Malmö Treatment Referral and Intervention Study (MATRIS)—effective referral from syringe exchange to treatment for heroin dependence: a pilot randomized controlled trial

Bråbäck, Martin; Nilsson, Suzan; Isendahl, Pernilla; Troberg, Katja; Brådvik, Louise; Håkansson, Anders

doi:10.1111/add.13249

Cited by 18 publications

(22 citation statements)

References 38 publications

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“…We did, however, not have any reason to suspect that the sample was not representative for patients at the OMT clinics. Age and gender distribution were similar to previous Swedish studies on patients in OMT [59, 60]. Use of street drugs and benzodiazepines was comparable to other clinical studies on patients in OMT in the southern Swedish region [9].…”

Section: Discussionsupporting

confidence: 86%

Nonmedical Use of Antihistaminergic Anxiolytics and Other Prescription Drugs among Persons with Opioid Dependence

Dahlman

Abrahamsson

Kral

et al. 2016

Journal of Addiction

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Background. Nonmedical prescription drug use (NMPDU) is an increasing problem, insufficiently studied among people in opioid maintenance treatment (OMT). This study investigates the prevalence of and factors associated with NMPDU for drug classes insufficiently described in opioid-dependent populations, including antihistaminergic anxiolytics and central stimulants. Methods. Study participants were recruited at two OMT clinics in Malmo, Sweden, between October 2014 and December 2015 (N = 73) and interviewed about their use, motivations for use, and acquisition and administration of prescription drugs. Results. The majority of the sample reported lifetime NMPDU: 60% for benzodiazepine-like hypnotics (z-drugs), 21% for pregabalin, 19% for stimulants, and 12%–15% for antihistaminergic anxiolytics. Lower age was associated with nonmedical benzodiazepine use (Adjusted Odds Ratio = 0.89; 95% Confidence Interval = 0.82–0.97). Illicit acquisition was reported by 61% of people using z-drugs, 46% of people using pregabalin, and 38% of people using prescription stimulants, but only by 6–10% of people using antihistaminergic anxiolytics. Conclusions. The substantial nonmedical use of pregabalin, z-drugs, and prescription stimulants found in this study suggests that clinicians should prescribe these drugs with great caution. Nonmedical use of antihistaminergic anxiolytics does not seem to be a clinical issue among people in OMT in a Swedish setting, but we propose future studies to monitor their use.

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Section: Discussionsupporting

confidence: 86%

Nonmedical Use of Antihistaminergic Anxiolytics and Other Prescription Drugs among Persons with Opioid Dependence

Dahlman

Abrahamsson

Kral

et al. 2016

Journal of Addiction

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“…In a previous publication, our group showed that SEPs can be efficient for structured referral of opioid-dependent individuals to evidence-based treatment ( 29 ). In this 12-month follow-up of the patients who entered treatment, we demonstrate high-retention rates despite having a study population with a high degree of substance-related problems at baseline, and despite using a rapid referral procedure from an out-of-treatment SEP setting.…”

Section: Discussionmentioning

confidence: 99%

“…The choice of medication was based on clinical characteristics and outside of the study protocol. The methods for this part of the study are described in detail elsewhere ( 29 ). Out of the 75 recruited and randomized patients, 71 started treatment with methadone or buprenorphine.…”

Section: Methodsmentioning

confidence: 99%

“…There is also evidence that when referred to OAT, SEP participants have a poorer treatment response ( 28 ). In contrast, in the recently published Malmö Treatment Referral and Intervention Study (MATRIS), we showed that SEP can be efficient for rapidly transferring heroin-dependent patients to evidence-based treatment with methadone and buprenorphine with high rates of referral (99%) and treatment entry (96%) ( 29 ). Previous data from the present setting, traditionally characterized by less rapid and high-threshold intake procedures, have demonstrated high rates of treatment retention for patients included in methadone or buprenorphine treatment ( 30 ).…”

Section: Introductionmentioning

confidence: 96%

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Malmö Treatment Referral and Intervention Study—High 12-Month Retention Rates in Patients Referred from Syringe Exchange to Methadone or Buprenorphine/Naloxone Treatment

et al. 2017

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BackgroundHeroin dependence is associated with high mortality. Opioid agonist treatment (OAT) with methadone or buprenorphine has strong evidence for treatment of this relapsing condition. In our setting, OAT has been associated with strict and demanding intake procedures, often with requirements of social stability, but also high, approximately 80 percent 12-month retention rates. In a recent randomized controlled trial, we demonstrated high rates of successful rapid referral from a syringe exchange programme (SEP) to treatment with methadone or buprenorphine, including actual treatment initiation. The objectives of this study were to assess 12-month retention rates, in order to assess whether a novel referral program of current drug users at a SEP would achieve retention rates comparable to more traditional intake procedures.MethodsThe present report is a 12-month follow-up of 71 patients who successfully started treatment with methadone or buprenorphine/naloxone. Patient data from baseline and at 12 months were collected.ResultsOut of the 71 patients who started treatment, 58 (82%) were still in treatment after 12 months.ConclusionThis was a population, referred from a SEP, with a high drug use severity on admission and no pretreatment requirement for social stability, but there were still high retention rates at 12 months comparable to regular opioid agonist clinics in our setting.

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“…As mentioned previously, OST is only available in Sweden through specialist care provision. Buprenorphine-naloxone is the recommended rst-line choice of OST medication [35].…”

Section: Study Design and Settingmentioning

confidence: 99%

Changes in opioid mortality following increased access to opioid substitution treatment

Andersson¹,

Håkansson²,

Berge³

et al. 2020

Preprint

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Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing mortality represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related mortality. Methods Detailed data on all opioid-induced deaths in Skåne during the two years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related mortalities in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention.Results There was a non-significant increase in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89-1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12-6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51-1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug intoxications in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84-0,97, p= 0.004). Conclusions Opioid-related mortality, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased opioid mortality. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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Malmö Treatment Referral and Intervention Study (MATRIS)—effective referral from syringe exchange to treatment for heroin dependence: a pilot randomized controlled trial

Abstract: A randomized controlled trial in a syringe exchange programme showed no evidence that a strength-based case management intervention improved attendance for treatment over referral alone. Attendance rates were high in both groups.

Cited by 18 publications

References 38 publications

Nonmedical Use of Antihistaminergic Anxiolytics and Other Prescription Drugs among Persons with Opioid Dependence

Nonmedical Use of Antihistaminergic Anxiolytics and Other Prescription Drugs among Persons with Opioid Dependence

Malmö Treatment Referral and Intervention Study—High 12-Month Retention Rates in Patients Referred from Syringe Exchange to Methadone or Buprenorphine/Naloxone Treatment

Changes in opioid mortality following increased access to opioid substitution treatment

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