Showing papers in "Substance Abuse Treatment Prevention and Policy in 2017"

Chronic pain and opioid misuse: a review of reviews.

Abstract: The crisis of prescription opioid (PO) related harms has focused attention toward identifying and treating high-risk populations. This review aims to synthesize systematic reviews on the epidemiology and clinical management of comorbid chronic pain and PO or other substance misuse. A systematic database search was conducted to identify systematic reviews published between 2000 and 2016. Eligible studies were systematic reviews related to chronic non-cancer pain and PO or other substance misuse. Evidence from the included reviews was synthesized according to epidemiology and clinical management themes. Of 1908 identified articles, 18 systematic reviews were eligible for final inclusion. Two meta-analyses estimated the prevalence of chronic non-cancer pain in individuals using POs non-medically to be approximately 48% to 60%, which is substantially higher than the prevalence of chronic non-cancer pain in general population samples (11% to 19%). Five systematic reviews estimated the rates of PO or other opioid use in chronic pain populations with substantial variation in results (0.05% to 81%), likely due to widely varying definitions of dependence, substance use disorder, misuse, addiction, and abuse. Several clinical assessment and treatment approaches were identified, including: standardized assessment instruments; urine drug testing; medication counts; prescription drug monitoring programs; blood level monitoring; treatment agreements; opioid selection; dosing and dispensing strategies; and opioid agonist treatment. However, the reviews commonly noted serious limitations, inconsistencies, and imprecision of studies, and a lack of evidence on effectiveness or clinical utility for the majority of these strategies. Overall, current systematic reviews have found a lack of high-quality evidence or consistent findings on the prevalence, risk factors, and optimal clinical assessment and treatment approaches related to concurrent chronic pain and substance misuse. Given the role of systematic reviews in guiding evidence-based medicine and health policy, there is an urgent need for high-quality primary research to guide future systematic reviews to address the escalating epidemic of harms related to chronic pain and substance misuse.

Global cocaine intoxication research trends during 1975–2015: a bibliometric analysis of Web of Science publications

Abstract: Cocaine is subject to recreational abuse as a stimulant and psychoactive agent, which poses a major worldwide health problem. The aim of the present study was to perform a bibliometric analysis of publication related to cocaine intoxication an insight of the research trends at a global level to enable recommendations for future research strategies in this field. Publications about cocaine intoxication were retrieved from the Web of Science (WoS) Core Collection database on December 28, 2016, and analysed regarding the following bibliometric indicators: research trends, document types, languages, countries/territories with their h-index, collaboration patterns, journals with their impact factors (IF), and institutions. In total, 2,902 scientific publications from 1975 to 2015 were retrieved from the WoS database. The annual number of publications related to cocaine toxicity increased slightly after 1990 and reached a peak of 148 in 1992, with an average of 103 publications per year. The USA outranked other countries/territories with 2,089 publications, of which 1,927 arose exclusively from the USA and 162 involved international collaborations. The h-index for all publications related to cocaine was 212, and the h-index for all publications related to cocaine intoxication was 99. Moreover, the USA had the highest h-index of 95, followed by Spain with h-index of 24, and Canada with h-index of 24. The main research topics were consistently reproductive toxicity, clinical management of acute cocaine exposure, laboratory methods for detection of exposure to cocaine, cocaine metabolism, and cocaine toxicity in animals. This is the first bibliometric approach to examining research related to cocaine toxicity and shows that research activity has become more global and extensive since 1990. The USA remains the leading country regarding published literature, the highest h-index, and greatest role in international collaborations.

Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review

Abstract: There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care. We synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised. We identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians’ primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening in areas beyond a clinician's primary area of practice was a common strategy for facilitating referral and integrated care, as was joint care planning. Despite considerable limitations and gaps in the literature in terms of the evaluation of integrated care strategies, particularly between AOD services, our review highlights several strategies that could be useful at multiple levels. Given the interconnectedness of integrated care strategies identified, implementation of multi-level strategies rather than single strategies is likely to be preferable.

Is there room for resilience? A scoping review and critique of substance use literature and its utilization of the concept of resilience.

Abstract: Research in the area of illicit substance use remains preoccupied with describing and analyzing the risks of people who use drugs (PWUD), however more recently there has been a drive to use a strengths-based or resilience approach as an alternative to investigating drug use. This leads us to ask: what can be known about PWUD from the point of view of resilience? The objective of this scoping review is to analyze how the concept of resilience is defined, operationalized, and applied in substance use research. Popular health, social science, psychology, and inter-disciplinary databases namely: SCOPUS, PUBMED, PsycINFO, and Sociological Abstracts were searched. Studies were selected if they used the concept of resilience and if substance use was a key variable under investigation. A total of 77 studies were identified which provided a definition of resilience, or attempted to operationalize (e.g., via scales) the concept of resilience in some manner. Data were charted and sorted using key terms and fundamental aspects of resilience. The majority of studies focus on youth and their resistance to, or engagement in, substance use. There is also a small but growing area of research that examines recovery from substance addiction as a form of resilience. Very few studies were found that thoroughly investigated resilience among PWUD. Consistently throughout the literature drug use is presented as a ‘risk factor’ jeopardizing one’s ability to be resilient, or drug use is seen as a ‘maladaptive coping strategy’, purporting one’s lack of resilience. Currently, substance use research provides a substantial amount of information about the internal strengths that can assist in resisting future drug use; however there is less information about the external resources that play a role, especially for adults. Though popular, outcome-based conceptualizations of resilience are often static, concealing the potential for developing resilience over time or as conditions change. Studies of resilience among PWUD predominantly concentrate on health-related behaviours, recovery-related factors or predefined harm reduction strategies. Indeed, overall, current conceptualizations of resilience are too narrow to recognize all the potential manifestations of resilience practices in the daily lives of individuals who actively use drugs.

