Changes in Quality of Life following Buprenorphine Treatment: Relationship with Treatment Retention and Illicit Opioid Use.

Buprenorphine Research (PubMed) - Fri, 05/08/2015 - 9:00am
Related Articles

Changes in Quality of Life following Buprenorphine Treatment: Relationship with Treatment Retention and Illicit Opioid Use.

J Psychoactive Drugs. 2015 Apr-Jun;47(2):149-157

Authors: Mitchell SG, Gryczynski J, Schwartz RP, Myers CP, O'Grady KE, Olsen YK, Jaffe JH

Abstract
Studies of substance abuse treatment outcomes that give priority to cessation of all drug use may obscure other tangible benefits of treatment that are important to patients. The aim of this study was to examine the association between changes in quality of life (QoL) and: (1) retention in treatment; and (2) opioid use as measured by self-report and urine testing. Participants were 300 African American men and women starting outpatient buprenorphine treatment. Participants completed assessments at baseline, three and six months consisting of the World Health Organization's Quality of Life brief scale, Addiction Severity Index, and urine testing for opioids. There were statistically significant increases over time across all four QoL domains: physical, psychological, environmental, and social. Self-reported frequency of opioid use was negatively associated with psychological QoL, but opioid urine test results were not significantly associated with any QoL domains. Continued treatment enrollment was significantly associated with higher psychological QoL and environmental QoL. Patients entering buprenorphine treatment experience improvements in QoL, which are amplified for patients who remain in treatment. Point-prevalence opiate urine test results obtained at each assessment were not associated with any of the QoL domains and may not accurately reflect improvements perceived by patients receiving buprenorphine treatment.

PMID: 25950595 [PubMed - as supplied by publisher]

Categories: Bup Feeds

The introduction of buprenorphine-naloxone film in opioid substitution therapy in Australia: Uptake and issues arising from changing buprenorphine formulations.

Buprenorphine Research (PubMed) - Fri, 05/08/2015 - 9:00am
Related Articles

The introduction of buprenorphine-naloxone film in opioid substitution therapy in Australia: Uptake and issues arising from changing buprenorphine formulations.

Drug Alcohol Rev. 2015 May 6;

Authors: Larance B, Dietze P, Ali R, Lintzeris N, White N, Jenkinson R, Degenhardt L

Abstract
INTRODUCTION AND AIMS: 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.
DESIGN AND METHODS: 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.
RESULTS: 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/prescriber 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/prescriber-recommended transfer was not.
DISCUSSION AND CONCLUSIONS: The introduction of BNX film in Australia varied across States. A perception of restricted choice in medication may have undermined initial acceptance in SA. [Larance B, Dietze P, Ali R, Lintzeris N, White N, Jenkinson R, Degenhardt L. The introduction of BNX film in opioid substitution therapy in Australia: Uptake and issues arising from changing buprenorphine formulations. Drug Alcohol Rev 2015;●●:●●-●●].

PMID: 25950232 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Pharmacokinetic and pharmacodynamic evaluation of high doses of buprenorphine delivered via high-concentration formulations in cats.

Buprenorphine Research (PubMed) - Thu, 05/07/2015 - 6:00am

Pharmacokinetic and pharmacodynamic evaluation of high doses of buprenorphine delivered via high-concentration formulations in cats.

J Feline Med Surg. 2015 May 5;

Authors: Taylor PM, Luangdilok CH, Sear JW

Abstract
OBJECTIVES: To evaluate the potential benefits of high-dose buprenorphine formulations for analgesia in cats, serial and crossover studies were undertaken to investigate their pharmacokinetics and thermal antinociceptive effects.
METHODS: Twelve healthy adult domestic shorthair cats (6.0 ± 1.1 kg bodyweight) were studied. Aqueous solutions of buprenorphine hydrochloride at 0, 0.02, 0.06, 0.12 and 0.24 mg/kg bodyweight and formulations containing 0, 0.3, 0.6 and 1.2 mg/ml with and without preservatives were given subcutaneously. Blood samples were taken and thermal threshold (TT) measured prior to and at regular time points up to 72 h after dosing. Descriptive statistics and analyses of variance were applied as appropriate.
RESULTS: Baseline TT was 47.6 ± 4.1°C, which increased in all groups treated with all buprenorphine dosages and formulations. After doses of 0.12 mg/kg and above, TT was significantly higher than baseline at most time points from 1-30 h post-treatment. The time to maximum effect (Tmax) ranged between 0.25 and 2.00 h; and plasma concentrations associated with maximum antinociceptive effect (Cmax) were 1.01-1.72 ng/ml after the 0.02 mg/kg dose, 1.4-4.9 ng/ml after the 0.06 mg/kg dose, 4.6-51.4 ng/ml after the 0.12 mg/kg dose and 5.3-22.3 ng/ml after the 0.24 mg/kg dose. The range of estimates for the buprenorphine elimination half-life were as follows: 0.02 mg/kg = 1.35-5.33 h; 0.06 mg/kg = 16.1-31.2 h; 0.12 mg/kg = 10.1-34.0 h; and 0.24 = mg/kg 16.1-31.6 h. The mean 'plasma concentration for the offset of analgesia' was 2.3 ± 2.0 ng/ml. No adverse effects were seen. The addition of preservatives to a high-concentration buprenorphine formulation had no impact on antinociception nor any side effects.
CONCLUSIONS AND RELEVANCE: Aqueous high-concentration buprenorphine formulations administered at 0.12 or 0.24 mg/kg have potential for clinical use in cats, providing prolonged antinociception in a single subcutaneous injection of minimal dose volume.

