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1.
Subst Abus ; 41(3): 269-274, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697171

RESUMO

Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are effective strategies for treatment of opioid use disorder (OUD) and reducing overdose risk. MOUD treatment rates continue to be low across the US, and currently, some evidence suggests access to evidence-based treatment is becoming increasingly difficult for those with OUD as a result of the 2019 novel corona virus (COVID-19). A major underutilized source to address these serious challenges in the US is community pharmacy given the specialized training of pharmacists, high levels of consumer trust, and general availability for accessing these service settings. Canadian, Australian, and European pharmacists have made important contributions to the treatment and care of those with OUD over the past decades. Unfortunately, US pharmacists are not permitted to prescribe MOUD and are only currently allowed to dispense methadone for the treatment of pain, not OUD. US policymakers, regulators, and practitioners must work to facilitate this advancement of community pharmacy-based through research, education, practice, and industry. Advancing community pharmacy-based MOUD for leading clinical management of OUD and dispensation of treatment medications will afford the US a critical innovation for addressing the opioid epidemic, fallout from COVID-19, and getting individuals the care they need.


Assuntos
Analgésicos Opioides/uso terapêutico , Serviços Comunitários de Farmácia , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Farmacêuticos , Âmbito da Prática , Austrália , Betacoronavirus , Buprenorfina/uso terapêutico , Canadá , Infecções por Coronavirus , Assistência à Saúde , Acesso aos Serviços de Saúde , Humanos , Metadona/uso terapêutico , Pandemias , Pneumonia Viral , Reino Unido , Estados Unidos
2.
Subst Use Misuse ; 55(11): 1900-1901, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32657207

RESUMO

BACKGROUND: Alarms have been raised that COVID-19 may disproportionately affect certain populations with substance use disorders, particularly Opioid Use Disorder (OUD), however warnings have largely focused on social risks such as reduced availability of services. Objectives: This commentary highlights three plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19. Results: Opioid-related respiratory depression may amplify risks of hypoxemia from COVID-19 viral pneumonia. Complex opioid immune modulation may impact host response to COVID-19, though the effect direction and clinical significance are unclear. Drug-drug interactions may affect individuals with OUD who are co-administered medications for OUD and medications for COVID-19, particularly due to cardiac adverse effects. Conclusions/Importance: There are plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19; these mechanisms require further study, and should be considered in individuals with OUD.


Assuntos
Analgésicos Opioides/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Infecções por Coronavirus/complicações , Hospedeiro Imunocomprometido/imunologia , Transtornos Relacionados ao Uso de Opioides/complicações , Pneumonia Viral/complicações , Insuficiência Respiratória/induzido quimicamente , Imunidade Adaptativa/imunologia , Analgésicos Opioides/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Interações Medicamentosas , Humanos , Imunidade Inata/imunologia , Metadona/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/imunologia , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Prognóstico , Insuficiência Respiratória/fisiopatologia
3.
Am J Vet Res ; 81(8): 656-664, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32700999

