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1.
Psychiatr Prax ; 47(1): 22-28, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31910457

RESUMEN

INTRODUCTION: Over the last decade, methamphetamine use has spread rapidly in Europe, leading to a significant medical shortfall in many regions. To date, there are no standardized German-language therapy programs for qualified detoxification and motivation treatment. We have developed a therapy manual ("CrystalClean") over 15 therapy modules, which was evaluated in the present pilot study with regard to feasibility and acceptability. METHODS: Observational study with systematic interviews over 3 months on 31 patients with methamphetamine dependence. RESULTS: Acceptability of most modules was rated as high by both patients and therapists. In addition, the manual was considered to be well feasible in inpatient daily routine. However, contact terminations frequently occurred when switching to outpatient treatment. CONCLUSION: Results from our study point to a high acceptance of the manual for the accompaniment of qualified detoxification and motivation treatment in patients with methamphetamine dependence. Feasibility in the clinical setting can be improved by reducing the number of modules to the 12 best evaluated and by increasing the frequency of therapies.


Asunto(s)
Lenguaje , Metanfetamina , Trastornos Relacionados con Opioides/rehabilitación , Trastornos Relacionados con Sustancias/rehabilitación , Europa (Continente) , Estudios de Factibilidad , Alemania , Humanos , Motivación , Aceptación de la Atención de Salud , Proyectos Piloto , Traducción
2.
BMC Health Serv Res ; 19(1): 663, 2019 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-31521159

RESUMEN

BACKGROUND: Although opioid agonist therapy is effective in treating opioid use disorders (OUD), retention in opioid agonist therapy is suboptimal, in part, due to quality of care issues. Therefore, we sought to describe the planning and implementation of a quality improvement initiative aimed at closing gaps in care for people living with OUD through changes to workflow and care processes in Vancouver, Canada. METHODS: The Best-practice in Oral Opioid agoniSt Therapy (BOOST) Collaborative followed the Institute for Healthcare Improvement's Breakthrough Series Collaborative methodology over 18-months. Teams participated in a series of activities and events to support implementing, measuring, and sharing best practices in OAT and OUD care. Teams were assigned monthly implementation scores to monitor their progress on meeting Collaborative aims and implementing changes. RESULTS: Seventeen health care teams from a range of health care practices caring for a total of 4301 patients with a documented diagnosis of OUD, or suspected OUD based on electronic medical record chart data participated in the Collaborative. Teams followed the Breakthrough Series Collaborative methodology closely and reported monthly on a series of standardized process and outcome indicators. The majority of (59%) teams showed some improvement throughout the Collaborative as indicated by implementation scores. CONCLUSIONS: Descriptive data from the evaluation of this initiative illustrates its success. It provides further evidence to support the implementation of quality improvement interventions to close gaps in OUD care processes and treatment outcomes for people living with OUD. This system-level approach has been spread across British Columbia and could be used by other jurisdictions facing similar overdose crises.


Asunto(s)
Centros Comunitarios de Salud/organización & administración , Implementación de Plan de Salud/organización & administración , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/rehabilitación , Mejoramiento de la Calidad/organización & administración , Canadá , Investigación sobre Servicios de Salud , Humanos , Grupo de Atención al Paciente
3.
BMC Health Serv Res ; 19(1): 632, 2019 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-31488142