PMID: 25944578 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Interim treatment: Bridging delays to opioid treatment access.

Buprenorphine Research (PubMed) - Wed, 05/06/2015 - 7:00am
Related Articles

Interim treatment: Bridging delays to opioid treatment access.

Prev Med. 2015 Apr 30;

Authors: Sigmon SC

Abstract
OBJECTIVE: Despite the undisputed effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. To mitigate these risks, the Food and Drug Administration in 1993 approved interim treatment, involving daily medication+emergency counseling only, when only a waitlist is otherwise available. We review the published research in the 20years since the approval of interim opioid treatment.
METHODS: A literature search was conducted to identify all randomized trials evaluating the efficacy of interim treatment for opioid-dependent patients awaiting comprehensive treatment.
RESULTS: . Interim opioid treatment has been evaluated in four controlled trials to date. In three, interim treatment was compared to waitlist or placebo control conditions and produced greater outcomes on measures of illicit opioid use, retention, criminality and likelihood of entry into comprehensive treatment. In the fourth, interim treatment was compared to standard methadone maintenance and produced comparable outcomes in illicit opioid use, retention and criminal activity.
CONCLUSIONS: Interim treatment significantly reduces patient and societal risks when conventional treatment is unavailable. Further research is needed to examine the generality of these findings, further enhance outcomes, and identify the patient characteristics which predict treatment response.

PMID: 25937593 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Importance of research and services among people who inject drugs in Pakistan.

Buprenorphine Research (PubMed) - Wed, 05/06/2015 - 7:00am
Related Articles

Importance of research and services among people who inject drugs in Pakistan.

J Pak Med Assoc. 2014 Dec;64(12):1413-4

Authors: Altaf A, Shah SA, Vermund S

PMID: 25842589 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

Buprenorphine/naloxone treatment practices in Malaysia: Results of national surveys of physicians and patients.

Buprenorphine Research (PubMed) - Tue, 05/05/2015 - 10:30am

Buprenorphine/naloxone treatment practices in Malaysia: Results of national surveys of physicians and patients.

Drug Alcohol Depend. 2015 Apr 21;

Authors: Vicknasingam B, Dazali MN, Singh D, Schottenfeld RS, Chawarski MC

Abstract
OBJECTIVE: Medication assisted treatment with buprenorphine/naloxone (Bup/Nx), including prescribing and dispensing practices of general practitioners (GPs) in Malaysia and their patients' experiences with this treatment have not been systematically examined. The current study surveyed GPs providing Bup/Nx treatment and patients receiving office-based Bup/Nx treatment in Malaysia.
METHODS: Two cross-sectional surveys of GPs (N=115) providing outpatient Bup/Nx maintenance treatment and of patients (N=253) currently receiving Bup/Nx treatment throughout peninsular Malaysia.
RESULTS: Physicians prescribed Bup/Nx dosages in the range of 2-4mg daily for 70% of patients and conducted urine testing in the past month on approximately 16% of their patients. In the patient survey, 79% reported taking daily Bup/Nx doses of 2mg or less; 82% reported that no urine toxicology testing had been conducted on them in the past month, 36% had an opiate positive urine test at the time of the survey, 43% reported illicit opiate use, 15% reported injection of heroin and 22% reported injection of Bup/Nx in the past month.
CONCLUSION: Low daily Bup/Nx doses, lack of behavioral monitoring or counseling, and high rates of continued drug use, including injection of drugs and medications during Bup/Nx treatment in Malaysia, indicate continuing problems with implementation and less than optimal treatment effectiveness. High cost of Bup/Nx in Malaysia may deter patients from seeking treatment and contribute to taking low Bup/Nx dosages. Improved training of physicians and establishing standards for Bup/Nx dosing, routine toxicology testing, and counseling may be needed to improve care and treatment response.