Lead poisoning among opium users in Iran: an emerging health hazard

Abstract: Lead (Pb) poisoning among people using opium has been an increasing problem in Iran. The present study highlights the clinical effects of lead toxicity associated with opium use in Iran, Kerman province. Between January 2016 and June 2016, patients with signs and symptoms of Pb poisoning were questioned to assess whether they had a history of opium dependency. In total, 249 patients were enrolled onto this cross-sectional study, all were opium dependent. Para-clinical data including blood lead level (BLL), demographic information, user preferences, and symptoms were obtained. The patients used either opium (83.9%), refined opium (6.4%) or a combination of both (9.7%) via ingestion (71.9%), smoking (8.4%) or a combination of both (19.7%). The overall median BLL was 80.0 μg/dL [IQR: 51.7–119.0]. The median BLL did not differ significantly between opium and refined opium users. Further, BLL was not significantly affected by the type of substance, route of use, duration of use, or daily quantity consumed. Common symptoms included abdominal pain (86.9%), constipation (75.8%), anorexia (71.5%) and nausea (54.7%). Linear regression analysis showed log of BLL was significantly associated with abdominal pain, myalgia and anorexia. The study unravelled an increase in opium-related Pb poisoning in the Kerman province. Raised awareness of this emerging Pb source and investigation of its aetiology is recommended. Pb poisoning should be considered among the primary differential diagnosis of opium users with gastrointestinal symptoms.

Systemic and individual factors in the buprenorphine treatment-seeking process: a qualitative study

Abstract: Opioid use is a significant problem in Alaska. Medication-assisted treatment for opioid use, including buprenorphine, reduces withdrawal symptoms and the harm associated with opioid abuse. Understanding consumers’ treatment-seeking process is important for addressing barriers to treatment, facilitating effective service utilization, and informing policy. To understand treatment-seeking behavior, we examined the attitudes, perceptions, and knowledge of those who would benefit from the medication-assisted treatment (MAT) buprenorphine. Qualitative data from 2 focus groups (each including 4 participants) and 3 in-depth interviews with people who have used or considered using buprenorphine in treatment for an opioid use disorder were analyzed using grounded theory and directed content analysis approaches. Key findings suggest that individual (withdrawal process, individual motivation) and systemic (sociocultural, political, societal values) factors frame the treatment seeking process. Participants’ progress on the treatment-seeking road was affected by models of addiction and MAT, which related to facilitators and barriers encountered in seeking treatment (e.g. support, resources, treatment structure). These factors shaped the longer-term road to recovery, which was seen as on ongoing process. The findings of this study suggest it is crucial for interventionists to take a contextual approach that considers individual and systemic factors involved in opioid addiction, treatment, and recovery. This study highlights ways policy makers and treatment providers can address the barriers consumers face in their treatment-seeking process in order to increase treatment access.

Prevalence and associated factors of illicit drug use among university students in the association of southeast Asian nations (ASEAN).

Abstract: Illicit drug use among university students has been recognized as a global public health issue in recent years. It may lead to poor academic performance that in turn leads to poor productivity in their later life. This study explores prevalence of and factors associated with illicit drug use among university students in the Association of Southeast Asian Nations (ASEAN). This multi-country cross-sectional study was conducted in 2015 in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam. A multi-stage cluster sampling was used to select undergraduate students from one or two universities in each country for self-administered questionnaire survey. Multivariate logistic regression analyses was performed to explore risk factors related to illicit drug use. Participants included 7,923 students with a mean age of 20.6 years (SD = 2.8), ranging from 18–30 years. The overall prevalence of frequent (≥10 times), infrequent (1–9 times) and ever (at least once) illicit drug use in the past 12 months was 2.2, 14.7, and 16.9%, respectively. After adjustment, male students were significantly less likely to be infrequent (1–9 times vs. never), but significantly more likely to be ever users compared to females. Compared to those living with parents/guardians, students living away from parents/guardians were significantly less likely to be frequent (≥10 times vs. never) and infrequent users. Students from lower-middle-income countries were significantly more likely to be frequent and infrequent users, but significantly less likely to be ever users compared to those from upper-middle or high-income countries. Students with poor subjective health status were significantly more likely to be frequent users compared to those who reported good subjective health status. Students who reported binge drinking in the past month were significantly more likely to be infrequent users, but significantly less likely to be ever users. Our findings indicate that prevalence of illicit drug use among university students in the ASEAN region varied by country. Concerted social intervention programs should be designed to address related health and behavioral problems such as illicit drug use and alcohol drinking with particular emphasis on at-risk subgroups of this young population.

Adherence to methadone maintenance treatment and associated factors among patients in Vietnamese mountainside areas.

