Regaining control: The patient experience of supervised compared with unsupervised consumption in opiate substitution treatment

2013 ◽  
Vol 33 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Caitlin Notley ◽  
Richard Holland ◽  
Vivienne Maskrey ◽  
Jessica Nagar ◽  
Christos Kouimtsidis
Keyword(s):  
Patient Experience ◽  
Substitution Treatment ◽  
Opiate Substitution Treatment

Pharmacists’ Role in the Continued Care of Patients under Opiate Substitution Treatment

Therapies ◽  
2013 ◽  
Vol 68 (6) ◽  
pp. 393-400 ◽  
Author(s):  
Nassir Messaadi ◽  
Aymeric Pansu ◽  
Olivier Cohen ◽  
Olivier Cottencin
Keyword(s):  
Substitution Treatment ◽  
Opiate Substitution Treatment

Misuse of Alcohol During Opiate Substitution Treatment

2010 ◽  
Vol 9 (3) ◽  
pp. 99-105
Author(s):  
Charles-Edouard Rengade ◽  
Raymund Schwan
Keyword(s):  
Substitution Treatment ◽  
Opiate Substitution Treatment

Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review

2016 ◽  
Vol 31 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Adam Bakker ◽  
Emmanuel Streel
Keyword(s):  
High Risk Group ◽  
Case Note ◽  
Treatment Retention ◽  
Patient Treatment ◽  
Substitution Treatment ◽  
National Guidelines ◽  
Opiate Substitution Treatment ◽  
The Uk ◽  
Treatment Mortality ◽  
Case Note Review

Background: Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis. Method: 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127. Outcomes measured: Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information. Results: Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information. Discussion: BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.

Incidence of hepatitis C in drug injectors: the role of homelessness, opiate substitution treatment, equipment sharing, and community size

2009 ◽  
Vol 137 (9) ◽  
pp. 1255-1265 ◽  
Author(s):  
N. CRAINE ◽  
M. HICKMAN ◽  
J. V. PARRY ◽  
J. SMITH ◽  
A. M. WALKER ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Substitution Treatment ◽  
Switching Regression ◽  
Community Size ◽  
Opiate Substitution Treatment ◽  
South Wales ◽  
Drug Injectors ◽  
Treatment Equipment ◽  
Incident Rate

SUMMARYA prospective cohort study estimated the incidence of hepatitis C virus (HCV) in drug injectors in South Wales (UK). In total, 286/481 eligible seronegative individuals were followed up after approximately 12 months. Dried blood spot samples were collected and tested for anti-HCV antibody and behavioural data were collected at baseline and follow-up. HCV incidence was 5·9/100 person-years [95% confidence interval (CI) 3·4–9·5]. HCV incidence was predicted by community size [incident rate ratio (IRR) 6·6, 95% CI 2·11–20·51,P=0·001], homelessness (IRR 2·9, 95% CI 1·02–8·28,P=0·047) and sharing injecting equipment (IRR 12·7, 95% CI 1·62–99·6,P=0·015). HCV incidence was reduced in individuals in opiate substitution treatment (IRR 0·34, 95% CI 0·12–0·99,P=0·047). In order to reduce follow-up bias we used multiple imputation of missing data using switching regression; after imputation estimated HCV incidence was 8·5/100 person-years (95% CI 5·4–12·7). HCV incidence varies with community size, equipment sharing and homelessness are associated with increased HCV incidence and opiate substitution treatment may be protective against HCV.

scholarly journals The impact of opiate substitution treatment on mortality risk in drug addicts: a natural experiment study

2019 ◽  
Vol 7 (3) ◽  
pp. 1-92 ◽  
Author(s):  
Colin D Steer ◽  
John Macleod ◽  
Kate Tilling ◽  
Aaron G Lim ◽  
John Marsden ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Mortality Risk ◽  
Treatment Duration ◽  
Hazard Ratio ◽  
Substitution Treatment ◽  
Opiate Substitution Treatment ◽  
All Cause Mortality ◽  
Prospective Longitudinal ◽  
Cessation Of Treatment

Background Opiate substitution treatment (OST) is the main treatment for people addicted to heroin and other opioid drugs. However, there is limited information on how the delivery of this treatment affects mortality risk. Objectives To investigate the associations of mortality risk with periods during treatment and following cessation of treatment, medication type, co-prescription of other medication and dosing regimens during titration and detoxification. The trends with time of prescribed medication, dose and treatment duration were also explored. Design Prospective longitudinal observational study. Setting UK primary care between 1998 and 2014. Participants A total of 12,780 patients receiving methadone, buprenorphine or dihydrocodeine. Main outcome measures All-cause mortality relating to 657 deaths and drug-related poisoning relating to 113 deaths. Data sources Clinical Practice Research Datalink with linked information on cause of death from the Office for National Statistics. Results For both outcomes, the lowest mortality risk was observed after 4 weeks of treatment and the highest risk was observed in the first 4 weeks following cessation of treatment [e.g. for drug-related poisoning, incidence rate ratio (IRR) 8.15, 95% confidence interval (CI) 5.45 to 12.19]. There was evidence that the treatment period risks varied with OST medication. The largest difference in risk was for the first 4 weeks of treatment for both outcomes, with patients on buprenorphine being at lower risk than those on methadone (e.g. for drug-related poisoning, IRR 0.08, 95% CI 0.01 to 0.48). The co-prescription of benzodiazepines was associated with linearly increasing the risk of drug-related deaths by dose (IRR 2.02, 95% CI 1.66 to 2.47), whereas z-drugs (zolpidem, zopiclone and zaleplon) were associated with increased risk of both all-cause (IRR 1.83, 95% CI 1.59 to 2.12) and drug-related (IRR 3.31, 95% CI 2.45 to 4.47) mortality. There was weak evidence that higher initial and final doses were associated with increased all-cause mortality risk. In the first 4 weeks of treatment, the risk increased by 4% for each 5-mg increment in methadone dose (1-mg increase in buprenorphine) (hazard ratio 1.04, 95% CI 1.00 to 1.09). In the first 4 weeks after treatment ceased, a similar increment in final dose increased the risk by 3% (hazard ratio 1.03, 95% CI 0.99 to 1.07). There were too few deaths to evaluate the effects on drug-related poisoning. The proportion of OST patients receiving buprenorphine increased between 1998 and 2006. Median treatment duration was consistently shorter for buprenorphine than for methadone for each year studied (overall median duration of 48 and 106 days, respectively). Limitations As this was an observational study, the possibility remains of bias from unmeasured factors, which covariate adjustment and inverse probability weighting can eliminate only partially. Conclusions Using buprenorphine as an alternative to methadone may not reduce mortality overall despite resulting in lower IRRs from shorter treatment duration. Clinical guidance needs to consider strengthening warnings about the co-prescription of a range of drugs for OST patients. Future work Our analyses need to be replicated using other clinical data sets in the UK and in other countries. New interventions and trials are required to investigate improving the retention of OST patients in primary care. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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