ORCID Profile
0000-0003-2905-8153
Current Organisation
University of Adelaide
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Publisher: Informa UK Limited
Date: 28-09-2000
Publisher: Wiley
Date: 25-03-2003
DOI: 10.1046/J.1360-0443.2003.00293.X
Abstract: The aims of this study were to determine the prevalence of methadone syrup injecting in Adelaide, South Australia and to characterize methadone injectors, including their heroin use and risk behaviours associated with heroin overdose. Cross-sectional design. Community setting, principally metropolitan Adelaide. Current heroin users (used heroin in the last 6 months), recruited through snowballing. Structured questionnaire. Of 365 participants, 18.4% reported having ever injected methadone syrup and 11.0% had injected methadone in the last 6 months. Those that had injected methadone were more likely to be male, and were more likely to be receiving methadone maintenance. They were also maintained on higher doses of methadone than subjects not injecting methadone. A history of methadone injection was associated with more heroin overdose experiences and greater dependence on heroin. Methadone injectors were also more likely to engage in risky behaviours associated with heroin overdose, including using heroin when no other people were present, not trial-tasting new batches of heroin and polydrug use. Methadone syrup injectors appear to be at greater risk of a series of harms than subjects not injecting methadone. The prevalence of methadone syrup injecting in Adelaide, South Australia was 11%, which was lower than prevalence in Sydney, New South Wales, but higher than in Melbourne, Victoria. Jurisdictional differences concerning the prevalence of methadone syrup injecting may reflect differing policies by each state to methadone dispensing.
Publisher: Frontiers Media SA
Date: 19-11-2018
Publisher: Informa UK Limited
Date: 2001
Publisher: Wiley
Date: 30-08-2002
DOI: 10.1046/J.1360-0443.2002.00185.X
Abstract: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed for the World Health Organization (WHO) by an international group of substance abuse researchers to detect psychoactive substance use and related problems in primary care patients. This report describes the new instrument as well as a study of its reliability and feasibility. The study was conducted at participating sites in Australia, Brazil, Ireland, India, Israel, the Palestinian Territories, Puerto Rico, the United Kingdom and Zimbabwe. Sixty per cent of the s le was recruited from alcohol and drug abuse treatment facilities the remainder was drawn from general medical settings and psychiatric facilities. The study was concerned primarily with test item reliability, using a simple test-retest procedure to determine whether subjects would respond consistently to the same items when presented in an interview format on two different occasions. Qualitative and quantitative data were also collected to evaluate the feasibility of the screening items and rating format. A total of 236 volunteer participants completed test and retest interviews at nine collaborating sites. Slightly over half of the s le (53.6%) was male. The mean age of the s le was 34 years and they had completed, on average, 10 years of education. The average test-retest reliability coefficients (kappas) ranged from a high of 0.90 (consistency of reporting 'ever' use of substance) to a low of 0.58 (regretted what was done under influence of substance). The average kappas for substance classes ranged from 0.61 for sedatives to 0.78 for opioids. In general, the reliabilities were in the range of good to excellent, with the following items demonstrating the highest kappas across all drug classes: use in the last 3 months, preoccupied with drug use, concern expressed by others, troubled by problems related to drug use, intravenous drug use. Qualitative data collected at the end of the retest interview suggested that the questions were not difficult to answer and were consistent with patients' expectations for a health interview. The data were used to guide the selection of a smaller set of items that can serve as the basis for more extensive validation research. The ASSIST items are reliable and feasible to use as part of an international screening test. Further evaluation of the screening test should be conducted.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.JSAT.2015.06.001
Abstract: To describe the methods and baseline characteristics of a cohort of people who t er with pharmaceutical opioids, formed to examine changes in opioid use following introduction of Reformulated OxyContin®. Participants were 606 people from three Australian jurisdictions who reported past month injecting, snorting, chewing or smoking of a pharmaceutical opioid and had engaged in these practices at least monthly in the past 6 months. Baseline interviews were conducted prior to introduction of Reformulated OxyContin® in April 2014. Patterns of opioid use and cohort characteristics were examined according to whether participants were prescribed opioid medications, or exclusively used erted medication. The cohort reported high levels of moderate/severe depression (61%), moderate/severe anxiety (43%), post-traumatic stress disorder (42%), chronic pain or disability (past 6 months, 54%) and pain (past month, 47%). Lifetime use of oxycodone, morphine, opioid substitution medications and codeine were common. Three-quarters (77%) reported ICD-10 lifetime pharmaceutical opioid dependence and 40% current heroin dependence. Thirteen percent reported past year overdose, and 70% reported at least one past month opioid injection-related injury or disease. The cohort displayed complex clinical profiles, but participants currently receiving opioid substitution therapy who were also prescribed other opioids particularly reported a wide range of risk behaviors, despite their health service engagement. Findings highlight the heterogeneity in the patterns and clinical correlates of opioid use among people who t er with pharmaceutical opioids. Targeted health interventions are essential to reduce the associated harms.
Publisher: BMJ
Date: 23-09-2004
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.MIDW.2015.11.011
Abstract: to utilise qualitative data from investigation of the screening tool ASSIST Version 3.0 with pregnant women to help determine its appropriateness for this cohort, thus informing potential innovations to enhance the questionnaire׳s utility. pregnant women were co-administered the ASSIST Version 3.0 and three established substance use questionnaires (the T-ACE for alcohol, the Timeline FollowBack for cannabis and the Revised Fagerstrom Questionnaire for tobacco). antenatal clinics and the antenatal ward of the Women׳s and Children׳s Hospital, Adelaide, South Australia. 104 pregnant substance-users. as well as the quantitative date (reported elsewhere), rich qualitative data documenting participants' perspectives and experiences in antenatal care were thematically analysed. Women constantly reported friends and family urging them to stop use. Although care providers also advocated cessation or curtailment of use, this advice was reported as unpredictable, with only some providers strongly attuned to such recommendations. Some women voiced suggestions for the appropriate level of provider advice. While pregnancy was often reported as a motivator for changing substance-using behaviour, others reported continued attachment to use which was clearly linked to dependence. Those who reported successful control of use were in contrast to others who were more pragmatic, sceptical in relation to attributable harms, and disinterested in change. There were limited reports of experiences of discrimination directed to pregnant substance users. However, those instances were clearly linked with subsequent lack of honest discussions with care providers, resulting in an absence of appropriate support. current absence of universal screening for substance use has the potential for less than optimal consequences for both mother and baby. appropriate screening accompanied by honest, non-judgmental dialogue can guide the necessary interventions to achieve better outcomes. The recent development of the more concise and easier to administer ASSIST-LITE was partly informed by this investigation.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.DRUGPO.2011.11.005
Abstract: Driven by the rapid spread of HIV, Vietnam's response to drug use has undergone significant transformation in the past decade. This paper seeks to identify and analyse factors that prompted these changes and to investigate their impact on the lives of people who use drugs. This policy analysis is based on a review of Vietnamese Government documents, peer-reviewed publications and the authors' knowledge of and involvement in drug policy in Vietnam. The last decade has witnessed a progressive change in the mindset of political leaders in Vietnam around illicit drug use and HIV issues. This has led to adoption of evidence-based interventions and the evolution of drug policy that support the scale up of these interventions. However, HIV prevalence among drug users at 31.5% remains high due to limited access to effective interventions and impediments caused by the compulsory treatment centre system. The twin epidemics of HIV and illicit drug use have commanded high-level political attention in Vietnam. Significant policy changes have allowed the implementation of HIV prevention and drug dependence treatment services. Nevertheless, inconsistencies between policies and a continued commitment to compulsory treatment centres remain as major impediments to the provision of effective services to drug users. It is critical that Vietnamese government agencies recognise the social and health consequences of policy conflicts and acknowledge the relative ineffectiveness of centre-based compulsory treatment. In order to facilitate practical changes, the roles of the three ministries directly charged with HIV and illicit drug use need to be harmonised to ensure common goals. The participation of civil society in the policymaking process should also be encouraged. Finally, stronger links between local evidence, policy and practice would increase the impact on HIV prevention and drug addiction treatment programming.
Publisher: Springer Science and Business Media LLC
Date: 2000
DOI: 10.2307/3343342
Publisher: Wiley
Date: 29-03-2008
DOI: 10.1111/J.1360-0443.2007.02114.X
Abstract: The concurrent, construct and discriminative validity of the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were examined in a multi-site international study. One thousand and 47 participants, recruited from drug treatment (n = 350) and primary health care (PHC) settings (n = 697), were administered a battery of instruments. Measures included the ASSIST the Addiction Severity Index-Lite (ASI-Lite) the Severity of Dependence Scale (SDS) the MINI International Neuropsychiatric Interview (MINI-Plus) the Rating of Injection Site Condition (RISC) the Drug Abuse Screening Test (DAST) the Alcohol Use Disorders Identification Test (AUDIT) the Revised Fagerstrom Tolerance Questionnaire (RTQ) and the Maudsley Addiction Profile (MAP). Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-Lite (r = 0.76-0.88), SDS (r = 0.59), AUDIT (r = 0.82) and RTQ (r = 0.78) and significantly greater ASSIST scores for those with MINI-Plus diagnoses of abuse or dependence (P < 0.001). Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems (r = 0.48-0.76). Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. Receiver operating characteristic (ROC) analysis was used to establish cut-off scores with suitable specificities (50-96%) and sensitivities (54-97%) for most substances. The findings demonstrated that the ASSIST is a valid screening test for identifying psychoactive substance use in in iduals who use a number of substances and have varying degrees of substance use.
Publisher: Wiley
Date: 03-1996
DOI: 10.1080/09595239600185701
Abstract: This study evaluated changes in client population and in retention rates following the introduction of a system of methadone maintenance streaming. A low intervention and low supervision stream was combined with two abstinence-orientated streams. Privileges of take-home doses and local pharmacy dose collection were contingent on successful participation in the abstinence-orientated streams. The clinic also modified policy to allow clients greater control over dose levels. The case notes of the first 100 clients entering the programme in the year prior to the changes (1991) and in the year following the changes (1993) were compared. The results showed a significant increase in retention rates. The demographic and heroin using histories did not change, but the newer programme attracted a greater proportion of clients with no previous history of methadone maintenance treatment. Mean clinic dose increased from 45 mg to 63 mg when clients were allowed to exert control over dose. These findings reveal improved outcomes in a public methadone maintenance programme as a result of policy changes designed to give clients greater control of their treatment.
Publisher: BMJ
Date: 13-01-2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2013
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.DRUGALCDEP.2012.12.009
Abstract: Buprenorphine-naloxone sublingual film was introduced in 2011 in Australia as an alternative to tablets. This study compared the two formulations on subjective dose effects and equivalence, trough plasma levels, adverse events, patient satisfaction, supervised dosing time, and impact upon treatment outcomes (substance use, psychosocial function). 92 buprenorphine-naloxone tablet patients were recruited to this outpatient multi-site double-blind double-dummy parallel group trial. Patients were randomised to either tablets or film, without dose changes, over a 31 day period. No significant group differences were observed for subjective dose effects, trough plasma buprenorphine or norbuprenorphine levels, adverse events and treatment outcomes. Buprenorphine-naloxone film took significantly less time to dissolve than tablets (173±71 versus 242±141s, p=0.007, F=7.67). The study demonstrated dose equivalence and comparable clinical outcomes between the buprenorphine-naloxone film and tablet preparations, whilst showing improved dispensing times and patient ratings of satisfaction with the film.