Abstract: Medication adherence is essential to achieve successful methadone maintenance treatment (MMT). However, treatment adherence among MMT patients in the mountainous setting in Vietnam has not been yet investigated. This study aimed to explore the medication adherence and associated factors in MMT patients in Tuyen Quang, a mountainous province. A cross-sectional survey was conducted in two MMT clinics namely Tuyen Quang and Son Duong. Convenience sampling method was used to recruit patients. Adherence to MMT was assessed by using three questions: 1) number of days that they missed doses in the last 4 days; 2) whether they missed doses during the last weekend and 3) when they missed a dose within the last 3 months. Adherence was considered optimal if patients reported ‘no’ to three questions. Socioeconomic status, health status (measured by EuroQol-5 Dimensions – 5 Levels – EQ5D5L and Visual analogue scale – VAS), substance use and abuse and methods to support adherence were also collected. Among 241 patients, 34.4% reported optimal adherence. Self-help was the most popular (89.2%) method used to support adherence. Risk factors of missing doses and suboptimal adherence included higher education and economic status; being a worker/farmer; longer duration of treatment; and suffering pain/discomfort and anxiety/depression. Protective factors were older age, having problems in usual activities/self-care, higher EQ-VAS and EQ-5D index; and reminded by mobile phone and family members. This study found a high sub-optimal adherence rate among MMT patients in a mountainous setting in Vietnam. Measuring adherence by using several simple items could be used periodically to monitor the treatment adherence in the clinical setting. Family and mobile phone support would have a potential role in supporting patients to adhere treatment.

Men's and women's response to treatment and perceptions of outcomes in a randomized controlled trial of injectable opioid assisted treatment for severe opioid use disorder.

Abstract: To test whether there are gender differences in treatment outcomes among patients receiving injectable opioids for the treatment of long-term opioid-dependence. The study additionally explores whether men and women have different perceptions of treatment effectiveness. This study is a secondary analysis from SALOME, a double-blind, phase III, randomized controlled trial testing the non-inferiorirty of injectable hydromorphone to injectable diacetylmorphine among 202 long-term street opioid injectors in Vancouver (Canada). Given this was a secondary analysis, no a priori power calaculation was conducted. Differences in baseline characteristics and six-month treatment outcomes (illicit heroin use, opioid use, crack cocaine use, non-legal activities, physical and psychological health scores, urine positive for street heroin markers, and retention) were analysed by gender using fitted models. Responses to an open ended question on reasons for treatment effectiveness were explored with a thematic analysis. Men and women differed significantly on a number of characteristics at baseline. For example, women were significantly younger, presented to treatment with significantly higher rates of prior month sex work (31.5% vs. 0%), and used significantly more crack cocaine (14.71 vs. 8.38 days). After six-months of treatment there were no significant differences in treatment outcomes by gender, after adjusting for baseline values. For both men and women, improved health and quality of life were the most common reasons provided for treatment effectiveness, however women were more specific in the types of health improvements. Despite presenting to treatment with vulnerabilities not faced to the same extent by men, at six-months women did not differ significantly from men in tested trial efficacy outcomes. While the primary outcome in the trial was the reduction of illicit opioid use, in the open-ended responses both men and women focused their comments on improvement in health and quality of life as reasons for treatment effectiveness. The supervised model of care with injectable medications provides a particularly suitable framework for providing care to opioid-dependent men and women not attracted or retained by other treatments. The absence of statistical differences reported in this secondary analysis may be due to lack of adequate statistical power to detect meaningful effects. This trial is registered with ClinicalTrials.gov (NCT01447212) Registered: October 4, 2011 at the following link: https://clinicaltrials.gov/ct2/show/NCT01447212 .

The opioid crisis: past, present and future policy climate in Ontario, Canada

Abstract: Addressing opioid use disorder has become a priority in Ontario, Canada, because of its high economic, social and health burden. There continues to be stigma and criticism relating to opioid use disorder and treatment options. The result has been unsystematic, partial, reactive policies and programs developed based on divergent points of view. The aim of this manuscript is to describe how past and present understandings, narratives, ideologies and discourse of opioid use, have impacted policies over the course of the growing opioid crisis. Assessing the impact of policy is complex. It involves consideration of conceptual issues of what impacts policy change. In this manuscript we argue that the development of polices and initiatives regarding opioids, opioid use disorder and opioid agonist treatment in the last decade, have been more strongly associated with the evolution of ideas, narratives and discourses rather than research relating to opioids. We formulate our argument using a framework by Sumner, Crichton, Theobald, Zulu, and Parkhurs. We use examples from the Canadian context to outline our argument such as: the anti- drug legislation from the Canadian Federal Conservative government in 2007; the removal of OxyContin™ from the drug formulary in 2012; the rapid expansion of opioid agonist treatment beginning in the early 2000s, the unilateral decision made regarding fee cuts for physicians providing opioid agonist treatment in 2015; and the most recent implementation of a narcotics monitoring system, which are all closely linked with the shifts in public opinion and discourse at the time of which these policies and programs are implemented. We conclude with recommendations to consider a multifactorial response using evidence and stakeholder engagement to address the opioid crisis, rather than a reactive policy approach. We suggest that researchers have an important role in shaping future policy by reframing ideas through knowledge translation, formation of values, creation of new knowledge and adding to the quality of public discourse and debate.

