ORCID Profile
0000-0001-5229-8257
Current Organisations
University of Sydney
,
South East Sydney Local Health District
,
Royal Australasian College of Physicians
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Publisher: Springer Science and Business Media LLC
Date: 08-06-2020
DOI: 10.1186/S12954-020-00377-0
Abstract: In 2016, the Australian federal government passed legislation enabling a range of cannabis-based products to be prescribed to patients by registered healthcare professionals. An online survey conducted immediately prior to these legislative changes found that the vast majority of respondents at the time were illicitly sourcing cannabis plant matter, smoking was the preferred route of administration and mental health, chronic pain, and sleep conditions were the most frequently cited reasons for medical cannabis use. This manuscript reports the results of a follow-up survey conducted in 2018–2019, the Cannabis As Medicine Survey (CAMS-18). The goal of this second questionnaire was to examine patterns of use and consumer perspectives regarding medical cannabis use in Australia, 2 years after the introduction of legal access pathways. Anonymous online cross-sectional survey with convenience s le, recruited mainly through online media between September 2018 and March 2019. Participants were adults (18 years or over) residing in Australia who reported using a cannabis product for self-identified therapeutic reasons during the preceding 12 months. The survey measured consumer characteristics, indications and patterns of medical cannabis use, routes and frequency of administration, perceived benefits and harms, experiences and preferred models of access to medical cannabis. Data were available for 1388 respondents. The main categories of condition being treated with medical cannabis were pain (36.4%), mental health (32.8%), sleep (9.2%), neurological (5.2%) and cancer (3.8%). Respondents reported using medical cannabis on 15.8 (11.2) days in the past 28, by inhaled (71.4%) or oral (26.5%) routes and spending AUD$82.27 ($101.27) per week. There were high levels of self-reported effectiveness, but also high rates of side effects. There was uncertainty regarding the composition of illicit cannabinoid products and concerns regarding their possible contamination. Few respondents (2.7%) had accessed legally prescribed medical cannabis, with the main perceived barriers being cost, disinterest from the medical profession and stigma regarding cannabis use. Chronic pain, mental health and sleep remain the main clinical conditions for which consumers report using medical cannabis. Despite 2 years of legal availability, most consumers in Australia reported accessing illicit cannabis products, with uncertainty regarding the quality or composition of cannabis products.
Publisher: Wiley
Date: 30-03-2022
DOI: 10.1111/DAR.13463
Abstract: Alcohol and other drug (AOD) use is common in Australia with significant health and community impacts. General practitioners (GP) often see people with AOD use however, there is little research to understand how specialist AOD services could assist GPs in the management of patients with AOD issues. Thirty‐five GPs working in general practice in a metropolitan area in Sydney in New South Wales, Australia, participated in one of three focus groups. The groups were recorded, transcribed and thematically analysed. The five themes raised by participants were: GP personal agency and interest in AOD issues GP education and training gaps improving pathways between GP and specialist AOD services easier access to AOD specialist advice and improving access to collaborative care for patients with complex AOD presentations. Participants requested education on screening, assessing, managing AOD issues, focused on alcohol, stimulants and high‐risk prescription medicines. They suggested better referral processes, discharge summaries and care planning for complex presentations. Participants wanted easy access to specialist advice and suggested collaborative care assisted by experienced AOD liaison nurses. Australia has several existing programs online referral pathways and specialist phone advice, that address some of the issues raised. Unfortunately, many participants were not aware of these. GP education must be supported by multiple processes, including durable referral pathways, ready access to local specialist advice, clear communication (including patient attendance and a treatment plan), care planning and written summaries.
