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1.
Subst Abus ; 41(2): 147-149, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32314951

RESUMEN

We highlight the critical roles that pharmacists have related to sustaining and advancing the changes being made in the face of the current COVID-19 pandemic to ensure that patients have more seamless and less complex access to treatment. Discussed herein is how the current COVID-19 pandemic is impacting persons with substance use disorders, barriers that persist, and the opportunities that arise as regulations around treatments for this population are eased.


Asunto(s)
Continuidad de la Atención al Paciente , Infecciones por Coronavirus/complicaciones , Trastornos Relacionados con Opioides/complicaciones , Trastornos Relacionados con Opioides/terapia , Trastornos Relacionados con Opioides/virología , Neumonía Viral/complicaciones , Betacoronavirus , Buprenorfina/uso terapéutico , Continuidad de la Atención al Paciente/legislación & jurisprudencia , Humanos , Metadona/uso terapéutico , Pandemias , Farmacéuticos , Estados Unidos
2.
BMJ ; 368: m772, 2020 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-32234712

RESUMEN

OBJECTIVE: To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. DESIGN: Population based retrospective cohort study. SETTING: Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada. PARTICIPANTS: 55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018. MAIN OUTCOME MEASURES: All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply. RESULTS: 7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk). CONCLUSIONS: Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.


Asunto(s)
Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/mortalidad , Adolescente , Adulto , Colombia Británica/epidemiología , Buprenorfina/uso terapéutico , Causas de Muerte , Estudios de Cohortes , Urgencias Médicas , Femenino , Fentanilo , Humanos , Drogas Ilícitas , Masculino , Metadona/uso terapéutico , Persona de Mediana Edad , Mortalidad/tendencias , Naloxona/uso terapéutico , Trastornos Relacionados con Opioides/terapia , Salud Pública , Estudios Retrospectivos , Medición de Riesgo , Adulto Joven
4.
PLoS One ; 15(2): e0229174, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32069314

RESUMEN

BACKGROUND: The opioid epidemic is a major public health crisis in the U.S. Contemporary data on opioid use disorder (OUD) related hospitalizations are needed. Our objective was to assess whether OUD hospitalizations and associated mortality are increasing over time and examine the factors associated healthcare utilization and mortality. METHODS AND FINDINGS: We examined the rates of OUD hospitalizations and associated mortality using the U.S. National Inpatient Sample (NIS) data from 1998-2016. Multivariable-adjusted logistic regression assessed the association of demographic, clinical and hospital characteristics with inpatient mortality and healthcare utilization (total hospital charges, discharge to a rehabilitation facility, length of hospital stay) during the index hospitalization for opioid use disorder. We calculated the odds ratio (OR) and 95% confidence intervals (CI). We estimated 781,767 OUD hospitalizations. The rate of OUD hospitalization and associated mortality (/100,000 overall NIS hospitalizations) increased from 59.8 and 1.2 in 1998-2000 to 190.7 and 5.9 in 2015-16, respectively. In the multivariable-adjusted analysis, the following factors were associated with worse outcomes; compared to age <34 years, older age was associated with higher risk of hospital charges above the median and length of stay >3 days, slightly higher risk of discharge to a rehabilitation facility. Higher Deyo-Charlson score was associated with higher hospital charges, length of hospital stay, and inpatient mortality. Women had lower odds of inpatient mortality than men and blacks had lower odds of mortality than whites. CONCLUSIONS: Rising OUD hospitalizations from 1998 to 2016 and increasing associated inpatient mortality are concerning. Certain groups are at higher risk of poor utilization outcomes and inpatient mortality. Resources and healthcare policies need to focus on the high-risk group to reduce mortality and associated utilization.


