Bup Feeds

Costs of care for persons with opioid dependence in commercial integrated health systems.

Buprenorphine Research (PubMed) - Sat, 08/16/2014 - 6:00am

Costs of care for persons with opioid dependence in commercial integrated health systems.

Addict Sci Clin Pract. 2014 Aug 14;9(1):16

Authors: Lynch FL, McCarty D, Mertens J, Perrin NA, Green CA, Parthasarathy S, Dickerson JF, Anderson BM, Pating D

Abstract
BACKGROUND: When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems.Objectives: To examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective.Research design: Retrospective cohort study.Subjects: Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204), over the time span 2007-2008.Measures: Health system utilization, cost, propensity scores.
RESULTS: Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment = $31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002).
CONCLUSIONS: Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives.

PMID: 25123823 [PubMed - as supplied by publisher]

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Methadone maintenance treatment may improve completion rates and delay opioid relapse for opioid dependent individuals under community corrections supervision.

Buprenorphine Research (PubMed) - Fri, 08/15/2014 - 6:30am

Methadone maintenance treatment may improve completion rates and delay opioid relapse for opioid dependent individuals under community corrections supervision.

Addict Behav. 2014 Jul 10;39(12):1736-1740

Authors: Clark CB, Hendricks PS, Lane PS, Trent L, Cropsey KL

Abstract
AIMS: Several studies have demonstrated the importance of agonist therapies such as methadone and buprenorphine for preventing relapse for individuals being released from jail or prison to the community. No studies have examined the impact of methadone for increasing the completion of community supervision requirements and preventing opioid relapse for individuals under community corrections supervision. This observational study compared the community corrections completion rate and opioid relapse rate of individuals receiving methadone maintenance therapy (MMT) to individuals who did not.
METHODS: Of the 2931 individuals enrolled under criminal justice supervision in the community, Treatment Accountability for Safer Communities (TASC), and who met criteria for opioid dependence, 329 (11%) individuals reported receiving MMT in the community.
RESULTS: The majority of participants were White (79.8%) and male (63.5%), with a mean age of 31.33years (SD=9.18), and were under supervision for 10.4months (SD=9.1). MMT participants were less likely to fail out of supervision compared to individuals not in MMT (39.0% vs. 52.9%, p<0.001), and had a lower rate of relapse (32.9%) and longer time to relapse (average days=89.7, SD=158.9) compared to the relapse rate (55.9%) and time to relapse (average days=60.5, SD=117.9) of those not on MMT.
CONCLUSIONS: While the observational nature of this study prevents causal inferences, these results suggest that utilization of MMT in community corrections may increase the likelihood of completing supervision requirements and delay time to opioid relapse. Providing agonist therapies to opioid dependent individuals under supervision appears to be a critical strategy in this important population.

PMID: 25117851 [PubMed - as supplied by publisher]

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Opioid Selective Antinociception Following Microinjection into the Periaqueductal Gray of the Rat.

Buprenorphine Research (PubMed) - Tue, 08/12/2014 - 9:00am
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Opioid Selective Antinociception Following Microinjection into the Periaqueductal Gray of the Rat.

J Pain. 2014 Aug 5;

Authors: Morgan MM, Reid RA, Stormann TM, Lautermilch NJ

Abstract
Morphine and fentanyl produce antinociception in part by binding to mu-opioid receptors (MOPr) in the periaqueductal gray (PAG). The present study tested the hypothesis that the PAG also contributes to the antinociceptive effects of other commonly used opioids (oxycodone, methadone, & buprenorphine). Microinjection of high doses of oxycodone (32 - 188 μg/0.4 μl) into the ventrolateral PAG of the rat produced a dose dependent increase in hot plate latency. This antinociception was evident within 5 min and nearly gone by 30 min. In contrast, no antinociception was evident following microinjection of methadone or buprenorphine into the ventrolateral PAG despite use of a wide range of doses and test times. Antinociception was evident following subsequent microinjection of morphine into the same injection sites or following systemic administration of buprenorphine demonstrating that the injections sites and drugs could support antinociception. Antinociception to systemic, but not PAG administration of buprenorphine occurred in both male and female rats. These and previous data demonstrate that the MOPr signaling pathway for antinociception in the PAG is selectively activated by some commonly used opioids (e.g., morphine, fentanyl and oxycodone), but not others (e.g., methadone or buprenorphine). The fact that methadone and buprenorphine produce antinociception following systemic administration demonstrates that MOPr signaling varies depending on location in the nervous system.
PERSPECTIVE: This study demonstrates that the periaqueductal gray contributes to the antinociceptive effects of some commonly used opioids (morphine, fentanyl and oxycodone), but not others (methadone or buprenorphine). Such functional selectivity in periaqueductal gray mediated opioid antinociception helps explain why the analgesic profile of opioids is so variable.

