Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: The C-SCOPE Study.

The aim of this analysis was to evaluate perceived barriers related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT). C-SCOPE was a study consisting of a self-administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and the United States between April and May 2017. A 5-point Likert scale (1 = not a barrier, 3 = moderate barrier, 5 = extreme barrier) was used to measure responses to perceived barriers for HCV testing, evaluation and treatment across the domains of the health system, clinic and patient. Among the 203 physicians enrolled (40% USA, 45% Europe, 14% Australia/Canada), 21% were addiction medicine specialists, 29% psychiatrists and 69% were metro/urban. OAT physicians in this study reported poor access to on-site venepuncture (35%), point-of-care HCV testing (16%), and noninvasive liver disease assessment (25%). Only 30% of OAT physicians reported personally treating HCV infection. Major perceived health system barriers to HCV management included the lack of funding for noninvasive liver disease testing, long wait times to see an HCV specialist, lack of funding for new HCV therapies, and reimbursement restrictions based on drug/alcohol use. Major perceived clinic barriers included the lack of peer support programmes and/or HCV case managers to facilitate linkage to care, the need to refer people off-site for noninvasive liver disease staging, the lack of support for on-site phlebotomy and the lack of on-site delivery of HCV therapy. This study highlights several important modifiable barriers to enhance HCV testing, evaluation and treatment among PWID attending OAT clinics.

Risk factors for fatal outcome in patients with opioid dependence treated with methadone in a family medicine setting in Croatia.

AIM: To determine the risk factors for fatal outcome in patients with opioid dependence treated with methadone at the primary care level. METHODS: A group of 287 patients with opioid dependence was monitored prospectively from 1995 to 2007. At the beginning of the study, we collected the data on patient baseline characteristics, treatment characteristics, and living environment. At the annual check-up, we collected the data on daily methadone dose, method of methadone therapy administration, and family physician's assessment of the patient's drug use status. RESULTS: Out of 287 patients, 8% died. Logistic regression analysis showed that the predictors of fatal outcome were continuation of drug use during previous therapeutic attempts (odds ratio [OR], 19.402; 95% confidence interval [CI], 1.659-226.873), maintenance therapy as the planned treatment modality (OR, 3.738; 95% CI, 1.045-13.370), living in an unstable relationship (OR, 9.275; 95% CI, 2.207-38.984), and loss of continuity of care (OR, 12.643; 95% CI, 3.001-53.253). CONCLUSION: The patients presenting these risk factors require special attention. It is important for family physicians to insist on compliance with the treatment protocol and intervene when they lose contact with the patient to prevent the fatal outcome.

Preliminary data on validity of the Drug Addiction Treatment Efficacy Questionnaire.

BACKGROUND: This study describes the validation process for the Slovenian version of the Drug Addiction Treatment Efficacy Questionnaire (DATEQ). SUBJECTS AND METHODS: DATEQ was constructed from the questionnaires used at the Centre for the Treatment of Drug Addiction, Ljubljana University Psychiatric Hospital, and within the network of Centres for the Prevention and Treatment of Drug Addiction in Slovenia during the past 14 years. The Slovenian version of the DATEQ was translated to English using the 'forward-backward' procedure by its authors and their co-workers. The validation process included 100 male and female patients with established addiction to illicit drugs who had been prescribed opioid substitution therapy. The DATEQ questionnaire was used in the study, together with clinical evaluation to measure psychological state and to evaluate the efficacy of treatment in the last year. To determinate the validity of DATEQ the correlation with the clinical assessments of the outcome was calculated using one-way ANOVA. RESULTS: The F value was 44.4, p<0.001 (sum of squares: between groups 210.4, df=2, within groups 229.7, df=97, total 440.1, df=99). At the cut-off 4 the sensitivity is 81% and specificity 83%. CONCLUSION: The validation process for the Slovenian DATEQ version shows metric properties similar to those found in international studies of similar questionnaires, suggesting that it measures the same constructs, in the same way and as similar questionnaires. However, the relatively low sensitivity and specificity suggests caution when using DATEQ as the only measure of outcome.