Publisher: Wiley
Date: 12-05-2020
DOI: 10.1111/DAR.13088
Publisher: Wiley
Date: 10-09-2019
DOI: 10.1002/DTA.2687
Publisher: Wiley
Date: 14-09-2021
DOI: 10.1111/DAR.13382
Abstract: In early 2020, many services modified their delivery of opioid treatment in response to the COVID‐19 pandemic, to limit viral spread and maintain treatment continuity. We describe the changes to treatment and preliminary analysis of the association with patients' substance use and well‐being. A pre‐post comparison of treatment conditions and patient self‐reported outcomes using data extracted from electronic medical records in the 5 months before (December 2019–April 2020) and after (May 2020–September 2020) changes were implemented in three public treatment services in South Eastern Sydney Local Health District. Data are available for 429/460 (93%) patients. Few (21, 5%) dropped out of treatment. In the ‘post’ period there was significantly more use of depot buprenorphine (12–24%), access to any take‐away doses (TAD 24–69%), access to ≥6 TAD per week (7–31%), pharmacy dosing (24–52%) and telehealth services. There were significant reductions in average opioid and benzodiazepine use, increases in cannabis use, with limited group changes in social conditions, or quality of life, psychological and physical health. At an in idual level, 22% of patients reported increases in their use of either alcohol, opioids, benzodiazepines or stimulants of ≥4 days in the past 4 weeks. Regression analysis indicates increases in substance use were associated with higher levels of supervised dosing. These preliminary findings suggest that the modified model of care continued to provide safe and effective treatment, during the pandemic. Notably, there was no association between more TAD and significant increases in substance use. Limitations are discussed and further evaluation is needed.
Publisher: Wiley
Date: 17-07-2021
DOI: 10.5694/MJA2.51180
Publisher: Wiley
Date: 14-07-2023
DOI: 10.5694/MJA2.52039
Abstract: To investigate the demographic characteristics, substance use, and self‐rated health of people entering treatment in New South Wales public health services for alcohol, hetamine‐type stimulants, cannabis, cocaine, or opioids use, by principal drug of concern. Baseline findings of a cohort study analysis of data in patient electronic medical records and NSW minimum data set for drug and alcohol treatment services. People completing initial Australian Treatment Outcomes Profile (ATOP) assessments on entry to publicly funded alcohol and other drug treatment services in six NSW local health districts/networks, 1 July 2016 – 30 June 2019. Socio‐demographic characteristics, and substance use and self‐rated health (psychological, physical, quality of life) during preceding 28 days, by principal drug of concern. Of 14 087 people included in our analysis, the principal drug of concern was alcohol for 6051 people (43%), opioids for 3158 (22%), hetamine‐type stimulants for 2534 (18%), cannabis for 2098 (15%), and cocaine for 246 (2%). Most people commencing treatment were male (9373, 66.5%), aged 20–39 years (7846, 50.4%), and were born in Australia (10 934, 86.7%). Polysubstance use was frequently reported, particularly by people for whom opioids or hetamine‐type stimulants were the principal drugs of concern. Large proportions used tobacco daily (53–82%, by principal drug of concern group) and reported poor psychological health (47–59%), poor physical health (32–44%), or poor quality of life (43–52%). The prevalence of social disadvantage and poor health is high among people seeking assistance with alcohol, hetamine‐type stimulants, cannabis, cocaine, or opioids use problems. Given the differences in these characteristics by principal drug of concern, health services should collect comprehensive patient information during assessment to facilitate more holistic, tailored, and person‐centred care.
Publisher: Wiley
Date: 21-01-2021
DOI: 10.1111/DAR.13228
Publisher: Wiley
Date: 29-06-2002
DOI: 10.1111/DAR.13346
Abstract: The Australian Treatment Outcomes Profile (ATOP) is a brief instrument that measures self‐reported substance use, health, and wellbeing in the previous 28 days for people in alcohol and other drug treatment. Previous studies have established the concurrent validity, inter‐rater, and test–retest reliability of the tool. The current study sought to identify recommended cutoff scores for ATOP items for psychological health, physical health and quality of life that identify clients reporting clinically significant problems warranting further assessment and/or intervention, compared to cutoffs used by ‘gold‐standard’ measures for these domains. Clients attending for treatment for problems with opioid ( n = 144) or alcohol use ( n = 134) completed the ATOP and comparison standardised questionnaires (Kessler‐10, Short Form Survey 12 and the Personal Wellbeing Index) with a researcher. Receiver operating characteristics analysis, along with clinician perspectives, were used to recommend cutoff scores for ATOP items indicative of clinically significant problems. A cutoff score of 5 or less out of 10 was identified as an optimal pragmatic cutoff for ATOP items relating to psychological health, physical health and quality of life items with regards to balancing sensitivity, specificity, and application in a treatment setting. The recommended clinical cutoffs will support clinicians and treatment services to identify clients who require further assessment and follow up for their psychological health, physical health and quality of life. The current study provides further evidence for the utility of the ATOP for in idual clinical review, service planning and research.