RESUMEN

BACKGROUND: Overdose deaths can be prevented by distributing take home naloxone (THN) kits. The emergency department (ED) is an opportune setting for overdose prevention, as people who use opioids frequently present for emergency care, and those who have overdosed are at high risk for future overdose death. We evaluated the implementation of an ED-based THN program by measuring the extent to which THN was offered to patients presenting with opioid overdose. We analyzed whether some patients were less likely to be offered THN than others, to identify areas for program improvement. METHODS: We retrospectively reviewed medical records from all ED visits between April 2016 and May 2017 with a primary diagnosis of opioid overdose at a large, urban tertiary hospital located in Alberta, Canada. A wide array of patient data was collected, including demographics, opioid intoxicants, prescription history, overdose severity, and whether a naloxone kit was offered and accepted. Multivariable analyses were used to identify patient characteristics and situational variables associated with being offered THN. RESULTS: Among the 342 ED visits for opioid overdose, THN was offered in 49% (n = 168) of cases. Patients were more likely to be offered THN if they had been found unconscious (Adjusted Odds Ratio 3.70; 95% Confidence Interval [1.63, 8.37]), or if they had smoked or injected an illegal opioid (AOR 6.05 [2.15,17.0] and AOR 3.78 [1.32,10.9], respectively). In contrast, patients were less likely to be offered THN if they had a current prescription for opioids (AOR 0.41 [0.19, 0.88]), if they were admitted to the hospital (AOR 0.46 [0.22,0.97], or if they unexpectedly left the ED without treatment or before completing treatment (AOR 0.16 [0.22, 0.97). CONCLUSIONS: In this real-world evaluation of an ED-based THN program, we observed that only half of patients with opioid overdose were offered THN. ED staff readily identify patients who use illegal opioids or experience a severe overdose as potentially benefitting from THN, but may miss others at high risk for future overdose. We recommend that hospital EDs provide additional guidance to staff to ensure that all eligible patients at risk of overdose have access to THN.


Asunto(s)
Analgésicos Opioides/envenenamiento , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Adulto , Alberta , Sobredosis de Droga/rehabilitación , Servicios Médicos de Urgencia/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Humanos , Masculino , Registros Médicos , Trastornos Relacionados con Opioides/rehabilitación , Estudios Retrospectivos
5.
Phytother Res ; 33(10): 2714-2725, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31359519

RESUMEN

Patients under methadone maintenance treatment (MMT) programs are susceptible to several complications including metabolic and clinical disorders. This study was designed to determine the effect of crocin supplementation on mental health parameters and metabolic profiles in subjects under MMT. The current randomized, double-blind, placebo-controlled, clinical trial was conducted among 53 patients under MMT to receive either 15 mg/day of crocin (n = 26) or placebo (n = 27) twice a day for 8 weeks. Crocin administration significantly decreased Beck Depression Inventory score (P = 0.01) and Beck Anxiety Inventory score (P = 0.008) compared with the placebo. In addition, crocin administration resulted in a significant reduction in fasting glucose (P = 0.003), insulin levels (P = 0.01), insulin resistance (P = 0.008), triglycerides (P = 0.001), very low-density lipoprotein (P = 0.001), total cholesterol levels (P = 0.03), and a significant increase in insulin sensitivity (.003) compared with the placebo. Additionally, crocin intake was associated with a significant reduction in high-sensitivity C-reactive protein (p < .001) and malondialdehyde (P = 0.001) and a significant rise in total antioxidant capacity levels (P = 0.01) compared with the placebo. The findings of this clinical trial indicate that taking crocin for 8 weeks by patients under MMT had beneficial effects on their mental health and improved their metabolic profiles.


Asunto(s)
Carotenoides/administración & dosificación , Metadona/uso terapéutico , Trastornos Relacionados con Opioides/rehabilitación , Adulto , Glucemia/análisis , Carotenoides/farmacología , Suplementos Dietéticos , Método Doble Ciego , Femenino , Humanos , Resistencia a la Insulina , Lípidos/sangre , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/metabolismo , Trastornos Relacionados con Opioides/psicología
7.
Therapie ; 74(3): 383-388, 2019 Jun.
Artículo en Francés | MEDLINE | ID: mdl-31178032