[Primary health care and family medicine--possibilities for treatment of opiate addicts]. / Mogucnosti u lijecenju ovisnika o opijatima u primarnoj zdravstvenoj zastiti i obiteljskoj medicini.

The global trend of promoting management and treatment of drug addicts in family physician offices is the result of the success of opioid agonist therapy. Studies have shown favorable results by shifting treatment into the hands of family physician. This process contributes to general health care of drug addicts and their health by linking different areas of health care, thereby providing comprehensive protection. Shifting treatment of addiction to family physician offices contributes to the elimination of treatment isolation and stigmatization, while further benefits are lower barriers to employment, increase in patient privacy and opportunity to provide health care. The aim of this study was to provide a concise overview of the knowledge from new clinical research over the past ten years on heroin addiction treatment in primary care. New research dealing with the approach to treating addicts indicates a direct link between receiving primary health care with a reduced likelihood of using heroin; furthermore, the main concerns of drug addicts for treatment are availability of more therapeutic programs, better functioning of existing programs, and improved staff relations towards them; final results and outcomes achieved by office and hospital treatment of drug addicts are similar and confirm the positive linear relationship between treatment duration and outcome. Studies comparing therapies show a positive effect of the adaptive methadone treatment maintenance model on the psychosocial factors; equal efficiency of treatment regardless of initiation with buprenorphine or with methadone; and equal effectiveness of levo-alpha-acetylmethadol treatment compared with methadone and diacetylmorphine as a good alternative for addiction therapy with previously unsatisfactory results. New studies on buprenorphine show equal effectiveness and cost of detoxification whether guided by a family physician or at the hospital; non-supervised therapy does not significantly influence the outcome, but is significantly cheaper; long-term therapy with buprenorphine in the doctor's office shows mild retention.

Introducing the Early Trauma Inventory Self Report - Short Form and its Qualitative and Quantitative Validation for the Slovenian General Population.

INTRODUCTION: Traumatic experience in childhood or adolescence has a significant impact on the development of chronic mental and physical conditions in adulthood. Thus, it is very important for health professionals, especially primary care physicians to have an inventory in order to detect early trauma for planning appropriate treatment, such as the Early Trauma Inventory (ETI). The aim of this paper is to test the psychometric properties of the Slovenian translation of the short, self-rated version (ETISR-SF), and to further validate the instrument. METHODS: The research was done in two parts - qualitative and quantitative. In the qualitative part, a questionnaire was translated and culturally adapted using the Delphi method. For the quantitative part, 51 patients with substance use disorders hospitalized at the Centre for the Treatment of Drug Addictions were recruited, along with 133 controls. The psychometric properties of the questionnaire were checked. Internal consistency was calculated using Cronbach's alpha, test-retest reliability was examined graphically using a Bland-Altman plot. Discriminant validity between groups was gauged using the independent samples t-test. RESULTS: Consensus in the Delphi study was reached in the second round. Cronbach's alpha varied between 0.60 - 0.85. Of the four domains, physical abuse had the lowest Cronbach's alpha. The test-retest reliability is high for all domains, with correlation coefficients ranging from 0.82 to 0.96. The non-clinical sample differed significantly from the clinical sample. CONCLUSION: The Slovenian translation of ETISR-SF is a satisfactory instrument for the evaluation of trauma before the age of 18.

Perceptions and self-reported competency related to testing, management and treatment of hepatitis C virus infection among physicians prescribing opioid agonist treatment: The C-SCOPE study.

