scholarly journals Addressing unmet needs in opiate dependence: supporting detoxification and advances in relapse prevention

2021 ◽  
pp. 1-11
Author(s):  
Katherine Herlinger ◽  
Anne Lingford-Hughes
Keyword(s):  
Relapse Prevention ◽  
Psychosocial Interventions ◽  
Opiate Dependence ◽  
Opioid Substitution Therapy ◽  
Harm Minimisation ◽  
Pharmacological Management ◽  
Current State ◽  
The Uk ◽  
Opioid Substitution

SUMMARY Despite record-breaking numbers of opiate related deaths in the UK in 2019, pharmacological management of opiate dependence has evolved little since the advent of methadone in 1965. Along with harm minimisation and psychosocial interventions, the mainstay of pharmacological treatment remains opioid substitution therapy (OST) using methadone or buprenorphine, with many patients receiving OST for many years. Even with these treatments, opiate users continue to face mortality risks 12 times higher than the general population, and emerging evidence suggests that individuals who remain on long-term OST present with a range of physical and cognitive impairments. Therefore, with a growing ageing opiate dependent population who would benefit from detoxification from OST, this article provides an overview of the current state of opiate dependence in clinical practice, explores the reasons why availability and acceptability of detoxification pathways are declining, and discusses emerging pharmacological therapies that could provide benefit in relapse prevention.

scholarly journals Reluctant to train, reluctant to prescribe: barriers to general practitioner prescribing of opioid substitution therapy

2012 ◽  
Vol 18 (4) ◽  
pp. 346 ◽  
Author(s):  
Christine Longman ◽  
Meredith Temple-Smith ◽  
Gail Gilchrist ◽  
Nicholas Lintzeris
Keyword(s):  
General Practitioner ◽  
General Practitioners ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
Negative Experiences ◽  
Practice Experience ◽  
Gp Model ◽  
Depth Interviews ◽  
Opioid Substitution

Opioid substitution therapy (OST) is a well-recognised, evidence-based treatment for opioid dependence. Since the early 1990s, Australia has used a community-based general practitioner (GP) model of prescribing, particularly within the state of Victoria, where over 85% of OST prescribing is undertaken by GPs in community settings. Yet the majority of GPs invited to complete the required OST training decline the offer, while of those who complete training, the majority prescribe to few or no patients. This study aimed to determine the reasons for this. Twenty-two in-depth interviews were conducted with Victorian GPs exploring the reasons why the majority declined training, and for trained GPs, why they prescribed to few or no patients in the first 12 months after training. General practitioners who declined to train were predominantly influenced by negative experiences with drug-seeking patients, although other secondary reasons also affected their decision. Some GPs who completed the training were prevented from prescribing by several structural and operational barriers, many of which could be addressed. Fear of deskilling with time became a further impediment. General practitioners who became regular prescribers were highly committed with lengthy general practice experience. Concerns exist about the recruitment process for OST prescriber training, where nearly all GPs decline the offer of training, and the barriers that prevent GPs prescribing after training. Action is needed to address barriers to GP OST training and prescribing, and further research is necessary to ascertain measures required to facilitate long-term prescribing.

scholarly journals 719 The Routine Use of Opioid Medication for Post-Operative Pain Relief Can Risk Long Term Dependence, In Patients Previously Opiate Naive

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S McGurk ◽  
T Majeed ◽  
C Magee
Keyword(s):  
Pain Relief ◽  
Opiate Dependence ◽  
Prescribing Practices ◽  
Department Of Health ◽  
Opiate Use ◽  
Post Operative Pain ◽  
The Us ◽  
Observational Cohort ◽  
The Uk