Publisher: Wiley
Date: 28-09-2021
DOI: 10.1111/DAR.13176
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.PSYCHRES.2016.02.038
Abstract: This study examined correlates of transient versus persistent psychotic symptoms among people dependent on meth hetamine. A longitudinal prospective cohort study of dependent meth hetamine users who did not meet DSM-IV criteria for lifetime schizophrenia or mania. Four non-contiguous one-month observation periods were used to identify participants who had a) no psychotic symptoms, (n=110) (b) psychotic symptoms only when using meth hetamine (transient psychotic symptoms, n=85) and, (c) psychotic symptoms both when using meth hetamine and when abstaining from meth hetamine (persistent psychotic symptoms, n=37). Psychotic symptoms were defined as a score of 4 or greater on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations or unusual thought content. Relative no psychotic symptoms, both transient and persistent psychotic symptoms were associated with childhood conduct disorder and comorbid anxiety disorders. Earlier onset meth hetamine use and being male were more specifically related to transient psychotic symptoms, while a family history of a primary psychotic disorder and comorbid major depression were specifically related to persistent psychotic symptoms. We conclude that there are overlapping but also distinct clinical correlates of transient versus persistent psychotic symptoms, suggesting potentially heterogeneous etiological pathways underpinning the psychotic phenomena seen amongst people who use meth hetamine.
Publisher: Wiley
Date: 03-2006
DOI: 10.1080/09595230500537209
Abstract: This study assessed treatment retention, compliance and completion of a 9-month buprenorphine replacement programme. In addition, changes in drug use and other relevant variables, as well as predictors of completion, were examined. Seventy-five opioid-dependent out-patients (mean age 26 years 33% females) who aimed for opioid abstinence were enrolled into the study. Assessments were undertaken prior to buprenorphine induction and again at 3, 6 and 9 months. Forty patients (53%) completed the buprenorphine programme. At 9 months, 67 patients (87%) were still in counselling. Mean attendance rates for buprenorphine dosing and counselling sessions were 0.91 and 0.74, respectively. There were significant and persistent reductions in drug use during treatment with, however, a reversed tendency in the 9th month. Psychiatric problems escalated at 9 months, and three patients died during the detoxification phase. Completion was predicted by fewer previous treatment episodes. Detoxification from buprenorphine is associated with substantial psychological distress and an increased death risk. Buprenorphine replacement therapy should be continued until the patient chooses to leave, and close monitoring during the detoxification phase is essential.
Publisher: Wiley
Date: 28-11-2021
DOI: 10.5694/MJA2.51336
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.DRUGALCDEP.2011.04.002
Abstract: These studies compared the ersion and injection of buprenorphine-naloxone (BNX), buprenorphine (BPN) and methadone (MET) in Australia. Surveys were conducted with regular injecting drug users (IDUs) (2004-2009, N=881-943), opioid substitution treatment (OST) clients (2008, N=440) and authorised OST prescribers (2007, N=291). Key outcome measures include the unsanctioned removal of supervised doses, ersion, injection, motivations, drug liking and street price. Levels of injection among IDUs were adjusted for background availability of medications. Doses not taken as directed by OST clients were adjusted by total number of daily doses dispensed. Among regular IDUs, levels of injection were lower for BNX relative to BPN, but comparable to those for MET, adjusting for background availability. Among OST clients, fewer BNX clients (13%) reported recently injecting their medication, than BPN (28%) and MET clients (23%). Fewer MET clients (10%) reported removal of supervised doses, than BPN (35%) and BNX clients (22%). There were no differences in prevalence of recent ersion (28% of all OST clients). Adjusting for the total doses dispensed, more BPN was injected (10%), removed (12%) and erted (5%), than MET (5%, <1% and 2% respectively) and BNX (5%, 9% and <1% respectively). In 2009, the median street price of BNX was equivalent to that for BPN. BNX was less commonly and less frequently injected than BPN, but both sublingual medications were erted more than liquid MET.
Publisher: Springer Science and Business Media LLC
Date: 16-10-2015
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.DRUGPO.2017.07.029
Abstract: During the last decade, international aid agencies and advocates have been working with Southeast Asian governments to move away from punitive responses towards people who use drugs to more public health, humane approaches. The lack of local scientific evidence about the effectiveness of different treatment approaches has made this advocacy work more challenging. This paper reflects on a generation of treatment research evidence and how it can assist advocacy efforts. The case ex le is the cost-effectiveness research, comparing centre-based compulsory treatment with community-based voluntary methadone maintenance treatment in Vietnam (2012-2015). Using our long-term and on-going connections with key Vietnamese decision-makers and government agencies, our collective experiences in drug policy advocacy and our unique insight into the working of government in Vietnam, we have used strategies to maximise opportunities for research to inform policy discussions. We have made an assessment here about the extent to which study findings have contributed to policy change in Vietnam and the challenges that impede progressive policy implementation. In doing this, we hope to make a contribution to the research evidence use literature.
Publisher: John Wiley & Sons, Ltd
Date: 20-07-2005
Publisher: MDPI AG
Date: 05-03-2021
Abstract: Ticks rank high among arthropod vectors in terms of numbers of infectious agents that they transmit to humans, including Lyme disease, Rocky Mountain spotted fever, Colorado tick fever, human monocytic ehrlichiosis, tularemia, and human granulocytic anaplasmosis. Increasing temperature is suspected to affect tick biting rates and pathogen developmental rates, thereby potentially increasing risk for disease incidence. Tick distributions respond to climate change, but how their geographic ranges will shift in future decades and how those shifts may translate into changes in disease incidence remain unclear. In this study, we have assembled correlative ecological niche models for eight tick species of medical or veterinary importance in North America (Ixodes scapularis, I. pacificus, I. cookei, Dermacentor variabilis, D. andersoni, Amblyomma americanum, A. maculatum, and Rhipicephalus sanguineus), assessing the distributional potential of each under both present and future climatic conditions. Our goal was to assess whether and how species’ distributions will likely shift in coming decades in response to climate change. We interpret these patterns in terms of likely implications for tick-associated diseases in North America.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2001
DOI: 10.1016/S0304-3959(00)00391-2
Abstract: Opioid substitution treatment for dependence may alter sensitivity to pain. Previous studies on pain sensitivity in methadone maintenance patients have yielded contradictory results. This study compared nociceptive responses between 16 patients on stable, once daily, doses of methadone and 16 matched control subjects. Two types of nociceptive stimuli were used: (1) electrical stimulation and (2) a cold pressor test. Two parameters were measured: detection for onset of pain, and pain tolerance. Methadone patients were tested over an inter-dosing period: at the time of trough plasma methadone concentration (0 h), and 3 h after their daily dose. Control subjects were tested twice 3 h apart. Blood s les were collected to determine plasma methadone concentration. In methadone patients, trough to peak increases in mean R-(-)- and S-(+)-methadone concentrations (118 and 138 ng/ml to 185 and 259 ng/ml, respectively) resulted in significant increases in pain detection and tolerance values for both nociceptive stimuli. Using electrical stimulation, methadone patients' pain tolerance values were lower than controls at 0 h, but higher than controls at 3 h no significant differences in pain detection values were found. For the cold pressor test, methadone patients detected pain significantly earlier than controls at 0 h, and were also substantially less pain tolerant than controls at both 0 and 3 h. There were no significant differences in pain detection values between the two groups at 3 h. Pain tolerance to pain detection ratios for methadone patients were significantly lower than controls for the cold pressor test at 0 and 3 h, and for electrical stimulation at 0 h only. In summary, the relative pain sensitivity of methadone maintenance patients is determined by the nature of the nociceptive stimulus (e.g. cold pressor test versus electrical stimulation), the plasma methadone concentration (trough versus peak plasma concentration), and whether thresholds are determined for detection of pain or pain tolerance. Although responding to changes in plasma methadone concentration, maintenance patients are markedly hyperalgesic to pain induced by the cold pressor test.
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1016/J.JSAT.2005.01.006
Abstract: To determine the role of treatment and client characteristics associated with the achievement of continuous heroin abstinence. Longitudinal cohort study. Sydney and Adelaide, Australia. 570 heroin users re-interviewed at 12 month follow-up for the Australian Treatment Outcome Study (ATOS). Continuous heroin abstinence was reported by 14% of participants. Continuous abstinence was associated with no previous treatment history, having entered treatment at baseline, and cumulative treatment exposure over the follow-up period. Longer retention times in index maintenance and residential rehabilitation treatments, but not detoxifications, were most associated with abstinence. At baseline, abstinent participants were more likely to have been classified as treatment ready, or to have used heroin less frequently and less likely to have been daily injectors, using cocaine or criminally involved. Approximately 14% of ATOS participants achieved continuous heroin abstinence over 12 months. Such an achievement was strongly associated with a longer "dose" of treatment, and with more treatment stability over the follow-up period.
Publisher: Wiley
Date: 09-1999
DOI: 10.1046/J.1360-0443.1999.94912792.X
Abstract: To examine a range of biological indicators of illicit drug use, including blood, urine, hair and saliva, addressing both technological and practical issues relating to their application and interpretation. The review process involved an examination of key reference texts and literature from the scientific fields of analytical and clinical toxicology. Urine remains the biological tool of choice for qualitative detection of illicit drug use in a clinical setting, while quantitative accuracy remains strictly the domain of blood. The growing sophistication of laboratory analysis may additionally make possible the routine use of hair s ling which can provide a much longer time frame for assessment. Breath, saliva, sweat or breast milk remain possibilities in the future. Accurate interpretation of the screening tests within a clinical setting alongside other relevant information remains the key to the usefulness of any test.
Publisher: Wiley
Date: 11-05-2015
DOI: 10.1111/ADD.12899
Abstract: Addictive behaviours are among the greatest scourges on humankind. It is important to estimate the extent of the problem globally and in different geographical regions. Such estimates are available, but there is a need to collate and evaluate these to arrive at the best available synthetic figures. Addiction has commissioned this paper as the first of a series attempting to do this. Online sources of global, regional and national information on prevalence and major harms relating to alcohol use, tobacco use, unsanctioned psychoactive drug use and gambling were identified through expert review and assessed. The primary data sources located were the websites of the World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Alberta Gambling Research Institute. Summary statistics were compared with recent publications on the global epidemiology of addictive behaviours. An estimated 4.9% of the world's adult population (240 million people) suffer from alcohol use disorder (7.8% of men and 1.5% of women), with alcohol causing an estimated 257 disability-adjusted life years lost per 100 000 population. An estimated 22.5% of adults in the world (1 billion people) smoke tobacco products (32.0% of men and 7.0% of women). It is estimated that 11% of deaths in males and 6% of deaths in females each year are due to tobacco. Of 'unsanctioned psychoactive drugs', cannabis is the most prevalent at 3.5% globally, with each of the others at < 1% 0.3% of the world's adult population (15 million people) inject drugs. Use of unsanctioned psychoactive drugs accounts for an estimated 83 disability-adjusted life years lost per 100 000 population. Global estimates of problem gambling are not possible, but in countries where it has been assessed the prevalence is estimated at 1.5%. Tobacco and alcohol use are by far the most prevalent addictive behaviours and cause the large majority of the harm. However, the quality of data on prevalence and addiction-related harms is mostly low, and comparisons between countries and regions must be viewed with caution. There is an urgent need to review the quality of data on which global estimates are made and coordinate efforts to arrive at a more consistent approach.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.DRUGALCDEP.2016.09.008
Abstract: In Vietnam, two dominant approaches for heroin treatment are center-based compulsory rehabilitation (CCT), funded by the Vietnamese government and community-based voluntary methadone maintenance treatment (MMT), funded primarily by international donors. Recent reduction in international funding requires more efficient allocation of government funding for public health programs. A cost-effectiveness analysis comparing two approaches provides a useful source of evidence to inform the government about funding reallocation. The study was a combined retrospective and prospective, non-randomized cohort comparison over three years of CCT and MMT in Vietnam, conducted between 2012 and 2014, involving 208 CCT participants and 384 MMT participants with heroin dependence. The primary end-point was drug-free days over three years. Total costs, including both program and participant personal costs were measured and cost-effectiveness compared. Mixed effects regression analyses were used to analyze effectiveness data and non-parametric bootstrapping method was used to compare cost-effectiveness. Over three years, MMT costed on average VND85.73 million (US$4108) less than CCT (95% CI: -VND76.88 million, -VND94.59 million). On average, a MMT participant had 344.20 more drug-free days compared to a CCT participant (p<0.001). The incremental cost-effectiveness ratio for MMT was -VND0.25 million (US$11.99) (95% CI: -VND0.34 million, -VND0.19 million) per drug-free day suggesting MMT is the more cost effective alternative. Compared to CCT, MMT is both less expensive and more effective in achieving drug-free days. If the government of Vietnam invests in MMT instead of CCT, it is potentially a cost-saving strategy for reducing illicit drug use among heroin dependent in iduals.