Asunto(s)
Hospitalización/estadística & datos numéricos , Trastornos Relacionados con Opioides/mortalidad , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/terapia , Estados Unidos/epidemiología
7.
J Altern Complement Med ; 26(1): 34-43, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31825240

RESUMEN

Objectives: To demonstrate the feasibility and acceptability of a brief mindfulness-based intervention taught by physicians for patients with opioid addiction and to determine if the intervention reduces likelihood of relapse or treatment failure within 6 months. Design: A prospective, feasibility, single-group, cohort pilot study. Setting: A Family Medicine teaching clinic serving a mixed urban and rural population in Bangor, Maine. Subjects: Adult patients initiating outpatient treatment for opioid addiction with buprenorphine (N = 40). Interventions: Study physicians conducted a 10- to 12-min education session for all patients starting treatment during the enrollment period, including a 5-min mindfulness exercise. Enrolled subjects received an MP3 player loaded with six mindfulness audio exercises (5-19 min) and were instructed to practice at least 5 min daily and record their practice in a logbook. Outcome measures: Acceptability and subjective usefulness to recovery were evaluated at 2, 4, and 6 months of follow-up, with qualitative analysis of themes in recorded poststudy interviews. Logbook entries and tablet-based surveys provided data on home mindfulness practice, classified as "high" or "low." Relapse or treatment failure was documented. Results: Feasibility and acceptability were demonstrated with 82% enrollment and 100%, 97%, and 90% completion of follow-up visits at 2, 4, and 6 months, respectively, among those still in treatment. Sustained positive impressions of the intervention and exercises remained at 6 months. Relapse or treatment failure was reduced in the "high" practice uptake group compared with "low" practice uptake (11% vs. 42%, p = 0.033). Conclusions: In contrast to more intensive 8-week models of meditation training, this study demonstrates that even a brief single training session can induce sustained home meditation practice that subjectively helped patients in recovery for opioid addiction and was associated with lower risk of relapse. Brief mindfulness-based interventions may be useful to increase access to mindfulness training in this population.


Asunto(s)
Buprenorfina/uso terapéutico , Atención Plena , Trastornos Relacionados con Opioides/terapia , Adulto , Estudios de Factibilidad , Femenino , Humanos , Masculino , Trastornos Relacionados con Opioides/epidemiología , Proyectos Piloto , Embarazo , Atención Primaria de Salud
8.
J Opioid Manag ; 15(6): 455-468, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31850507

RESUMEN

OBJECTIVE: The goal of the study was to assess knowledge gaps and practice patterns of US-based addiction specialists, primary care physicians (PCPs), nurse practitioners (NPs), and physician assistants (PAs) who treat patients with opioid use disorder (OUD). DESIGN: As part of a prospective study, the authors developed a survey tool consisting of case-vignettes and questions designed to reveal practice patterns and highlight gaps in clinician knowledge. SETTING: The primary study setting included clinicians practicing in outpatient care. PARTICIPANTS: The surveys were distributed via email between August and September 2017 to a national sample of addiction specialists, PCPs, and NPs/PAs that see at least one patient per week and at least 1 percent of their patient population had to be diagnosed with OUD. RESULTS: The knowledge assessment results varied among the clinicians surveyed. Addiction specialists saw more patients with OUD than PCPs, NPs, or PAs. They also demonstrated a higher level of understanding and knowledge of the various domains assessed. CONCLUSIONS: There are multiple educational intervention strategies that can support the clinicians; including reducing restrictions to access treatment for OUD, care coordination programs for patients to improve early access to treatment and education, and frequent chart audit and feedback programs to support clinician decision making and education.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Trastornos Relacionados con Opioides , Analgésicos Opioides , Humanos , Enfermeras Practicantes/psicología , Trastornos Relacionados con Opioides/terapia , Asistentes Médicos/psicología , Médicos de Atención Primaria/psicología , Pautas de la Práctica en Medicina , Estudios Prospectivos
9.
J Opioid Manag ; 15(6): 487-494, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31850510

