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1.
Ann Palliat Med ; 9(2): 586-610, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008341

RESUMO

This state-of-the-art review comprehensive covers the benefits and risks of tapering opioids. The review discusses opioid strategies and pitfalls that may occur during tapering. The purpose of this review is to expand the knowledge of clinicians regarding tapering opioids and equip them to be able to successfully reduce and stop opioid therapy when appropriate.


Assuntos
Analgésicos Opioides/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Manejo da Dor/métodos , Síndrome de Abstinência a Substâncias/prevenção & controle , Dor Crônica/tratamento farmacológico , Humanos , Síndrome de Abstinência a Substâncias/terapia , Suspensão de Tratamento
2.
PLoS One ; 15(1): e0227350, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923197

RESUMO

BACKGROUND: In the US, medication assisted treatment, particularly with office-based buprenorphine, has been an important component of opioid dependence treatment among patients with iatrogenic addiction to opioid analgesics. The predictors of initiating buprenorphine for addiction among opioid analgesic patients have not been well-described. METHODS: We conducted a time-to-event analysis using data from the North Carolina (NC) Prescription Drug Monitoring Program (PDMP). Our outcome of interest was time-to-initiation of sublingual buprenorphine. Our study population was a prospective cohort of all state residents receiving a full-agonist opioid analgesic between 2011 and 2015. Predictors of initiation of sublingual buprenorphine examined included: age, gender, cumulative pharmacies and prescribers utilized, cumulative opioid intensity (defined as cumulative opioid exposure divided by duration of opioid exposure), and benzodiazepine dispensing. FINDINGS: Of 4.3 million patients receiving opioid analgesics in NC between 2011 and 2015 (accumulated 8.30 million person-years of follow-up), and a total of 28,904 patients initiated buprenorphine formulations intended for addiction treatment (overall rate 3.48 per 1,000 person-years). In adjusted multivariate models, the utilization of 3 or more pharmacies (HR: 2.93; 95% CI: 2.82, 3.05) or 6 or more controlled substance prescribers (HR: 12.09; 95% CI: 10.76, 13.57) was associated with buprenorphine initiation. A dose-response relationship was observed for cumulative opioid intensity (HR in highest decile relative to lowest decile: 5.05; 95% CI: 4.70, 5.42). Benzodiazepine dispensing was negatively associated with buprenorphine initiation (HR: 0.63; 95% CI: 0.61, 0.65). CONCLUSIONS: Opioid analgesic patients utilizing multiple prescribers or pharmacies are more likely to initiate sublingual buprenorphine. This finding suggests that patients with multiple healthcare interactions are more likely to be treated for high-risk opioid use, or may be more likely to be identified and treated for addiction. Future research should utilize prescription monitoring program data linked to electronic health records to include diagnosis information in analytic models.


Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Programas de Monitoramento de Prescrição de Medicamentos , Adulto , Benzodiazepinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Transtornos Relacionados ao Uso de Opioides/epidemiologia
3.
PLoS One ; 15(1): e0227298, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945092

RESUMO

BACKGROUND: Substance use is disproportionately high among people who are homeless or vulnerably housed. We performed a systematic overview of reviews examining the effects of selected harm reduction and pharmacological interventions on the health and social well-being of people who use substances, with a focus on homeless populations. METHODS AND FINDINGS: We searched MEDLINE, EMBASE, PsycINFO, Joanna Briggs Institute EBP, Cochrane Database of Systematic Reviews and DARE for systematic reviews from inception to August 2019. We conducted a grey literature search and hand searched reference lists. We selected reviews that synthesized evidence on supervised consumption facilities, managed alcohol programs and pharmacological interventions for opioid use disorders. We abstracted data specific to homeless or vulnerably housed populations. We assessed certainty of the evidence using the GRADE approach. Our search identified 483 citations and 30 systematic reviews met all inclusion criteria, capturing the results from 442 primary studies. This included three reviews on supervised consumption facilities, 24 on pharmacological interventions, and three on managed alcohol programs. Supervised consumption facilities decreased lethal overdoses and other high risk behaviours without any significant harm, and improved access to care. Pharmaceutical interventions reduced mortality, morbidity, and substance use, but the impact on retention in treatment, mental illness and access to care was variable. Managed alcohol programs reduced or stabilized alcohol consumption. Few studies on managed alcohol programs reported deaths. CONCLUSIONS: Substance use is a common chronic condition impacting homeless populations. Supervised consumption facilities reduce overdose and improve access to care, while pharmacological interventions may play a role in reducing harms and addressing other morbidity. High quality evidence on managed alcohol programs is limited.


Assuntos
Transtornos Relacionados ao Uso de Álcool/reabilitação , Overdose de Drogas/prevenção & controle , Pessoas em Situação de Rua/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Populações Vulneráveis/estatística & dados numéricos , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Overdose de Drogas/epidemiologia , Redução do Dano , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/psicologia , Habitação/organização & administração , Habitação/estatística & dados numéricos , Humanos , Antagonistas de Entorpecentes/uso terapêutico , Estudos Observacionais como Assunto , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Avaliação de Programas e Projetos de Saúde , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Populações Vulneráveis/psicologia
4.
Am J Public Health ; 110(1): 45-50, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725310