A mixed methods study of HIV-related services in buprenorphine treatment

Abstract: Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers’ medical specialty and across practice settings. Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients receive HIV testing, and availability of on-site HIV testing. Prescribers’ medical specialty, practice settings, caseload demographics, and physician demographics were measured. Multivariate models of HIV services were estimated, while accounting for the nesting of physicians within states. Qualitative interviews revealed that physicians often use injection behaviors as the primary indicator for whether a patient should be tested for HIV. Interviews revealed that HIV-related services were often viewed as beyond the scope of practice among general psychiatrists. Surveys indicated that prescribers screened for an average of 3.2 of 5 HIV risk behaviors (SD = 1.6) at intake. About 62.0% of prescribers delivered HIV education to patients and 53.2% recommended HIV testing to all new patients, but only 32.3% offered on-site HIV testing. Addiction specialists and psychiatrists screened for significantly more HIV risk behaviors than physicians in other specialties. Addiction specialists and psychiatrists were significantly less likely than other physicians to offer on-site testing. Physicians in individual medical practice were significantly less likely to recommend HIV testing and to offer onsite testing than physicians in other settings. Buprenorphine treatment providers have not uniformly integrated HIV-related screening, education, and testing services for patients. Differences by medical specialty and practice setting suggest an opportunity for targeting efforts to increase implementation.

Health and behavioral factors associated with binge drinking among university students in nine ASEAN countries.

Abstract: Heavy drinking among university students has been globally recognized as a major public health burden. In the Association of Southeast Asian Nations (ASEAN) region, studies on this issue have been scant, country-specific and in different time frames. The aim of this study was to identify social and behavioral factors associated with binge drinking among university students in nine ASEAN countries. This cross-sectional study was conducted in 2015 among 8809 undergraduate university students from 13 universities in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam using self-administered questionnaire. Multivariate logistic regression analyses were conducted to explore the associated factors. More than half (62.3%) of the study sample were female with a mean age of 20.5 (SD = 2.0) years. Of total, 12.8% were infrequent (

Cohort profile: seek, test, treat and retain United States criminal justice cohort.

Abstract: The STTR treatment cascade provides a framework for research aimed at improving the delivery of services, care and outcomes of PLWH The development of effective approaches to increase HIV diagnoses and engage PLWH in subsequent steps of the treatment cascade could lead to earlier and sustained ART treatment resulting in viral suppression There is an unmet need for research applying the treatment cascade to improve outcomes for those with criminal justice involvement The Seek, Test, Treat, and Retain (STTR) criminal justice (CJ) cohort combines data from 11 studies across the HIV treatment cascade that focused on persons involved in the criminal justice system, often but not exclusively for reasons related to substance use The studies were conducted in a variety of CJ settings and collected information across 11 pre-selected domains: demographic characteristics, CJ involvement, HIV risk behaviors, HIV and/or Hepatitis C infections, laboratory measures of CD4 T-cell count (CD4) and HIV RNA viral load (VL), mental illness, health related quality of life (QoL), socioeconomic status, health care access, substance use, and social support The STTR CJ cohort includes data on 11,070 individuals with and without HIV infection who range in age from 18 to 77 years, with a median age at baseline of 37 years The cohort reflects racial, ethnic and gender distributions in the US CJ system, and 64% of participants are African-American, 12% are Hispanic and 83% are men Cohort members reported a wide range of HIV risk behaviors including history of injection drug use and, among those who reported on pre-incarceration sexual behaviors, the prevalence of unprotected sexual intercourse ranged across studies from 4% to 79% Across all studies, 53% percent of the STTR CJ cohort reported recent polysubstance use The STTR CJ cohort is comprised of participants from a wide range of CJ settings including jail, prison, and community supervision who report considerable diversity in their characteristics and behavioral practices We have developed harmonized measures, where feasible, to improve the integration of these studies together to answer questions that cannot otherwise be addressed

Parents' and peers' normative influence on adolescents' smoking: results from a Swiss-Italian sample of middle schools students.

Abstract: Adolescents observe and imitate people to whom they are associated in their social context, and the normative factors sent out by reference groups are crucial determinants of their decision to smoke. The aim of the study is to investigate how adolescents’ smoking changes when they are exposed to factors of pro-smoking normative influence by parents and peers, and how age moderate this relation. A cross sectional survey collected data from 5657 students, aged between 11 and 14, from public and private middle schools in the Italian region of Switzerland (Ticino) on their smoking habits, perceived parents’ and peers’ approval and smoking. Multinomial logistic regression show that, as adolescents get older, more of the pro-smoking factors come from peers and parents, the higher the risk gets of being a “heavy smoker” has compared against having no experience with smoking. Living in a context with no factor of normative influence toward smoking play a protective role against smoking, and this effect becomes more important than more harmful the smoking behavior in question is. Furthermore, peers’ descriptive norms are more influential for adolescents to become “light” and “heavy smokers”, while smoking being approved by peers is important for adolescents to become accustomed to smoking. Findings support the different influence of parents’ and peers’ norms on adolescents’ smoking, and highlight the importance of peers’ model behavior as the most important factor influencing smoking during adolescence. Such results have implications for programs that aim to prevent or reduce smoking in early adolescence when friendship choice starts to become crucial.

Korean national athletes' knowledge, practices, and attitudes of doping: a cross-sectional study.