Publisher: Wiley
Date: 31-08-2023
DOI: 10.1111/DAR.13742
Publisher: Wiley
Date: 16-12-2022
DOI: 10.1111/DAR.13588
Abstract: Amphetamine type substances (ATS) are commonly used by Australian alcohol and other drug service entrants. We describe demographic characteristics, patterns of ATS and other substance use, health and social conditions among clients entering New South Wales (NSW) public alcohol and other drug services. Retrospective cohort of 13,864 records across six health districts (2016–2019) for clients seeking substance use treatment. These districts service approximately 44% of the NSW population aged 15 years and over. Multivariate analysis was conducted on a subs le for whom full data were available ( N = 9981). Data included NSW Minimum Data Set for drug and alcohol treatment services and Australian Treatment Outcomes Profile items. Over the preceding 4 weeks, 77% ( n = 10,610) of clients ( N = 13,864) reported no recent ATS use, 15% ( n = 2109) reported ‘low frequency’ (1–12 days) and 8% ( n = 1145) ‘high frequency’ (13–28 days) use. ATS use was most common among people attending for ATS or opioids as primary drug of concern. A multinomial regression ( N = 9981) identified that clients reporting recent arrest (aOR 1.74, 95% CI 1.36, 2.24), higher cannabis use frequency (aOR 1.01, 95% CI 1.00, 1.02), lower opioid use frequency (aOR 0.98, 95% CI 0.97, 0.99) and poorer quality of life (aOR 0.91, 95% CI 0.86, 0.97) were more likely to report ‘high frequency’ rather than ‘low frequency’ ATS use. People who use ATS experience health and social issues that may require targeted responses. These should be integrated across all services, not only for clients with ATS as principal drug of concern.
Publisher: American Medical Association (AMA)
Date: 09-04-2021
Publisher: Elsevier BV
Date: 11-2020
Publisher: Wiley
Date: 16-02-2022
DOI: 10.1111/DAR.13444
Abstract: Prior research has examined the prevalence and correlates of cannabis use disorder (CUD) in people who use cannabis however, these are poorly described for people using cannabis for medical reasons. Data came from a 2018 to 2019 online, anonymous, cross‐sectional survey of Australians reporting using either illicit or licit cannabis for medical reasons within the past year. Included were questions on demographics, current and lifetime patterns of cannabis use, clinical conditions for which medical cannabis was used, and in idual criteria for CUD and cannabis withdrawal syndrome. Bayesian Horseshoe logistic regression models were used to identify covariates associated with meeting CUD DSM‐5 conditions for any‐CUD (≥2/11 criteria) and moderate–severe‐CUD (≥4/11). A total of 905 participants were included in the analysis. The majority (98%) used illicit cannabis products. Criteria for any‐CUD criteria were met by 290 (32.0%), and 117 (12.9%) met criteria for moderate–severe‐CUD. Tolerance (21%) and withdrawal (35%) were the most commonly met criteria. Correlates with the strongest association with CUD were inhaled route of administration [odds ratio (OR) = 2.96, 95% credible interval 1.11, 7.06], frequency of cannabis use (OR = 1.24, 1.11–1.35), proportion of cannabis for medical reasons (OR = 0.83, 0.74, 0.94), frequency of tobacco use (OR = 1.10, 1.03, 1.17), age (OR = 0.75, 0.64, 0.90) and pain as main clinical indication (OR = 0.58, 0.36, 1.00). Prevalence of CUD in medical cannabis users appears comparable to ‘recreational’ users, with many similar correlates. CUD was associated with using cannabis to treat mental health rather than pain conditions and inhaled over other routes of administration.