RESUMO

OBJECTIVE: To determine the effects of coadministration of naltrexone, a human opioid abuse deterrent, on the pharmacokinetics and pharmacodynamics of a methadone-fluconazole combination administered orally to dogs. ANIMALS: 12 healthy Beagles. PROCEDURES: Dogs (body weight, 10.7 to 13.9 kg) were randomly allocated to 2 groups in a parallel design study. All dogs received fluconazole (100 mg [7.19 to 9.35 mg/kg], PO). Twelve hours later (time 0), dogs were administered methadone (10 mg [0.72 to 0.93 mg/kg]) plus fluconazole (50 mg [3.62 to 4.22 mg/kg]; methadone-fluconazole) or methadone (10 mg [0.72 to 0.93 mg/kg]) plus fluconazole (50 mg [3.60 to 4.67 mg/kg]) and naltrexone (2.5 mg [0.18 to 0.23 mg/kg]; methadone-fluconazole-naltrexone), PO, in a gelatin capsule. Blood samples were collected for pharmacokinetic analysis, and rectal temperature and sedation were assessed to evaluate opioid effects at predetermined times up to 24 hours after treatment. RESULTS: Most dogs had slight sedation during the 12 hours after drug administration; 1 dog/group had moderate sedation at 1 time point. Mean rectal temperatures decreased significantly from baseline (immediate pretreatment) values from 2 to ≥ 12 hours and 2 to ≥ 8 hours after methadone-fluconazole and methadone-fluconazole-naltrexone treatment, respectively. Geometric mean maximum observed concentration of methadone in plasma was 35.1 and 33.5 ng/mL and geometric mean terminal half-life was 7.92 and 7.09 hours after methadone-fluconazole and methadone-fluconazole-naltrexone treatment, respectively. Naltrexone was sporadically detected in 1 dog. The active naltrexone metabolite, ß-naltrexol, was not detected. The inactive metabolite, naltrexone glucuronide, was detected in all dogs administered methadone-fluconazole-naltrexone. CONCLUSIONS AND CLINICAL RELEVANCE: Opioid effects were detected after oral administration of methadone-fluconazole or methadone-fluconazole-naltrexone. Further studies assessing additional opioid effects, including antinociception, are needed.


Assuntos
Doenças do Cão , Transtornos Relacionados ao Uso de Opioides , Administração Oral , Analgésicos Opioides , Animais , Cães , Fluconazol , Humanos , Metadona , Naltrexona
4.
Medicine (Baltimore) ; 99(22): e20429, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481444

RESUMO

Determining the clinically optimal dose in methadone maintenance therapy (MMT) is a time-consuming procedure, which considers clinical signs and symptoms.To perform a quantitative trait locus association for identifying genetic variants for MMT dosage that underlie heroin addiction and methadone metabolism and then integrate several genotypic and phenotypic factors are potential predictors for clinically optimal MMT dose for personalized prescription.In total, 316 heroin-dependent patients undergoing MMT were recruited at the Addiction Center of the China Medical University Hospital. A multinomial logistic regression model was used to assess associations between genetic polymorphisms and MMT dosing. The data were randomly separated into training and testing sets. In order to enhance the prediction accuracy and the reliability of the prediction model, we used areas under the receiver operating characteristic curves to evaluate optimal MMT dose in both training and testing sets.Four single nucleotide polymorphisms, namely rs806368 in CNR1, s1386493 in TPH2, s16974799 in CYP2B6, and rs2229205 in OPRL1, were significantly associated with the maximum MMT dose (P < .05). The genetic risk score (GRS) was associated with maximum MMT dose, and after adjustments for age, sex, and body mass index, the GRS remained independently associated with the maximum MMT dose. The area under the receiver operating characteristic curve of the combined GRS and craving score was 0.77 for maximum MMT dose, with 75% sensitivity and 60% specificity.Integrating the GRS and craving scores may be useful in the evaluation of individual MMT dose requirements at treatment initiation. Optimal dose prediction allows clinicians to tailor MMT to each patient's needs.


Assuntos
Fissura , Dependência de Heroína/tratamento farmacológico , Dependência de Heroína/genética , Metadona/administração & dosagem , Entorpecentes/administração & dosagem , Medicina de Precisão , Adulto , Citocromo P-450 CYP2B6/genética , Feminino , Estudos de Associação Genética , Marcadores Genéticos , Humanos , Masculino , Tratamento de Substituição de Opiáceos , Polimorfismo de Nucleotídeo Único , Locos de Características Quantitativas , Receptor CB1 de Canabinoide/genética , Receptores Opioides/genética , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Triptofano Hidroxilase/genética
5.
Med Clin North Am ; 104(4): 695-708, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505261

RESUMO

The diagnosis of opioid use disorder (OUD) is often overlooked or inadequately managed during the inpatient admission. When recognized, a common strategy is opioid detoxification, an approach that is often ineffective and can be potentially dangerous because of loss of tolerance and subsequent risk for overdose. Medication for addiction treatment (MAT), including methadone and buprenorphine, is effective and can be dispensed in the hospital for both opioid withdrawal and initiation of maintenance treatment. Hospitalists should be knowledgeable about diagnosing and managing patients with OUD, including how to manage acute pain or MAT during the perioperative setting.