Abstract: Despite the efforts of the World Anti-Doping Agency and national anti-doping agencies at the international level, a relatively low and steady rate of positive doping tests still persists all over the world. Evidence on adolescents using doping substances exists, and the proportion of adolescents engaging in doping practices is small but significant. In relation to the international research trends on anti-doping, this study aims to evaluate doping knowledge, practices, and attitudes among Korean adult and adolescent elite athletes to provide effective information on anti-doping policies and education programs. This study was a cross-sectional study of 454 Korean elite athletes (249 adults in 23 events and 205 adolescents in 22 events). Data were collected by an interviewer-administered questionnaire containing items regarding doping practices and knowledge, brief definitions of performance-enhancing substances/methods and recreational substances, and the Performance Enhancement Attitude Scale (PEAS). Adolescent (47.3%) and adult (57.0%) athletes received information on banned substances of their respective sports from the Korea Anti-Doping Agency, and 39.0 and 53.4% of adolescents and adults, respectively, had knowledge of banned substances and had permissive attitudes toward doping compared to those who were unaware. Adolescent and adult athletes have inadvertently (1.5 and 3.6%, respectively) or knowingly (1.0 and 2.8%, respectively) taken banned performance-enhancing substances, and 2.4 and 3.2%, respectively, knew someone who had taken banned substances. And the adolescent athletes in motor skill category (PEAS: 40.24 ± 10.91) were more permissive toward doping than those in team category (PEAS: 35.08 ± 10.21). An in-depth anti-doping education for Korean athletes should be more widely implemented, and effective anti-doping policy should meet the athletes’ demographic characteristics, personalities, and values.

"I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service.

Abstract: The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff. This qualitative study was undertaken as part of a three-year mixed methods community-based participatory research (CBPR) project that aimed to empirically describe a remote Aboriginal drug and alcohol rehabilitation service. Researchers utilised purposive sampling to conduct 21 in-depth, semi-structured interviews. The interviews used a ‘research yarning’ approach, a form of culturally appropriate conversation that is relaxed and narrative-based. The interview transcripts were thematically coded using iterative categorization. The emerging themes were then analysed from an Interpretative Phenomenological Analysis, focusing on how participants’ lived experiences before and during their admission to the service shaped their perceptions of the program. A total of 12 clients (mean age 35 years, SD 9.07, 91% Aboriginal) and 9 staff (2 female, 7 male, mean age 48 years, SD 8.54, 67% Aboriginal) were interviewed. Five themes about specific program components were identified in the interview data: healing through culture and country; emotional safety and relationships; strengthening life skills; improved wellbeing; and perceived areas for improvement. This research found that Aboriginal drug and alcohol residential rehabilitation is not just about length of time in treatment, but also about the culture, activities and relationships that are part of the treatment process. This study highlights that cultural elements were highly valued by both clients and staff of a remote Aboriginal residential rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.

Implementation of methadone therapy for opioid use disorder in Russia – a modeled cost-effectiveness analysis

Abstract: Opioid agonist therapy using methadone, an effective treatment of opioid use disorders (OUD) for people who inject drugs (PWID), is recommended by the World Health Organization as essential to curtail the growing HIV epidemic. Yet, despite increasing prevalence of OUD and HIV, methadone therapy has not yet been implemented in Russia. The aim of this modeling study was to estimate the cost-effectiveness of methadone therapy for Russian adults with a diagnosed OUD. We modeled the projected program implementation costs and estimated disability-adjusted life years (DALYs) averted over a 10-year period, associated with the provision of methadone therapy for a hypothetical, unreplenished cohort of Russian adults with an OUD (n = 249,000), in comparison to the current therapies at existing addiction treatment facilities. Our model compared four distinct scenarios of treatment coverage in the cohort ranging from 3.1 to 55%. Providing methadone therapy to as few as 3.1% of adults with an OUD amounted to an estimated almost 50,000 DALYs averted over 10 years at a cost of just over USD 17 million. Further expanding service coverage to 55% resulted in an estimated almost 900,000 DALYs averted, at a cost of about USD 308 million. Our study indicated that implementing opioid agonist therapy with methadone to treat OUD at existing facilities in Russia is highly cost-effective.

Identifying and reducing disparities in successful addiction treatment completion: testing the role of Medicaid payment acceptance

Abstract: Medicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs’ acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites. We analyzed client and program data from 122 publicly funded treatment programs in 2010 and 112 programs in 2013. These data were merged with information regarding 15,412 adult clients from both periods, of whom we selected only Mexican Americans (n = 7130, 46.3%) and non-Latino Whites (n = 8282, 53.7%). We used multilevel logistic regression and variance decomposition to examine associations and underlying factors associated with Mexican American and White differences in treatment completion. Variables of interest included client demographics; drug use severity and mental health issues; and program license, accreditation, and acceptance of Medicaid payments. Mexican Americans had lower odds of treatment completion (OR = 0.677; 95% CI = 0.534, 0.859) compared to non-Latino Whites. This disparity was explained in part by primary drug used, greater drug use severity, history of mental health disorders, and program acceptance of Medicaid payments. The interaction between Mexican Americans and acceptance of Medicaid was statistically significant (OR = 1.284; 95% CI = 1.008, 1.637). Findings highlighted key program and client drivers of this disparity and the promising role of program acceptance of Medicaid payment to eliminate disparities in treatment completion among Mexican Americans. Implications for health policy during the Trump Administration are discussed.

History of medication-assisted treatment and its association with initiating others into injection drug use in San Diego, CA.