PMID: 25106089 [PubMed - as supplied by publisher]

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Faster, better, stronger: Towards new antidepressant therapeutic strategies.

Buprenorphine Research (PubMed) - Wed, 08/06/2014 - 7:30am

Faster, better, stronger: Towards new antidepressant therapeutic strategies.

Eur J Pharmacol. 2014 Aug 1;

Authors: O'Leary OF, Dinan TG, Cryan JF

Abstract
Major depression is a highly prevalent disorder and is predicted to be the second leading cause of disease burden by 2020. Although many antidepressant drugs are currently available, they are far from optimal. Approximately 50% of patients do not respond to initial first line antidepressant treatment, while approximately one third fail to achieve remission following several pharmacological interventions. Furthermore, several weeks or months of treatment are often required before clinical improvement, if any, is reported. Moreover, most of the commonly used antidepressants have been primarily designed to increase synaptic availability of serotonin and/or noradrenaline and although they are of therapeutic benefit to many patients, it is clear that other therapeutic targets are required if we are going to improve the response and remission rates. It is clear that more effective, rapid-acting antidepressants with novel mechanisms of action are required. The purpose of this review is to outline the current strategies that are being taken in both preclinical and clinical settings for identifying superior antidepressant drugs. The realisation that ketamine has rapid antidepressant-like effects in treatment resistant patients has reenergised the field. Further, developing an understanding of the mechanisms underlying the rapid antidepressant effects in treatment-resistant patients by drugs such as ketamine may uncover novel therapeutic targets that can be exploited to meet the Olympian challenge of developing faster, better and stronger antidepressant drugs.

PMID: 25092200 [PubMed - as supplied by publisher]

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Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients: A Randomized Clinical Trial.

Buprenorphine Research (PubMed) - Tue, 08/05/2014 - 9:00am
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Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients: A Randomized Clinical Trial.

JAMA Intern Med. 2014 Aug 1;174(8):1369-1376

Authors: Liebschutz JM, Crooks D, Herman D, Anderson B, Tsui J, Meshesha LZ, Dossabhoy S, Stein M

Abstract
Importance: Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known.
Objective: To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization.
Design, Setting, and Participants: From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group.
Interventions: Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital's primary care clinic (linkage).
Main Outcomes and Measures: Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report).
Results: During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P < .001). At 6 months, 12 linkage participants (16.7%) and 2 detoxification participants (3.0%) were receiving buprenorphine OAT (P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P < .01) in an intent-to-treat analysis.
Conclusions and Relevance: Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge.
Trial Registration: clinicaltrials.gov Identifier: NCT00987961.

PMID: 25090173 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Adding an Internet-Delivered Treatment to an Efficacious Treatment Package for Opioid Dependence.

Buprenorphine Research (PubMed) - Tue, 08/05/2014 - 9:00am
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Adding an Internet-Delivered Treatment to an Efficacious Treatment Package for Opioid Dependence.

J Consult Clin Psychol. 2014 Aug 4;

Authors: Christensen DR, Landes RD, Jackson L, Marsch LA, Mancino MJ, Chopra MP, Bickel WK

Abstract
Objective: To examine the benefit of adding an Internet-delivered behavior therapy to a buprenorphine medication program and voucher-based motivational incentives. Method: A block-randomized, unblinded, parallel, 12-week treatment trial was conducted with 170 opioid-dependent adult patients (mean age = 34.3 years; 54.1% male; 95.3% White). Participants received an Internet-based community reinforcement approach intervention plus contingency management (CRA+) and buprenorphine or contingency management alone (CM-alone) plus buprenorphine. The primary outcomes, measured over the course of treatment, were longest continuous abstinence, total abstinence, and days retained in treatment. Results: Compared to those receiving CM-alone, CRA+ recipients exhibited, on average, 9.7 total days more of abstinence (95% confidence interval [CI = 2.3, 17.2]) and had a reduced hazard of dropping out of treatment (hazard ratio = 0.47; 95% CI [0.26, 0.85]). Prior treatment for opioid dependence significantly moderated the additional improvement of CRA+ for longest continuous days of abstinence. Conclusions: These results provide further evidence that an Internet-based CRA+ treatment is efficacious and adds clinical benefits to a contingency management/medication based program for opioid dependence. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

PMID: 25090043 [PubMed - as supplied by publisher]

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