Medications for opioid use disorder during the war in Ukraine: a more comprehensive view on the government response—Authors’ reply

Bromberg, Daniel J.; Madden, Lynn M.; Meteliuk, Anna; Ivasiy, Roman; Leon, Samy J. Galvez de; Klyucharyov, Konstantin; Altice, Frederick L.

doi:10.1016/j.lanepe.2023.100583

Cited by 8 publications

(8 citation statements)

References 6 publications

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“…As the pandemic recommendations subside, important lessons learned here provide insights into future strategies to consider with OAT patients as uncertainty evolves. As OAT providers in Ukraine shifted to tele-health during the pandemic, they were remarkably resilient when shifting their services in response to Russia’s invasion of Ukraine in February 2022 ( 51–55 ). Moreover, the lessons learned from COVID-19 suggest that transformation in service delivery appears to have several advantages without marked adverse consequences.…”

Section: Discussionmentioning

confidence: 99%

High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine

Galvez,

Altice,

Meteliuk

et al. 2023

Front. Public Health

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BackgroundThe COVID-19 pandemic resulted in marked disruptions in healthcare delivery in Ukraine related to emergency guidance in response to treating opioid use disorder (OUD). Patients with OUD, a group with high levels of comorbid medical and psychiatric disorders, and prescribed opioid agonist therapies (OAT) were rapidly shifted to take-home dosing if they were deemed clinically stable. The impact of these shifts on patient stress and related substance use during the pandemic, however, is unknown.MethodsIn early May 2020, 269 randomly selected OAT patients in Ukraine were surveyed to assess their stress level and substance use using the validated Perceived Stress Scale and examined correlates of severe perceived stress.ResultsOverall, 195 (72.5%) met criteria for moderate to severe levels of stress, which was independently correlated with having started OAT within the past 12 months (aOR: 1.33; 95%CI: 1.15–1.55), living in a large metropolitan area (aOR: 1.31; 95%CI: 1.18–1.46), having been asked by others to share their medication (aOR: 1.13; 95%CI: 1.02–1.25), and having an increase of over 10 min in transportation time to get to treatment (aOR: 1.16; 95%CI: 1.04–1.29). Twenty seven (10%) patients felt at high risk of relapse, while 24 (8.9%) patients reported purchasing drugs.ConclusionDuring a time of great uncertainty soon after emergency guidance to the COVID-19 pandemic, there was extraordinary high levels of perceived stress reported. In response to emergency guidance, OAT patients should be screened for perceived stress and certain subgroups should be targeted for additional psychosocial support.

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Section: Discussionmentioning

confidence: 99%

High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine

Galvez,

Altice,

Meteliuk

et al. 2023

Front. Public Health

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“…The intervention involved informing participants on the risks of opioid use by illustrating the potential hazards and adverse health consequences and the relative benefits of OAT (e.g., prevention of overdose, HIV risk reduction and criminal activity) relative to continued injection of opioids. OAT in Ukraine, aside from some newly emerging private clinics [ 44 , 45 ], is provided free by the Ministry of Health. The brief intervention was audio-recorded for quality control and fidelity assessment, with coaching provided to intervention deliverers.…”

Section: Methodsmentioning

confidence: 99%

Aligning public health and public safety: Probation as a touchpoint to identify and link patients with opioid use disorder to opioid agonist treatment

Bromberg,

Galvez de Leon,

Litz

et al. 2023

PLOS Glob Public Health

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Background People in criminal justice settings (CJS) have high rates of opioid use disorder (OUD) and HIV. Probation is part of the CJS and congregates many individuals with high rates of mental health and substance use disorders relative to the general population; nevertheless, probation remains a major improvement to incarceration. As a steppingstone to full decarceration efforts, community supervision settings like probation can be leveraged as “touchpoints” to identify and link people with OUD (and other co-morbid conditions) to treatment and reduce criminal activity. Methodology To determine the feasibility of a modified screening, brief intervention and referral to treatment (SBIRT) strategy to link probationers to opioid agonist therapies (OAT) in the newly created probation system in Ukraine, we conducted a single-arm SBIRT intervention in eight probation centers in four Ukrainian administrative regions. For those screening positive for OUD, interest in OAT was assessed before and after a brief intervention. Those interested in OAT were referred to community OAT services. Participants with OUD also underwent HIV testing. Principal findings Of the 1,298 consecutive individuals screened, 208 (16.0%) met criteria for opioid dependence. Of these, 122 (58.7%) enrolled in brief intervention, of which 54 (44.3%) had HIV and 14 (25.9%) of these were newly diagnosed. After the brief intervention, interest in starting OAT increased significantly from a median of 7.0 to 8.0 (P = <0.001) using a 10-point scale. Thirty (N = 30; 24.6%) of the enrolled participants initiated OAT and 21 of these (70%) were retained in treatment for 6 months. Significance The prevalence of OUD (and HIV) is high among people in probation in Ukraine. SBIRT can identify a large number of people eligible for OAT, many of whom were willing to initiate and remain on OAT. Integrating SBIRT into probation can potentially assist with OAT scale-up and help address HIV prevention efforts.

