Using Client's Routine Urinalysis Records From Multiple Treatment Systems to Model Five-Year Opioid Substitution Treatment Outcomes

BACKGROUND:

At global, national, and local level, the need for ongoing, timely and cost efficient, comprehensive drug treatment monitoring, and evaluation systems have clearly been well recognized.

OBJECTIVES:

To test the feasibility of linking laboratory data and client intake data and its usefulness for modeling retrospectively, for the first time, 5-year longitudinal drug treatment outcomes in an Irish opiate treatment setting.

METHODS:

A multisite, retrospective, longitudinal cohort study was implemented to evaluate outcomes for opiate users based on 1.7 million routine urinalysis results collected from 4,518 individuals presenting for opioid substitution treatment in Ireland from January 2006 to December 2010.

RESULTS:

Analysis of opiates, cocaine, benzodiazepine, and cannabis use at treatment intake, 6 months and at 1-5 year follow-ups revealed differences in urinalysis protocols; significant differences in age of first drug use between those using and not using opiates at 5 years; significant decreases in opiate use; increases in benzodiazepine use and significant increasing effects of concurrent cocaine and benzodiazepine use on the odds of using opiates. Time series analysis of weekly proportions opiate positive predicted 16% (95% confidence interval: 7%-25%) of clients would be opiate positive 5 years postinitial intake. 

CONCLUSIONS: 

Underutilized urinalysis data can be used to address the need for cost effective, efficient evidence of drug-treatment outcomes across time, place, and systems. Linking and matching the cross-sectional data across sites and times also revealed where improvements in electronic records could be made.

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By:  Comiskey CM1, Snel A1.

• 1 School of Nursing and Midwifery, Trinity College, University of Dublin , Dublin , Ireland.
• Subst Use Misuse. 2016 Mar 20;51(4):498-507. doi: 10.3109/10826084.2015.1126738. Epub 2016 Mar 4. 

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Non-Prescribed Use of Opioid Substitution Medication: Patterns & Trends in Sub-Populations of Opioid Users in Germany

Background

Non-prescribed use of opioid substitution medication (NPU) appears to represent a relevant source of opioids among European drug users. Little is known about the prevalence of NPU in Germany and possible differences between subgroups of opioid users. The present study examines NPU and other drug use patterns among drug consumption room (DCR) clients, opioid substituted DCR clients, and patients recruited in opioid substitution treatment (OST) practices.

Methods

Cross-sectional data was collected in 2011 from 842 opioid users in 10 DCRs and 12 OST practices across 11 German cities. Structured interviews comprised indicators for socio-demographics, health status, drug use, motives for NPU, and the availability and price of illicit substitution medication. Group differences were examined with one-way ANOVAs, chi-square tests, or t-tests, and factors for NPU were included in a multivariate model. Over-time comparisons were performed with similar data collected in 2008.

Results

Lifetime, 30-day and 24-h NPU prevalence for the total sample was 76.5%, 21.9%, and 9.3%, respectively, with methadone being the most frequently used substance. NPU, poly-drug use and injection drug use were more common among DCR clients, especially among DCR clients not in OST. The three groups featured distinct socio-demographic characteristics, with substituted patients being more socially integrated, while few differences in health parameters emerged. Motives for NPU were mostly related to potential shortcomings of OST, such as insufficient dosages, difficulties with transportation, and lack of access. NPU prevalence was found to be higher than in 2008, while injection rate of substitution medication was similarly low. Main factors associated with NPU were not being in OST, past 24-h use of other drugs, and younger age.

Conclusion

Although diverted methadone or buprenorphine are rarely used as main drugs, NPU is prevalent among opioid users, particularly among DCR clients not in OST. OST reduces NPU if opioid users’ needs are met.

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By:  Bernd Schulte, Christiane S. Schmidt, Lisa Strada, Christine Götzke, Philipp Hiller, Benedikt Fischer, Jens Reimer

Affiliations

Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

Correspondence

Corresponding author. Tel.: +49 040 7410 57906.

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Is The Promise of Methadone Kenya's Solution to Managing HIV & Addiction?

BACKGROUND AND OBJECTIVES:

Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the 'promise of methadone' to Kenya.

METHODS, SETTING AND PARTICIPANTS:

We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone.

RESULTS:

The modelled impact of OST shows relatively slight reductions in HIV incidence (5-10%) and prevalence (2-4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impact with increased coverage, with 40% coverage producing a 20% reduction in HIV incidence, even when accounting for relatively high sexual transmissions. Qualitative findings emphasise a culture of 'rationed expectation' in relation to access to care and a 'poverty of drug treatment opportunity'. In this context, the promise of methadone may be narrated as a symbol of hope-both for individuals and community-in relation to addiction recovery.

CONCLUSIONS:

Methadone offers HIV prevention potential, but there is a need to better model the effects of sexual HIV transmission in mediating the impact of OST among PWID in settings characterised by a combination of generalised and concentrated epidemics. We find that individual and community narratives of methadone as hope for recovery coexist with policy narratives positioning methadone primarily in relation to HIV prevention. Our analyses show the value of mixed methods approaches to investigating newly-introduced interventions.

