statistically significant differences in retention (t = 1.87, p = .06) or in rates of weekly opioid negative urine tests (t = 1.96, p = .06) between medication groups, over the course of 24 weeks. The XR-NTX group had higher rates of weekly negative urine drug tests for other non-opioid substances (t = 2.83; p < .05) compared to the buprenorphine group. Males were retained in treatment longer and had higher rates of opioid negative weeks compared to females.

CONCLUSIONS:

Our results suggest that relapse prevention medications including both buprenorphine and XR-NTX can be effectively incorporated into standard community treatment for opioid addiction in young adults with good results. Specialty programming focused on opioid addiction in young adults may provide a promising model for further treatment development.

Purchase full article at:   http://goo.gl/n9kEsy

By:    Vo HT1, Robbins E1, Westwood M1, Lezama D1, Fishman M1,2.

• 1 Maryland Treatment Centers , Baltimore , MD , USA.
• 2 Johns Hopkins School of Medicine , Baltimore , MD , USA.
• Subst Abus. 2016 Jan 28:0 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Cue-Induced Craving to Paraphernalia & Drug Images in Opioid Dependence

BACKGROUND AND OBJECTIVES:

Stimuli that are repeatedly paired with substance use, such as drug paraphernalia, can themselves elicit drug craving. The aim of this study was to examine whether particular cue types elicit greater craving responses than others among individuals with opioid dependence.

METHODS:

Participants seeking inpatient treatment for opioid dependence were recruited for a study of cue-induced craving. This sample (N = 50), included 25 primary heroin users, 20 primary prescription opioid users, and 5 users of heroin and prescription opioids equally. Participants completed a cue reactivity task, in which images of drug-related stimuli were presented on a computer screen, each followed by a question assessing state drug craving.

RESULTS:

Overall, participants reported higher craving following paraphernalia stimuli relative to drug stimuli. However, this was moderated by opioid type; there was significantly higher craving in response to images of paraphernalia cues in the heroin group, and higher craving in response to drug cues in the prescription opioid group.

DISCUSSION AND CONCLUSIONS:

These findings highlight potential differences in cue reactivity to opioid paraphernalia and drug cues, which appears to be moderated by drug type.

SCIENTIFIC SIGNIFICANCE:

Cue-induced craving is an important factor in relapse. This study adds further to the literature on cue-induced craving in opioid dependence, suggesting that craving may vary based on both cue type and opioid type. Future studies designed to discriminate the impact of substance of abuse, route of administration, and cue type will help to further clarify cue-induced craving in this population.

Purchase full article at:   http://goo.gl/ZDa9VI

By:  McHugh RK1,2, Fulciniti F1, Mashhoon Y2,3, Weiss RD1,2.

• 1Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.
• 2Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
• 3Behavioral Psychopharmacology Research Laboratory, McLean Imaging Center, McLean Hospital, Belmont, Massachusetts. 
• Am J Addict. 2016 Feb 5. doi: 10.1111/ajad.12344.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Risk Factors for Relapse & Higher Costs among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities & Treatment History

Clinical trials show that opioid agonist therapy (OAT) with methadone or buprenorphine is more effective than behavioral treatments, but state policymakers remain ambivalent about covering OAT for long periods. 

We used Medicaid claims for 52,278 Massachusetts Medicaid beneficiaries with a diagnosis of opioid abuse or dependence between 2004 and 2010 to study associations between use of methadone, buprenorphine or other behavioral health treatment without OAT, and time to relapse and total healthcare expenditures. 

Cox Proportional Hazards ratios for patients treated with either methadone or buprenorphine showed approximately 50% lower risk of relapse than behavioral treatment without OAT. Expenditures per month were from $153 to $233 lower for OAT episodes compared to other behavioral treatment. 

Co-occurring alcohol abuse/dependence quadrupled the risk of relapse, other non-opioid abuse/dependence doubled the relapse risk and severe mental illness added 80% greater risk compared to those without each of those disorders. 

Longer current treatment episodes were associated with lower risk of relapse. Relapse risk increased as prior treatment exposure increased but prior treatment was associated with slightly lower total healthcare expenditures. 

These findings suggest that the effectiveness of OAT that has been demonstrated in clinical trials persists at the population level in a less controlled setting and that OAT is associated with lower total healthcare expenditures compared to other forms of behavioral treatment for patients with opioid addiction. 

Co-occurring other substance use and mental illness exert strong influences on cost and risk of relapse, suggesting that individuals with these conditions need more comprehensive treatment

Purchase full article at:   http://goo.gl/LJFglO

By:  Clark RE1, Baxter JD2, Aweh G3, O'Connell E3, Fisher WH4, Barton BA5.