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“…Until 2016, OAT in the form of methadone was exclusively provided at governmental clinics. The administration of methadone was primarily conducted as a daily, directly supervised therapy; however, due to the onset of the COVID-19 pandemic and the ongoing war in Ukraine, there has been a notable expansion in the availability of take-home dosing for methadone [17,18]. This change has allowed individuals to have more flexibility in managing their treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Another development in the OAT landscape occurred in 2021 with the introduction of methadone in Ukrainian prisons, aiming to address the needs of incarcerated individuals struggling with opioid addiction. More relaxation of THD during the 2022 invasion of Ukraine by Russia also occurred [20], and further accelerated the adaptation of new models of OAT delivery [17,18,20,21]. As OAT delivery continues to be in flux, understanding patient preferences can inform emerging models of care and scale-up.…”

Section: Introductionmentioning

confidence: 99%

Preferences and decisional considerations relating to opioid agonist therapy among Ukrainian people who use drugs: A conjoint analysis survey

Bromberg,

Madden,

Fraenkel

et al. 2024

PLOS Glob Public Health

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Scaling up opioid agonist therapies (OAT) is the most effective strategy to control combined HIV and opioid epidemics, especially in Eastern Europe and Central Asia (EECA), where HIV incidence and mortality continue to increase. Patient concerns about OAT, however, have undermined scale-up. The objective of this study is to understand Ukrainian opioid use disorder patient preferences about OAT to guide the development of an evidence-informed decision aid for clinical decision-making. We conducted a conjoint-based choice (CBC) survey. Participants were asked to about their preferences relating to 7 attributes of OAT (cost, dosing frequency, concerns about withdrawal symptoms, adverse side effects, improvements in quality of life, precipitation of withdrawal and legislative requirements to be registered as a drug dependent person) and 20 attribute levels for receiving OAT under differing potential treatment constraints. Data were analyzed using Hierarchical Bayesian models. Using respondent-driven sampling and random sampling, we recruited 2,028 people who inject drugs with opioid use disorder. Relative importance (RIS) and partial-worth utility scores (PWUS) were used to assess preferences for attributes and thresholds within each attribute. Cost and dosing frequency were the most important attributes (RIS = 39.2% and RIS = 25.2%, respectively) to potential patients, followed by concerns about withdrawal symptoms (RIS = 10.8%), adverse side effects (RIS = 9.0%), quality-of-life improvement (RIS = 7.5%), precipitation of euphoria (5.2%) and requirement to be registered as a drug- dependent person (RIS = 3.1%). The monthly cost-threshold for willingness-to-pay was 1,900 UAH ($70 USD). In Ukraine, where both governmental and private OAT clinics have emerged and provide markedly different delivery strategies, preferences are mostly driven by out-of-pocket expenses, despite many patients being willing to pay for OAT. Programmatic demands (flexibility and ease of acquiring medications) remain an important consideration while for a minority, clinical concerns about withdrawal symptoms, adverse side effects and OAT impact on life play a smaller role.

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Medications for opioid use disorder during the war in Ukraine: a more comprehensive view on the government response—Authors’ reply

Cited by 8 publications

References 6 publications

High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine

High perceived stress in patients on opioid agonist therapies during rapid transitional response to the COVID-19 pandemic in Ukraine

Aligning public health and public safety: Probation as a touchpoint to identify and link patients with opioid use disorder to opioid agonist treatment

Preferences and decisional considerations relating to opioid agonist therapy among Ukrainian people who use drugs: A conjoint analysis survey

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