Does Prescription Length of Buprenorphine Influence Treatment Outcomes in Opioid Use Disorder? A Retrospective Cohort Study from North India.

OBJECTIVE: Buprenorphine (BUP) effectively suppresses non-prescription opioid use and increases treatment retention in opioid use disorder (OUD). However, short prescription length may interfere with treatment retention and recovery. We wanted to examine whether the outcomes of BUP treatment differ in high (HPL up to 4 wk) and low-prescription (LPL 1-2 wk) length groups. METHODS: We compared time to treatment discontinuation (TD), non-prescription opioid-positive urine screen, buprenorphine-negative urine screen, and self-reported non-prescription opioid use between two different cohorts of LPL (case record: June 2018 to August 2019; n = 105; observation endpoint: 31 October 2019) and HPL groups (case record: June 2020 to Aug 2021; n = 133; observation endpoint: 31 October 2021). We used Kaplan-Meier survival analysis and log-rank tests for between-group comparisons. We used Cox regression analysis to adjust for age, opioid potency, comorbidities, family income, and marital status. RESULTS: Subjects' age and buprenorphine dose were significantly lower, and the percentage of high-potency opioid users was significantly higher in the LPL group. In the unadjusted survival analysis, the median time to BUP discontinuation in the HPL was longer than that of the LPL [LPL= 22.4 ± 4.3 wk; HPL = 33.1 ± 8.5 wk; χ2(1)= 5.7; p=.02]. The survival distributions of other outcomes did not differ between groups. When adjusted for covariates, neither the prescription length nor other covariates independently predicted any treatment outcome. CONCLUSION: Higher prescription length might be associated with longer treatment retention. We provide preliminary evidence to support greater flexibility in BUP treatment, enhancing its scalability and attractiveness.

Telemedicine-assisted stepwise approach of service delivery for substance use disorders in India.

Restricted access to healthcare during COVID-19 pandemic warranted an urgent adaptation of telemedicine practice. We describe a synchronous, stepwise (telephonic, video, and in-person consultation) direct-care model. From 18th May to 31st August 2020, 128 new and 198 follow-up patients received consultation. Eighty-nine percent of new patients required video-consultation. Sixty-eight percent of follow-up cases were managed by telephonic consultation. A third of new and a fifth of the follow-up patients had to be called for physical consultation. Limited access to and understanding of the technologies, potential breach in privacy, and restrictions imposed on online prescription of medications posed significant challenges.

Depression in schizophrenia: Prevalence and its impact on quality of life, disability, and functioning.

BACKGROUND: Limited information is available on the prevalence of depression and its correlates in patients with schizophrenia in clinical remission. This study aims to understand the prevalence of depression in patients with schizophrenia currently in clinical remission and evaluate the impact of depression on the functioning, disability, and quality of life. METHODOLOGY: 250 participants diagnosed with schizophrenia, currently in clinical remission, were recruited by convenient sampling and assessed on the Calgary Depression Scale for Schizophrenia (CDSS). Participants were also assessed on positive and negative syndrome scale (PANSS), Global Assessment of Functioning Scale, Indian Disability Evaluation and Assessment Scale, and World Health Organization Quality of Life - Bref Version. RESULTS: As per CDSS, the prevalence of mild depression (≥ 5) and significant depression (≥ 7) were 27.6 % and 18.8 % respectively. The presence of significant depression was associated higher level of residual psychopathology on PANSS (in general psychopathology score, prosocial score and total score), poor functioning, higher level of disability in the domain of interpersonal activities, higher prevalence of physical comorbidity and poor quality of life compared to those without significant depression. CONCLUSIONS: Around one-fifth of patients with schizophrenia have significant depression during the phase of clinical remission. It has a negative impact on functioning, is associated with a higher level of disability in the domain of interpersonal activities, and poor quality of life compared to those without significant depression. Hence, addressing depression should be an integral part of schizophrenia management in clinical remission to improve the overall outcome of patients with schizophrenia.

The link between bipolarity and substance use: A controlled clinic based study.

OBJECTIVES: Because of high rates of co-occurrence, common familial risk, and phenotypic similarities, we conjectured that substance use and bipolar disorder might have a common substrate of origin in bipolarity and that they might lie on a continuum of bipolarity. Thus it was aimed to investigate the association between bipolarity and substance use through a controlled, clinic based study. METHODS: Cross sectional assessment and comparison of bipolarity as trait in four groups, namely the substance use disorder (SUD), bipolar disorder (BPAD), dual diagnosis (DD), and the healthy control (HC) groups. Bipolar spectrum diagnostic scale (BSDS) was used. The quality of life in these four groups was also assessed using WHOQOL-Bref scale. RESULTS: The mean Bipolar spectrum diagnostic scale (BSDS) score in SUD was 11.0 ± 5.3 which was more than that of HC (6.2 ± 3.9) and lesser than that in BPAD (18.4 ± 4.2) and DD (20.6 ± 3.6). Differences among all four groups were statistically significant. SUD group was found to have significantly higher score than healthy control. The BSDS score of DD and BPAD groups were higher than those of SUD but the difference between BPAD and DD was non-significant. DISCUSSION: The results showed a potential association between substance dependence and bipolarity. Mood dysregulation appears to be the link between the two. The gradient of bipolarity detected by BSDS screener suggests a continuum model between substance use and bipolar disorder. However, this is a clinic based study and only male patients have been taken for study.