BACKGROUND: This study evaluated competency related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT). METHODS: C-SCOPE is a study consisting of a self-administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and USA between April-May 2017. A 7-point scale was used to measure < average competence (score >4 of 7) related to HCV testing, management and treatment. RESULTS: Among 203 physicians (40% USA, 45% Europe, 14% Australia/Canada) 21% were addiction medicine specialists, 29% psychiatrists, and 70% were metro/urban [mean PWID managed, 51; years of experience, 11]. The majority perceived HCV testing (82%) and treatment (85%) among PWID as important. The minority reported < average competence with respect to regular screening (12%) and interpretation of HCV test results (14%), while greater proportions reported < average competence in advising patients about new HCV therapies (28%), knowledge of new treatments (37%), and treatment/management of HCV (40%). In adjusted analysis, factors independently associated with < average self-reported competency related to the ability to treat HCV and manage side effects included fewer years in medical practice, fewer numbers of patients treated for HCV infection in the past six months, not having obtained information on screening, diagnosing or treatment of HCV, not having attended any training on HCV in the past year, and not having read or consulted AASLD/IDSA, EASL or other guidelines for HCV. CONCLUSION: Physicians treating HCV infection among PWID attending OAT clinics recognized the importance of HCV testing and treatment. However, self-perceived competency related to HCV management and treatment was low, highlighting the importance of improved HCV education and training among physicians practicing in clinics offering OAT.

Ability to work and employability of patients in opioid substitution treatment programs in Slovenia.

AIM: To assess the ability to work and employability of individuals taking part in opioid substitution treatment programs (OSTP). METHODS: The study was composed of two surveys. In the first survey, 237 of 480 patients enrolled in OSTP responded to the questionnaire about their employment status, opinion about employment, and perception of assignments before and during OSTP. In the second survey, 66 of 100 employers responded to the questionnaire on the occurrence, perception, and management of addiction problems in their companies. RESULTS: Unemployment rate in individuals enrolled in OSTP was 43.5% and decreased during OSTP by 10.5% (P=0.027). Irregular use of OSTP medications was the most important factor for unemployment (odds ratio, 2.44; P=0.016). OSTP was highly effective in achieving a positive change in patients' perception of different kinds of assignments previously perceived as beyond their abilities. Thus, perception of mentally demanding assignments (P<0.001), working at unfavorable hours (P<0.001), and forced work pace (P<0.001) represented much lower burden after entering OSTP. Only 6.6% of employers reported illicit drugs as being a problem at their companies and 79.1% believed they would not recognize a person under the influence of illicit drugs. In 93.0% of the cases, applicants for a job would have had lower chances if they had been drug users; the percentage was slightly higher for those taking part in OSTP (94.7%). CONCLUSION: OSTP in Slovenia was effective in increasing both employability and OSTP patients' ability to work. To facilitate complete rehabilitation, particularly in obtaining employment for the patients, the process must involve the society as a whole.

Slow-release oral morphine for maintenance treatment of opioid addicts intolerant to methadone or with inadequate withdrawal suppression.

AIMS: Evaluation of the efficacy, safety and acceptability of slow-release oral morphine (SROM) in opioid addicts intolerant to methadone or with inadequate withdrawal suppression. DESIGN: Prospective, open, non-comparative multi-centre study. SETTING: Twelve out-patient Centres for Prevention and Treatment of Drug Addiction in Slovenia. PARTICIPANTS: Male and female opioid addicts (age>18 years) under methadone maintenance therapy requiring a change of treatment in order to continue more effectively with maintenance. INTERVENTIONS: Maintenance therapy with methadone was switched to once-daily SROM. MEASUREMENTS: Efficacy evaluations were based on the reduction of side effects and on the degree of suppression of opiate craving, signs and symptoms of withdrawal. In addition, self-reported somatic and psychic symptoms (SCL-27) as well as World Health Organization quality of life-related (WHO QOL) parameters were monitored. FINDINGS: Thirty-nine subjects intolerant to methadone and 28 subjects showing inadequate withdrawal suppression under methadone>or=90 mg/day were included as two separate groups in the efficacy analyses. Treatment was switched easily from methadone to SROM on a 1:8 ratio. Four-week SROM treatment resulted in significant reduction of side effects reported under methadone. Signs and symptoms of opioid withdrawal as well as craving for opiates were improved significantly in patients with inadequate response to methadone. Physical and psychological wellbeing improved significantly under SROM treatment. SROM was tolerated very well. CONCLUSIONS: Maintenance treatment with SROM appears to be a clinically useful alternative treatment in subjects not tolerating methadone or with inadequate withdrawal suppression.