Abstract: Medication-assisted treatment (MAT) remains the gold standard for the treatment of opioid use disorder. MAT also reduces the frequency of injecting among people who inject drugs (PWID). Relatedly, data suggest that PWID play a key role in the initiation of others into drug injecting by exposing injecting practices to injection-naive drug users. Our primary objective was to test whether a history of MAT enrollment is associated with a reduced odds of PWID providing injection initiation assistance. Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256–01), is a multi-site cohort study assessing the impact of socio-structural factors on the risk that PWID provide injection initiation assistance. Data were drawn from a participating cohort of PWID in San Diego, CA. The primary outcome was reporting ever providing injection initiation assistance; the primary predictor was reporting ever being enrolled in MAT. Logistic regression was used to model associations between MAT enrollment and ever initiating others into injecting while adjusting for potential confounders. Participants (n = 354) were predominantly male (n = 249, 70%). Thirty-eight percent (n = 135) of participants reported ever initiating others into injection drug use. In multivariate analysis, participants who reported a history of MAT enrollment had significantly decreased odds of ever providing injection initiation assistance (Adjusted Odds Ratio [AOR]: 0.62, 95% Confidence Interval [CI]: 0.39–0.99). These preliminary findings suggest an association between MAT enrollment and a lower odds that male PWID report providing injection initiation assistance to injection-naive drug users. Further research is needed to identify the pathways by which MAT enrollment may impact the risk that PWID initiate others into drug injecting.

Licit and illicit substance use patterns among university students in Germany using cluster analysis

Abstract: The use of multiple licit and illicit substances plays an important role in many university students’ lives. Previous research on multiple substance use patterns of university students, however, often fails to examine use of different illicit substances and/or hookah. Our objective was to complement and advance the current knowledge about common consumption patterns regarding illicit substances and hookah use in this group. Students from eight German universities completed an online survey as part of the INSIST study (‘INternet-based Social norms Intervention for the prevention of substance use among STudents’) regarding their consumption of alcohol, tobacco, hookah, cannabis and other illicit substances. Cluster analysis identified distinct consumption patterns of concurrent and non-concurrent substance use and multinomial logistic regressions described key sociodemographic factors associated with these clusters. Six homogeneous groups were identified: ‘Alcohol Abstainers’ (10.8%), ‘Drinkers Only’ (48.2%), ‘Drinkers and Cigarette Smokers’ (14.6%), ‘Cannabis and Licit Substance Users’ (11.2%), ‘Hookah Users with Co-Use’ (9.8%) and ‘Illicit Substance Users with Co-Use’ (5.4%). Illicit substance use clustered with the consumption of alcohol, tobacco and cannabis. Hookah use was regularly associated with alcohol consumption, less commonly associated with tobacco or cannabis use and very rarely associated with use of other illicit substances. Individuals consuming licit and illicit substances or hookah were mostly male and lived together with other students. Characteristics such as the number of years an individual had spent studying at a university, subject of study, immigrant background and religious affiliation were less commonly associated with cluster membership. Although we found substance use patterns in our sample largely similar to previous reports, we identified an important subgroup of individuals using both illicit and licit substances. These individuals may benefit especially from targeted interventions that focus on modifying addictive behavior patterns. DRKS00007635 . Registered 17 December 2014 (retrospectively registered).

Use of crystal methamphetamine among male adolescents in Cape Town, South Africa: Caregivers' experiences

Abstract: Against the background that crystal methamphetamine (colloquially known as “tik”) is extensively used by the emerging working class Coloured youth in Cape Town, South Africa, this exploratory qualitative study was conducted to explore the experience of mothers whose children use methamphetamine. The researchers conducted one-to-one semi-structured in-depth interviews with sixteen (16) purposively selected caregivers (mothers) whose sons use methamphetamine. Interviews were recorded and simultaneously translated and transcribed. Thematic analysis was used to identify themes related to the experiences of caregivers of youth with methamphetamine problems. Findings showed that youth misbehaviour provided a context that led to feelings of shame and embarrassment. Participants also experienced personal challenges which included emotional problems, fear and self-blame. Participants also expressed family disruptions and financial drain as adverse experiences as a results of their sons’ misbehaviour. The study results highlight the psychosocial challenges for caregivers of children who use methamphetamine. These findings underscore the need for effort to be directed at the development of formal support interventions for mothers of youth who are troubled with addiction.

Relationships between received and perceived social support and health-related quality of life among patients receiving methadone maintenance treatment in Mainland China.

Abstract: Social support has been considered one of the most important factors of health-related quality of life (HRQoL) evaluations among different populations; however, few studies have explored the relationships of both received and perceived social support to HRQoL among patients undergoing methadone maintenance treatment (MMT). Thus, the purpose of this cross-sectional study was to clarify these relationships. Participants were patients admitted at the two largest privately and publicly funded MMT clinics in Xi’an. The main explanatory variable was social support, both received (i.e., social network support and professional support services) and perceived (Multidimensional Scale of Perceived Social Support). The outcome was HRQoL, which was evaluated using the Short-Form 36 Health Survey version 2 (SF-36v2) and the Quality of Life Scale for Drug Addicts (QOL-DAv2.0). We carried out independent samples t-tests and multiple linear regression analysis to examine the relationships between received and perceived social support and HRQoL. The study findings revealed that patients with good social support had significantly higher scores on the SF-36v2 and QOL-DAv2.0 (p < 0.05). After controlling for individual characteristics, the significant factors predicting HRQoL were good family relationships, usually communicating with others, a convenient service time, appropriate treatment charges, and good perceived social support (p < 0.05). Our results suggest that received and perceived social support influences HRQoL among individuals receiving MMT. Thus, these variables should be considered during health management efforts and interventions directed at this patient population.