Publisher: Wiley
Date: 05-2008
DOI: 10.1080/09595230801923710
Abstract: Southeast and East Asia has become a global hub for meth hetamine production and trafficking over the past decade. This paper describes the rise of meth hetamine supply and to what extent use of the drug is occurring in the region. The current review uses data collected through the Drug Abuse Information Network for Asia and the Pacific (DAINAP) and other available sources to analyse retrospectively meth hetamine trends within Southeast and East Asia. Southeast and East Asia has experienced a meth hetamine epidemic in the past decade which began around 1997 and peaked in 2000-2001. While the situation has since stabilised in many countries, meth hetamine trafficking and use are still increasing in parts of the Mekong region and there is evidence of large-scale manufacture in Cambodia, Indonesia, Malaysia and the Philippines. Meth hetamine is typically smoked or ingested, but injection of the drug is apparent. While the peak of the meth hetamine epidemic has passed in parts of Southeast and East Asia, attention is needed to minimise the potential consequences of spreading meth hetamine production, trafficking and use in the Mekong region and in the peninsular and archipelago of Southeast Asia.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.PNPBP.2011.01.014
Abstract: The concept of negative symptoms in meth hetamine (MA) psychosis (e.g., poverty of speech, flatten affect, and loss of drive) is still uncertain. This study aimed to use differential item functioning (DIF) statistical techniques to differentiate the severity of psychotic symptoms between MA psychotic and schizophrenic patients. Data of MA psychotic and schizophrenic patients were those of the participants in the WHO Multi-Site Project on Meth hetamine-Induced Psychosis (or WHO-MAIP study) and the Risperidone Long-Acting Injection in Thai Schizophrenic Patients (or RLAI-Thai study), respectively. To confirm the unidimensionality of psychotic syndromes, we applied the exploratory and confirmatory factor analyses (EFA and CFA) on the eight items of Manchester scale. We conducted the DIF analysis of psychotic symptoms observed in both groups by using nonparametric kernel-smoothing techniques of item response theory. A DIF composite index of 0.30 or greater indicated the difference of symptom severity. The analyses included the data of 168 MA psychotic participants and the baseline data of 169 schizophrenic patients. For both data sets, the EFA and CFA suggested a three-factor model of the psychotic symptoms, including negative syndrome (poverty of speech, psychomotor retardation and flatten/incongruous affect), positive syndrome (delusions, hallucinations and incoherent speech) and anxiety/depression syndrome (anxiety and depression). The DIF composite indexes comparing the severity differences of all eight psychotic symptoms were lower than 0.3. The results suggest that, at the same level of syndrome severity (i.e., negative, positive, and anxiety/depression syndromes), the severity of psychotic symptoms, including the negative ones, observed in MA psychotic and schizophrenic patients are almost the same.
Publisher: Wiley
Date: 25-03-2003
DOI: 10.1046/J.1360-0443.2003.00335.X
Abstract: To assess the efficacy of buprenorphine compared with methadone maintenance therapy for opioid dependence in a large s le using a flexible dosing regime and the marketed buprenorphine tablet. Patients were randomized to receive buprenorphine or methadone over a 13-week treatment period in a double-blind, double-dummy trial. Three methadone clinics in Australia. Four hundred and five opioid-dependent patients seeking treatment. Patients received buprenorphine or methadone as indicated clinically using a flexible dosage regime. During weeks 1-6, patients were dosed daily. From weeks 7-13, buprenorphine patients received double their week 6 dose on alternate days. Retention in treatment, and illicit opioid use as determined by urinalysis. Self-reported drug use, psychological functioning, HIV-risk behaviour, general health and subjective ratings were secondary outcomes. Intention-to-treat analyses revealed no significant difference in completion rates at 13 weeks. Methadone was superior to buprenorphine in time to termination over the 13-week period (Wald chi 2 = 4.371, df = 1, P = 0.037), but not separately for the single-day or alternate-day dosing phases. There were no significant between-group differences in morphine-positive urines, or in self-reported heroin or other illicit drug use. The majority (85%) of the buprenorphine patients transferred to alternate-day dosing were maintained in alternate-day dosing. Buprenorphine did not differ from methadone in its ability to suppress heroin use, but retained approximately 10% fewer patients. This poorer retention was due possibly to too-slow induction onto buprenorphine. For the majority of patients, buprenorphine can be administered on alternate days.
Publisher: Wiley
Date: 06-2004
Publisher: Wiley
Date: 06-2004
Publisher: Wiley
Date: 03-1999
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.DRUGALCDEP.2013.12.005
Abstract: We compared the ersion and injection of a new formulation of buprenorphine, a buprenorphine-naloxone film product (BNX film), with buprenorphine-naloxone tablets (BNX tablets), mono-buprenorphine (BPN) and methadone (MET) in Australia. Surveys were conducted with people who inject drugs regularly (PWID) (2004-2012) and opioid substitution treatment (OST) clients (2012, N=543). Key outcome measures: the unsanctioned removal of supervised doses, ersion, injection, motivations, drug liking and street price. Levels of injection among PWID were adjusted for background availability of medication using sales data. Doses not taken as directed by OST clients were adjusted by total number of daily doses dispensed. Among out-of-treatment PWID, levels of injection for BNX film were comparable to those for MET and BNX tablet formulations, adjusting for background availability BPN injecting levels were higher. Among OST clients, recent injecting of one's medication was similar among clients in all OST types weekly or more frequent injection of prescribed doses was reported by fewer BNX film clients (3% 95% CI: 1-6) than BPN clients (11% 95% CI: 3-17), but at levels similar to those observed among MET and BNX tablet clients. The proportion of BNX film doses injected was lower than that for BPN and BNX tablets, and equivalent to that for MET. The majority of BNX film doses injected by OST clients were unsupervised doses, although some injection of supervised doses of BNX film did occur. The median price of all buprenorphine forms on the illicit market was the same. Non-adherence and ersion of the BNX film formulation was similar to MET and BNX tablet formulations BPN had higher levels of all indicators of non-adherence and ersion.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2010
Publisher: Elsevier BV
Date: 05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-1970
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.DRUGALCDEP.2013.03.001
Abstract: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST 3.0 index test) is a structured interview for alcohol, tobacco, cannabis, stimulants, sedatives and opioid use disorders in general medical settings. Perceived administration time deters routine use. This study releases a short-form: the ASSIST-Lite. Diagnostic accuracy study among 2082 adults recruited from general medical (70%) and specialist mental health/addiction treatment services (22%). Current DSM-IV substance dependence (MINI International Neuropsychiatric Interview) and moderate-severe tobacco dependence (Fagerstrom Nicotine Dependence Test) were reference standards. Exploratory factor and item-response theory models re-calibrated ordinal test items. Items for the ASSIST-Lite were selected by diagnostic accuracy evaluation (area under the receiver-operating characteristic [AUC] curve [≤0.7]), sensitivity, specificity, positive and negative predictive values [PVP, NVP], kappa, likelihood ratios [LR+, LR-], and clinical utility index [CU+, CU-]). For each substance an item pair was selected (AUC [0.8-1.0], sensitivity [0.8-1.0], specificity [0.7-0.8], PVP [0.8-1.0], NVP [0.7-1.0], kappa [0.5-0.9], LR+ [2.5-5.9], LR- [0.0-0.2], CU+ [0.7-0.9], and CU- [0.5-0.8]). Gender, age and recruitment setting (specialist mental health versus general medical) did not moderate accuracy, with the exception of opioids (AUC <0.7, participants ≥59 years). Male opioid users had more severe substance involvement scores that females (differential item functioning analysis, P=0.00). There was no evidence of differential accuracy between countries (AUC range, 0.8-1.0). The ASSIST-Lite is an ultra-rapid screener which has been optimised for general medical settings. Optionally, a criterion question can be added to capture hazardous drinking, and to capture use of another type of mood-altering substance.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JSAT.2018.01.011
Abstract: In Vietnam, like many countries in East and Southeast Asia, the government has invested heavily in center-based compulsory treatment (CCT) as the mainstay demand reduction strategy for illicit drug use. This approach has been criticised on human rights grounds. Meanwhile, community-based voluntary methadone maintenance treatment (MMT) has been implemented for nearly a decade with promising results. To date, there have been no comparative Vietnamese studies of these approaches. The study, involving 208 CCT participants and 384 MMT participants with heroin dependence, was a combined retrospective and prospective observational study conducted over three years between 2012 and 2014 (with data at five time-points). The primary outcome was: self-report heroin use (confirmed by urinalysis). The four secondary outcomes were: illegal behaviours, overdose, blood-borne virus (BBV) risk behaviours, and monthly drug expenditure. Mixed effects regression analyses, which took into account baseline differences between the groups, were used to analyse the data. This study is registered with ClinicalTrials.gov, number NCT03071315. The study found MMT was more strongly associated with four outcome measures compared to CCT (reduction in heroin use (β = 3.39, SE = 0.31, p < .0001) (equivalent to an odds ratio of 29.67 (95% CI 21.76-40.45)), reduction in illegal behaviours (β = 0.94, SE = 0.39, p < .0001), (equivalent to an odds ratio of 2.56 (95% CI 1.79-3.78)), reduction in BBV risk behaviours (β = 1.08, SE = 0.17, p < .0001), (equivalent to an odds ratio of 2.94 (95% CI 2.48-3.49)), and reduction in monthly drug spending (β = -VND1,515,200 (equivalent to US$72.00), SE = VND452,900, p < .0001)). The analyses did not support the hypothesis that MMT was associated with better outcomes pertaining to overdose (β = -0.27, SE = 0.30, p = .62), probably due to the infrequency of these self-reported events. Our observational study suggests that MMT is associated with greater reductions in heroin use, BBV risk behaviours, drug-related illegal behaviours, and monthly drug spending compared with CCT. In the context that the CCT approach has been criticized for human rights violations, this study provides evidence to support the scale up of MMT and the transition of CCT to voluntary community based treatment.
Publisher: Springer Science and Business Media LLC
Date: 11-01-2017
Publisher: Wiley
Date: 25-06-2002
Publisher: Wiley
Date: 07-08-2008
DOI: 10.1111/J.1360-0443.2008.02249.X
Abstract: Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries. Longitudinal cohort study. Purposively selected OST sites in Asia (China, Indonesia, Thailand), Eastern Europe (Lithuania, Poland, Ukraine), the Middle East (Iran) and Australia. Seven hundred and twenty-six OST entrants. Participants were interviewed at treatment entry, 3 and 6 months. Standardized instruments assessed drug use, treatment history, physical and psychological health, quality of life, criminal involvement, blood-borne virus (BBV) risk behaviours and prevalence of human immunodeficiency virus (HIV) and hepatitis C. Participants were predominantly male, aged in their early 30s and had attained similar levels of education. Seroprevalence rates for HIV were highest in Thailand (52%), followed by Indonesia (28%) and Iran (26%), and lowest in Australia (2.6%). Treatment retention at 6 months was uniformly high, averaging approximately 70%. All countries demonstrated significant and marked reductions in reported heroin and other illicit opioid use HIV (and other BBV) exposure risk behaviours associated with injection drug users (IDU) and criminal activity, and demonstrated substantial improvement in their physical and mental health and general wellbeing over the course of the study. OST can achieve similar outcomes consistently in a culturally erse range of settings in low- and middle-income countries to those reported widely in high-income countries. It is associated with a substantial reduction in HIV exposure risk associated with IDU across nearly all the countries. Results support the expansion of opioid substitution treatment.