PMID: 25935736 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Factors associated with willingness to take extended release naltrexone among injection drug users.

Buprenorphine Research (PubMed) - Tue, 05/05/2015 - 10:30am

Factors associated with willingness to take extended release naltrexone among injection drug users.

Addict Sci Clin Pract. 2015 May 3;10(1):12

Authors: Ahamad K, Milloy MJ, Nguyen P, Uhlmann S, Johnson C, Korthuis TP, Kerr T, Wood E

Abstract
BACKGROUND: Although opioid-agonist therapy with methadone or buprenorphine/naloxone is currently the mainstay of medical treatment for opioid use disorder, these medications often are not well accepted or tolerated by patients. Recently, extended release naltrexone (XR-NTX), an opioid antagonist, has been advanced as an alternative treatment. The willingness of opioid-addicted patients to take XR-NTX has not been well described.
METHODS: Opioid-using persons enrolled in a community-recruited cohort in Vancouver, Canada, were asked whether or not they would be willing to take XR-NTX. Logistic regression was used to independently identify factors associated with willingness to take the medication.
RESULTS: Among the 657 participants surveyed between June 1, 2013, and November 30, 2013, 342 (52.1%) were willing to take XR-NTX. One factor positively associated with willingness was daily heroin injection (adjusted odds ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.02-2.31), whereas Caucasian ethnicity was negatively associated (AOR = 0.59; 95% CI = 0.43-0.82). Satisfaction with agonist therapy (13.4%) and unwillingness to stop opioids being used for pain (26.9%) were the most common reasons for being unwilling to take XR-NTX.
CONCLUSIONS: A high level of willingness to take XR-NTX was observed in this setting. Interestingly, daily injection heroin use was positively associated with willingness, whereas Caucasian participants were less willing to take XR-NTX. Although explanations for unwillingness were described in this study, further research is needed to investigate real-world acceptability of XR-NTX as an additional option for the treatment of opioid use disorder.

PMID: 25935714 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Direct Injection LC-MS-MS Analysis of Opiates, Methamphetamine, Buprenorphine, Methadone and Their Metabolites in Oral Fluid from Substitution Therapy Patients†.

Buprenorphine Research (PubMed) - Tue, 05/05/2015 - 10:30am

Direct Injection LC-MS-MS Analysis of Opiates, Methamphetamine, Buprenorphine, Methadone and Their Metabolites in Oral Fluid from Substitution Therapy Patients†.

J Anal Toxicol. 2015 May 2;

Authors: Liu HC, Lee HT, Hsu YC, Huang MH, Liu RH, Chen TJ, Lin DL

Abstract
A rapid and sensitive liquid chromatography-tandem mass spectrometry (LC-MS-MS) method was developed, validated and applied to simultaneous analysis of oral fluid samples for the following 10 analytes: methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), buprenorphine, norbuprenorphine, morphine, codeine, 6-acetylmorphine, 6-acetylcodeine, amphetamine, and methamphetamine. The oral fluid sample was briefly centrifuged and the supernatant was directly injected into the LC-MS-MS system operated under reverse-phase chromatography and electrospray ionization (ESI). Deuterated analogs of the analytes were adopted as the internal standards and found to be effective (except for buprenorphine) to compensate for potential matrix effects. Each analytical run took <10 min. Linearity range (r(2) > 0.99) established for buprenorphine and the other nine analytes were 5-100 and 1-100 ng/mL. Intra- and interday precision (% CV) ranges for the 10 analytes were 0.87-12.2% and 1.27-12.8%, while the corresponding accuracy (%) ranges were 91.8-113% and 91.9-111%. Limits of detection and quantitation established for these 10 analytes were in the ranges of 0.1-1.0 and 0.25-1.0 ng/mL (5 ng/mL for buprenorphine). The method was successfully applied to the analysis of 62 oral fluid specimens collected from patients participating in methadone and buprenorphine substitution therapy programs. Analytical results of methadone and buprenorphine were compared with data derived from GC-MS analysis and found to be compatible. Overall, the direct injection LC-MS-MS method performed well, permitting rapid analysis of oral fluid samples for simultaneous quantification of methadone, buprenorphine, opiate and amphetamine drug categories without extensive sample preparation steps.