RESUMEN

Recent data on methadone from 2008 to 2017 by the French addictovigilance network warms on the increase of methadone use, its diversion, its increase of overdose risk factors (opioids associated, occasional use) and deaths. Whereas methadone is an essential drug for opioid addiction, its use remains complex because of its pharmacology leading to increase the awareness of health professionals.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Metadona/administración & dosificación , Tratamiento de Sustitución de Opiáceos/métodos , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/farmacología , Sobredosis de Droga , Francia , Humanos , Metadona/efectos adversos , Metadona/farmacología , Tratamiento de Sustitución de Opiáceos/efectos adversos , Trastornos Relacionados con Opioides/rehabilitación , Farmacovigilancia
8.
Lancet ; 393(10182): 1760-1772, 2019 04 27.
Artículo en Inglés | MEDLINE | ID: mdl-30878228

RESUMEN

Opioid use disorder is characterised by the persistent use of opioids despite the adverse consequences of its use. The disorder is associated with a range of mental and general medical comorbid disorders, and with increased mortality. Although genetics are important in opioid use disorder, younger age, male sex, and lower educational attainment level and income, increase the risk of opioid use disorder, as do certain psychiatric disorders (eg, other substance use disorders and mood disorders). The medications for opioid use disorder, which include methadone, buprenorphine, and extended-release naltrexone, significantly improve opioid use disorder outcomes. However, the effectiveness of medications for opioid use disorder is limited by problems at all levels of the care cascade, including diagnosis, entry into treatment, and retention in treatment. There is an urgent need for expanding the use of medications for opioid use disorder, including training of health-care professionals in the treatment and prevention of opioid use disorder, and for development of alternative medications and new models of care to expand capabilities for personalised interventions.


Asunto(s)
Trastornos Relacionados con Opioides/rehabilitación , Adulto , Analgésicos Opioides/envenenamiento , Prestación de Atención de Salud , Sobredosis de Droga/prevención & control , Diagnóstico Precoz , Femenino , Predicción , Humanos , Masculino , Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Síndrome de Abstinencia a Sustancias/etiología , Síndrome de Abstinencia a Sustancias/rehabilitación , Estados Unidos/epidemiología
9.
West J Emerg Med ; 20(2): 198-202, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30881536

RESUMEN

As the consequences of liberal opioid prescribing have become apparent, efforts to address the role of the health care system in supporting more balanced opioid use and the prevention and treatment of opioid use disorder have increased. Developing a unified and multidisciplinary approach can lead to an integrated care model that emphasizes primary prevention, harm reduction, and transition to life-sustaining treatment while also maintaining attentiveness to effective pain management. A model for this, which follows the nomenclature in proscribing antimicrobial use, is the development of an opioid stewardship program. Such programs allow for the integration of diverse perspectives and new mandates and uses a patient-centered approach with an iterative evaluation process. We describe a group of adoptable efforts that have been utilized successfully at our institutions and may be adapted and optimized to the needs and resources of other hospitals and health care systems.


Asunto(s)
Trastornos Relacionados con Opioides/rehabilitación , Analgésicos Opioides/uso terapéutico , Programas de Gobierno , Hospitales , Humanos , Trastornos Relacionados con Opioides/prevención & control , Manejo del Dolor/métodos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas
10.
Expert Opin Drug Saf ; 18(3): 211-217, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30722706

RESUMEN

INTRODUCTION: In the last few decades, the consumption of opioid analgesics in many countries, particularly the US, has dramatically increased. This rise has been paralleled by a proportional number of opioid-related deaths. Areas covered: The development of opioid guidelines was a response to this health crisis with the intention of reducing the risk of harm related to opioid prescribing. These guidelines have received varying responses ranging from support to criticism. Pain physicians may often provide multidimensional management as the paradigm for responsible opioid treatment. Interventions should focus on preventing new cases of opioid addiction, identifying early cases of opioid addiction, and ensuring access to effective addiction treatment. Expert opinion: Many activities have been suggested to face the opioid epidemic. Reducing supply is one of the most relevant aspects. Clinicians should find a fine balance that meets the patient's need for pain relief while minimizing the chance for abuse.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Trastornos Relacionados con Opioides/prevención & control , Pautas de la Práctica en Medicina/normas , Analgésicos Opioides/efectos adversos , Accesibilidad a los Servicios de Salud , Humanos , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/rehabilitación , Dolor/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Estados Unidos/epidemiología
12.
Nord J Psychiatry ; 73(1): 24-30, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30636473