Assuntos
Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/terapia , Educação de Pacientes como Assunto/métodos , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Redução do Dano , Hospitalização , Humanos , Metadona/uso terapêutico , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/psicologia
6.
Medicine (Baltimore) ; 99(24): e19963, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541447

RESUMO

Covertly using heroin during methadone maintenance treatment (MMT) is very common among heroin-dependent patients, which has posed threats to the physical health of heroin-dependent patients and social safety. Covertly using heroin may be influenced by many factors, especially social capital. Therefore, we aimed to investigate the relationship between behaviors of covertly using heroin during MMT and social capital heroin-dependent patients in Sichuan Province, China. A cross-sectional study was conducted between October and November 2018, with a total of 581 heroin-dependent patients participating in the study. In addition to socio-demographic characteristics and heroin use related behaviors, the questionnaire also included the measures of social capital: social network (SN), social support (SP), community participation (CP) and social trust (ST). Multivariate logistic regression analyses were used to estimate the association between different measures of social capital and heroin use. The prevalence of covertly using heroin of heroin during MMT was 31.0% among our participants in the 6 months before the study. After adjusting for socio-demographic factors and heroin-use related variables, SN (OR = 0.85, 95% CI: 0.76-0.95), SP (OR = 0.89, 95% CI: 0.83-0.95), and ST (OR = 0.88, 95% CI: 0.81-0.95) were significantly associated with heroin use. Results suggest that social capital may have a protective effect on behavior of covertly using heroin during MMT, which should be consider in the interventions for heroin-dependent patients, in order to reduce the incidence of heroin use during MMT as well as improve the compliance of MMT.


Assuntos
Dependência de Heroína/tratamento farmacológico , Heroína/efeitos adversos , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Adulto , China/epidemiologia , Participação da Comunidade/métodos , Estudos Transversais , Feminino , Heroína/administração & dosagem , Dependência de Heroína/epidemiologia , Dependência de Heroína/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Prevalência , Capital Social , Rede Social , Apoio Social
7.
J Evid Based Dent Pract ; 20(1): 101399, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32381408

RESUMO

AIMS AND OBJECTIVES: There is an increased interest to incorporate interprofessional educational models in the academic dental institutions to serve both student education and patient care. The aim of this report is to integrate evidence-based dentistry (EBD) with an interprofessional approach to treat methadone maintenance therapy (MMT) patients. Current example illustrates the case of a 26-year-old man receiving MMT who presented at Tufts University School of Dental Medicine with the chief complaint of "I want to fix my teeth." He presented with a collapsed vertical dimension of occlusion, extensive partial edentulism on both arches with bone loss, and a past history of drug abuse since the age of 16 years. MATERIALS AND METHODS: The 5-step (ask, acquire, appraise, apply, assess) framework for the EBD process was used. First, the PICO (population, intervention, comparison, and outcome) question was asked, and then the literature was acquired and appraised. An expert librarian assisted in finding articles on the effects of methadone on the oral cavity and consequences that will affect dental treatment. The search was conducted on PubMed, using the following keywords: oral health, dentistry, dental health, and methadone. The search was performed from 1/1/2005 to 1/1/2018. After appraisal, the studies were applied in the clinical setting and treatment outcomes were assessed both subjectively and objectively. RESULTS: The initial search identified there is sparse evidence on the topic. Only 34 articles were acquired. Based on the scientific evidence published, the interprofessional expertise of the clinical care team, and patient's perspective, 4 treatment plan options were proposed. The selected treatment plan was considered the best option considering an EBD person-centered approach. Progress of treatment, outcomes, and lessons learned were assessed. CONCLUSIONS: This study demonstrates that incorporating EBD concepts and an interprofessional approach, MMT patients can be successfully treated. Future studies on this topic are recommended, specially considering the growth of the opioid epidemic in the past years and the need to treat the MMT patients and educate students.