RESUMEN

OBJECTIVE: To characterize hedonic eating behaviors such as sugar cravings, food preferences, and appetitive responsiveness for sweet and hyper-palatable foods, and to determine the prevalence of addictive like eating behaviors and food addiction (FA) in individuals receiving medication-assisted treatment (MAT) for opioid use disorder (OUD). DESIGN: Quasi-experimental. SETTING: Outpatient MAT center. PARTICIPANTS: Nonpregnant adult patients undergoing MAT (n = 116) receiving either buprenorphine/naloxone or methadone for at least 6 months. MAIN OUTCOME MEASURES: Hedonic eating, FA, and food craving. RESULTS: Of the aggregate sample, 13.3 percent met criteria for FA. More than onethird of all subjects endorsed consuming larger amounts of highly palatable food than intended, unsuccessful attempts to quit or cut down on eating such foods, and a great deal of time spent on consuming or recovering from consuming such foods. Both medication groups demonstrated greatest cravings for sweets and fast foods followed by carbohydrates and fats (p < 0.001). Similarly, subjects reported "giving in" most frequently to sweets and fast foods followed by carbohydrates then fats (p < 0.001). Greater appetitive responsiveness was noted in the presence of hyper-palatable foods. No group differences were found. Weight change was not associated with addictive like eating, food craving, or appetitive responsiveness. CONCLUSIONS: Individuals receiving MAT exhibit preferences for sweet and fast foods that appear to be influenced by the proximity of such foods. FA was present. Collectively, such eating behaviors and food preferences may pose additional adverse health consequences and associated co-morbidities. This underlies the importance of comprehensive healthcare for patients with OUD, including nutrition education and evaluation of eating behaviors and food preferences.


Asunto(s)
Conducta Adictiva/epidemiología , Conducta Alimentaria , Preferencias Alimentarias , Trastornos Relacionados con Opioides , Adulto , Analgésicos Opioides , Conducta Adictiva/psicología , Ansia , Grasas de la Dieta , Ingestión de Alimentos , Comida Rápida , Conducta Alimentaria/psicología , Humanos , Trastornos Relacionados con Opioides/complicaciones , Trastornos Relacionados con Opioides/terapia
11.
PLoS Med ; 16(11): e1002963, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31743335

RESUMEN

BACKGROUND: In light of the accelerating and rapidly evolving overdose crisis in the United States (US), new strategies are needed to address the epidemic and to efficiently engage and retain individuals in care for opioid use disorder (OUD). Moreover, there is an increasing need for novel approaches to using health data to identify gaps in the cascade of care for persons with OUD. METHODS AND FINDINGS: Between June 2018 and May 2019, we engaged a diverse stakeholder group (including directors of statewide health and social service agencies) to develop a statewide, patient-centered cascade of care for OUD for Rhode Island, a small state in New England, a region highly impacted by the opioid crisis. Through an iterative process, we modified the cascade of care defined by Williams et al. for use in Rhode Island using key national survey data and statewide health claims datasets to create a cross-sectional summary of 5 stages in the cascade. Approximately 47,000 Rhode Islanders (5.2%) were estimated to be at risk for OUD (stage 0) in 2016. At the same time, 26,000 Rhode Islanders had a medical claim related to an OUD diagnosis, accounting for 55% of the population at risk (stage 1); 27% of the stage 0 population, 12,700 people, showed evidence of initiation of medication for OUD (MOUD, stage 2), and 18%, or 8,300 people, had evidence of retention on MOUD (stage 3). Imputation from a national survey estimated that 4,200 Rhode Islanders were in recovery from OUD as of 2016, representing 9% of the total population at risk. Limitations included use of self-report data to arrive at estimates of the number of individuals at risk for OUD and using a national estimate to identify the number of individuals in recovery due to a lack of available state data sources. CONCLUSIONS: Our findings indicate that cross-sectional summaries of the cascade of care for OUD can be used as a health policy tool to identify gaps in care, inform data-driven policy decisions, set benchmarks for quality, and improve health outcomes for persons with OUD. There exists a significant opportunity to increase engagement prior to the initiation of OUD treatment (i.e., identification of OUD symptoms via routine screening or acute presentation) and improve retention and remission from OUD symptoms through improved community-supported processes of recovery. To do this more precisely, states should work to systematically collect data to populate their own cascade of care as a health policy tool to enhance system-level interventions and maximize engagement in care.