RESUMEN

PROBLEM: Although efficacy studies of opioid maintenance treatment (OMT) have shown evidence of treatment benefits, there is still need for studies on its effectiveness in natural clinical processes. This study investigates the development in health, substance use and social conditions of those who applied for OMT, including those denied access or discharged. METHOD: First, persons assessed for admittance in 2005-2011 (n = 127) were categorized into four trajectory groups based on whether they were admitted or denied (n = 19), discharged (n = 31), readmitted (n = 21) or had been undergoing OMT without interruption (n = 56). Second, 99 of these, the analytical sample, were interviewed at follow-up using (a) the Addiction Severity Index (ASI) for seven problem-areas and housing, and (b) self-rated change in 11 problem areas. The ASI was compared to baseline interviews after 55 months (mean). Third, outcomes within groups was studied in relation to alternative interventions. RESULTS: Within the analytical sample, those denied OMT showed no improvements at group level, those discharged had some improvements, more if readmitted than if not and those with uninterrupted OMT showed the most comprehensive improvements. Those outside OMT, denied and discharged, had considerable mortality risks related to ongoing drug use, especially in lack of well-planned alternative interventions. CONCLUSION: Improvements strongly relate to access to OMT. This study underscores that access to OMT improves the situation in all areas investigated and decreases the risk for drug-related death. It underscores the importance of two major risk situations, i.e. being denied OMT and being discharged.


Asunto(s)
Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/rehabilitación , Adulto , Femenino , Humanos , Masculino , Alta del Paciente , Readmisión del Paciente/estadística & datos numéricos , Suecia , Resultado del Tratamiento
13.
Subst Use Misuse ; 54(3): 473-481, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30618327

RESUMEN

BACKGROUND: Previous research suggests that relatively few hospitalized patients with opioid-related conditions receive substance use treatment during their inpatient stay. Without treatment, these individuals may be more likely to have subsequent hospitalizations for continued opioid use disorder. OBJECTIVE: To evaluate the relationship between receipt of inpatient drug detoxification and/or rehabilitation services and subsequent opioid-related readmission. METHODS: This study used combined hospital inpatient discharge and emergency department visit data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. Our sample consisted of 329,037 patients from seven states with an opioid-related index hospitalization occurring between March 2010 and September 2013. Multivariate analysis was conducted to examine the relationship between opioid-related readmission and the receipt of inpatient drug detoxification and/or rehabilitation during the index visit. RESULTS: A relatively small percentage (19.4%) of patients with identified opioid-related conditions received treatment for drug use during their hospital inpatient stay. Patients who received drug rehabilitation, but not drug detoxification, during an opioid-related index hospitalization had lower odds of an opioid-related readmission within 90 days of discharge (odds ratio = 0.60, 95% confidence interval = 0.54-0.67) compared with patients with no inpatient drug detoxification or rehabilitation. Conclusions/Importance: A low percentage of patients receive inpatient services for drug use during an index stay involving an opioid-related diagnosis. Our findings indicate that receipt of drug rehabilitation services in acute care hospitals is associated with a lower 90-day readmission rate. Further research is needed to understand factors associated with the receipt of inpatient services and readmissions.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Pacientes Internos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Readmisión del Paciente , Adulto , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/rehabilitación , Estudios Retrospectivos , Estados Unidos
14.
Curr Drug Res Rev ; 11(1): 67-72, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29749316