Publisher: Elsevier BV
Date: 10-2071
Publisher: Elsevier BV
Date: 12-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-04-2021
DOI: 10.1097/ADM.0000000000000855
Abstract: To review the currently available evidence on transfer strategies from methadone to sublingual buprenorphine used in clinical trials and observational studies of medication for opioid use disorder treatment, and to consider whether any strategies yield better clinical outcomes than others. Six medical and public health databases were searched for articles and conference abstracts. The Cochrane Central Register of Controlled Trials and the World Health Organization International Clinical Trials Registry Platform were used to identify unpublished trial results. Records were dually screened, and data were extracted and checked independently. Results were summarized qualitatively and, when possible, analyzed quantitatively. Eighteen studies described transfer from methadone to buprenorphine. Transfer protocols were extremely varied. Most studies reported successful rates of transfer, even among studies involving transfer from high methadone doses, although lower pretransfer methadone dose was significantly associated with higher rate of successful transfer. Precipitated withdrawal was not reported frequently. A range of innovative approaches to transfer from methadone to buprenorphine remains untested. Few studies have used designs that enable comparison of different approaches to transfer patients from methadone to buprenorphine. Most international clinical guidelines provide recommendations consistent with the available evidence. However, clinical guidelines should be perceived as providing “guidance” rather than “protocols,” and clinicians and patients need to exercise judgment when attempting transfers.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-04-2021
DOI: 10.1097/ADM.0000000000000854
Abstract: The mainstay of treatment for opioid use disorder are medications, methadone (a full opioid agonist), or buprenorphine (a partial opioid agonist), in conjunction with psychosocial interventions. Both treatments are effective but safety, efficacy, and patient preference can lead to a decision to change from one treatment to the other. Transfer from buprenorphine to methadone is not clinically challenging however, changing from methadone to buprenorphine is more complex. Published reports describe varied approaches to manage this transfer to both minimize patient symptoms associated with withdrawal from methadone and reduce risk of precipitating withdrawal symptoms with introduction of the partial agonist buprenorphine [Lintzeris et al. J Addict Med . 2020 in press]. There is no single approach for methadone to buprenorphine that is superior to others and no approach that is suitable for all case presentations. This case conference describes three different approaches to achieve a successful methadone to buprenorphine transfer and provides commentary on how the case may be managed based on published transfer “strategies.”
Publisher: Wiley
Date: 04-01-2021
DOI: 10.1111/ADD.15331
Publisher: Wiley
Date: 26-01-2021
DOI: 10.1111/BCP.14715
Abstract: Pregabalin has become widely used as an alternative to opioids in treating certain types of chronic non‐cancer pain, but few studies have examined its clinical efficacy outside trials. We address this gap by examining the utilization, correlates and clinical outcomes of pregabalin use among an Australian community‐based cohort of people prescribed opioids for chronic non‐cancer pain. Through a five‐year prospective cohort study ( n = 1514) we examined associations between pregabalin use and pain severity and interference, mental health, opioid dose and past month use of ambulance and emergency department services. We used fixed‐effects regression models to examine within‐participant differences, and random‐effects regression models to examine within‐ and between‐participant differences in clinical outcomes. In an analysis of cases with complete data over five‐years ( n = 896), the prevalence of pregabalin use ranged from 16% at cohort entry to 29% at 36‐ and 48‐months, and 46% reported pregabalin use at any time during the five years. Pregabalin use was associated with greater pain severity and interference and greater use of high‐risk opioid doses ( oral morphine equivalents/day). Pregabalin use was not associated with changes in mental health symptoms, ambulance or emergency department attendance in the fixed or random effects models. Pregabalin use was common, but for most people use was not associated with clinically meaningful improvements in pain or functioning.