Below:  Projected impact of opioid substitution treatment (OST) on HIV prevalence and incidence at varied coverage levels

Full article at:   http://goo.gl/baQ8F1

By:   Tim Rhodes,1 Andy Guise,1 James Ndimbii,2 Steffanie Strathdee,3 Elizabeth Ngugi,4 Lucy Platt,1 Ann Kurth,5 Charles Cleland,5 and Peter Vickerman1

1Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK

2Kenyan Consortium of AIDS Non-Government Organisations, Nairobi, Kenya

3Division of Global Health, School of Medicine, University of California at San Diego, San Diego, USA

4Centre for HIV Prevention Research, University of Nairobi, Nairobi, Kenya

5Institute for Global Health, College of Nursing, New York University, New York, USA

Correspondence to Professor Tim Rhodes; Email: ku.ca.mthsl@sedohr.mit

  

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Script in a Day Intervention for Individuals Who Are Injecting Opioids: A Feasibility Randomized Control Trial

Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID feasibility trial explored the processes of conducting a randomized control trial (RCT) with people who inject drugs (PWID) in a low-threshold agency. Feasibility of the intervention investigated whether offering PWID immediate access to OST via specialist primary care increased numbers in OST at 3 months, compared with offering advice and case management.

Un-blinded RCT was conducted at Bristol Drugs Project needle exchange. A total of 311 individuals were eligible and 100 consented to participate. Trial process outcomes involved exploring OST status at 3 months; secondary outcomes were substance use and health-related quality of life measures.

Follow-up was 86%. At 3 months, 51% intervention and 47% of control participants were in OST (OR of success of intervention 1.17 (0.54-2.57)). Opioid use reduced by 79 and 73%, respectively (OR of intervention success 1.38 (0.5-3.7)). Physical and mental health improved but there was little differences between groups.

The feasibility of conducting the trial was a success, but there was insufficient evidence of an effect compared with intensive case management. Further development and evaluation of case management approaches in low-threshold agencies is warranted.

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By: Beattie A1, Marques EM1, Barber M2, Greenwood R3, Ingram J1, Ayres R4, Neale J4, Rees A4, Coleman B5, Hickman M6.

• 1School of Social and Community Medicine, University of Bristol, Bristol, UK.
• 2Lawrence Hill Health Centre, Bristol, UK.
• 3NIHR Research Design Service-South West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
• 4Bristol Drugs Project, Bristol, UK.
• 5Bristol City Council, Bristol, UK.
• 6School of Social and Community Medicine, University of Bristol, Bristol, UK Bristol City Council, Bristol, UK.  

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Impact of Opioid Substitution Therapy for Scotland's Prisoners on Drug-Related Deaths Soon After Prisoner Release

To assess whether the introduction of a prison-based opioid substitution therapy (OST) policy was associated with a reduction in drug-related deaths (DRD) within 14 days after prison release.

Before prison-based OST (1996-2002), 305 DRDs occurred in the 12 weeks after 80 200 qualifying releases, 3.8 per 1000 releases [95% confidence interval (CI) = 3.4-4.2]; of these, 175 (57%) occurred in the first 14 days. After the introduction of prison-based OST (2003-07), 154 DRDs occurred in the 12 weeks after 70 317 qualifying releases, a significantly reduced rate of 2.2 per 1000 releases (95% CI = 1.8-2.5). However, there was no change in the proportion which occurred in the first 14 days, either for all DRDs (87: 56%) or for opioid-related DRDs.

Following the introduction of a prison-based opioid substitution therapy (OST) policy in Scotland, the rate of drug-related deaths in the 12 weeks following release fell by two-fifths. However, the proportion of deaths that occurred in the first 14 days did not change appreciably, suggesting that in-prison OST does not reduce early deaths after release.

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By: Bird SM1, Fischbacher CM2, Graham L2, Fraser A3.

• 1MRC Biostatistics Unit, Cambridge, UK.
• 2NHS National Services Scotland, Edinburgh, UK.
• 3NHS Health Scotland, Edinburgh, UK.

The Extramedical Use & Diversion of Opioid Substitution Medications & Other Medications in Prison Settings in Australia Following the Introduction of Buprenorphine-Naloxone Film

INTRODUCTION AND AIMS:

Around 65% of people incarcerated in prisons in Australia, America and Europe have a history of drug dependence, sometimes treated with opioid substitution treatment (OST) medications. Studies report that those in treatment in prison do engage in some level of diversion to others, whether on a voluntary or coerced basis. We aimed to examine the use of prescribed and non-prescribed OST medications by those in prisons, especially buprenorphine-naloxone film (BNX-F); the extent of non-adherence and diversion and reasons for such practices; and the impact of the introduction of BNX-F into the prison system.

DESIGN AND METHODS:

Mixed methods study drawing on: (i) structured interviews with current OST clients (n = 60) who reported being incarcerated in the 12 months prior to being interviewed and (ii) qualitative interviews with key experts working in corrections and prison (or justice) health settings.

RESULTS:

The majority were prescribed OST medications in prison, with 25% removing all or part of their supervised dose on at least one occasion, and 44% reporting use of non-prescribed medications. Some reported intravenous use (14% injected). One-third of OST recipients reported selling/sharing OST medications with others in prison. The introduction of BNX-F into the prison system saw different diversion methods used and removal from dosing within prison.

DISCUSSION AND CONCLUSIONS:

Despite prison being a highly regulated and controlled environment, some level of diversion and sharing of psychoactive medication occurs among prisoners. The buprenorphine formulations used in OST present particular challenges with respect to supervised dosing in this setting. [White N, Ali R, Larance B, Zador D, Mattick RP, Degenhardt L]. The extramedical use and diversion of opioid substitution medications and other medications in prison settings in Australia following the introduction of buprenorphine-naloxone film.

Via: http://ht.ly/RRnma

By: White N1, Ali R1, Larance B2, Zador D2, Mattick RP2, Degenhardt L2.

• 1Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, Australia.
• 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
  
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Fuelling the Epidemics: Challenges Facing HIV, Hepatitis C and Opioid Treatment Services Programmes for PWID in Eastern Ukraine

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Opioid Substitution Treatment and Hepatitis C: Opportunities for Prevention

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