• 1Department of Family Medicine and Community Health, University of Massachusetts Medical School; Department of Quantitative Health Sciences, University of Massachusetts Medical School. Electronic address: robin.clark@umassmed.edu.
• 2Department of Family Medicine and Community Health, University of Massachusetts Medical School; Center for Health Policy and Research, University of Massachusetts Medical School.
• 3Center for Health Policy and Research, University of Massachusetts Medical School.
• 4School of Criminology and Justice Studies, University of Massachusetts Lowell.
• 5Department of Quantitative Health Sciences, University of Massachusetts Medical School; Center for Health Policy and Research, University of Massachusetts Medical School.
• J Subst Abuse Treat. 2015 Oct;57:75-80. doi: 10.1016/j.jsat.2015.05.001. Epub 2015 May 7. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Bone Mineral Density and Its Determinants in Men with Opioid Dependence

Data on the influence of opioid substitution therapy (OST) on skeletal health in men is limited. This cross-sectional study aimed to determine the prevalence of low bone mass in male drug users and to evaluate the relationship between endogenous testosterone and bone mass. We recruited 144 men on long-term opioid maintenance therapy followed in the Center of Addiction Medicine in Basel, Switzerland. Data on medical and drug history, fracture risk and history of falls were collected. Bone mineral density (BMD) was evaluated by densitometry and serum was collected for measurements of gonadal hormones and bone markers. 35 healthy age- and BMI-matched men served as the control group. The study participants received OST with methadone (69 %), morphine (25 %) or buprenorphine (6 %). 

Overall, 74.3 % of men had low bone mass, with comparable bone mass irrespective of OST type. In older men (≥40 years, n = 106), 29.2 % of individuals were osteoporotic (mean T-score -3.0 ± 0.4 SD) and 48.1 % were diagnosed with osteopenia (mean T-score -1.7 ± 0.4 SD). In younger men (n = 38), 65.8 % of men had low bone mass. In all age groups, BMD was significantly lower than in age-and BMI-matched controls. In multivariate analyses, serum free testosterone (fT) was significantly associated with low BMD at the lumbar spine (p = 0.02), but not at the hip. When analysed by quartiles of fT, lumbar spine BMD decreased progressively with decreasing testosterone levels. 

We conclude that low bone mass is highly prevalent in middle-aged men on long-term opioid dependency, a finding which may partly be determined by partial androgen deficiency.

Purchase full article at:   http://goo.gl/kuw7Zs

By:  Gotthardt F1, Huber C1, Thierfelder C1, Grize L2,3, Kraenzlin M4, Scheidegger C1, Meier C5.

• 1Basel Center for Addiction Medicine, Basel, Switzerland.
• 2Biostatistics Unit, Swiss Tropical and Public Health Institute Basel, Basel, Switzerland.
• 3University of Basel, Basel, Switzerland.
• 4Division of Endocrinology, Diabetology and Metabolism, University Hospital, Missionsstrasse 24, 4055, Basel, Switzerland.
• 5Division of Endocrinology, Diabetology and Metabolism, University Hospital, Missionsstrasse 24, 4055, Basel, Switzerland. christian.meier@unibas.ch. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Predictors of Continued Use of Extended-Released Naltrexone (XR-NTX) for Opioid-Dependence: An Analysis of Heroin & Non-Heroin Opioid Users in Los Angeles County

Highlights

• Some studies suggest better pharmacotherapy adherence and/or retention rates among non-heroin opioid users compared to heroin users. Therefore, this study examined predictive associations of subsequent doses of extended-release naltrexone (XR-NTX) among heroin and non-heroin opioid users.
• Non-heroin opioid users and heroin users are retained in XR-NTX treatment for comparable periods of time. However, those who identify as homeless, inject opioids (regardless of opioid-type), or were diagnosed with a mental illness are less likely to be retained in treatment with XR-NTX.
• Further, XR-NTX may contribute to decreases in urges to use among heroin and non-heroin opioid users.

Extended-release naltrexone (XR-NTX) is associated with an increased number of opioid-free days, improved adherence rates in substance use disorder treatment programs, and reduced cravings and drug-seeking behaviors. 

There is little evidence on the predictive associations between baseline characteristics of opioid-dependent patients and XR-NTX utilization. Some studies have demonstrated better pharmacotherapy adherence and/or retention rates among non-heroin opioid users compared to heroin users. 

This study examines predictive associations between characteristics of patients and XR-NTX utilization, as well as participants’ urge to use opiates. Our findings suggest that XR-NTX may contribute to decreases in urges to use among both heroin and non-heroin opioid users. Non-heroin opioid users and heroin users were retained in XR-NTX treatment for comparable periods of time. However, those who identified as homeless, injected opioids (regardless of opioid-type), or were diagnosed with a mental illness were less likely to be retained in treatment with XR-NTX.