Publisher: Springer Science and Business Media LLC
Date: 17-03-2020
Publisher: Wiley
Date: 20-04-2022
DOI: 10.1111/DAR.13474
Abstract: Naloxone is a life‐saving medication that reverses opioid overdose naloxone can be provided on a ‘take‐home’ basis so naloxone can be administered outside of the health‐care setting. The Overdose Response and Take Home Naloxone (ORTHN) project established a model of care for take‐home naloxone (THN) interventions across alcohol and other drug and harm reduction services in NSW, Australia. This paper evaluates the staff training and credentialing program, and examines staff attitudes and perspectives regarding the provision of THN interventions in these settings. Staff across seven services were trained through a ‘train‐the‐trainer’ credentialing model to deliver ORTHN, including naloxone supply. Staff were surveyed regarding their experience, attitudes and knowledge on THN prior to and after training, and after 6 months. At the 6 months follow up, staff were asked about the interventions they provided, barriers and enablers to uptake, and opinions regarding future rollout. A total of 204 staff were trained and credentialed to provide the ORTHN intervention. Most (60%) were nurses, followed by needle syringe program workers and allied health/counsellors (32%). Linear and logistic regression analyses indicated that the training program was associated with significant improvements in staff knowledge and attitudes towards overdose and THN however, only attitudinal improvements were maintained over time. There were high rates of staff satisfaction with the ORTHN intervention and training. The ORTHN program is ‘fit for purpose’ for broad implementation in these settings. A number of potential barriers (e.g. time, medication and staffing costs) and enablers (e.g. peer engagement, regulatory framework for naloxone supply) in implementing THN interventions were identified.
Publisher: Wiley
Date: 24-04-2023
DOI: 10.1111/DAR.13671
Abstract: Standardised data collection processes allow for harmonisation and comparison of data across different studies and services. This project aimed to develop a ‘core dataset’ to serve as the default collection when designing future studies and evaluations, building upon data routinely collected in clinical alcohol and other drugs (AOD) settings in NSW, Australia. A working group was established, comprising clinicians, researchers, data managers and consumers from public sector and non‐government organisation AOD services in the NSW Drug and Alcohol Clinical Research and Improvement Network. A series of Delphi meetings occurred to reach consensus on the data items to be included in the core dataset for three domains: demographics, treatment activity and substance use variables. There were 20–40 attendees at each meeting. An initial consensus criterion of having received % of the vote was established. Given the difficulty in reaching consensus for most items, subsequently, this was changed to eliminate items that received votes, after which the item receiving the most votes would be selected. This important process received considerable interest and buy‐in across the NSW AOD sector. Ample opportunity for discussion and voting was provided for the three domains of interest, allowing participants to contribute their expertise and experience to inform decisions. As such, we believe the core dataset includes the best options currently available to collect data for these domains in the NSW AOD context, and potentially more broadly. This foundational study may inform other attempts to harmonise data across AOD services.
Publisher: Wiley
Date: 04-03-2020
DOI: 10.1111/DAR.13050
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: 22-12-2021
DOI: 10.1111/ADB.13125
Abstract: Some evidence suggests that males and females may differ in their responses to acute cannabis effects, including subjective drug effects and behavioural effects, and cannabinoid pharmacokinetics. This is significant given current changes to cannabis‐related policies and, in consequence, increased cannabis accessibility. The present study combines data from two randomized controlled trials to investigate possible differences among males ( n = 21) and females ( n = 19) in the acute effects of vaporized cannabis containing 13.75 mg Δ9‐tetrahydrocannabinol (THC), with and without cannabidiol (CBD 13.75 mg). To control for differences in the timing of assessments, peak (or peak change from baseline) scores were calculated for a range of measures including subjective drug effects, cognitive performance, cardiovascular effects, and plasma concentrations of THC, CBD, and their respective primary metabolites. While THC elicited robust and significant changes in all but one outcome measure relative to placebo, relatively few sex differences were observed after controlling for BMI and plasma THC concentrations. Relative to females, males performed better overall on a ided attention task (DAT) and had higher peak plasma concentrations of 11‐nor‐9‐carboxy‐THC (11‐COOH‐THC). Males and females did not differ with respect to plasma concentrations of any other analyte, subjective drug effects, or cardiovascular measures. These data indicate an absence of systematic sex differences in acute cannabis effects given a moderate dose of vaporized cannabis. They do not preclude the possibility that sex differences may emerge with higher THC doses or with other commonly used routes of administration (e.g., orally administered oils or edibles).