Influences of perfectionism and motivational climate on attitudes towards doping among Korean national athletes: a cross sectional study.

Abstract: The motives for elite athletes to dope are related primarily to maintaining and improving their physical performance. Especially, elite athletes training to compete in the Olympics may feel unique situational pressure, which may in turn induce powerful motivation for doping and predict doping behavior. This study aimed to investigate possible factors associated with attitudes towards doping in Korean national athletes who competed in the Rio 2016 Olympic Games. A total of 198 athletes (95 female, 103 male) completed the questionnaire, which covered demographic information, doping-related experiences, Performance Enhancement Attitude Scale (PEAS), Perfectionism in Sports Scale (PSS; coach’s criticism, concern over mistakes, and personal standards), and Perceived Motivational Climate in Sport Questionnaire-2 (PMCSQ-2; ego-involving and task-involving climates). Pearson’s correlation coefficients were used to identify correlations among PEAS, PSS, and PMCSQ-2 scores, and stepwise multiple linear regression was performed to investigate possible factors significantly associated with attitudes towards doping. The coach’s criticism of PSS was slightly or weakly related to the concern over mistakes of PSS and the ego-involving climate of PMCSQ-2, respectively. And the concern over mistakes sub-scale of perfectionism was related to attitudes towards doping, but weakly. Effective anti-doping policy should meet athletes’ perfectionism, and more studies that identify other factors that influence athletes’ doping attitudes are needed.

Problematic khat use as a possible risk factor for harmful use of other psychoactive substances: a mixed method study in Ethiopia.

Abstract: Substance use disorders along with neuropsychiatric disorders contributed about 14% of the global burden of disease. Harmful alcohol use, is a known contributor for many harms (accidents, suicide, violence, and complication of other psychiatric and medical disorders). In the Western countries, alcohol and nicotine are gateway drugs to cannabis use, and cannabis use is a risk factor for other illicit drugs such as cocaine and heroin. Khat use is another psychoactive substance which is common in East African and Arabian Peninsula. But there is a knowledge gap regarding the position of khat use or problematic khat use in sequential progression of different psychoactive substances. Therefore, we aimed to understand and investigate the relationship of problematic khat use and other psychoactive substances in Ethiopia. Exploratory mixed methods study was employed. Quantitative cross sectional survey was done among 102 khat users, and 4 focus group discussions and 11 in-depth interviews were conducted to understand the pathways between khat use and other psychoactive substances use in 2014. Non random sampling (purposive and snowballing) was employed for both quantitative and qualitative studies. Khat users from khat cafeterias, shops, and from other open markets of khat in Addis Ababa were invited to participate. Currently significant majorities of khat users (86.3%) used at least one other psychoactive substance after they started khat use. The prevalence of harmful drinking was 53.9% among khat users. Problematic khat use was a significant predictor of harmful drinking (p < 0.05). About one from ten respondents engaged to risky sexual behavior pushed by the effect of khat after chewing. The proportion of psychoactive substances use especially harmful drinking among khat users was observed higher compared to other cross sectional surveys conducted among general population. In Ethiopia, intervention and policy on harmful alcohol use could consider problematic khat use as one possible risky factor. A rigorous methodology which could test gateway hypothesis of problematic psychoactive substances use could be warranted.

Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study.

Abstract: Co-occurring severe mental and substance use disorders are associated with physical, psychological and social complications such as homelessness and unemployment People with severe mental and substance use disorders are difficult to engage with care The lack of treatment worsens their health and social conditions and increases treatment costs, as emergency department visits arise Case management has proved to be effective in promoting engagement with care of people with severe mental and substance use disorders However, this impact seemed mainly related to the case management model The Intensive Case Management for Addiction (ICMA) aimed to improve engagement with care of people with severe mental and substance use disorders, insufficiently engaged with standard treatment This innovative multidisciplinary mobile team programme combined Assertive Community Treatment and Critical Time Intervention methodologies The aim of the study was to observe the impact of ICMA upon service use, treatment adherence and quality of support networks Participants’ psychosocial and mental functioning, and substance use were also assessed throughout the intervention The study was observational Eligible participants were all the people entering the programme during the first year of implementation (April 2014–April 2015) Data were collected through structured questionnaires and medical charts Assessments were conducted at baseline and at 12 months follow-up or at the end of the programme if completed earlier McNemar-Bowker’s Test, General Linear Model repeated-measures analysis of variance and non-parametric Wilcoxon Signed Rank tests were used for the analysis A total of 30 participants took part in the study Results showed a significant reduction in the number of participants visiting the general emergency department compared to baseline A significantly decreased number of psychiatric emergency department visits was also registered Moreover, at follow-up participants improved significantly their treatment adherence, clinical status, social functioning, and substance intake and frequency of use These promising results highlight the efficacy of the ICMA The intervention improved engagement with care and the psychosocial situation of people with severe mental and substance use disorders, with consequent direct impact on their substance misuse

Sleep disturbance and its associations with severity of dependence, depression and quality of life among heroin-dependent patients: a cross-sectional descriptive study.