Assuntos
Odontologia Baseada em Evidências , Metadona , Adulto , Humanos , Masculino , Resultado do Tratamento
8.
PLoS One ; 15(4): e0230845, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275723

RESUMO

CONTEXT: Despite being associated with dependence and social stigma, methadone is a potential end-of-life option in complex cancer pain. OBJECTIVES: To explore attitudes and opinions about methadone and its potential role and current use in complex end-of-life pain. METHODS: Semi-structured interviews (n = 30) with physicians in specialized palliative care, transcribed and analyzed with conventional qualitative content analysis. RESULTS: According to the physicians, patients and relatives expressed unexpectedly few negative attitudes, not affecting methadone's use as an analgesic. Complex pain in bone-metastatic cancer of the prostate, breast and kidney, as well as pancreatic cancer and sarcomas were recurrent suggestions of appropriate indications. Most of the informants stated that they applied a mechanism-based treatment and mainly prescribed low-dose methadone as an add-on to an existing opioid therapy to benefit from methadone´s proposed NMDA-receptor inhibiting properties, e.g. in cases with reduced opioid sensitivity. Despite its complex pharmacokinetics with a long half-life, most informants expressed defined strategies to avoid side-effects such as respiratory depression, especially when initiating treatment in the home-care setting. While many palliative care physicians expressed an overly enthusiastic attitude, others stressed the risks of overconfidence, low precision in use, and overlooked treatment options. Besides the obvious physical pain-relieving effects, they stated that effective pain relief could result in a reduced workload and emotional empowerment, both for physicians and staff. CONCLUSION: Methadone, especially in the form of low-dose add-on to other opioids is widely advocated in Swedish specialized palliative care as a practical and safe method with rapid onset in complex pain situations at the end of life.


Assuntos
Dor do Câncer/tratamento farmacológico , Metadona/uso terapêutico , Cuidados Paliativos/estatística & dados numéricos , Adulto , Idoso , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/psicologia , Inquéritos e Questionários , Suécia
10.
PLoS One ; 15(4): e0231467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302325

RESUMO

BACKGROUND: Despite the World Health Organization listing methadone as an essential medication, effective dose selection is challenging, especially in racial and ethnic minority populations. Subtherapeutic doses can result in withdrawal symptoms while supratherapeutic doses can result in overdose and death. Although CYP3A4 was conventionally considered the principal methadone metabolizing enzyme, more recent data have identified CYP2B6 as the principal enzyme. CYP2B6 has ethnically-associated polymorphisms that affect the metabolic rate. Our objective was to investigate the effects of genetic and nongenetic factors on methadone metabolism. METHODS: We measured trough plasma methadone levels in 100 participants with opioid use disorder. We assessed methadone metabolism by calculating the metabolite ratio (major metabolite: 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine [EDDP] divided by methadone concentration). We assessed hepatic fibrosis and steatosis by transient elastography and CYP2B6 alleles, principally responsible for methadone metabolism. Mixed effects models modeled the data in 97 participants. RESULTS: Participants were largely male (58%), minority (61% African American) and non-Hispanic (68%). Forty percent were HCV mono-infected, 40% were uninfected, and 20% were HCV/HIV co-infected. Female sex had significant effects on (R)- and (S)-methadone metabolism (p = 0.016 and p = 0.044, respectively). CYP2B6 loss of function (LOF) alleles significantly affected (S)-methadone metabolism (p = 0.012). Body mass index (BMI) significantly affected (R)-methadone metabolism (p = 0.034). Methadone metabolism appeared to be lower in males, in individuals with LOF alleles, and elevated BMI. CONCLUSIONS: Genetic analysis, especially in minority populations, is essential to delivering individualized treatments. Although the principal methadone metabolizing enzyme remains controversial, our results suggest that sex, CYP2B6 genotype, and BMI should be incorporated into multivariate models to create methadone dosing algorithms. Methadone dosing algorithms should facilitate medication delivery, improve patient satisfaction, and diminish overdose potential.