PMID: 25935159 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Diversion of opioid maintenance treatment medications and predictors for diversion among Finnish maintenance treatment patients.

Buprenorphine Research (PubMed) - Sun, 05/03/2015 - 9:00am
Related Articles

Diversion of opioid maintenance treatment medications and predictors for diversion among Finnish maintenance treatment patients.

Int J Drug Policy. 2015 Apr 1;

Authors: Launonen E, Alho H, Kotovirta E, Wallace I, Simojoki K

Abstract
BACKGROUND: Diversion (i.e. selling or giving away) of opioid maintenance treatment (OMT) medications is a challenge that concerns many units providing OMT worldwide and tools for prevention are needed. The object of this study was to examine the prevalence and predictors for diversion of the OMT medications buprenorphine-naloxone (BNX) and methadone (MET) among Finnish OMT patients.
METHODS: A cross-sectional study was conducted among all Finnish OMT patients of whom 60% (n=1508) participated. The data were collected by anonymous questionnaires distributed through all OMT units in Finland. To evaluate predictors for diversion, we used binominal regression analysis with unadjusted and adjusted ORs. Selling and/or giving away of OMT medication was used as a dependent variable and explanatory variables were gender, age, duration of OMT, type of OMT medication and dose, dispensation method of OMT medication, place of residence and intravenous use of any intoxicating drugs during the past six months.
RESULTS: Of all 1508 respondents, 7% (n=100) had sold and 12% (n=169) had given their OMT medication to others, 57% for money and 23% in exchange for other drugs. In multivariate analysis, predictors associated with diversion were BNX as OMT medication (OR 2.76, 95% CI 1.76-4.33), low (<9.0mg/day) BNX dose (OR 1.74, 95% CI 1.01-2.98), intravenous use of intoxicating drugs during the past six months (OR 4.48, 95% CI 3.13-6.43) and increasing length of OMT (OR 1.01, 95% CI 1.01-1.02). Age, place of residence or unsupervised pharmacy distribution of BNX were not associated with diversion.
CONCLUSIONS: In order to reduce diversion, more interventions are needed to support patients to stop concurrent substance abuse. Increasing control measures, for example, increased supervision, are unlikely to prevent diversion. Given that sub-optimal dosing of BNX increases the risk of diversion, more attention should be paid to providing patients with an optimal medical dose.

PMID: 25934054 [PubMed - as supplied by publisher]

Categories: Bup Feeds

The impact of chronic pain on opioid addiction treatment: a systematic review protocol.

Buprenorphine Research (PubMed) - Fri, 05/01/2015 - 8:30am
Related Articles

The impact of chronic pain on opioid addiction treatment: a systematic review protocol.

Syst Rev. 2015;4(1):49

Authors: Dennis BB, Bawor M, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z

Abstract
BACKGROUND: The consequences of opioid relapse among patients being treated with opioid substitution treatment (OST) are serious and can result in abnormal cardiovascular function, overdose, and mortality. Chronic pain is a major risk factor for opioid relapse within the addiction treatment setting. There exist a number of opioid maintenance therapies including methadone, buprenorphine, naltrexone, and levomethadyl acetate (LAAM), of which the mediating effects of pain on treatment attrition, substance use behavior, and social functioning may differ across therapies. We aim to 1) evaluate the impact of pain on the treatment outcomes of addiction patients being managed with OST and 2) identify the most recently published opioid maintenance treatment guidelines from the United States, Canada, and the UK to determine how the evidence is being translated into clinical practice.
METHODS/DESIGN: The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Dissertations and theses Database, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. We will search www.
GUIDELINES: gov and the National Institute for Care and Excellence (NICE) databases to identify the most recently published OST guidelines. All screening and data extraction will be completed in duplicate. Provided the data are suitable, we will perform a multiple treatment comparison using Bayesian meta-analytic methods to produce summary statistics estimating the effect of chronic pain on all OSTs. Our primary outcome is substance use behavior, which includes opioid and non-opioid substance use. We will also evaluate secondary endpoints such as treatment retention, general physical health, intervention adherence, personal and social functioning, as well as psychiatric symptoms.
DISCUSSION: This review will capture the experience of treatment outcomes for a sub-population of opioid addiction patients and provide an opportunity to distinguish the best quality guidelines for OST. If chronic pain truly does result in negative consequences for opioid addiction patients, it is important we identify which OSTs are most appropriate for chronic pain patients as well as ensure the treatment guidelines incorporate this information.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014014015 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014015#.VS1Qw1wkKGM.