Purchase full article at:   http://goo.gl/Wc8H6R

By:   Sarah J. Cousins, M.P.H., Seyed Ramin Radfar, M.D., M.P.H.,  Desirée Crèvecoeur-MacPhail, Ph.D., Alfonso Ang, Ph.D., Kendall Darfler, B.A., Richard A. Rawson, Ph.D.

Affiliations

University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, USA 90025

Correspondence

Corresponding author at: UCLA Integrated Substance Abuse Programs (http://www.uclaisap.org/), Semel Institute for Neuroscience and Human Behavior, at the David Geffen School of Medicine, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025.

SarahJCousins@ucla.edu

DOI: http://dx.doi.org/10.1016/j.jsat.2015.12.004

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Correlates of Imprisonment in Opioid-Dependent Men & Women in New South Wales, Australia

INTRODUCTION AND AIMS:

Involvement in the criminal justice system is common among opioid-dependent people. This study aimed to determine prevalence and adolescent-onset correlates of adult imprisonment among opioid-dependent men and women in New South Wales, Australia.

DESIGN AND METHODS:

Participants were recruited from opioid substitution therapy clinics and completed a face-to-face, structured interview. Data were collected on demographic characteristics, family history, substance dependence and psychiatric disorders. Adolescent-onset correlates of adult incarceration (including interactions with gender) were examined using logistic regression.

RESULTS:

Opioid-dependent men were significantly more likely than opioid-dependent women to report adult imprisonment (66% vs 40%; P < 0.001). In a multivariable logistic regression model, older age, male gender, having completed high school education only, having dependent children or living independently prior to age 18 years, a history of juvenile detention and adolescent-onset opioid dependence were all significantly associated with increased odds of adult imprisonment. Adolescent-onset depression was associated with a halving of odds of adult imprisonment. The only variable for which we observed an interaction with gender was juvenile detention, which had a significantly greater impact on the odds of imprisonment for men than women.

DISCUSSION AND CONCLUSIONS:

More than half of this sample of opioid dependent adults had a history of imprisonment. Variables that are associated with imprisonment in the general population, such as childhood maltreatment, were not important in predicting imprisonment in this sample. Further study is required to understand the interaction between sex and juvenile detention in predicting adult imprisonment.

Purchase full article at:   http://goo.gl/6b9FFp

By:   Larney S1,2, Cama E1, Nelson E3, Larance B1, Degenhardt L1,4,5,6.

• 1National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
• 2Alpert Medical School, Brown University, Providence, USA.
• 3Department of Psychiatry, Washington University School of Medicine, St Louis, USA.
• 4School of Population and Global Health, University of Melbourne, Melbourne, Australia.
• 5Department of Global Health, School of Public Health, University of Washington, Seattle, USA.
• 6Murdoch Children's Research Institute, Melbourne, Australia. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Delayed Ego Strength Development in Opioid Dependent Adolescents and Young Adults

Objective. To evaluate ego strengths, in the context of Erikson's framework, among adolescents and young adults diagnosed with opioid dependence as compared to non-drug using youth. 

Methods. Opioid dependent (n = 51) and non-drug using control (n = 31) youth completed the self-administered Psychosocial Inventory of Ego Strengths (PIES). The PIES assesses development in the framework of Erikson's ego strength stages. Multivariate linear regression modeling assessed the independent association of the primary covariate (opioid dependent versus control) as well as potential confounding variables (e.g., psychiatric comorbidities, intelligence) with total PIES score. 

Results. Mean total PIES score was significantly lower in opioid dependent youth (231.65 ± 30.39 opioid dependent versus 270.67 ± 30.06 control; p < 0.01). Evaluation of the PIES subscores found significant (p < 0.05) delays in all ego strength areas (hope, will, purpose, competence, fidelity, love, care, and wisdom). When adjusting for potential confounders, opioid dependence remained a significant (p < 0.001) independent predictor of total PIES score. 

Conclusion. Adolescents with opioid dependence demonstrated significant delays in ego strength development. A treatment approach acknowledging this delay may be needed in the counseling and treatment of adolescents with opioid dependence.

Full article at:   http://goo.gl/rQpYfq

By:   Benjamin A. Abramoff, 1 Hannah L. H. Lange, 2 Steven C. Matson, 3 , 4 Casey B. Cottrill, 4 Jeffrey A. Bridge, 2 , 3Mahmoud Abdel-Rasoul, 3 and Andrea E. Bonny 2 , 3 , 4 , *

¹Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, GA 30322, USA

²The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA

³The Ohio State University, Columbus, OH 43210, USA

⁴Nationwide Children's Hospital, Columbus, OH 43205, USA

*Andrea E. Bonny: Email: gro.snerdlihcediwnoitan@ynnob.aerdna

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health