Publisher: Wiley
Date: 28-02-2012
DOI: 10.1111/J.1360-0443.2011.03740.X
Abstract: This study evaluated the effectiveness of a brief intervention (BI) for illicit drugs (cannabis, cocaine, hetamine-type stimulants and opioids) linked to the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST screens for problem or risky use of 10 psychoactive substances, producing a score for each substance that falls into either a low-, moderate- or high-risk category. Prospective, randomized controlled trial in which participants were either assigned to a 3-month waiting-list control condition or received brief motivational counselling lasting an average of 13.8 minutes for the drug receiving the highest ASSIST score. Primary health-care settings in four countries: Australia, Brazil, India and the United States. A total of 731 males and females scoring within the moderate-risk range of the ASSIST for cannabis, cocaine, hetamine-type stimulants or opioids. ASSIST-specific substance involvement scores for cannabis, stimulants or opioids and ASSIST total illicit substance involvement score at baseline and 3 months post-randomization. Omnibus analyses indicated that those receiving the BI had significantly reduced scores for all measures, compared with control participants. Country-specific analyses showed that, with the exception of the site in the United States, BI participants had significantly lower ASSIST total illicit substance involvement scores at follow-up compared with the control participants. The sites in India and Brazil demonstrated a very strong brief intervention effect for cannabis scores (P < 0.005 for both sites), as did the sites in Australia (P < 0.005) and Brazil (P < 0.01) for stimulant scores and the Indian site for opioid scores (P < 0.01). The Alcohol, Smoking and Substance Involvement Screening Test-linked brief intervention aimed at reducing illicit substance use and related risks is effective, at least in the short term, and the effect generalizes across countries.
Publisher: Elsevier BV
Date: 1994
DOI: 10.1016/0376-8716(94)90131-7
Abstract: The injecting behaviour and risky needle use of a s le of 193 methadone maintenance clients was investigated. The majority of the s le (n = 116) reported injecting one or more drugs in the month prior to data collection. Compared with non-injectors, the injectors were slightly younger, had been on the methadone program for a shorter period of time, had lower methadone doses and more severe drug and legal problems. The injecting sub-group was examined in more detail by comparing those subjects whose injecting practices conformed to guidelines on minimizing risk of HIV transmission with those who, in the preceding month, made at least one injection contravening these guidelines and thus placed themselves at risk of contracting HIV. A greater proportion of these risky injectors were unemployed. Importantly, risky injectors had lesser knowledge of means of preventing the spread of HIV than safe injectors. It is concluded that the reduction of HIV transmission could be enhanced by improvements in methadone programs, particularly ensuring adequate dosing and high retention rates. Further, there is a need to improve knowledge with regard to what are safe and what are risky injecting practices and needle/syringe cleaning methods.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.DRUGPO.2021.103492
Abstract: Opioid agonist treatment (OAT) is an effective intervention for opioid dependence. Extended-release buprenorphine injections (BUP-XR) may have additional potential benefits over sublingual buprenorphine. This single-arm trial evaluated outcomes among people receiving 48 weeks of BUP-XR in erse community healthcare settings in Australia, permitting examination of outcomes when BUP-XR is delivered in standard practice. Participants were recruited from a network of specialist public drug treatment services, primary care and some private practices in three states. Following a minimum 7 days on 8-32 mg of sublingual buprenorphine (±naloxone), participants received monthly subcutaneous BUP-XR injections administered by a healthcare practitioner and completed monthly research interviews. The primary endpoint was retention in treatment at 48 weeks. Participants (n = 100) were 28% women, mean age 44 years with a long history of OAT (median 5.8 years) heroin was the most common opioid of concern (58%). Treatment retention at 24 and 48 weeks was 86% and 75%, respectively. Participants with past-month injecting drug use (OR 0.23 95%CI: 0.09-0.61) or heroin use (OR 0.23 95%CI: 0.08-0.65) at baseline had lower odds of being retained in treatment to 48 weeks. Reductions in multiple forms of extra-medical drug use were observed. Improvements in quality of life, participation in employment, and treatment satisfaction measures were also observed. This real-world implementation study of BUP-XR demonstrated high retention and treatment satisfaction. This study provides important additional data on the uptake and experience of clients, with relevance for policy makers, health service planners, administrators, and practitioners. In ior. ClinicalTrials.gov Identifier: NCT03809143.
Publisher: Elsevier BV
Date: 03-2004
Publisher: Wiley
Date: 12-02-1990
Publisher: Wiley
Date: 09-10-2015
DOI: 10.1111/DAR.12344
Abstract: We report 2 years of post-marketing surveillance of the ersion and injection of buprenorphine-naloxone (BNX) film following its introduction in 2011. Interviews were conducted with people who inject drugs regularly (PWID) (2004-2013), opioid substitution therapy clients (2013, n = 492) and key experts (n = 44). Key outcomes were unsanctioned removal of supervised doses, ersion, injection and street price. Prevalence of past 6-month injection among PWID was adjusted for background availability of opioid substitution therapy medications using sales data. Among out-of-treatment PWID, the levels of regular (weekly+) BNX film injection were comparable to methadone and BNX tablets, and lower than mono-buprenorphine, adjusting for background availability. Fewer BNX film clients [3% 95% (CI) 1-5] regularly injected their medication than mono-buprenorphine clients (25% 95% CI 11-39), but at levels equivalent to those among methadone (3% 95% CI 1-6) and BNX tablet clients (2% 95% CI 0-6). Key experts perceived BNX film needed less supervised dosing time as it dissolved rapidly and was harder to remove from the mouth than sublingual tablets however, removal of supervised doses was higher among BNX film clients (15% 95% CI: 10-20) than methadone clients (3% 95% CI 1-6), and not significantly different from BNX tablet (11% 95% CI 2-21) and mono-buprenorphine clients (31% 95% CI 16-46). Two years post-introduction, levels of BNX film ersion and injection remained comparable with those for methadone and BNX tablets, and lower than mono-buprenorphine. We found no evidence that BNX film has lower non-adherence and ersion than the tablet formulation. [Larance B, Mattick R, Ali R, Lintzeris N, Jenkinson R, White N, Kihas I, Cassidy R, Degenhardt L. Diversion and injection of buprenorphine-naloxone film two years post-introduction in Australia. Drug Alcohol Rev 2015].
Publisher: BMJ
Date: 07-2020
DOI: 10.1136/BMJOPEN-2019-034389
Abstract: Opioid agonist treatment is effective for opioid dependence and newer extended-release buprenorphine (BUP-XR) injections represent a significant development. The Community Long-Acting Buprenorphine (CoLAB) study aims to evaluate client outcomes among people with opioid dependence receiving 48 weeks of BUP-XR treatment, and examines the implementation of BUP-XR in erse community healthcare settings in Australia. The CoLAB study is a prospective single-arm, multicentre, open-label trial of monthly BUP-XR injections in people with opioid dependence. Participants are being recruited from a network of general practitioner and specialist drug treatment services located in the states of New South Wales, Victoria and South Australia in Australia. Following a minimum 7 days on 8–32 mg of sublingual buprenorphine (±naloxone), participants will receive monthly subcutaneous BUP-XR injections administered by a healthcare practitioner at intervals of 28 days (−2/+14 days). The primary endpoint is participant retention in treatment at 48 weeks after treatment initiation. Secondary endpoints will evaluate dosing schedule variations, craving, withdrawal, substance use, health and well-being, and client-reported treatment experience. Qualitative and costing substudies will examine implementation barriers and facilitators at the client and provider level. The study has received ethics approval from the St Vincent’s Hospital Sydney Human Research Ethics Committee (Ref. HREC/18/SVH/221). The findings will be disseminated via publication in peer-reviewed journals, presentations at national and international scientific conferences, and in relevant community organisation publications and forums. NCT03809143 CoLAB1801, V.4.0 dated 01 August 2019
Publisher: SAGE Publications
Date: 2000
DOI: 10.1080/000486700529
Publisher: Elsevier BV
Date: 09-2016
Publisher: Wiley
Date: 09-2005
DOI: 10.1080/09595230500286039
Abstract: The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the s le (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.JSAT.2011.07.009
Abstract: This article presents the results of a 6-month prospective cohort study of methadone maintenance treatment (MMT) in Indonesia. The study aimed to investigate the predictor variables of retention in MMT in Indonesia. The duration of treatment (in days) was the main outcome of the study. For the study, program, client, social network, and accessibility factors were investigated as potential predictors of retention. The study analyzed the relative weight of each factor in predicting treatment retention. The s le consisted of 178 clients drawn from three participating clinics: Rumah Sakit Ketergantungan Obat and Tanjung Priok in Jakarta and Sanglah in Bali. The 3- and 6-month retention rates were 74.2% and 61.3%, respectively. These rates are comparable with previous studies conducted in developed countries. A survival analysis using a robust estimation for the Cox PH regression found that the strongest predictors of retention were methadone dose followed by an interaction between take-home dose and the experience of the clinic providing this treatment. Other significant predictor variables included age, perceived clinic accessibility, and client's belief in the program. The study concludes that MMT cannot solely rely on the pharmacology for retention but should also promote informed access to take-home doses.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.DRUGALCDEP.2014.03.018
Abstract: Convergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies. Multicentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile n=703) and Global Assessment of Functioning (GAF DSM-IV Axis V n=695). Following item-level screening (inter-rater reliability [IRR] n=388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively. 2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055-0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by s le, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile 46.9%) Class 2 (low severity, low complexity, high strengths 25.4%) and Class 3 (high severity, high complexity, low strengths 27.7%). Class 2 had higher GAF (z=4.30). Class 3 predicted follow-up drug use (z=2.02) and lower GAF (z=3.51). The ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed.
Publisher: Wiley
Date: 04-1994
DOI: 10.1080/09595239400185271
Abstract: In accordance with public health principles, this paper is concerned with examining the in idual, economic and political outcomes of in-patient treatment for alcohol dependence. It is argued that in-patient treatment for alcohol dependence per se is not justifiable at any of these levels, although in-patient treatment is justifiable for the treatment of the serious biomedical sequelae of dependence. For the alcohol-dependent person, the drinking, social, financial, psychological, work-related and health outcomes of out-patient treatment are as good as those for in-patient treatment economically, out-patient programmes are more cost-effective than in-patient programmes politically, moving the focus of treatment away from in-patient services is more likely to contribute to a cultural milieu which recognizes problems associated with alcohol dependence early and in their many different forms, rather than only by their long-term health consequences.
Publisher: Elsevier BV
Date: 05-2002
DOI: 10.1016/S0376-8716(02)00007-8
Abstract: Studies of relative LAAM-methadone preference have indicated that a significant proportion of patients prefer levo-alpha-acetylmethadol (LAAM). The present study was designed to determine whether this preference is associated with better treatment outcomes. Sixty-two stable methadone patients participated in a randomised crossover clinical trial. They received LAAM (alternate days) and methadone (daily) for 3 months each, followed by a further 6-month period during which they were free to choose between the drugs. LAAM maintenance was associated with a lower rate of heroin use than methadone maintenance based on analysis of morphine concentration in hair and equivalent health outcomes. The majority of subjects showed a preference for LAAM (n=27, 69.2%) rather than methadone (n=12, 30.8%). The main reasons given for the LAAM preference were that it produced less withdrawal (39.3%), fewer side effects (28.5%), less craving for heroin (17.9%), and entailed fewer pick-up days (14.3%). Those who chose LAAM had lower levels of heroin use during LAAM maintenance, significantly better outcomes on two sub-scales of the SF-36 (Vitality and Mental Health), and reported that they felt more normal and that they were 'held' better when on LAAM. For those who chose methadone, there were no differences in outcomes between the LAAM and methadone maintenance periods. Preference for LAAM is associated with treatment outcomes as good or better than those with methadone.