Abstract: Sleep disturbance is common and may adversely affect treatment outcome, mental health, and quality of life in heroin-dependent patients. Previous studies have focused upon patients receiving treatment. We conducted a cross-sectional descriptive study to explore the 1-month prevalence of sleep disturbance and its associations with socio-demographic, substance-related characteristics, severity of dependence, severity of depression, and quality of life among heroin-dependent patients before entering treatment program. The sample (n = 514) comprised individuals with heroin dependence attending the methadone maintenance treatment program and the therapeutic community at a psychiatric center in Nantou, Taiwan between 2008 and 2014. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) with a global score greater than 5 indicating sleep disturbance. Centre for Epidemiologic Studies Depression Scale, Severity of Dependence Scale, and World Health Organization Quality of Life-BREF were also approached. T-test, chi-square tests, and multivariate logistic regression were performed to measure associations between variables and sleep disturbance. The 1-month prevalence of sleep disturbance (PSQI > 5) was 76.3% among 514 subjects with heroin dependence. Heroin users with sleep disturbance had significantly more life events in the previous year, higher rate of unemployment, greater cigarette consumption, more substance related criminal convictions, longer length of heroin use, higher rate of injectors, greater severity of dependence, greater severity of depression, and lower quality of life compared to those without sleep disturbance. Severity of dependence, severity of depression, and physical health domain of quality of life remained significantly associated with sleep disturbance after adjusting for other variables. Heroin-dependent patients had a high 1-month prevalence of sleep disturbance, and this was associated with greater severity of dependence, greater severity of depression, and poorer physical health-related quality of life. Early assessments and interventions for sleep disturbance among patients with heroin dependence are recommended.

Combating substance misuse: competences and preparation of special education department students.

Abstract: Background This study examines Jordanian special education department students’ competences and preparation relating to combating substance misuse (SM).

Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs

Abstract: People who inject drugs (PWID) often have poor health and lack access to health care The aim of this study was to examine whether PWID engage in self-treatment through nonmedical prescription opioid use (NMPOU) We describe the prevalence and features of self-reported physical pain and its association with NMPOU PWID (N = 702) in San Francisco, California (age 18+) were recruited to complete interviewer administered surveys between 2011 and 2013 Multivariate logistic regression analysis was conducted to examine the associations among self-reported pain dimensions (past 24-h average pain, pain interference with functional domains) and NMPOU, controlling for age, sex, psychiatric illness, opioid substitution treatment, homelessness, street heroin use and unmet healthcare needs Almost half of the sample reported pain, based on self-reported measures in the 24 h before their interview The most common pain locations were to their back and lower extremities Past 24-h NMPOU was common (147%) and associated with past 24 h average pain intensity on a 10 point self-rating scale (adjusted odds ratio [AOR] = 215, 95% confidence interval [CI] 121–380), and past 24 h pain interference with general activity (AOR 182 [95% CI 104–321]), walking ability (AOR 252 [95% CI 137–463]), physical ability (AOR 201 [95% CI 116–345]), sleep (AOR 198 [95% CI 113–348]) and enjoyment of life (AOR 179 [95% CI 102–315]) Both pain and NMPOU are common among PWID, and highly correlated in this study These findings suggest that greater efforts are needed to direct preventive health and services toward this population

What constitutes problematic khat use? An exploratory mixed methods study in Ethiopia

Abstract: Khat is a psycho-stimulant herb, which has been in use in traditional societies in East Africa and the Middle East over many centuries. Although khat is reported to cause various health problems, what constitutes problematic khat use has never been systematically investigated. This study explored the acceptable and problematic uses of khat from the perspective of users. The study used a mixed methods design (exploratory sequential) in which qualitative (emic) data were collected to develop a framework to define problematic khat use. The qualitative data were gathered through in-depth interviews (N = 13) and focus group discussions (N = 34). By supplementing the emic experiences considered to constitute problematic khat use with an etic definition, DSM-5 criteria for stimulant related disorders, a structured questionnaire was developed. Subsequently a cross-sectional evaluation of 102 respondents was carried out. Respondents both for qualitative and quantitative study were selected through purposive sampling and snowballing methods. Qualitative data were transcribed and subjected to thematic analysis whereas quantitative data were analyzed using descriptive and nonparametric statistics. Khat use was acceptable socio-culturally and for functional purposes. However, even in these acceptable contexts there was a restriction to the amount, frequency and type of khat used, and in relation to the experience of the individual using khat and other personal characteristics. More specifically, khat use was considered problematic if there was: 1) Impairment (in social and occupational functioning); 2) loss of control in the use of khat; and 3) withdrawal symptoms when not using khat. Among the participants who use khat (n = 102), 45.1% (n = 46) used khat on a daily basis. The commonest indicators of problematic khat use endorsed by the khat users were loss of control over chewing (73.5%), continuing use of khat despite harm (72.5%) and efforts to avoid withdrawal from khat (61.8%). Despite reported religious, sociocultural and functional benefits to the use of khat, those with defined problematic khat use have impaired mental health, and social and occupational performance. Comparison of these respondent defined indicators of problem behavior matched almost completely to the DSM-5 (etic-defined) understanding of problematic stimulant use. Although the findings have relevant clinical, research and policy implications, the study focused on users purposively identified. Future larger scale definitive studies are required to make concrete policy recommendations.

Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach

Abstract: People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics. A qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients’ records and service reports were conducted. Three nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives’ support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants’ reports, revealing the fragility of trust and the focus on abstinence within this setting. The mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of “fixing” has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.