RESUMEN

BACKGROUND: Drug dependence or substance use disorder not only affects a person's life but also brings a lot of challenges for families and communities and imposes heavy burdens on them. There are various therapies in the domain of addiction whose main purposes are to reduce or to cut down substance abuse. OBJECTIVE: This study aimed to determine the effectiveness of group spiritual intervention on selfesteem and happiness among male clients undergoing methadone maintenance treatment. METHODS: This study was an intervention study in which 60 clients affected with substance abuse and undergoing methadone maintenance treatment were recruited. The study samples were selected through convenience sampling method and then divided randomly into two groups of 30 individuals: intervention and control. The intervention group attended group spiritual interventions for 10 sessions. Self-esteem and happiness among the study participants were also measured through Coopersmith Self-Esteem Inventory and Oxford Happiness Questionnaire before and after the intervention. RESULTS: The results showed a significant difference between both intervention and control groups in terms of self-esteem and happiness (P < 0.05); so that the participants in the intervention group demonstrated a significant improvement in their self-esteem and happiness. CONCLUSION: It was concluded that group spiritual intervention as a useful method could be effective in enhancing self-esteem and happiness among addicted individuals undergoing methadone maintenance treatment. The given treatment could be also used as a complementary therapy beside methadone maintenance treatment to reduce the likelihood of people returning to substance abuse.


Asunto(s)
Felicidad , Tratamiento de Sustitución de Opiáceos/psicología , Trastornos Relacionados con Opioides/terapia , Psicoterapia de Grupo/métodos , Autoimagen , Espiritualidad , Adulto , Humanos , Masculino , Metadona/uso terapéutico , Persona de Mediana Edad , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/psicología , Trastornos Relacionados con Opioides/rehabilitación , Satisfacción Personal , Resultado del Tratamiento
15.
Am J Psychiatry ; 176(2): 129-137, 2019 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30336703

RESUMEN

OBJECTIVE: The oral formulation of the opioid antagonist naltrexone has shown limited effectiveness for treatment of opioid use disorder due to poor adherence. Long-acting injection naltrexone (XR-naltrexone), administered monthly, circumvents the need for daily pill taking, potentially improving adherence, and has been shown to be superior to placebo in reducing opioid use over 6 months of treatment. This open-label trial compared the outcomes of patients with opioid use disorder treated with XR-naltrexone or oral naltrexone in combination with behavioral therapy. METHOD: Sixty opioid-dependent adults completed inpatient opioid withdrawal and were transitioned to oral naltrexone. They were stratified by severity of opioid use (six or fewer bags versus more than six bags of heroin per day) and randomly assigned (1:1) to continue treatment with oral naltrexone (N=32) or XR-naltrexone (N=28) for 24 weeks. The first dose of XR-naltrexone (380 mg) was administered prior to discharge, with monthly doses thereafter, and oral naltrexone was given in a 50-mg daily dose. All participants received weekly behavioral therapy to support treatment and adherence to naltrexone. RESULTS: A Cox proportional hazards model adjusting for race, gender, route of use, and baseline opioid use severity indicated that significantly more patients were retained in treatment for 6 months in the XR-naltrexone group (16 of 28 patients, 57.1%) than in the oral naltrexone group (nine of 32 patients, 28.1%) (hazard ratio=2.18, 95% CI=1.07, 4.43). CONCLUSIONS: Patients receiving XR-naltrexone had twice the rate of treatment retention at 6 months compared with those taking oral naltrexone. These results support the use of XR-naltrexone combined with behavioral therapy as an effective treatment for patients seeking opioid withdrawal and nonagonist treatment for preventing relapse to opioid use disorder.