Publisher: Wiley
Date: 19-10-2020
DOI: 10.1111/JSR.13211
Publisher: Wiley
Date: 27-11-2019
DOI: 10.1111/DAR.13015
Abstract: Take-home naloxone (THN) interventions are an effective response to preventing overdose deaths, however uptake across Australia remains limited. This project designed, implemented and evaluated a model of care targeting opioid users attending alcohol and other drug (AOD) treatment, needle and syringe programs (NSP) and related health services targeting people who inject drugs. Service providers, consumers and regulators collaboratively designed a THN brief intervention (ORTHN, Overdose Response with Take-Home Naloxone) involving client education and supply of naloxone in pre-filled syringes, delivered by nursing, allied health and NSP workers. ORTHN interventions were implemented in over 15 services across New South Wales, Australia. The evaluation included client knowledge, attitudes, substance use and overdose experiences immediately before and 3 months after ORTHN intervention in a subs le of participants. Six hundred and sixteen interventions were delivered, with 145 participants recruited to the research subs le, of whom 95 completed the three-month follow up. Overdose-related attitudes amongst participants improved following ORTHN, with no evidence of increased substance use or failure to implement other 'first responses' (e.g. calling an ambulance). Nine participants (10%) reversed an overdose using THN in the follow-up period. Participants identified a willingness to access THN from a range of services. While a minority (16%) indicated they were unwilling to pay for THN, the median price that participants were willing to pay was $AUD20 (IQR $10.40). The ORTHN model of care for THN appears an effective way to disseminate THN to people who use opioids attending AOD, NSP and related health-care settings.
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2020-044696
Abstract: To examine the safety of an agonist-type treatment, lisdexamfetamine (LDX), at 250 mg/day among adults with meth hetamine (MA) dependence. A dose-escalating, phase-2, open-label, single-group study of oral LDX at two Australian drug treatment services. The study was conducted at two Australian stimulant use disorder treatment clinics. There were 16 participants: at least 18 years old, MA dependent for at least the preceding 2 years using ICD-10 criteria, reporting use of MA on at least 14 of the preceding 28 days. Daily, supervised LDX of 100–250 mg, single-blinded to dose, ascending-descending regimen over 8 weeks (100–250 mg over 4 weeks followed by 4-week dose reduction regimen, 250–100 mg). Participants were followed through to week 12. Primary outcomes were safety, drug tolerability and regimen completion at the end of week 4. Participants were followed to week 12. Secondary outcomes included: change in MA use craving withdrawal severity of dependence risk behaviour change in other substance use medication acceptability potential for non-prescription use adherence and neurocognitive functioning. Fourteen of 16 participants (87.5%) completed escalation to 250 mg/day. Two participants withdrew from the trial in the first week: one relocated away from the study site, the other self-withdrew due to a possible, known side effect of LDX (agitation). There was one serious adverse event of suicidal ideation which resolved. All other adverse events were mild or moderate in severity and known side effects of LDX. No participant was withdrawn due to adverse events. MA use decreased from a median of 21 days (IQR: 16–23) to 13 days (IQR: 11–17) over the 4-week escalation period (p=0.013). LDX at a dose of up to 250 mg/day was safe and well tolerated by study participants, warranting larger trials as a pharmacotherapy for MA dependence. ACTRN12615000391572.
Publisher: Elsevier BV
Date: 05-2021
Publisher: American Medical Association (AMA)
Date: 10-05-2021
Publisher: Wiley
Date: 16-07-2021
DOI: 10.1111/ADD.15627
Abstract: Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under‐treatment of opioid dependence in these settings world‐wide. This study assessed the safety of subcutaneous slow‐release depot buprenorphine in custody. Open‐label, non‐randomized trial. Correctional centres in New South Wales, Australia. Sixty‐seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM‐5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine patients already stable on oral methadone treatment were recruited to the comparison arm. Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone. Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self‐reported ersion and substance use at baseline and weeks 4 and 16. Retention in depot buprenorphine treatment was 92.3%. Ninety‐four per cent of patients reported at least one adverse event, typically mild and transient. No ersion was identified. The prevalence of self‐reported non‐prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007–0.018, P 0.0001). This first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of ersion.
No related grants have been discovered for Nicholas Lintzeris.