Publisher: Elsevier BV
Date: 11-2019
Publisher: Elsevier BV
Date: 10-09-2003
DOI: 10.1016/S0376-8716(03)00169-8
Abstract: This article presents the cost-effectiveness results of a randomised controlled trial conducted in two Australian cities. The trial was designed to assess the safety, efficacy and cost-effectiveness of buprenorphine versus methadone in the management of opioid dependence. The trial utilised a flexible dosing regime that was tailored to the clinical need of the patients, with high maximum doses, using the marketed formulation, under double-blind conditions. A total of 405 subjects were randomised to a treatment at one of three specialist outpatient drug treatment centres in Adelaide and Sydney, Australia. The perspective of the cost-effectiveness analysis was that of the service provider and included costs relevant to the provision of treatment. The primary outcome measure used in the economic analysis was change in heroin-free days from baseline to the sixth month of treatment. Treatment with methadone was found to be both less expensive and more effective than treatment with buprenorphine, which suggests methadone dominates buprenorphine. However, statistical testing found that the observed difference between the cost-effectiveness of methadone and buprenorphine treatments was not statistically significant. The results of this study provide useful policy information on the costs and outcomes associated with the use of methadone and buprenorphine and indicate that buprenorphine provides a viable alternative to methadone in the treatment of opioid dependence.
Publisher: SAGE Publications
Date: 07-2002
Publisher: Elsevier BV
Date: 12-1998
DOI: 10.1111/J.1467-842X.1998.TB01491.X
Abstract: To investigate correlates of retention on the South Australian Methadone Program during 1981-91. Retrospective study of a nonstratified random s le of 229 HIV-negative clients who received methadone between January 1981 and June 1991. Data were collected from clinical records of the 229 HIV-negative clients and also from the 40 clients known to be infected with HIV during the decade. Being HIV positive, receiving larger maximum doses of methadone, receiving methadone from a private pharmacy and enrolling later in the decade were all associated with longer retention times on the program. This study supports the findings of previous studies, that maximum dose of methadone is crucial to retention in methadone programs, But even allowing for maximum dose, obtaining methadone from a private pharmacy was also strongly associated with retention on the program. The more 'humane' clinic policy later in the decade is likely to have increased retention and reduced illicit drug use also.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.DRUGALCDEP.2014.05.018
Abstract: To develop a stability typology among opioid substitution therapy patients using a range of adherence indicators derived from clinical guidelines, and determine whether stable patients receive more unsupervised doses. An interviewer-administered cross-sectional survey was used in opioid substitution therapy programmes in three Australian jurisdictions, totalling 768 patients in their current treatment episode for ≥4 weeks. A structured questionnaire collated data from patients about their demographics, treatment characteristics, past 6-month drug use and medication adherence, psychosocial stability, comorbidity, child welfare concerns and levels of supervised dosing. Latent class analysis (LCA) was used to derive a stability typology. Linear regression models examined predictors of unsupervised dosing in the past month. LCA identified two classes: (i) a higher-adherence group (67%) who had low-moderate probabilities of endorsing the opioid substitution therapy stability indicators and (ii) a lower-adherence group (33%) who had moderate-high probabilities of endorsing the stability indicators. There was no association between adherence profile and the number of unsupervised doses. Significant predictors of receiving larger numbers of unsupervised doses included being older, living in New South Wales or South Australia (vs. Victoria), receiving methadone (vs. mono-buprenorphine), being prescribed in private clinic or general practice (vs. public clinic), reporting a longer current treatment episode, not receiving a urine drug screen in the past month, being currently employed and not having a prison history. This study suggested that system-level factors and observable indicators of social functioning were more strongly associated with the receipt of less supervised treatment. Future research should examine this issue using prospectively collected data.
Publisher: Wiley
Date: 03-09-2004
Publisher: Wiley
Date: 28-10-2008
Publisher: Wiley
Date: 30-10-2015
DOI: 10.1111/ADD.12746
Abstract: A new oxycodone formulation (Reformulated OxyContin® was released in Australia, early 2014. It was developed as a t er-resistant ('abuse-deterrent') formulation of the drug. We summarize methods used in the National Opioid Medication Abuse Deterrence (NOMAD) study, which will examine: (i) whether there is a reduction in extra-medical use (including via t ering) of OxyContin® following the introduction of Reformulated OxyContin® (ii) potential changes in extra-medical use of non-abuse-deterrent forms of oxycodone, other pharmaceutical opioids and illicit drugs (iii) whether methods of t ering with Reformulated OxyContin® become widespread over time (iv) Reformulated OxyContin®'s attractiveness on the illicit market and (v) sales, prescriptions and harms related to OxyContin® and other drugs. There are three major components. First, analyses of existing routine data sources such as: pharmaceutical sales prescribing data data on drug overdose deaths and survey data on drug use in the general population and among people who inject drugs secondly, specific data on OxyContin® collected through the Illicit Drug Reporting System and thirdly, a prospective cohort of n = 606 people who regularly misuse or t er with pharmaceutical opioids was formed prior to the introduction of Reformulated OxyContin®, followed-up twice post-release to examine potential changes after Reformulated OxyContin®'s introduction. The study's strengths lie in varied data collections interrupted time-series analysis and prospective cohort. To our knowledge, this is one of the most comprehensive and transparently conducted studies conducted to date of the potential impact of an opioid medication upon use, t ering and ersion. Results have the potential to inform policymakers, clinicians, consumers and researchers alike.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Wiley
Date: 05-2005
DOI: 10.1080/09595230500170266
Abstract: The concurrent, construct, discriminative and predictive validity of the World Health Organization's Alcohol Substance Involvement Screening Test (ASSIST) were examined in an Australian s le. One hundred and fifty participants, recruited from drug treatment (n = 50) and primary health care (PHC) settings (n = 100), were administered a battery of instruments at baseline and a modified battery at 3 months. Measures included the ASSIST the Addiction Severity Index-Lite (ASI-Lite) the Severity of Dependence Scale (SDS) the MINI International Neuropsychiatric Interview (MINI-Plus) the Rating of Injection Site Condition (RISC) the Drug Abuse Screening Test (DAST) the Alcohol Use Disorders Identification Test (AUDIT) the Revised Fagerstrom Tolerance Questionnaire (RTQ) and the Maudsely Addiction Profile (MAP). Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-lite, SDS, AUDIT and DAST and significantly greater ASSIST scores for those with diagnoses of abuse or dependence. Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems. Participants diagnosed with attention deficit/hyperactivity disorder or antisocial personality disorder had significantly higher ASSIST scores than those not diagnosed as such. Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. ROC analysis was able to establish cut-off scores for an Australian s le, with suitable specificities and sensitivities for most substances. Predictive validity was demonstrated by similarity in ASSIST scores obtained at baseline and at follow-up. The findings demonstrated that the ASSIST is a valid screening test for psychoactive substance use in in iduals who use a number of substances and have varying degrees of substance use.
Publisher: Wiley
Date: 06-1998
DOI: 10.1080/09595239800186991
Abstract: Phase I of this study was designed to inform the development of a range of responses to hazardous and harmful hetamine use. Research techniques from Rapid Assessment Methodology (RAM) were utilized to collect data. A survey of current hetamine users included the Short Form 36 (SF36) Health Status Questionnaire, for which South Australian population norms were published in 1995. This facilitated comparisons of the health of this s le of hetamine users with that of the general population. The s le were found to have significantly poorer health than the general population. The self-reported prevalence of mental health problems in the s le was consistent with previous Australian research on hetamine use. Approximately one-third of the s le reported that they had experienced symptoms of anxiety, depression, mood swings and aggressive outbursts prior to their use of hetamines. Two-thirds of the s le reported symptoms of anxiety and depression since starting to use hetamines, almost half reported mood swings and aggressive outbursts, and over a third reported panic attacks and paranoia. One of the most important findings was a strong association between mental and physical health problems and the severity of dependence on hetamines. The implications of these results for interventions with hetamine users are discussed.
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.ADDBEH.2005.05.016
Abstract: This economic evaluation was part of the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project. Data from four trials of heroin detoxification methods, involving 365 participants, were pooled to enable a comprehensive comparison of the cost-effectiveness of five inpatient and outpatient detoxification methods. This study took the perspective of the treatment provider in assessing resource use and costs. Two short-term outcome measures were used-achievement of an initial 7-day period of abstinence, and entry into ongoing post-detoxification treatment. The mean costs of the various detoxification methods ranged widely, from AUD 491 dollars(buprenorphine-based outpatient) to AUD 605 dollars for conventional outpatient AUD 1404 dollars for conventional inpatient AUD 1990 dollars for rapid detoxification under sedation and to AUD 2689 dollars for anaesthesia per episode. An incremental cost-effectiveness analysis was carried out using conventional outpatient detoxification as the base comparator. The buprenorphine-based outpatient detoxification method was found to be the most cost-effective method overall, and rapid opioid detoxification under sedation was the most cost-effective inpatient method.
Publisher: Wiley
Date: 23-11-2020
DOI: 10.1111/ADD.15297
Abstract: Not all people experiencing opioid dependence benefit from oral opioid agonist treatment. The aim of this study was to examine perceptions of (supervised) injectable opioid agonist treatment (iOAT) (described as ‘an opioid similar to heroin self‐injected at a clinic several times a day’) among people who regularly use opioids and determine how common iOAT eligibility criteria accord with interest in iOAT. Cross‐sectional survey Sydney, Melbourne and Hobart, Australia A total of 344 people (63% male) who use opioids regularly and had ever injected opioids, interviewed December 2017–March 2018. The mean age of participants was 41.5 years [standard deviation (SD) = 8.5]. Primary outcome measures were interest in iOAT, factors associated with interest and the proportion of participants who would be eligible using common criteria from trials and guidelines. We examined willingness to travel for iOAT, medication preferences and perspectives on whom should receive iOAT. Overall, 53% of participants ( n = 182) believed that iOAT would be a good treatment option for them. Participants who believed that iOAT was a good treatment option for them were more likely to be male [adjusted odds ratio (aOR) = 1.76, 95% confidence interval (CI) = 1.10–2.82], have used heroin in the past month (aOR = 6.03, 95% CI = 2.86–12.71), currently regularly inject opioids (aOR = 1.84, 95% CI = 1.16–2.91) and have met ICD‐10 criteria for opioid dependence (aOR = 3.46, 95% CI = 1.65–7.24). Those interested in iOAT had commenced more treatment episodes (aOR =1.06, 95% CI = 1.00–1.12). Among those interested in iOAT ( n = 182), 26% ( n = 48) met common eligibility criteria for iOAT. Interest in injectable opioid agonist treatment does not appear to be universal among people who regularly use opioids. Among study participants who expressed interest in injectable opioid agonist treatment, most did not meet common eligibility criteria.