Asunto(s)
Terapia Conductista , Naltrexona/administración & dosificación , Antagonistas de Narcóticos/administración & dosificación , Trastornos Relacionados con Opioides/rehabilitación , Administración Oral , Adulto , Preparaciones de Acción Retardada , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Naltrexona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Recurrencia , Resultado del Tratamiento
16.
Neuropsychol Rehabil ; 29(8): 1273-1289, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29161998

RESUMEN

Aim: To examine the efficacy of cognitive rehabilitation treatment (CRT) for people with opioid use disorder who were recruited into a methadone maintenance treatment (MMT) programme. Method: 120 male subjects were randomly assigned to (1) MMT plus CRT in two months or (2) MMT plus a control intervention. Subjects were assessed at the beginning, mid-point and post-intervention as well as at 1-, 3- and 6-month follow-up time points. Results: Analysis with repeated measure ANOVA showed that the CRT group performed significantly better in tests of learning, switching, processing speed, working memory and memory span. Moreover, the CRT group had significantly lower opiate use over the control group during 3-months follow-up. Analysis including only those with a history of methamphetamine use showed that the CRT group had significantly lower amphetamine use. No group differences were observed for treatment retention. Conclusions: Our findings provide evidence that adding CRT as an adjunct intervention to MMT can improve cognitive performance as well as abstinence from both opiates and stimulants.


Asunto(s)
Terapia Cognitivo-Conductual , Trastornos Relacionados con Opioides/rehabilitación , Adulto , Cognición , Terapia Combinada , Estudios de Seguimiento , Humanos , Masculino , Metadona/uso terapéutico , Narcóticos/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/psicología , Método Simple Ciego , Resultado del Tratamiento
17.
Int J Offender Ther Comp Criminol ; 63(2): 257-275, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30058416

RESUMEN

Adults presenting with substance use and mental health disorders in the criminal justice system is well documented. While studies have examined drug courts and medication-assisted treatment (MAT), few have examined social and behavioral health indicators, and even fewer have multiple study periods. This study employed a comprehensive approach to studying the MAT contribution to drug court success; reduce substance use, mental health symptoms, and risky behaviors; and the role that violence or trauma plays in mental health symptomatology. Using three time points, our findings indicated that MAT did not play a significant role in the reduction of substance use, risky behaviors, or mental health symptoms or increasing the odds of successful court graduation. However, there was an overall improvement from intake to termination in reduction of substance use, risky behaviors, and mental health symptomatology. Other factors, including social support, may play a role in drug court graduation. Policy implications are discussed.


Asunto(s)
Derecho Penal , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/rehabilitación , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Ohio , Apoyo Social , Adulto Joven
18.
Clin Exp Nephrol ; 23(3): 342-348, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30218298

RESUMEN

BACKGROUND: Kidney injury is a serious comorbidity among HIV-infected patients. Intravenous drug use is listed as one of the risk factors for impaired renal function; however, this group is rarely assessed for specific renal-related risks. METHODS: Patients attending methadone program from 1994 to 2015 were included in the study. Data collected included demographic data, laboratory tests, antiretroviral treatment history, methadone dosing and drug abstinence. Patients' drug abstinence was checked monthly on personnel demand. We have evaluated two study outcomes: (1) having at least one or (2) three eGFR < 60 ml/min (MDRD formula). RESULTS: In total, 267 persons, with 2593 person-years of follow-up were included into analyses. At the time of analyses, 251 (94%) were on antiretroviral therapy (ARV). Fifty-two (19.5%) patients had 1eGFR and 20 (7.5%) 3eGFR < 60. In univariate analysis, factors significantly increasing the odds of impaired renal function were: female gender, detectable HIV RNA on ART, age at registration per 5 years older, atazanavir use and time on antiretroviral treatment per 1 year longer. In the multivariate model, only female gender (OR 4.7; p = 0.002), time on cART (OR 1.11; p = 0.01) and baseline eGFR (OR 0.71; p = 0.001) were statistically significant. CONCLUSIONS: We have demonstrated a high rate of kidney function impairment among HIV-1 positive patients in the methadone program. All risk factors for decreased eGFR in this subpopulation of patients were similar to those described for general HIV population with very high prevalence in women. These findings imply the need for more frequent kidney function monitoring in this subgroup of patients.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Enfermedades Renales/epidemiología , Enfermedades Renales/fisiopatología , Metadona/uso terapéutico , Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/rehabilitación , Adulto , Fármacos Anti-VIH/uso terapéutico , Sulfato de Atazanavir/uso terapéutico , Quimioterapia Combinada , Femenino , Tasa de Filtración Glomerular , Infecciones por VIH/complicaciones , Humanos , Indinavir/uso terapéutico , Masculino , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/complicaciones , Polonia/epidemiología , Factores de Riesgo , Factores Sexuales , Tenofovir/uso terapéutico , Factores de Tiempo
19.
BMJ Open ; 8(12): e021443, 2018 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-30552244

