Addiction medicine

About: Addiction medicine is a research topic. Over the lifetime, 1070 publications have been published within this topic receiving 23685 citations.

Buprenorphine diversion and misuse in outpatient practice.

Abstract: This case is an amalgamation of several real patients in office-based treatment for prescription opioid dependence synthesized into a single theoretical case. The case illustrates the various ways in which medication diversion and misuse may be encountered in clinical practice and therapeutic responses designed to maximize positive treatment outcomes. It is followed by discussions from several expert addiction medicine providers from 3 different countries, giving their perspectives on the salient aspects of this case. This case conference should be of particular interest to clinicians working with opioid-dependent patients in an outpatient setting.

Integrating medical care and addiction treatment.

Abstract: The segregation of addiction treatment and medical care is an unfortunate consequence of policies and practices that have developed in the United States over many years. New research points toward the benefits of integrating these 2 systems of care, and the development of new behavioral and pharmacologic treatments for addiction is destined to render their separation increasingly untenable. However, movement toward integration faces substantial regulatory and political obstacles.

Management of opioid use disorder and associated conditions among hospitalized adults: A Consensus Statement from the Society of Hospital Medicine.

Abstract: Hospital-based clinicians frequently care for patients with opioid withdrawal or opioid use disorder (OUD) and are well-positioned to identify and initiate treatment for these patients. With rising numbers of hospitalizations related to opioid use and opioid-related overdose, the Society of Hospital Medicine convened a working group to develop a Consensus Statement on the management of OUD and associated conditions among hospitalized adults. The guidance statement is intended for clinicians practicing medicine in the inpatient setting (e.g., hospitalists, primary care physicians, family physicians, advanced practice nurses, and physician assistants) and is intended to apply to hospitalized adults at risk for, or diagnosed with, OUD. To develop the Consensus Statement, the working group conducted a systematic review of relevant guidelines and composed a draft statement based on extracted recommendations. Next, the working group obtained feedback on the draft statement from external experts in addiction medicine, SHM members, professional societies, harm reduction organizations and advocacy groups, and peer reviewers. The iterative development process resulted in a final Consensus Statement consisting of 18 recommendations covering the following topics: (1) identification and treatment of OUD and opioid withdrawal, (2) perioperative and acute pain management in patients with OUD, and (3) methods to optimize care transitions at hospital discharge for patients with OUD. Most recommendations in the Consensus Statement were derived from guidelines based on observational studies and expert consensus. Due to the lack of rigorous evidence supporting key aspects of OUD-related care, the working group identified important issues necessitating future research and exploration.

The Centre for Addiction and Mental Health Concurrent Disorders Screener.

Abstract: Objectives: To review the characteristics of psychiatric screening tools currently available in addiction treatment services for rapid assessment of comorbid pathology and to introduce the Centre for Addictions and Mental Health Concurrent Disorders Screener (CAMH-CDS), a computer-administered questionnaire that screens for the occurrence of 11 Axis I disorders plus all substance use disorders, as well as for a history of conduct disorder. Methods: We describe the structure, contents, and application of the CAMH-CDS. We undertook a sensitivity and specificity trial involving 171 subjects, a test-retest reliability study with 301 participants, and an open-label concordance study with 656 respondents. All subjects were regular clients of a major addiction treatment facility. Results: The CAMH-CDS was easily and effectively used by addiction counsellors with limited or no mental health training. It has a low rate of false-negative responses, and it yields excellent test-retest reliability figures. It is highly sensitive to identifying persons with psychiatric disturbances; however, its ability to discriminate among specific disorders appears to be more limited. Conclusions: The CAMH-CDS can be reliably used to rule out the presence of psychiatric comorbidity in addiction service populations. As with other psychiatric screening instruments, its sensitivity values are stronger than its specificity values. The use of nonstructured clinical evaluations as the gold standard for diagnosis and a likely variance in the patients' symptom reports between the 2 examinations may have contributed to the latter finding. (Can J Psychiatry 2004;49:843-850) Information on funding and support and author affiliations appears at the end of the article. Clinical Implications * This instrument will help addiction workers perform a more comprehensive clinical evaluation of their clients. * The instrument's simplicity and ease of administration should facilitate its use in all types of addiction treatment facilities, even when counsellors have limited professional qualifications. Limitations * This instrument has been validated in an addiction treatment population only. * Its psychometric properties have been tested against clinical diagnoses that were not independently confirmed and that were not made through structured interviews. Key Words: psychiatric assessment, screening instruments, addiction, comorbidity Psychiatric disorders are highly prevalent among persons seeking care in addiction treatment services (1). The rates of comorbidity found in the population attending such facilities are in fact higher than those observed in substance abusers surveyed in nonclinical settings (2). Additional psychiatric disturbances adversely affect the course and therapeutic response of addictive disorders (3). Not only do substance abusers with psychiatric comorbidity show poorer results in addiction treatment services, they also tend to make excessive use of health and social services as a whole (4). If cooccurring psychiatrie disorders are identified and attended to in a timely fashion, the clinical outcome of these complex cases can be significantly improved. However, the capacity to perform comprehensive psychiatric examinations does not exist in a large number of addiction treatment programs, and it is not realistic or sensible to expect such procedures to be a mandatory component of the standard clinical protocols. Indeed, a complete psychiatric evaluation performed universally for all clients would be costly, impractical, and even unwarranted: current psychiatric disorders-those requiring specific clinical management at the time-can be expected to affect only about one-third of the client population processed at any given treatment centre (5). There is therefore a need for a procedure that will help identify the group of addiction clients whose treatment-planning assessment must definitely include an in-depth psychiatric examination. …