Publisher: Wiley
Date: 12-07-2012
DOI: 10.1111/J.1360-0443.2012.03933.X
Abstract: To evaluate the impact of community-based drug treatment on meth hetamine use using inverse probability of treatment-weighted (IPTW) estimators to derive treatment effects. A longitudinal prospective cohort study with follow-ups at 3 months, 1 year and 3 years. Treatment effects were derived by comparing groups at follow-up. IPTW estimators were used to adjust for pre-treatment differences between groups. Sydney and Brisbane, Australia. Participants were meth hetamine users entering community-based detoxification (n = 112) or residential rehabilitation (n = 248) services and a quasi-control group of meth hetamine users (n = 101) recruited from the community. Frequency of meth hetamine use between interviews (no use, less than weekly, 1-2 days per week, 3+ days per week), continuous abstinence from meth hetamine use, past month meth hetamine use and meth hetamine dependence. Detoxification did not reduce meth hetamine use at any follow-up relative to the quasi-control group. Relative to quasi-control and detoxification groups combined, residential rehabilitation produced large reductions in the frequency of meth hetamine use at 3 months [odds ratio (OR) = 0.23, 95% confidence interval (CI) 0.15-0.36, P < 0.001), with a marked attenuation of this effect at 1 year (OR 0.62, 95% CI 0.40-0.97, P = 0.038) and 3 years (OR = 0.71, 95% CI 0.42-1.19, P = 0.189). The greatest impact was for abstinence: for every 100 residential rehabilitation clients there was a gain of 33 being continuously abstinent at 3 months, with this falling to 14 at 1 year and 6 at 3 years. Community-based residential rehabilitation may produce a time-limited decrease in meth hetamine use, while detoxification alone does not appear to do so.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2002
Publisher: Elsevier BV
Date: 02-2018
Publisher: SAGE Publications
Date: 10-2010
DOI: 10.1080/08897077.2010.514243
Abstract: Key to the dissemination of evidence-based addiction treatments is the exchange of experiences and mutual support among treatment practitioners, as well as the availability of accurate addiction training materials and effective trainers. To address the shortage of such resources, the United Nations Office on Drugs and Crime (UNODC) created Treatnet, a network of 20 drug dependence treatment resource centers around the world. Treatnet's primary goal is to promote the use of effective addiction treatment practices. Phase I of this project included ( 1 ) selecting and establishing a network of geographically distributed centers ( 2 ) conducting a capacity-building program consisting of a training needs assessment, development of training packages, and the training of 2 trainers per center in 1 content area each and ( 3 ) creating good-practice documents. Data on the training activities conducted by the trainers during their first 6 months in the field are presented. Plans for Phase II of the Treatnet project are also discussed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2006
Publisher: BMJ
Date: 07-2018
DOI: 10.1136/BMJOPEN-2017-020723
Abstract: Meth hetamine dependence is a growing public health concern. There is currently no pharmacotherapy approved for meth hetamine dependence. Lisdexamfetamine (LDX) dimesylate, used in the treatment of attention-deficit hyperactivity disorder and binge eating disorder, has potential as an agonist therapy for meth hetamine dependence, and possible benefits of reduced risk of aberrant use due to its novel formulation. A double-blind randomised controlled trial will be used to evaluate the efficacy of LDX in reducing meth hetamine use. The target s le is 180 participants with meth hetamine dependence of ≥2 years, using ≥14 days out of the previous 28, who have previously attempted but not responded to treatment for meth hetamine use. Participants will be randomly assigned to receive either a 15-week intervention consisting of induction (1 week of 150 mg LDX or placebo), maintenance (12 weeks of 250 mg LDX or placebo) and reduction (1 week of 150 mg LDX or placebo and 1 week of 50 mg LDX or placebo). All participants will be given access to four sessions of cognitive–behavioural therapy as treatment as usual and receive a 4-week follow-up appointment. The primary outcomes are efficacy (change from baseline in days of meth hetamine use by self-report for the last 28 days at week 13 and urinalyses confirmation of meth hetamine use) and safety (treatment-related adverse events). Secondary outcomes are total number of days of self-report meth hetamine use over the 12-week active treatment, longest period of abstinence during treatment period, percentage of achieving ≥21 days abstinence, craving, withdrawal, dependence, retention, bloodborne virus transmission risk behaviour, criminal behaviour, as well measures of abuse liability, physical and mental health, other substance use, cognitive performance, psychosocial functioning, treatment retention and satisfaction. Additionally, the study will assess the cost-effectiveness of LDX relative to the placebo control. The study has been approved by the Human Research Ethics Committee of St. Vincent’s Hospital, Sydney, Australia (HREC/16/SVH/222). Contact the corresponding author for the full trial protocol. ACTRN12617000657325 Pre-results.
Publisher: Wiley
Date: 04-06-2018
DOI: 10.1111/ADD.14234
Abstract: This review provides an up-to-date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation. In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days) 15.2% for daily tobacco smoking and 3.8, 0.77, 0.37 and 0.35% for past-year cannabis, hetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age-standardized prevalence of alcohol dependence was 843.2 per 100 000 people for cannabis, opioids, hetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High-income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability-adjusted life-years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance-attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age-standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe attributable age-standardized tobacco mortality rates and DALYs were highest in Oceania. In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability-adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low- and middle-income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.
Publisher: Elsevier BV
Date: 09-1999
Publisher: Wiley
Date: 09-01-2008
DOI: 10.1111/J.1360-0443.2007.02090.X
Abstract: To (i) examine the predictors of mortality in a randomized study of methadone versus buprenorphine maintenance treatment (ii) compare the survival experience of the randomized subject groups and (iii) describe the causes of death. Ten-year longitudinal follow-up of mortality among participants in a randomized trial of methadone versus buprenorphine maintenance treatment. Recruitment through three clinics for a randomized trial of buprenorphine versus methadone maintenance. A total of 405 heroin-dependent (DSM-IV) participants aged 18 years and above who consented to participate in original study. Baseline data from original randomized study dates and causes of death through data linkage with Births, Deaths and Marriages registries and longitudinal treatment exposure via State health departments. Predictors of mortality examined through survival analysis. There was an overall mortality rate of 8.84 deaths per 1000 person-years of follow-up and causes of death were comparable with the literature. Increased exposure to episodes of opioid treatment longer than 7 days reduced the risk of mortality there was no differential mortality among methadone versus buprenorphine participants. More dependent, heavier users of heroin at baseline had a lower risk of death, and also higher exposure to opioid treatment. Older participants randomized to buprenorphine treatment had significantly improved survival. Aboriginal or Torres Strait Islander participants had a higher risk of death. Increased exposure to opioid maintenance treatment reduces the risk of death in opioid-dependent people. There was no differential reduction between buprenorphine and methadone. Previous studies suggesting differential effects may have been affected by biases in patient selection.
Publisher: Faculty of Medicine Prince of Songkla University
Date: 04-03-2019
Abstract: Psychoactive substances – chemical compounds which can alter a person’s mood, thoughts, and behaviors may be liable to misuse and cause addiction. Internationally, many strategies have been implemented in order to limit the supply and demand of illegal substances, with a wide variation at the country level. Thailand is an upper-middle income country in Southeast Asia. Since 2015, Thai authorities and policymakers have instituted many changes to the legal controls on illegal drugs. The aim of this review was to summarise the history of drug control and regulation in Thailand, focusing on opioids (including Kratom), meth hetamines and cannabis, and the outcome of recent strategies. Recent measures towards decriminalising substance use disorders are also discussed.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2018-025204
Abstract: North America is amid an opioid use epidemic. Opioid agonist treatment (OAT) effectively reduces extramedical opioid use and related harms. As with all pharmacological treatments, there are risks associated with OAT, including fatal overdose. There is a need to better understand risk for adverse outcomes during and after OAT, and for innovative approaches to identifying people at greatest risk of adverse outcomes. The Opioid Agonist Treatment and Safety study aims to address these questions so as to inform the expansion of OAT in the USA. This is a retrospective cohort study using linked, routinely collected health data for all people seeking OAT in New South Wales, Australia, between 2001 and 2017. Linked data include hospitalisation, emergency department presentation, mental health diagnoses, incarceration and mortality. We will use standard regression techniques to model the magnitude and risk factors for adverse outcomes (eg, mortality, unplanned hospitalisation and emergency department presentation, and unplanned treatment cessation) during and after OAT, and machine learning approaches to develop a risk-prediction model. This study has been approved by the Population and Health Services Research Ethics Committee (2018HRE0205). Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely-collected health Data statement.
Publisher: Oxford University Press (OUP)
Date: 12-2003
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/PY17056
Abstract: This report presents the findings from the Australian component of the Phase III World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) randomised controlled trial investigating the effectiveness of a 5–10-min brief intervention (BI) for illicit drug use delivered in primary healthcare (PHC) settings. Participants (n=171) recruited from a South Australian PHC setting (sexual health clinic) who scored in the ‘moderate risk’ range on the ASSIST were randomly allocated to an intervention group or wait-list control group at baseline and were followed up 3 months later. The ASSIST was administered to both groups at baseline and follow up as a measure of relative risk. Those in the intervention group received a prescribed 10-step BI at baseline. The majority (n=63) of participants received the BI for hetamine-type stimulants (ATS) or cannabis (n=17). There was a significant reduction in total illicit substance (P .001) and ATS Involvement (P .01) for those receiving the ASSIST-linked BI, compared with control participants. There was no significant effect on cannabis involvement. The results of this study demonstrate that the ASSIST-linked BI may be a reasonably easy and effective way of reducing illicit substance use by Australian PHC clients.
Publisher: Cambridge University Press (CUP)
Date: 28-05-2012
DOI: 10.1017/S2040174412000372
Abstract: The World Health Organization has identified substance use in the top 20 risk factors for ill health. Risks in pregnancy are compounded, with risk to the woman's health, to pregnancy progression and on both the foetus and the newborn. Intrauterine exposure can result in negative influences on offspring development, sometimes into adulthood. With effectively two patients, there is a clear need for antenatal screening. Biomarker reliability is limited and research efforts have been directed to self-report tools, often attempting to address potential lack of veracity if women feel guilty about substance use and worried about possible stigmatization. Tools, which assume the behaviour, are likely to elicit more honest responses querying pre-pregnancy use would likely have the same effect. Although veracity is heightened if substance use questions are embedded within health and social functioning questionnaires, such tools may be too lengthy clinically. It has been proposed that screening only for alcohol and tobacco, with focus on the month pre-pregnancy, could enable identification of all other substances. Alternatively, the Revised Fagerstrom Questionnaire could be used initially, tobacco being highly indicative of substance use generally. The ASSIST V.3.0 is readily administered and covers all substances, although the pregnancy ‘risk level’ cut-off for tobacco is not established. Alcohol tools – the 4Ps , TLFB and ‘drug’ CAGE ( with E: query of use to avoid withdrawal ) – have been studied with other substances and could be used. General psychosocial distress and mental ill-health often co-exist with substance use and identification of substance use needs to become legitimate practice for obstetric clinicians.
Publisher: Elsevier BV
Date: 2021
Publisher: Oxford University Press (OUP)
Date: 22-03-2017
Abstract: To evaluate the feasibility of conducting a study of structured brief intervention (BI) for reducing problem alcohol use among in iduals who experienced earthquake. Following the Wenchuan earthquake, 1336 clients from 18 local hospitals were invited to complete the Alcohol Use Disorders Identification Test (AUDIT). Of those, 239 in iduals (AUDIT score of greater than or equal to 7) were included in the study. The participants from intervention village hospitals who were assigned to the BI group (n = 118) received a structured BI lasting 15-30 min plus general health education. The participants from the control village hospitals were assigned to the control group (n = 121) only received general health education. Baseline and post-intervention assessments at 12 weeks were conducted using the AUDIT, Substance Abuse Knowledge Scale (SAKS), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and General Well-being Schedule. At 3 months follow-up, the BI group had reduced scores on AUDIT (F = 65.84 P < 0.001) and increased on SAKS (F = 44.45 P < 0.001), but the control group had increased scores on SAS (F = 10.76 P = 0.001) and SDS (F = 18.43 P < 0.001) compared with baseline. BI group showed more decreases for AUDIT scores (group × time effect, F = 34.8 P < 0.001), and had mores increases for SAKS scores (group × time effect, F = 15.7 P < 0.001) compared with control group. The study demonstrated the feasibility of a study of BI in problem alcohol users who experienced traumatic events. Further research need to be done to test the effectiveness of BI over a longer period of time, and provide evidence in support of BI as an effective technique in China.