RESUMEN

INTRODUCTION: Hepatitis C virus (HCV) infection affects 0.7% of the general population, and up to 40% of people prescribed opioid substitution therapy (OST) in Scotland. In conventional care, less than 10% of OST users are tested for HCV and less than 25% of these initiate treatment. Community pharmacists see this group frequently to provide OST supervision. This study examines whether a pharmacist-led 'test & treat' pathway increases cure rates for HCV. METHODS AND ANALYSIS: This protocol describes a cluster-randomised trial where 60 community pharmacies provide either conventional or pharmacy-led care. All pharmacies offer dried blood spot testing (DBST) for HCV. Participants have attended the pharmacy for OST for 3 months; are positive for HCV genotype 1 or 3; are not co-infected with HIV and/or hepatitis B; have no decompensated liver disease; are not pregnant. For conventional care, pharmacists refer HCV-positive participants to a local centre for assessment. In the pharmacy-led arm, pharmacists assess participants themselves in the pharmacy. Drug prescribing is by nurse prescribers (conventional arm) or pharmacist prescribers (pharmacy-led arm). Treatment in both arms is delivered as daily modified directly observed therapy in a pharmacy. Primary trial outcome is number of sustained virological responses at 12 weeks after treatment completion. Secondary trial outcomes are number of tests taken; treatment uptake; completion; adherence; re-infection. An economic evaluation will assess potential cost-effectiveness. Qualitative research interviews with clients and health professionals assess acceptability of a pharmacist-led pathway. ETHICS AND DISSEMINATION: This protocol has been ethically approved by the East of Scotland Research Ethics Committee 2 (15/ES/0086) and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Caldicott guardian approval was given on 16 December 2016 to allow NHS Tayside to pass information to the cluster community pharmacies about the HCV test status of patients that they are seeing to provide OST supervision. NHS R&D approvals have been obtained from each health board taking part in the study. Informed consent is obtained before study enrolment and only anonymised data are stored in a secured database, enabling an audit trail. Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT02706223; Pre-results.


Asunto(s)
Antivirales/uso terapéutico , Hepatitis C/rehabilitación , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/rehabilitación , Servicios Farmacéuticos , Adulto , Antivirales/economía , Análisis por Conglomerados , Análisis Costo-Beneficio , Femenino , Hepatitis C/diagnóstico , Hepatitis C/economía , Hepatitis C/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Tratamiento de Sustitución de Opiáceos/economía , Trastornos Relacionados con Opioides/economía , Trastornos Relacionados con Opioides/epidemiología , Aceptación de la Atención de Salud , Servicios Farmacéuticos/economía , Investigación Cualitativa , Escocia , Resultado del Tratamiento , Adulto Joven
20.
BMC Health Serv Res ; 18(1): 911, 2018 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-30497467

RESUMEN

BACKGROUND: The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. METHODS: Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. RESULTS: Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. CONCLUSIONS: To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross- departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Metadona/uso terapéutico , Trastornos Relacionados con Opioides/rehabilitación , Adulto , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Actitud Frente a la Salud , Benzodiazepinas , Comprensión , Consejo , Empleo , Femenino , Humanos , Irlanda , Soledad , Masculino , Motivación , Trastornos Relacionados con Opioides/psicología , Influencia de los Compañeros , Relaciones Profesional-Paciente , Características de la Residencia
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