Asunto(s)
Trastornos Relacionados con Opioides/terapia , Trastornos Relacionados con Sustancias/terapia , Analgésicos Opioides/uso terapéutico , Protocolos Clínicos , Estudios Transversales , Sobredosis de Droga/psicología , Sobredosis de Droga/terapia , Humanos , Naltrexona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Rhode Island/epidemiología , Medición de Riesgo/métodos , Factores de Riesgo , Servicio Social , Participación de los Interesados , Estados Unidos/epidemiología
12.
Nurs Clin North Am ; 54(4): 495-501, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31703775

RESUMEN

This article offers a brief review geared toward primary care providers of the most critical aspects of the management of opiate use disorder, including screening, brief intervention, and referral to treatment as well as medication-assisted treatment and the alarming trends and dangers of illicitly produced fentanyl.


Asunto(s)
Analgésicos Opioides/efectos adversos , Sobredosis de Droga/prevención & control , Trastornos Relacionados con Opioides/diagnóstico , Atención Primaria de Salud , Sobredosis de Droga/tratamiento farmacológico , Fentanilo/efectos adversos , Humanos , Trastornos Relacionados con Opioides/terapia
14.
Medicine (Baltimore) ; 98(39): e17319, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31574863

RESUMEN

BACKGROUND: Heroin addiction remains a significant public health problem worldwide, and relapse to heroin use following cessation of agonist maintenance treatment is common. The problems associated with use of opioid agonists mean that non-opioid therapies need to be developed to ameliorate acute and protracted opioid withdrawal syndromes. METHODS: Fifteen men with opioid use disorder on methadone maintenance treatment have been enrolled from an addiction treatment center as an experimental group in this case-controlled study. This group is receiving laser meridian massage on the back, including the Bladder meridian and Governor Vessel, 3 times weekly for 4 weeks. An age-matched control group that does not receive laser meridian massage has also been enrolled. Urinary morphine levels are being checked before and after 2 and 4 weeks of treatment. Subjects are requested to self-report their number of episodes or days of heroin use and 0 to 10-point visual analogue scale scores for heroin craving/refusal to use heroin during the previous week before and after 2 and 4 weeks of treatment. Quality of life will be reported using the Short Form-12v2 before and after 4 weeks of treatment. Pulse diagnosis will be recorded and heart rate variability calculated after one single treatment session. The baseline patient characteristics will be compared between the experimental and control groups using the independent t test and Chi-square test. Data are compared between the 2 groups using repeated-measures analysis of variance, generalized estimating equations, and the paired t test. OBJECTIVE: To investigate the effect of adjuvant laser meridian massage in men with opioid use disorder on methadone maintenance treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04003077.


Asunto(s)
Rayos Láser , Masaje , Meridianos , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/terapia , Puntos de Acupuntura , Adulto , Analgésicos Opioides/uso terapéutico , Estudios de Casos y Controles , Humanos , Masculino , Masaje/instrumentación , Masaje/métodos , Síndrome de Abstinencia a Sustancias/terapia
16.
Lancet ; 394(10208): 1560-1579, 2019 10 26.
Artículo en Inglés | MEDLINE | ID: mdl-31657732

RESUMEN

We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3-47·9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Sobredosis de Droga/mortalidad , Trastornos Relacionados con Opioides/epidemiología , Analgésicos Opioides/envenenamiento , Sobredosis de Droga/epidemiología , Salud Global , Conocimientos, Actitudes y Práctica en Salud , Humanos , Trastornos Relacionados con Opioides/prevención & control , Trastornos Relacionados con Opioides/terapia , Prevalencia , Factores de Riesgo
17.
J Consult Clin Psychol ; 87(10): 845-848, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556661

RESUMEN

To respond to the rapidly increasing awareness of the many serious issues related to the opioid crisis that are being encountered by our broad clinical-scientist and practitioner audience, we assembled a special issue on opioid use in all areas of clinical and clinical-health psychology. Together, the papers that comprise this collection shed light on critical issues regarding the opioid crisis within the field of clinical psychology, identify gaps in the knowledge base and directions for future investigations, and enhance our ability to provide effective and compassionate care for those who are experiencing problems with opiate use as well as their friends, families, and communities. Given the training that clinical and clinical-health psychologists receive, and our roles in providing clinical services to the population, we have focused this issue around articles addressing assessment, prevention, and treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Trastornos Relacionados con Opioides/terapia , Humanos , Psicología Clínica
18.
J Consult Clin Psychol ; 87(10): 918-926, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556668