Publisher: Wiley
Date: 06-2008
Publisher: Wiley
Date: 19-05-2020
DOI: 10.1111/ADD.15087
Publisher: Wiley
Date: 09-2015
DOI: 10.1111/DAR.12317
Abstract: 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 ersion 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 ersion and reasons for such practices and the impact of the introduction of BNX-F into the prison system. 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. 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 ersion methods used and removal from dosing within prison. Despite prison being a highly regulated and controlled environment, some level of ersion 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 ersion of opioid substitution medications and other medications in prison settings in Australia following the introduction of buprenorphine-naloxone film. Drug Alcohol Rev 2015 ●●:●●-●●].
Publisher: Wiley
Date: 05-2005
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.DRUGALCDEP.2015.02.038
Abstract: There is increasing concern about t ering of pharmaceutical opioids. We describe early findings from an Australian study examining the potential impact of the April 2014 introduction of an abuse-deterrent sustained-release oxycodone formulation (Reformulated OxyContin(®)). Data on pharmaceutical opioid sales drug use by people who inject drugs regularly (PWID) client visits to the Sydney Medically Supervised Injecting Centre (MSIC) and last drug injected by clients of inner-Sydney needle-syringe programmes (NSPs) were obtained, 2009-2014. A cohort of n=606 people t ering with pharmaceutical opioids was formed pre-April 2014, and followed up May-August 2014. There were declines in pharmacy sales of 80mg OxyContin(®) post-introduction of the reformulated product, the dose most commonly erted and injected by PWID. Reformulated OxyContin(®) was among the least commonly used and injected drugs among PWID. This was supported by Sydney NSP data. There was a dramatic reduction in MSIC visits for injection of OxyContin(®) post-introduction of the new formulation (from 62% of monthly visits pre-introduction to 5% of visits, August 2014). The NOMAD cohort confirmed a reduction in OxyContin(®) use/injection post-introduction. Reformulated OxyContin(®) was cheaper and less attractive for t ering than Original OxyContin(®). These data suggest that, in the short term, introduction of an abuse-deterrent formulation of OxyContin(®) in Australia was associated with a reduction in injection of OxyContin(®), with no clear switch to other drugs. Reformulated OxyContin(®), in this short follow-up, does not appear to be considered as attractive for t ering.
Publisher: Wiley
Date: 18-06-2015
DOI: 10.1111/DAR.12279
Abstract: The harms associated with non-medical use of pharmaceutical opioid analgesics are well established however, less is known about the characteristics and drug-use patterns of the growing and hidden populations of people using pharmaceutical opioids illicitly, including the frequency of pharmaceutical opioid injection. This paper aimed to undertake a detailed examination of jurisdictional differences in patterns of opioid use among a cohort of people who regularly t er with pharmaceutical opioids in Australia. Data were drawn from the National Opioid Medications Abuse Deterrence study. The cohort was recruited from New South Wales (NSW n = 303), South Australia (SA n = 150) and Tasmania (TAS n = 153) to participate in face-to-face structured interviews collecting data on use of pharmaceutical opioids, benzodiazepines, other sedative drugs and illicit substances, as well as the harms associated with substance use. TAS participants reported greater use and injection of certain pharmaceutical opioids (particularly morphine and methadone tablets), and limited heroin use, with lower rates of engagement in opioid substitution treatment, compared with NSW participants. NSW participants were more socially disadvantaged and more likely to report risky injecting behaviours and injecting-related injuries and diseases compared with SA and TAS participants. SA participants reported greater rates of pain conditions, greater use of pain-based services, as well as broader use of pharmaceutical opioids in regards to forms and route of administration, compared with NSW participants. Distinct jurisdictional profiles were evident for people who t er with pharmaceutical opioids, potentially reflecting jurisdictional differences in prescribing regulatory mechanisms and addiction treatment models.
Publisher: Wiley
Date: 06-05-2015
DOI: 10.1111/DAR.12277
Abstract: Buprenorphine-naloxone (BNX) film for opioid dependence treatment was introduced in Australia in 2011. A key difference in State policy approaches saw transfer from BNX tablets to BNX film mandated in South Australia (SA) with New South Wales (NSW) and Victoria (VIC) having less stringent policies. This study examined (i) how initiations and transfers were implemented, (ii) the profile and predictors of adverse effects as self-reported by BNX film clients, and (iii) dosing issues. Survey of 334 buprenorphine (BPN), BNX tablet and BNX film clients and semi-structured interviews with 39 key experts (KEs) in 2012. Comparisons are made between clients interviewed in SA versus NSW and VIC combined. Among the 180 current BNX film clients, 23% started treatment on BNX film, 18% requested a transfer to BNX film and 59% (n = 106) reported their clinic rescriber recommended transfer to BNX film. Among clients who were offered but refused a transfer to BNX film (n = 66), the most common reason was 'I am happy with my current treatment and do not see a reason to change' (53%). Some opioid substitution therapy clients and KE viewed transfers as 'forced' (i.e. no choice of buprenorphine formulation). Multivariable regression showed residing in SA (vs. NSW/VIC) and a shorter length of current treatment episode were associated with more BNX film-attributed adverse effects but clinic rescriber-recommended transfer was not. The introduction of BNX film in Australia varied across States. A perception of restricted choice in medication may have undermined initial acceptance in SA.
Publisher: Wiley
Date: 05-02-2020
DOI: 10.1111/ADD.14941
Abstract: To examine perceptions of extended‐release (XR) buprenorphine injections among people who regularly use opioids in Australia. Cross‐sectional survey prior to implementation. XR‐buprenorphine was registered in Australia in November 2018. Sydney, Melbourne and Hobart. Participants A total of 402 people who regularly use opioids interviewed December 2017 to March 2018. Primary outcome concerned the proportion of participants who believed XR‐buprenorphine would be a good treatment option for them, preferred weekly versus monthly injections and perceived advantages/disadvantages of XR‐buprenorphine. Independent variables concerned the demographic characteristics and features of current opioid agonist treatment (OAT medication‐type, dose, prescriber/dosing setting, unsupervised doses, out‐of‐pocket expenses and travel distance). Sixty‐eight per cent [95% confidence interval (CI) = 63–73%] believed XR‐buprenorphine was a good treatment option for them. They were more likely to report being younger [26–35 versus 55 years odds ratio (OR) = 3.16, 95% CI = 1.12–8.89 P = 0.029], being female (OR = 1.67, 95% CI = 1.04–2.69 P = 0.034), 10 years school education (OR = 1.87, 95% CI = 1.12–3.12 P = 0.016) and past‐month heroin (OR = 1.81, 95% CI = 1.15–2.85 P = 0.006) and meth hetamine use (OR = 1.90, 95% CI = 1.20–3.01 P = 0.006). Fifty‐four per cent reported no preference for weekly versus monthly injections, 7% preferred weekly and 39% preferred monthly. Among OAT recipients ( n = 255), believing XR‐buprenorphine was a good treatment option was associated with shorter treatment episodes (1–2 versus ≥ 2 years OR = 3.93, 95% CI = 1.26–12.22 P = 0.018), fewer unsupervised doses (≤ 8 doses past‐month versus no take‐aways OR = 0.50 95% CI = 0.27–0.93 P = 0.028) and longer travel distance (≥ 5 versus 5 km OR = 2.10, 95% CI = 1.20–3.65 P = 0.009). Sixty‐nine per cent reported ‘no problems or concerns’ with potential differences in availability, flexibility and location of XR‐buprenorphine. Among regular opioid users in Australia, perceptions of extended‐release buprenorphine as a good treatment option are associated with being female, recent illicit drug use and factors relating to the (in)convenience of current opioid agonist treatment.
Publisher: Oxford University Press (OUP)
Date: 18-03-2019
Publisher: Wiley
Date: 30-01-2019
DOI: 10.1111/ADD.14546
Publisher: Wiley
Date: 12-05-2021
DOI: 10.1111/ADD.15514
Abstract: There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment and prescriber characteristics. Retrospective longitudinal study. New South Wales, Australia. People entering the opioid agonist treatment programme for the first time between August 2001 and December 2015. Time in opioid agonist treatment (primary outcome) was modelled using a generalized estimating equation model to estimate associations with person, treatment and prescriber characteristics. The impact of medication type on opioid agonist treatment retention reduced over time the risk of leaving treatment when on buprenorphine compared with methadone was higher among those who entered treatment earlier [e.g. 2001–03: odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.45–1.75] and lowest among those who entered most recently (2013–15: OR = 1.23, 95% CI = 1.11–1.36). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR = 0.94, 95% CI = 0.93–0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past‐year psychosis disorder and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment. In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in opioid agonist treatment.
Publisher: Wiley
Date: 09-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2006
Publisher: Wiley
Date: 14-07-2015
DOI: 10.1111/DAR.12308
Abstract: Experiences of buprenorphine-naloxone (BNX) sublingual film injection are not well documented or understood. We examined how people who inject BNX film seek and share information about this practice, document the methods used to prepare BNX film for injection, and report participants' experiences of this practice. Interviews were (n = 16) conducted with people who indicated that they had injected BNX film since its introduction onto the Australian market. Semistructured interviews were recorded and transcribed. NVivo10 program (QSR International) was used to analyse the data using qualitative description methodology. Participants largely reported similar BNX film preparation techniques, although the texture of BNX film during preparation to inject was reported to be unusual (gluggy), and there were many varied accounts associated with the amount of water used. Physical harms reported as associated with injecting BNX film were described (including local and systemic issues) participants reported injecting the film to enhance its immediate effects, yet generally reported that sublingual administration provided longer-lasting effects. Understanding knowledge acquisition about injecting new formulations of opioid substitution therapy is crucial in developing more effective harm-reduction strategies. Dissemination by peer networks to those who are currently or planning to inject BNX film regarding the 'gelatine like' texture when mixing, using only cold water and double filtering is important to ensure safer injecting practices. Findings from this study highlight the importance of peer networks for the dissemination of harm-reduction information. Introduction of new formulations internationally requires more qualitative studies to inform safer practices.
Publisher: Informa UK Limited
Date: 2002
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.DRUGALCDEP.2016.07.003
Abstract: The aims were to determine: (i) quantity and frequency of same-day use of opioids with benzodiazepines and/or alcohol amongst people who regularly t er with pharmaceutical opioids and (ii) socio-demographic, mental health, harms and treatment profile associated with same-day use of high doses. The cohort (n=437) completed a retrospective 7-day diary detailing opioid, benzodiazepine, and alcohol intake. Oral morphine equivalent (OME) units and diazepam equivalent units (DEU) were calculated, with >200mg OME, >40mg DEU and >4 standard alcoholic drinks (each 10g alcohol) considered a "high dose". One-half (47%) exclusively consumed opioids without benzodiazepines/alcohol 26% had days of opioid use with and without benzodiazepines/alcohol and 26% always used opioids and benzodiazepines/alcohol. Same-day use of opioids with benzodiazepines/alcohol typically occurred on 1-3days in the past week. Six in ten (61%) participants reported high dose opioid use on at least one day one in five (20%) reported high dose opioid and high dose benzodiazepine/alcohol use on at least one day. The latter group were more likely to use prescribed opioid substitution therapy, often alongside erted pharmaceutical opioids. Socio-demographic and clinical profiles did not vary according to high dose opioid, alcohol and benzodiazepine use, and there was no association with harms. Same-day use of opioids with benzodiazepines/alcohol, and high dose combinations, are common amongst people who t er with pharmaceutical opioids. Assessment of concomitant benzodiazepine/alcohol use during opioid therapy, implementation of real-time prescription monitoring systems, and research to clarify upper safe limits for polydrug depressant use, are potential implications.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/PY18035
Abstract: This study explored the experience and self-reported changes in health behaviours of people in a primary healthcare setting who received a brief intervention (BI) for illicit drugs linked to the Alcohol Smoking Substance Involvement Screening Test (ASSIST). Eighty-two participants from a sexual health clinic in Adelaide, South Australia, who were involved in a randomised controlled trial investigating the effectiveness of an ASSIST-linked BI delivered at baseline, were re-interviewed 3 months later and were administered a semi-structured questionnaire designed to elicit participant perspectives on the BI. Overall, participants’ comments were positive, with 78% reporting that the BI had some influence on their drug-taking behaviour 72% reporting they had attempted to reduce drug use. Their comments highlighted several ways in which the BI helped them become ‘aware’ of the potential risks of using, the risks of continued substance use, the benefits of stopping or cutting down substance use and the strategies they used to change their behaviour. A smaller proportion of participants reported that the BI had no influence. These results indicate the ASSIST-linked BI is a brief, simple-to-administer intervention that provides participants with an opportunity to voluntarily and successfully enter into an intentional process of change.
