Comparative Drug Use and Psychosocial Profiles of Opioid Dependents Applying for Medication Versus Medication‐Free Treatment

Cumberbatch, Zulema; Copersino, Marc L.; Stitzer, Maxine L.; Jones, Hendrée E.

doi:10.1081/ada-120037376

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…For those denied OMT or discharged,the study shows a high risk for overdoses in line with previous research [15], and it motivates offering extensive and well-tailored support and other treatment options to them [13]. Care providers should develop attractive forms of supplementary care or refer patients to such care provided by other organizations, if needed [19,37]. To prevent attrition, it is important to train staff in non-judgmental and non-confrontational communication strategies, and to reduce the waiting time for possibility to re-apply for OMT.…”

Section: Discussionsupporting

confidence: 67%

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Opioid maintenance treatment: trajectories in and out of treatment

Monwell

Gerdner

2019

Nordic Journal of Psychiatry

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Problem: Although efficacy studies of opioid maintenance treatment (OMT) have shown evidence of treatment benefits, there is still need for studies on its effectiveness in natural clinical processes. This study investigates the development in health, substance use and social conditions of those who applied for OMT, including those denied access or discharged. Method: First, persons assessed for admittance in 2005-2011 (n = 127) were categorized into four trajectory groups based on whether they were admitted or denied (n = 19), discharged (n = 31), readmitted (n = 21) or had been undergoing OMT without interruption (n = 56). Second, 99 of these, the analytical sample, were interviewed at follow-up using (a) the Addiction Severity Index (ASI) for seven problem-areas and housing, and (b) self-rated change in 11 problem areas. The ASI was compared to baseline interviews after 55 months (mean). Third, outcomes within groups was studied in relation to alternative interventions. Results: Within the analytical sample, those denied OMT showed no improvements at group level, those discharged had some improvements, more if readmitted than if not and those with uninterrupted OMT showed the most comprehensive improvements. Those outside OMT, denied and discharged, had considerable mortality risks related to ongoing drug use, especially in lack of wellplanned alternative interventions. Conclusion: Improvements strongly relate to access to OMT. This study underscores that access to OMT improves the situation in all areas investigated and decreases the risk for drug-related death. It underscores the importance of two major risk situations, i.e. being denied OMT and being discharged.

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Section: Discussionsupporting

confidence: 67%

“…To prevent attrition, it is important to train staff in non-judgmental and non-confrontational communication strategies, and to reduce the waiting time for possibility to re-apply for OMT. Additional interventions based on the individual needs should include psychosocial support and comorbidity care [6,16,19,37].…”

Section: Discussionmentioning

confidence: 99%

Opioid maintenance treatment: trajectories in and out of treatment

Monwell

Gerdner

2019

Nordic Journal of Psychiatry

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“…3,4 For opioid dependent individuals who enter drug-free treatment, the road to recovery typically begins with detoxification. However, detoxification appears to be ineffective as a stand-alone treatment for opioid dependence, with relapse rates that range from 65% to 80% at one month post-discharge.…”

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confidence: 99%

Abstinence‐contingent recovery housing and reinforcement‐based treatment following opioid detoxification

et al. 2012

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Aims To conduct a randomized, controlled trial of abstinence-contingent recovery housing delivered with or without intensive day treatment among individuals exiting residential opioid detoxification. Design Random assignment to one of three conditions: Recovery housing alone (RH), abstinence-contingent recovery housing with RBT (RH+RBT), or usual care (UC). RH and RH+RBT participants received 12 weeks of paid recovery housing contingent upon drug abstinence. RH+RBT participants also received 26 weeks of RBT, initiated concurrently with recovery housing. Assessments were conducted at 1, 3, and 6 months after treatment enrollment. Setting Outpatient drug-free substance abuse treatment program in Baltimore, Maryland. Participants Patients (N = 243) who completed medication-assisted opioid detoxification. Measurements Primary outcome was drug abstinence (opioid- and cocaine-negative urine and no self-reported opioid or cocaine use in the previous 30 days). Secondary outcomes included abstinence at all time points (1, 3, and 6 months), days in recovery housing, and employment. Findings Overall rates of drug abstinence were 50% for RH+RBT, 37% for RH, and 13% for UC (p < .001). At 6 months, RH+RBT participants remained more likely to meet abstinence criteria than UC participants (37% vs. 20%, p = .016). Length of stay in recovery housing mediated abstinence outcomes and was longer in RH+RBT (49.5 days) than in RH (32.2 days; p < .002). Conclusions Abstinence-contingent recovery housing improves abstinence in opioid-dependent adults following medication-assisted detoxification. The addition of intensive ‘reinforcement-based treatment’ behavioural counseling further improves treatment outcomes in part by promoting longer recovery house stays.

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“…However, study results suggest the relation between psychosocial problems and treatment outcome may be more complex than is commonly assumed [48][49][50][51].…”

Section: Discussionmentioning

confidence: 83%

Maintenance Treatment of Opioid Dependence and Patterns of Non-Prescribed Drug Use: Results of a 4-Year Trial

Giacomuzzi¹,

Ertl²,

Pavlic³

et al. 2006

LDDD

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To establish the extent to which participants in maintenance treatment programmes (methadone and sublingual buprenorphine) used opioids, benzodiazepines, ethanol, cocaine and amphetamines, and to define the pattern of such use over time.Design: A retrospective analysis of data of 42,610 analyses from urinalysis screening.Setting: Outpatient drug treatment centre, Measurements: Enzyme-multiplied immunoassay and gas chromatography-mass spectrometry.Results: Urine samples from 23.4% (N = 4998) of those in the methadone treatment group and 16.5% (N = 1110) in the sublingual buprenorphine group tested positive for consumption of additional drugs (p < 0.001). The most frequently detected drugs were benzodiazepines (63% of all methadone, and 40% of all sublingual buprenorphine positive samples; (p < 0.001)) and opioids (26% of all methadone, and 21% of all sublingual buprenorphine positive samples; (p < 0.001)). In both of the treatment programmes morphine abuse (63%) was higher than heroin (7%). There was a significant decrease of benzodiazepine abuse in the study period (2000)(2001)(2002)(2003) both among clients receiving methadone (p < 0.001) and those receiving sublingual buprenorphine (p = 0.006). Benzodiazepine (Spearman rank correlation coefficient r = 0.281, p < 0.001), cocaine (r = 0.057, p = 0.007), ethanol (r = 0.073, p= 0.028) and morphine (r = -0.179, p < 0.001) abuse were associated with age in sublingual buprenorphine treated patients. Methadone clients showed a lifetime relation for cocaine (r = -0.032, p = 0.007), ethanol (Spearman corr. coeff. r = 0.118, p < 0.001), morphine (r = -0.107, p < 0.001) and dihydrocodeine abuse (r = 0.093, p < 0.001). Discussion:The present data indicate that nonprescribed drug use remains a persistent problem for patients in maintenance treatment. Substances misused are mainly opioids and benzodiazepines. Non-prescribed morphine has replaced heroin.

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Comparative Drug Use and Psychosocial Profiles of Opioid Dependents Applying for Medication Versus Medication‐Free Treatment

Cited by 9 publications

References 23 publications

Opioid maintenance treatment: trajectories in and out of treatment

Opioid maintenance treatment: trajectories in and out of treatment

Abstinence‐contingent recovery housing and reinforcement‐based treatment following opioid detoxification

Maintenance Treatment of Opioid Dependence and Patterns of Non-Prescribed Drug Use: Results of a 4-Year Trial

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