PMID: 25927914 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Maintenance Treatment with Opium Tincture: A Preliminary Qualitative Study of the Factors Related to Treatment entry.

Buprenorphine Research (PubMed) - Fri, 05/01/2015 - 8:30am
Related Articles

Maintenance Treatment with Opium Tincture: A Preliminary Qualitative Study of the Factors Related to Treatment entry.

Iran J Public Health. 2014 Aug;43(8):1123-31

Authors: Daneshmand R, Alam Mehrjerdi Z, Samiee M

Abstract
BACKGROUND: The current preliminary study aimed to explore the reasons that a group of opiate-dependent patients reported for entry into opium tincture treatment (OTT).
METHODS: Through examinations of 52 qualitative focus group interviews with patients from six OTT centers and 10 health providers (in key informant interviews) in Tehran, this study highlights the factors that participants reported as the reasons associated with entry into OTT. Quantitative data including demographic data and details of drug use were analyzed by using SPSS.v.18.0. Qualitative data was analyzed by using Atlas-ti software.
RESULTS: 86.5% of patients were male and 13.5% were female. The median age of patients was 39 yr. The most frequently reasons associated with entry into OTT included methadone misconceptions including dissatisfaction with taking methadone as a chemical medication, methadone dependence, and long duration of MMT. The other reasons included the recommendation of other people in treatment and OT-related characteristics and expectations including the herbal compound of OT, treating opiate craving and withdrawal symptoms, and improving general health.
CONCLUSION: The study findings preliminarily showed the reasons associated with entry into OTT in a sample of treatment seekers. Longitudinal studies with more representative samples and follow-up stages are required to evaluate the clinical effectiveness of OTT as a maintenance treatment in comparison with methadone and buprenorphine. Patient-centered program and policy implications are discussed.

PMID: 25927042 [PubMed]

Categories: Bup Feeds

Medicaid coverage of medications to treat alcohol and opioid dependence.

Buprenorphine Research (PubMed) - Thu, 04/30/2015 - 7:00am

Medicaid coverage of medications to treat alcohol and opioid dependence.

J Subst Abuse Treat. 2015 Apr 16;

Authors: Mark TL, Lubran R, McCance-Katz EF, Chalk M, Richardson J

Abstract
Substance use disorders affect 12% of Medicaid beneficiaries. The prescription drug epidemic and growing need for treatment of alcohol and opioid dependence have refocused states' attention on their provision of substance use disorder treatment services, including medications. This study characterized how Medicaid programs cover these treatment medications. Data were from 2013 Medicaid pharmacy documents, 2011 and 2012 Medicaid state drug utilization records, and a 2013 American Society of Addiction Medicine survey. Results showed that only 13 state Medicaid programs included all medications approved for alcohol and opioid dependence on their preferred drug lists. The most commonly excluded were extended-release naltrexone (19 programs), acamprosate (19 programs), and methadone (20 programs). For combined buprenorphine-naloxone, 48 Medicaid programs required prior authorization, and 11 programs used 1- to 3-year lifetime treatment limits. Given the chronic nature of substance use disorders and the overwhelming evidence supporting ongoing coverage for many of these medications, states may want to reexamine substance use disorder benefits.

PMID: 25921475 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Erratum.

Buprenorphine Research (PubMed) - Thu, 04/30/2015 - 7:00am
Related Articles

Erratum.

J Addict Nurs. 2015 Jan-Mar;26(1):52

Authors:

Abstract
The publisher found that the following CE tests were published with incorrect DOIs:In the CE Test for "The Baltimore Buprenorphine Initiative: Understanding the Role of Buprenorphine in Addressing Heroin Addiction in an Urban-Based Community." (2014). Journal of Addictions Nursing, 25(1), 26Y27, doi: 10.1097/JAN.0000000000000013 should have been doi: 10.1097/JAN.0000000000000024. In the CE Test for "Substance Abuse Treatment Processes and Outcomes in Day/Outpatient Health Maintenance Organization Setting." (2014). Journal of Addictions Nursing, 25(3), 137Y138, doi: 10.1097/JAN.0000000000000013 should have been doi: 10.1097/JAN.0000000000000044. In the CE Test for "NADA Protocol: Integrative Acupuncture in Addictions." (2014). Journal of Addictions Nursing, 25(4), 188Y189, doi: 10.1097/JAN.0000000000000013 should have been doi: 10.1097/JAN.0000000000000057.

PMID: 25920103 [PubMed - in process]

Categories: Bup Feeds

Pages

Subscribe to BupPractice aggregator - Bup Feeds