Abstract Introduction Post-operative pain relief commonly involves opiates. Rising concerns about misuse has increased scrutiny of prescribing practices. In the UK, 12.5% of prescriptions are for opiates. In the US, the Department of Health and Human Services has declared an epidemic of opiate misuse. We aimed to evaluate opiate prescribing practices post-operatively, within a UK teaching hospital, and establish the risk of prolonged opiate use. Method A pan-speciality retrospective observational cohort study was performed. Patients who underwent surgery in the year 2018 were included. Patients were opiate naïve if their admission Medicine reconciliation and GP record described no opiates for the previous year. Endpoints: the proportion of patients discharged with opiates and the proportion of patients remaining on opiates at 1- and 2-years post admission. Results 20526 operations were performed on 17524 patients, across pan-specialities. 8772 patients were discharged on opiates. 673 required further opiates from their GP after discharge, of which 331 were previously opiate naive. At 1 year post op, 180 previously naive patients remained on opiates. Conclusions Attention needs to be given to the risk of developing opiate dependence post-operatively. An evidence-based approach should support clinicians in preventing an opiate crisis in the UK.

scholarly journals Community pharmacists’ role in preventing opioid substitution therapy-related deaths: a qualitative investigation into current UK practice

2020 ◽  
Author(s):  
R Yadav ◽  
Denise Taylor ◽  
G Taylor ◽  
J Scott
Keyword(s):  
Community Pharmacists ◽  
Daily Basis ◽  
Integrated System ◽  
Substitution Therapy ◽  
Structured Interviews ◽  
Opioid Substitution Therapy ◽  
North East ◽  
Ability To Act ◽  
The Uk ◽  
Opioid Substitution

© 2019, The Author(s). Background Opioid substitution therapy involves prescribing of medical substitutes like methadone and buprenorphine to patients who are addicted to opioids. The majority of opioid substitution therapy dispensing in the UK is done by community pharmacists and they often see the patients on daily basis. It is unknown to what extent community pharmacists implement the policy to prevent overdose in patients receiving such treatment. Objective To explore what UK community pharmacists think about their role in preventing opium substitution-related deaths, their understanding of the risks associated with this substitution therapy and their views on what else community pharmacists could do to reduce such deaths. Setting Twenty four community pharmacists from two areas in UK (Worcestershire and Bath and North East Somerset). Method Between January and March 2013, community pharmacists providing opoin substitution therapy were interviewed in their pharmacy, using semi-structured interviews. Interpretative Phenomenology Analysis was used to analyse the data. Main outcome measure Thematically organised description of professional practice as reported by the participants against the clinical/practice guidance for opioid substitution therapy in UK. Results While participants felt their role to be essential in providing the service, they did not feel part of an integrated system. Participants’ ability to act in risk situations was affected by their knowledge, confidence in intervening in such situation, as well as the support they receive in providing the service. Conclusion Participants reported large differences in how ‘opioid substitution therapy’ services are provided in community pharmacy. Lack of knowledge among some pharmacists and lack of support in providing the service resulted in some patients at high risk not having their risks acted upon.

scholarly journals Community pharmacists’ role in preventing opioid substitution therapy-related deaths: a qualitative investigation into current UK practice

2020 ◽  
Author(s):  
R Yadav ◽  
Denise Taylor ◽  
G Taylor ◽  
J Scott
Keyword(s):  
Community Pharmacists ◽  
Daily Basis ◽  
Integrated System ◽  
Substitution Therapy ◽  
Structured Interviews ◽  
Opioid Substitution Therapy ◽  
North East ◽  
Ability To Act ◽  
The Uk ◽  
Opioid Substitution

© 2019, The Author(s). Background Opioid substitution therapy involves prescribing of medical substitutes like methadone and buprenorphine to patients who are addicted to opioids. The majority of opioid substitution therapy dispensing in the UK is done by community pharmacists and they often see the patients on daily basis. It is unknown to what extent community pharmacists implement the policy to prevent overdose in patients receiving such treatment. Objective To explore what UK community pharmacists think about their role in preventing opium substitution-related deaths, their understanding of the risks associated with this substitution therapy and their views on what else community pharmacists could do to reduce such deaths. Setting Twenty four community pharmacists from two areas in UK (Worcestershire and Bath and North East Somerset). Method Between January and March 2013, community pharmacists providing opoin substitution therapy were interviewed in their pharmacy, using semi-structured interviews. Interpretative Phenomenology Analysis was used to analyse the data. Main outcome measure Thematically organised description of professional practice as reported by the participants against the clinical/practice guidance for opioid substitution therapy in UK. Results While participants felt their role to be essential in providing the service, they did not feel part of an integrated system. Participants’ ability to act in risk situations was affected by their knowledge, confidence in intervening in such situation, as well as the support they receive in providing the service. Conclusion Participants reported large differences in how ‘opioid substitution therapy’ services are provided in community pharmacy. Lack of knowledge among some pharmacists and lack of support in providing the service resulted in some patients at high risk not having their risks acted upon.

