Bridging waitlist delays with interim buprenorphine treatment: Initial feasibility

Sigmon, Stacey C.; Meyer, Andrew; Hruska, Bryce; Ochalek, Taylor A.; Rose, Gail L.; Badger, Gary J.; Brooklyn, John; Heil, Sarah H.; Higgins, Stephen T.; Moore, Brent A.; Schwartz, Robert P.

doi:10.1016/j.addbeh.2015.07.030

Cited by 33 publications

(32 citation statements)

References 72 publications

(92 reference statements)

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“…While further analysis is needed to understand how much of the overdose burden involves multi‐pill use, several implications stand out in terms of prevention: First, development of affordable and effective pill dispensers may be useful for high‐risk patients and have been shown to be effective for buprenorphine adherence; second, due to the large quantities of pills ingested, encouraging greater utilization of prescription monitoring programs or prescribing guidelines could serve to deter access; third, multi‐pill use of intact tablets will not be prevented through abuse‐deterrent formulations meant to reduce/inhibit non‐oral use. Novel “abuse‐deterrent formulations” should be a higher priority in terms of (1) effectively deterring the effects or release of drug from ingesting multiple opioid tablets and (2) immediate‐release opioids, which were the most commonly ingested in our sample and which are prescribed at rates that vastly outnumber those for extended‐release opioids …”

Section: Discussionmentioning

confidence: 99%

“…While further analysis is needed to understand how much of the overdose burden involves multi-pill use, several implications stand out in terms of prevention: First, development of affordable and effective pill dispensers may be useful for high-risk patients and have been shown to be effective for buprenorphine adherence 13 ; second, due to the large quantities of pills ingested, encouraging greater utilization of prescription monitoring programs or prescribing guidelines could serve to deter access; third, multi-pill use of intact tablets will not be prevented through abuse-deterrent formulations meant to reduce/inhibit non-oral use. Novel "abuse-deterrent formulations"…”

Section: Discussionmentioning

confidence: 99%

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Understanding multi‐pill ingestion of prescription opioids: Prevalence, characteristics, and motivation

Ellis

Cicero

Dart

et al. 2018

Pharmacoepidemiology and Drug

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Purpose Oral use is the primary route of administration among non‐medical prescription opioid users. While progression to non‐oral routes and shifts to stronger opioids have been previously studied as ways to cope with tolerance, the prevalence and patterns of those who cope by increasing the number of pills/tablets ingested at one time (ie, multi‐pill use) has not been assessed. Methods A subset (N = 231) of treatment‐seeking opioid users from a national opioid surveillance system, participating in the Researchers and Participants Interacting Directly (RAPID) Program, completed an online survey centered on multi‐pill use. Results Over two‐thirds of non‐medical prescription opioid users had a history of multi‐pill use (67.7%), defined as ingesting four or more of the same pill, intact and at the same time. Among these (n = 154), the median maximum number of pills taken at one time was eight, with over 20% ingesting 11 or more pills in a single instance. Nearly half engaged in multi‐pill ingestion more than once a day in the past month (43.8%), with accessibility to lower dose pills being the primary motivator (85.4%). Hydrocodone immediate‐release (IR) compounds were by far the most frequently endorsed (90.3%), followed by oxycodone IR tablets with acetaminophen (76.0%) and oxycodone IR tablets containing no acetaminophen/ibuprofen (56.5%). Conclusions These results indicate that the ingestion of multiple opioid pills/tablets is extremely common among treatment‐seeking opioid users. This, and other forms of non‐medical oral use of prescription opioids, should be taken under consideration when developing prevention and intervention efforts targeting the opioid epidemic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Understanding multi‐pill ingestion of prescription opioids: Prevalence, characteristics, and motivation

Ellis

Cicero

Dart

et al. 2018

Pharmacoepidemiology and Drug

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“…Because participants were predominantly older African Americans, most of whom were unemployed, it is not clear to what degree findings from this study can be generalized to other MTP populations. Finally, Baltimore, with virtually no waiting lists for entry to opioid treatment at the time of the study, may have led to a change in program responses to rule infractions in TAU to resemble PCM more closely (except for optional counseling), and may not be typical of other localities in the United States with waiting lists .…”

Section: Discussionmentioning

confidence: 99%

Patient-centered methadone treatment: a randomized clinical trial

et al. 2016

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Background and aims Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12-months following admission, compared with methadone treatment-as-usual. Design Two-arm open-label randomized trial. Setting Two methadone treatment programs (MTPs) in Baltimore, Maryland, USA. Participants 300 newly-admitted MTP patients were enrolled between September 13, 2011 and March 26, 2014. Their mean age was 42.7 years (SD=10.1) and 59% were males. Intervention Newly-admitted MTP patients were randomly assigned to either Patient-centered Methadone Treatment (PCM; n=149) which modified the MTP’s rules (e.g., counseling attendance was optional) and counselor roles (e.g., counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n=151). Measurements The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior, and quality of life, and retention in treatment. Findings There was no significant difference between PCM and TAU conditions on opioid-positive urine screens at 12 months (adjusted odds ratio = 0.98 95% confidence interval (CI) = 0.61,1.56). There were also no significant differences in any of the secondary outcome measures (all Ps>0.05) except Quality of Life Global Score (P=0.04; 95% CI: 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps>0.05). Conclusions Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.

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“…2 The use of interim treatment with buprenorphine without formal counseling while patients remain on waiting lists may mitigate this risk during delays in treatment. 3 …”

Section: To the Editormentioning

confidence: 99%