Treatment of Opioid-Use Disorders

Benumof, Jonathan L.

doi:10.1056/nejmc1610830

Cited by 42 publications

(15 citation statements)

References 50 publications

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“…An advantage of MMT in the public setting is that it is usually provided with minimal direct expense to the patient [ 44 ]. MMT requires daily visits to receive methadone; although with time and duration of abstinence, patients can take home doses for self-administration [ 45 ]. OTPs may also be staffed by other healthcare providers who can provide primary or specialty care for a range of co-morbid psychiatric conditions, HIV and HCV [ 46 •].…”

Section: Resultsmentioning

confidence: 99%

Integrated Models of Care for Individuals with Opioid Use Disorder: How Do We Prevent HIV and HCV?

et al. 2018

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Purpose of ReviewTo describe models of integrated and co-located care for opioid use disorder (OUD), hepatitis C (HCV), and HIV.Recent FindingsThe design and scale-up of multidisciplinary care models that engage, retain, and treat individuals with HIV, HCV, and OUD are critical to preventing continued spread of HIV and HCV. We identified 17 models within primary care (N = 3), HIV specialty care (N = 5), opioid treatment programs (N = 6), transitional clinics (N = 2), and community-based harm reduction programs (N = 1), as well as two emerging models.SummaryKey components of such models are the provision of (1) medication-assisted treatment for OUD, (2) HIV and HCV treatment, (3) HIV pre-exposure prophylaxis, and (4) behavioral health services. Research is needed to understand differences in effectiveness between co-located and fully integrated care, combat the deleterious racial and ethnic legacies of the “War on Drugs,” and inform the delivery of psychiatric care. Increased access to harm reduction services is crucial.Electronic supplementary materialThe online version of this article (10.1007/s11904-018-0396-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Integrated Models of Care for Individuals with Opioid Use Disorder: How Do We Prevent HIV and HCV?

et al. 2018

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“…This is important due to the increasing amount of reported methadone diversion. 31 Furthermore, opioid dependence is a chronic and relapsing disorder 3 This finding is in line with the fact that amphetamine preparations may contain lactose in different amounts to dilute or to add bulk to the abused substance. 18 In our previous study, we applied an enzymatic method to detect the disaccharides lactose and sucrose mainly in PM urine samples, 24 and a correlation was found between lactose concentration and the presence of BPN or BNX.…”

Section: Intravenous Abuse Of Other Substancesmentioning

confidence: 79%

“…Opioid maintenance treatment (OMT) aims at preventing or significantly reducing illicit opioid abuse, drug-related crimes, intravenous substance abuse, and risks associated with overdose. [1][2][3][4] It enables the treatment of opioid dependence and improves patients' psychosocial welfare. 1 The need for efficient OMT has been emphasized lately, especially in the context of the opioid crisis in the United States.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 The most commonly used OMT medication is either methadone (MET) or buprenorphine, the latter being administered in the form of monobuprenorphine (BPN) or the combination preparation buprenorphinenaloxone (BNX). 3,4 The opioid antagonist naloxone in BNX may reduce the risk of diversion and intravenous abuse, 4 but it does not prevent these actions completely [9][10][11] among tablet or film users. 12 Injection use of BPN is the most biologically efficient route of administration in terms of bioavailability.…”

Section: Introductionmentioning

confidence: 99%

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Enzymatic assay for urine lactose in the assessment of recent intravenous abuse of buprenorphine

Keltanen

Heikman

Muhonen

et al. 2019

Drug Testing and Analysis

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Laboratory methods for differentiating intravenous substance abuse from medical oral or sublingual use are lacking. The disaccharides lactose and sucrose are common excipients in both medical preparations and illicit drugs. If substances are abused intravenously, the disaccharides are excreted unchanged in urine. This study evaluated whether urine lactose indicates recent intravenous abuse of substances with special reference to buprenorphine (BPN). Samples were attained from 21 patients in assessment for opioid maintenance treatment (OMT) and from 29 patients already enrolled in OMT. Patients were divided in two groups. Group 1 patients reported intravenous abuse of BPN within 48 hours and Group 2 more than 48 hours since the last injection. The urine samples were assayed for lactose using an enzymatic method. To verify intravenous abuse, examination of needle marks and mass spectrometric analysis of abused substances was performed. Urine lactose concentration was significantly higher in Group 1 (86 mg/L) than in Group 2 (24 mg/L). All samples with lactose concentration more than 140 mg/L were given by the Group 1 patients, who all had recent injection marks. A significant inverse correlation was found between the time from last injection and the urine lactose concentration within the 48‐hour post‐injection period. Elevated lactose concentrations in urine could indicate intravenous abuse of substances containing lactose. The co‐occurrence of higher than 140 mg/L of lactose in urine by means of enzymatic assay verified by fresh puncture sites is a potential indicator of recent intravenous abuse of BPN.

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“…Opioid maintenance treatment is increasingly recognized as an effective management strategy in the treatment of heroin use disorders (2). Under supervised agonist delivery, harmful illicit use of drugs can be significantly reduced, and the user’s mental health can be improved (3, 4).…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Survey of Buprenorphine Substitute Treatment With Minimal Dosage in Heroin Use Disorder

et al. 2019

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Objectives: It is widely accepted that buprenorphine maintenance treatment (BMT) with dosages above 8 mg daily is effective for patients with heroin use disorder. In this study, the authors evaluated the effectiveness of long-term BMT for heroin users in China, with dosages kept on a much smaller level.Methods: This is a retrospective observational study of 72 patients who had undergone detoxification and continued with buprenorphine maintenance between 2007 and 2016. Measurements such as self-reported relapse status, buprenorphine doses, protracted symptoms, general health condition, and self-reported side effects were included.Results: At the time of interview, 51 patients had remained abstinent at follow-up (including 13 who were opioid-free). The dosages of buprenorphine were 1.33 ± 0.88 (ranging 0.3–3.5) mg/day when maintenance treatment was initiated and 1.2 ± 0.8 (ranging 0.2–3.2) mg/day at the last follow-up. The remaining patients had either relapsed on heroin (n = 11) or switched to compulsory treatment (n=10). In general, abstinent patients had minimal protracted symptoms, especially in physical symptoms. Opioid-free abstainers were more likely to report good physical health than patients on buprenorphine. Predictors of worse outcomes (relapsed or switched to compulsory treatment) were lower education levels, younger age, and younger onset of illicit drug use.Conclusions: This study shows promising results of minimal-dosage BMT in treating heroin use disorder. We recommend further studies applying minimal-dosage BMT in China and worldwide.

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Treatment of Opioid-Use Disorders

Cited by 42 publications

References 50 publications

Integrated Models of Care for Individuals with Opioid Use Disorder: How Do We Prevent HIV and HCV?

Integrated Models of Care for Individuals with Opioid Use Disorder: How Do We Prevent HIV and HCV?

Enzymatic assay for urine lactose in the assessment of recent intravenous abuse of buprenorphine

A Retrospective Survey of Buprenorphine Substitute Treatment With Minimal Dosage in Heroin Use Disorder

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