RESUMEN

OBJECTIVE: Risk for prescription opioid addiction is an endemic public health concern, especially for adults with chronic pain. This study examined craving as a mediator from pain to opioid use outcomes during prescription opioid addiction treatment and tested whether counseling in pain coping skills moderated the effects of craving on treatment outcomes. METHOD: Secondary analysis on a sample (N = 148) randomized to standard or enhanced counseling for 12 weeks with adjunct opioid maintenance medication. Multilevel analyses examined mediated effects between weekly pain, craving, and opioid use, and tested the interaction between craving and a counseling module on pain coping skills. RESULTS: Greater pain predicted greater craving (ß = 0.25, p < .001), which predicted next-week opioid use (ß = 0.17, p < .001). A statistically significant indirect effect of craving (ß = 0.04, 95% CI [0.02, 0.06]) mediated 95% of the total effect from pain to opioid use. A significant interaction (b = -0.22, p < .01) revealed that after receiving the pain coping module, the association between craving and next-week opioid use was reduced, with greater exposure to the module associated with stronger effects (b = -0.12, p < .01). CONCLUSION: More severe pain predicts greater opioid use due to the association between pain and cravings. Pain coping skills counseling suppressed the association between cravings and opioid use. For adults with chronic pain receiving treatment for prescription opioid addiction, interventions that address cravings through behavioral pain coping skills may be crucial for achieving optimal treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Adaptación Psicológica , Analgésicos Opioides/uso terapéutico , Dolor Crónico/psicología , Consejo , Ansia , Trastornos Relacionados con Opioides/terapia , Adulto , Dolor Crónico/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/psicología , Resultado del Tratamiento
19.
J Consult Clin Psychol ; 87(10): 927-940, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556669

RESUMEN

OBJECTIVE: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. METHOD: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. RESULTS: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02). CONCLUSIONS: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Dolor Crónico/terapia , Atención Plena , Grupos de Autoayuda , Adulto , Afecto , Anciano , Analgesia/psicología , Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/psicología , Trastornos Relacionados con Opioides/terapia , Procesos Psicoterapéuticos , Resultado del Tratamiento
20.
J Consult Clin Psychol ; 87(10): 941-951, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556670

RESUMEN

OBJECTIVE: While several behavioral interventions have shown efficacy in opioid use disorder treatment, little is known regarding which behavioral interventions work best for youth, and if treatment responses vary by developmental age or sex. We explored latency to first episode of opioid use among adolescents and young adults following opioid use disorder treatment initiation with: (a) adolescent community reinforcement approach (A-CRA), (b) motivational enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) or CBT alone (MET/CBT or CBT alone), or (c) treatment as usual (TAU; 12-step facilitation, supportive therapy). METHOD: Adolescents and young adults (N = 785) entering treatment for opioid use disorder were followed for 1 year. Survival analysis was used to assess variation in latency to first episode of opioid use by treatment received, as well as moderation by age group and sex. RESULTS: Those receiving MET/CBT or CBT alone, and TAU fared better than those receiving A-CRA. For adolescent males, those receiving TAU or A-CRA had poorer outcomes compared with those receiving MET/CBT or CBT alone, while no differences were found between treatments for female adolescents. Female young adults receiving TAU had lower hazard of opioid use compared with those receiving A-CRA, and MET/CBT or CBT alone, and male young adults receiving A-CRA had higher hazard than those receiving TAU, and MET/CBT or CBT alone. CONCLUSIONS: Findings highlight different treatments may be more efficacious for youth based on developmental age and sex. Clinicians working with young people with opioid use disorder should consider patients' developmental stage and sex when considering treatment approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Cognitivo-Conductual , Entrevista Motivacional , Trastornos Relacionados con Opioides/terapia , Proyectos de Investigación , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Trastornos Relacionados con Opioides/psicología , Resultado del Tratamiento , Adulto Joven
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