Assuntos
Metadona/uso terapêutico , Alelos , Analgésicos Opioides/uso terapêutico , Estudos Transversais , Citocromo P-450 CYP2B6/genética , Citocromo P-450 CYP3A/genética , Grupos Étnicos , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Sistemas Automatizados de Assistência Junto ao Leito , Polimorfismo Genético/genética , Medicina de Precisão
11.
Ann Palliat Med ; 9(2): 537-541, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233628

RESUMO

Opioids are an important tool in the management of acute and chronic (cancer and non-cancer) pain. Pain and palliative care practitioners are frequently called upon to switch a patient from one opioid regimen to a different regimen either to gain better pain control, to minimize opioid-related adverse effects, to overcome opioid tolerance, or due to a change in patient status. To this end, equianalgesic tables have been published to guide practitioners in making these calculations. Despite being built on the best data available, equianalgesic tables do not tell the whole story, requiring the practitioner to thoroughly consider the patient's situation, and unknown variables. A five-step process is presented in this article that espouse a safe and effective way to switch from one opioid regimen to another. Directions for the future include better refinement of the data that informs the equianalgesic table, and perhaps inclusion of opioid utility data.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor/tratamento farmacológico , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Relação Dose-Resposta a Droga , Cálculos da Dosagem de Medicamento , Humanos , Metadona/uso terapêutico , Morfina/uso terapêutico , Epidemia de Opioides/prevenção & controle , Manejo da Dor/métodos
12.
BMJ ; 368: m772, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32234712

RESUMO

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.


Assuntos
Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/mortalidade , Adolescente , Adulto , Colúmbia Britânica/epidemiologia , Buprenorfina/uso terapêutico , Causas de Morte , Estudos de Coortes , Emergências , Feminino , Fentanila , Humanos , Drogas Ilícitas , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Mortalidade/tendências , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/terapia , Saúde Pública , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
14.
Subst Abus ; 41(2): 147-149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32314951

RESUMO

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.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por Coronavirus/complicações , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Opioides/virologia , Pneumonia Viral/complicações , Betacoronavirus , Buprenorfina/uso terapêutico , Continuidade da Assistência ao Paciente/legislação & jurisprudência , Humanos , Metadona/uso terapêutico , Pandemias , Farmacêuticos , Estados Unidos
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(3): 331-336, 2020 Mar 10.
Artigo em Chinês | MEDLINE | ID: mdl-32294830

RESUMO

Objective: To understand the characteristics and explore the influencing factors of HBsAg positivity in methadone maintenance treatment (MMT) clinic patients. Methods: A face to face interview and medical record review were conducted in 1 040 patients at three MMT clinics in Guangxi from September to November in 2014. The questionnaire information included general demographic characteristics, drug use history, MMT status, sexual behaviors, and health status, etc. Blood samples were collected from the patients at the same time for the detections of the level of HBsAg, anti-HBs and anti-HCV. By using χ(2) test, unconditional logistic regression model and Bayesian network model the influencing factors for HBsAg positivity in MMT clinic patients and the complex network relationship among these factors were explored. Results: A total of 1 031 MMT clinic patients were surveyed, the HBsAg positive rate was 11.35% (117/1 031). The anti-HCV positive rate was 71.77% (740/1 031), among the anti-HCV positive patients, the HBsAg positive rate was 10.27% (76/740). After adjusting for the confounding factors, anti-HBs positive persons might not be HBsAg positive (OR=0.05, 95%CI: 0.03-0.09), and anti-HCV positive persons might not be HBsAg positive too (OR=0.30, 95%CI: 0.17-0.52) compared with anti-HBs negative and anti-HCV negative persons, respectively. The persons with family history of hepatitis B virus infection were more likely to be HBsAg positive compared those with no such family history (OR=5.30, 95%CI: 2.68-10.52). Bayesian network model analysis results showed that family history of hepatitis B virus infection and anti-HBs were directly related with HBsAg positivity. Anti-HCV, intravenous drug use in the past three months and other drug using during treatment were indirectly related with HBsAg positivity. Conclusions: Anti-HBs, family history of hepatitis B virus infection, anti-HCV, intravenous drug use in past three months and other drug use during treatment were related with the HBsAg positivity in MMT clinic patients. So, it is necessary to enhance health education, improve health awareness and decrease high risk behaviors to reduce the rate of HBV infection.