Publisher: Wiley
Date: 08-07-2021
DOI: 10.1111/DAR.13350
Abstract: This study aimed to gather a range of opinions, including those of affected people (consumers, concerned others) to identify clinical research priorities for meth hetamine and emerging drugs of concern in Australia, to guide the work of the National Centre for Clinical Research on Emerging Drugs (NCCRED). A priority setting study was conducted (February–March 2019) in four phases: online stakeholder survey, thematic analysis of responses, rapid literature review, expert panel ranking of priorities against predetermined criteria. Forty‐seven respondents completed the survey, including people identifying as one or more of: researcher (53%, n = 25), clinician (45% n = 21), family/friend/caregiver of someone who uses meth hetamine/emerging drugs (15%, n = 7) and consumer of meth hetamine/emerging drugs (13%, n = 6). Expert panel, evidence‐informed top‐ranked clinical research priorities for meth hetamine were: strategies to overcome barriers to intervention uptake, pilot medication trials for adults seeking treatment, and communication strategies regarding evidence‐based treatments. For emerging drugs of concern, top‐ranked priorities were: piloting community‐located drug checking, feasibility of social media/other opportunities to alert consumers of emerging risks, GHB overdose and withdrawal management, and impacts of an early warning information system on reducing harms. We demonstrate feasibility of a structured, collaborative clinical research priority setting process. Results have informed the establishment of NCCRED using the identified priorities to guide seed funding, fellowships/scholarships and research programs. Broader uptake of this methodology by policymakers/research funders would assist to embed areas of concern identified by affected communities and other stakeholders in research prioritisation.
Publisher: Elsevier BV
Date: 28-06-2006
DOI: 10.1016/J.DRUGALCDEP.2005.11.009
Abstract: To determine 1 year outcomes for drug use, criminality, psychopathology and injection-related health problems in those entering treatment for heroin dependence in Australia. Longitudinal prospective cohort study. Seven hundred and forty five in iduals entering treatment (methadone/buprenorphine maintenance therapy detoxification residential rehabilitation) and 80 heroin users not seeking treatment. Sydney, Melbourne and Adelaide, Australia. A total of 657 in iduals were re-interviewed at 1 year, 80% of the original s le. There were substantial reductions in heroin and other drug use across all three treatment modalities. The majority of those who had entered treatment were heroin abstinent at 1 year (maintenance therapy 65%, detoxification 52%, residential rehabilitation 63%) compared to 25% of the non-treatment s le. The reduction in heroin use among the treatment s les was paralleled by reductions in poly drug use. There were also substantial reductions in risk-taking, crime and injection-related health problems across all treatment groups, and less marked reductions among the non-treatment group. Psychopathology was dramatically reduced among the treatment modalities, while remaining stable among the non-treatment group. Positive outcomes at 1 year were associated with a greater number of cumulative treatment days experienced over the 1 year follow-up period ('treatment dose') and fewer treatment episodes undertaken in that time ('treatment stability'). At 1 year, there were impressive reductions in drug use, criminality, psychopathology and injection-related health problems following treatment exposure. The positive findings were associated with a greater "dose" of treatment, and with more treatment stability over the follow-up period.
Publisher: Wiley
Date: 22-07-2022
DOI: 10.1111/DAR.13513
Abstract: Substance use is a common contributing factor to emergency department (ED) presentations. While screening, brief intervention, and referral to treatment for alcohol and tobacco is common in ED settings, it is not routinely conducted for illicit substances. This study aimed to deploy the ASSIST‐Lite to screen for risky use of alcohol and other drugs in the ED, to identify differences in risk based on between demographic characteristics. All ED attenders, aged 18 years or older, deemed well enough to participate were approached. Recruitment occurred at the Royal Adelaide Hospital ED between May and June 2017. Participants were asked to self‐complete the ASSIST‐Lite in the ED waiting room. Overall, 632 people were approached, of which 479 (75.8%) agreed to participate. Alcohol (72.2%), tobacco (27.1%) and cannabis (15.2%) were most commonly reported. Eighty‐nine participants reported moderate‐ or high‐risk use of two substances, and a further 49 in iduals reported moderate‐ or high‐risk use of three or more substances. Across most substances, age, gender and employment status was associated with risky substance use, with higher likelihood of risk reported by males, unemployed and younger participants. Unemployment was also significantly associated with increased risk severity for both moderate and high‐risk illicit use. The rate of risky illicit and polysubstance use found here highlight the need more focused research in ED settings. The findings also provide support for more routine screening, and early intervention approaches and suggest the need for active referral pathways through an alcohol and other drug consultation liaison service.
Publisher: American Medical Association (AMA)
Date: 03-2013
DOI: 10.1001/JAMAPSYCHIATRY.2013.283
Abstract: Meth hetamine is associated with psychotic phenomena, but it is not clear to what extent this relationship is due to premorbid psychosis among people who use the drug. To determine the change in the probability of psychotic symptoms occurring during periods of meth hetamine use. Longitudinal prospective cohort study. A fixed-effects analysis of longitudinal panel data, consisting of 4 noncontiguous 1-month observation periods, was used to examine the relationship between changes in meth hetamine use and the risk of experiencing psychotic symptoms within in iduals over time. Sydney and Brisbane, Australia. A total of 278 participants 16 years of age or older who met DSM-IV criteria for meth hetamine dependence on entry to the study but who did not meet DSM-IV criteria for lifetime schizophrenia or mania. Clinically significant psychotic symptoms in the past month, defined as a score of 4 or more on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations, or unusual thought content. The number of days of meth hetamine use in the past month was assessed using the Opiate Treatment Index. There was a 5-fold increase in the likelihood of psychotic symptoms during periods of meth hetamine use relative to periods of no use (odds ratio [OR], 5.3 [95% CI, 3.4-8.3] P < .001), this increase being strongly dose-dependent (1-15 days of meth hetamine use vs abstinence in the past month: OR, 4.0 [95% CI, 2.5-6.5] ≥16 days of meth hetamine use vs abstinence in the past month: OR, 11.2 [95% CI, 5.9-21.1]). Frequent cannabis and/or alcohol use (≥16 days of use in the past month) further increased the odds of psychotic symptoms (cannabis: OR, 2.0 [95% CI, 1.1-3.5] alcohol: OR, 2.1 [95% CI, 1.1-4.2]). There was a large dose-dependent increase in the occurrence of psychotic symptoms during periods of meth hetamine use among users of the drug.
Publisher: Wiley
Date: 30-09-2015
DOI: 10.1002/PDS.3883
Abstract: In April 2014, a t er-resistant controlled-release oxycodone formulation was released in Australia. We aimed to determine whether there are latent classes of people who t er with pharmaceutical opioids based on frequency of opioid and illicit drug use, the demographic and clinical profiles of these groups, and if there were changes in use and harms following the introduction. A prospective cohort of 606 people who regularly t er with pharmaceutical opioids was interviewed January to March 2014 (Wave 1) and May to August 2014 (Wave 2). Latent class analysis identified groups based on non-prescribed opioid, illicit drug and prescribed opioid substitution therapy (OST) use at Wave 1. Regression models examined whether group membership predicted use and harms at Wave 2. Four groups were identified: frequent OST group (39%), mixed OST/heroin group (7%), infrequent pharmaceutical opioid and heroin group (44%) and frequent oxycodone group (25%). Compared with the frequent OST group, the infrequent pharmaceutical opioid/heroin group was more likely to report non-everyday pain and risky alcohol use, and the frequent oxycodone group had higher odds of homelessness. At Wave 2, oxycodone use decreased across groups (odds ratios (OR) ≤ 0.18, p < 0.001, particularly for the frequent oxycodone group: OR ≤ 0.05, p < 0.001), with reductions in days of use (g ≥ 0.35, p < 0.050). Non-prescribed pharmaceutical opioid use, illicit drug use and harms remained stable or decreased. Despite heterogeneity among people who t er with pharmaceutical opioids, the t er-resistant formulation was followed by reductions in oxycodone t ering among high-frequency and low-frequency users. There was no evidence of increased use of other opioids or illicit drugs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Future Medicine Ltd
Date: 05-2014
DOI: 10.2217/PGS.14.56
Abstract: Methadone is the major opioid substitution therapy for opioid dependence. Dosage is highly variable and is often controlled by the patient and prescriber according to local and national policy and guidelines. Nevertheless many genetic factors have been investigated including those affecting its metabolism (CYP2B6-consistent results), efflux transport (P-gp-inconsistent results), target μ-opioid receptor (μ-opioid receptor-inconsistent results) and a host of other receptors (DRD2) and signaling elements (GIRK2 and ARRB2 not replicated). None by themselves have been able to substantially explain dosage variation (the major but not sole end point). When multiple genes have been combined such as ABCB1, CYP2B6, OPRM1 and DRD2 a greater contribution to dosage variation was found but not as yet replicated. As stabilization of dosage needs to be made rapidly, it is imperative that larger internationally based studies be instigated so that genetic contribution to dosage can be properly assessed, which may or may not tailor to different ethnic groups and each country’s policy towards an outcome that benefits all.
Publisher: Wiley
Date: 05-01-2011
DOI: 10.1111/J.1465-3362.2010.00274.X
Abstract: To examine Australian opioid substitution treatment (OST) prescribers' perceptions of (i) ersion and/or injection of methadone, buprenorphine, buprenorphine-naloxone by patients and (ii) effectiveness of current treatment policies in minimising the associated risks. 1278 authorised OST prescribers, identified by each jurisdiction's health department records, were sent a postal survey in 2007. Reminder letters and additional copies of the survey were sent to non-responders at weeks four and eight following the initial mail-out. Respondents went into a draw to win one of ten $100 book vouchers. Although the response rate was 26% (N = 291), participating prescribers served half (49%) of all OST patients in Australia. Prescribers perceived more buprenorphine patients removed supervised doses (7%) and erted unsupervised doses (20%), compared with methadone patients (1% and 4% respectively) and buprenorphine-naloxone patients (3% and 2% respectively). Prescribers reported significantly more buprenorphine and buprenorphine-naloxone patients injected doses (5% respectively), compared with methadone patients (2%). Non-adherence was identified through patient self-report (51%), and the reports of pharmacists (49%) and other staff (34%). More prescribers were confident in assessing the risk of injection (54%) than ersion (37%). Many prescribers responded 'don't know' to quantitative survey items. Qualitative responses highlighted uncertainties in assessing ersion/injection and whether current responses constituted 'best practice'. Australian prescribers perceive most patients adhere with OST, although they may underestimate the levels of ersion. Prescribers' beliefs about patients' behaviours are important and influence decisions to prescribe, medication choice and suitability for unsupervised dosing. The uncertainties in assessing and responding to ersion/injection may be a factor deterring prescribers' participation in OST.
No related grants have been discovered for Robert ALI.