scholarly journals Substance, structure and stigma: Parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods

2013 ◽  
Vol 24 (6) ◽  
pp. e35-e42 ◽  
Author(s):  
Amy Chandler ◽  
Anne Whittaker ◽  
Sarah Cunningham-Burley ◽  
Nigel Williams ◽  
Kelly McGorm ◽  
...  
Keyword(s):  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
The Uk ◽  
Opioid Substitution

Technology Transfer in HEIs

2005 ◽  
Vol 19 (5) ◽  
pp. 345-361
Author(s):  
Tas Gohir ◽  
Grier Palmer
Keyword(s):  
Biological Sciences ◽  
Technology Transfer ◽  
Academic Entrepreneurship ◽  
Ivy League ◽  
Current State ◽  
Financial Exploitation ◽  
Transfer Operation ◽  
The Uk ◽  
Economic Assets

The UK's bioscience research base is one of the country's genuine long-term economic assets. It is critically important for the UK not to repeat past mistakes, when financial exploitation of innovative and groundbreaking bioresearch went overseas. This study reviews commercialization from the Department of Biological Sciences at Warwick University as a microcosm of the current state of technology transfer in academia. Its technology transfer operation is typical of many other such organizations. Warwick University does, however, have the benefit of being in the ‘Ivy League’ of UK universities and is regarded as a beacon of entrepreneurial flair. If the power of academic entrepreneurship is to be fully unleashed anywhere, Warwick is as well placed as any to capitalize on the opportunities. While the purpose of the study has been to consider how Warwick's enormous entrepreneurial prowess can be harnessed for the greater commercialization of its bioscience research, many of the conclusions and recommendations are applicable to other departments and academic institutions worldwide.

scholarly journals Mainstreaming of genomic medicine in gastroenterology, present and future: a nationwide survey of UK gastroenterology trainees

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030505
Author(s):  
Ibrahim Al Bakir ◽  
Gregory Malcolm Sebepos-Rogers ◽  
Hilary Burton ◽  
Kevin J Monahan
Keyword(s):  
Personalised Medicine ◽  
Genomic Medicine ◽  
Nationwide Survey ◽  
Training Programme ◽  
Genomic Testing ◽  
Web Based ◽  
Current State ◽  
Future Clinical Practice ◽  
The Uk

ObjectiveGenomics and personalised medicine are increasingly relevant for patients with gastroenterological conditions. We aim to capture the current state of genomics training in gastroenterology to review current understanding, clinical experience and long-term educational needs of UK trainees.Design and settingA web-based nationwide survey of all UK gastroenterology specialty trainees was conducted in 2017.Results100 trainees (14% of UK gastroenterology trainees) completed this survey. Only 9% and 16% of respondents believe that their local training programme adequately prepares them for the future clinical practice using genomic medicine and personalised medicine, respectively. Barriers identified include the need for greater trainee education (95%), inadequate clinical guidance to base interventions on the results of genomic testing (53%), concerns over misinterpretation by patients (43%) and overuse/misuse of testing by clinicians (34%).Survey respondents felt prepared to perform HFE genotyping (98%), assess TPMT status (97%) and interpret HLA subtyping for suspected coeliac disease (85%). However, only a minority felt prepared to perform the following investigations: polyposis screening (34%), hereditary pancreatitis screening (30%), testing for Lynch yndrome (33%) and KRAS testing for colorectal cancer (20%).Most respondents would support holding dedicated training days on genomic medicine (83%), formal training provisions for the mainstreaming of genomic testing (64%), an update to the UK gastroenterology specialty training curriculum and examinations (57%) and better-defined referral pathways for local genomic services (91%).ConclusionMost gastroenterology trainees in this survey feel ill equipped to practise genomic and personalised medicine as consultants. We propose specific revisions to the UK gastroenterology specialty curriculum that addresses trainees needs.

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