Assuntos
Antígenos de Superfície da Hepatite B/sangue , Hepatite B/epidemiologia , Metadona/uso terapêutico , Teorema de Bayes , China/epidemiologia , Humanos , Fatores de Risco , Centros de Tratamento de Abuso de Substâncias
17.
PLoS One ; 15(3): e0229787, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32126120

RESUMO

OBJECTIVE: To identify the geographic, organisational, and payment correlates of buprenorphine and methadone treatment among substance abuse treatment (SAT) providers. METHODS: Secondary analyses of the National Survey of Substance Abuse Treatment Services (NSSATS) from 2007-16 were conducted. We provide bivariate descriptive statistics regarding substance abuse treatment services which offered buprenorphine and methadone treatment from 2007-16. Using multiple logistic regression, we regressed geographic, organisational, and payment correlates on buprenorphine and methadone treatment. RESULTS: Buprenorphine is increasingly offered at SAT facilities though uptake remains comparatively low outside of the northeast. SAT facilities run by tribal governments or Indian Health Service which offer buprenorphine remain low compared to privately operated SAT facilities (AOR = 0.528). The odds of offering buprenorphine among facilities offering free or no charge treatment (AOR = 0.838) or a sliding fee scale (AOR = 0.464) was lower. SAT facilities accepting Medicaid payments showed higher odds of offering methadone treatment (AOR = 2.035). CONCLUSIONS: Greater attention towards the disparities in provision of opioid agonist therapies is warranted, especially towards the reasons why uptake has been moderate among civilian providers. Additionally, the care needs of Native Americans facing opioid-related use disorders bears further scrutiny.


Assuntos
Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/reabilitação , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Analgésicos Opioides/efeitos adversos , Buprenorfina/economia , Buprenorfina/uso terapêutico , Efeitos Psicossociais da Doença , Geografia , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Medicaid/economia , Medicaid/estatística & dados numéricos , Metadona/economia , Metadona/uso terapêutico , Antagonistas de Entorpecentes/economia , Tratamento de Substituição de Opiáceos/economia , Tratamento de Substituição de Opiáceos/tendências , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Centros de Tratamento de Abuso de Substâncias/economia , Centros de Tratamento de Abuso de Substâncias/organização & administração , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos/epidemiologia
18.
Ann Palliat Med ; 9(2): 579-585, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32156130

RESUMO

Methadone has unique characteristics that make it an attractive agent for the treatment of chronic pain and opioid drug dependence. However, methadone prescription requires more clinical experience and close monitoring of patients to avoid its undesirable side effects. Recently, levorphanol has emerged as "a forgotten opioid" with a similar profile as methadone. Levorphanol has no impact on QTc prolongation and considerably less drug-drug interactions as compared to methadone. Lack of commercial availability, providers' unfamiliarity, and limited clinical data on its effectiveness remain practical issues. The objective of this article is to review and compare the safety considerations for methadone and levorphanol use.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Levorfanol/uso terapêutico , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Analgésicos Opioides/efeitos adversos , Sistema Nervoso Central/efeitos dos fármacos , Relação Dose-Resposta a Droga , Humanos , Levorfanol/efeitos adversos , Metadona/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/etiologia , Equivalência Terapêutica
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