RESUMO

Objectives. To determine the number of people who inject drugs (PWID) in Canada and the annual coverage of opioid agonist treatment (OAT) and needle-and-syringe provision for PWID.Methods. We estimated the number of PWID in 11 of 13 Canadian provinces and territories in 2011 by using indirect multiplier methods based on provincial and territorial methadone recipient totals and proportion of surveyed PWID receiving methadone. We modeled annual increases for 2011 to 2016 on Quebec and British Columbia longitudinal data. We calculated needle-and-syringe coverage (World Health Organization [WHO] recommendation: ≥ 200 per PWID) and OAT coverage (WHO recommendation: ≥ 40 per 100 PWID) per province and territory annually.Results. An estimated 130 000 individuals in Canada (0.55%) injected drugs in 2011, increasing to 171 900 individuals (0.70%) in 2016. Needle-and-syringe coverage increased from 193 to 291 per PWID, and OAT coverage increased from 55 to 66 per 100 PWID over the study period.Conclusions. While the number of PWID increased between 2011 and 2016, OAT coverage remained high, and needle-and-syringe coverage generally improved over time.Public Health Implications. These data will inform public health surveillance, service planning, and resource allocation, and assist monitoring of treatment and harm-reduction coverage outcomes.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Programas de Troca de Agulhas/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Analgésicos Opioides/uso terapêutico , Canadá , Feminino , Redução do Dano , Humanos , Estudos Longitudinais , Masculino , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico
5.
Artigo em Inglês | MEDLINE | ID: mdl-31877950

RESUMO

The quality of family relationships is important for individual and family well-being. Improving family relationships is also an important goal in methadone maintenance treatment (MMT). Little is known about factors associated with the improvement of family relationships among MMT clients. This study aimed to identify factors associated with family relationship improvement in MMT. We retrospectively analyzed existing data from 2006 to 2014 at 15 MMT clinics in Guangdong, China, including 2171 subjects with 4691 follow-ups. Generalized estimating equations were used to investigate the association between living status transitions, behavior changes and family relationship improvement, with covariates controlled for. Family relationship improvement was found in 23.1% of all follow-up intervals. Participants who began living with family, living on a regular wage, and gained employment were more likely to have improved family relationships. The quality of family relationships also improved among participants who ceased contact with drug-addicted fellows, ceased drug use, and those who were sexually active. These results suggest that improvement in living status, positive changes in drug use, and sexual activity are associated with family relationship improvement and corresponding interventions may be developed to facilitate clients' recovery.


Assuntos
Analgésicos Opioides/uso terapêutico , Relações Familiares , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , China , Emprego , Feminino , Humanos , Masculino , Tratamento de Substituição de Opiáceos/métodos , Características de Residência , Estudos Retrospectivos , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico
6.
BMC Health Serv Res ; 19(1): 822, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703741

RESUMO

BACKGROUND: As the drug poisoning crisis worsens in North America and opioid use disorder (OUD)-related hospital admissions increase, policymakers and hospital administrators are beginning to recognize the important role of hospitals in the OUD care continuum. This study explores and describes how U.S. addiction medicine physicians created and presented business propositions to hospital administrators to support the development of addiction medicine consult (AMC) services. METHODS: Fifteen qualitative interviews were completed with board-certified or board-eligible addiction medicine physicians from 14 U.S. hospitals. The interviews occurred as part of a broader mixed methods study exploring hospital service delivery for patients admitted with OUD. Using a directed content analysis, the transcribed interviews were coded, analyzed, and final themes consolidated. RESULTS: Semi-structured interviews completed with addiction medicine physicians from established (n = 9) and developing (n = 5) AMC services at 14 U.S. hospitals explored how clinical champions persuaded hospital administrators to support AMC service development. Four elements were foundational to making the "business case": 1) describing the prevalence of substance use disorder (SUD) or OUD in the hospital; 2) identifying the negative financial impacts of not treating SUDs during hospitalization; 3) highlighting the ongoing care quality and treatment gap for hospitalized patients with SUDs; and 4) noting the success of other institutional AMC services. Study findings informed the creation of tools to support AMC service development: 1) an AMC service business case template, and 2) an AMC service design and operations resource list. CONCLUSIONS: OUD-related hospital admissions are unlikely to abate. Hospital administrators should consider innovative care delivery mechanisms to improve care for persons with OUD. AMC services may be a promising delivery mechanism to achieve this aim. For clinical and administrative champions, understanding how to communicate the potential effectiveness of this intervention to hospital leaders is an essential first step to AMC service creation.


Assuntos
Medicina do Vício/organização & administração , Transtornos Relacionados ao Uso de Opioides/reabilitação , Continuidade da Assistência ao Paciente , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade da Assistência à Saúde , Encaminhamento e Consulta , Estados Unidos
7.
Medicine (Baltimore) ; 98(39): e17319, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574863

RESUMO

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.


Assuntos
Lasers , Massagem , Meridianos , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/terapia , Pontos de Acupuntura , Adulto , Analgésicos Opioides/uso terapêutico , Estudos de Casos e Controles , Humanos , Masculino , Massagem/instrumentação , Massagem/métodos , Síndrome de Abstinência a Substâncias/terapia
8.
BMC Infect Dis ; 19(1): 774, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488064

RESUMO

BACKGROUND: HCV (Hepatitis C virus) is a prevalent chronic disease with potentially deadly consequences, especially for drug users. However, there are no special HCV or HIV (human immunodeficiency virus)-related intervention programs that are tailored for drug users in China; to fill this gap, the purpose of this study was to explore HCV and HIV-related knowledge among drug users in MMT (methadone maintenance treatment) sites of China and to investigate the effectiveness of HCV and HIV-related education for improving the knowledge of IDUs (injection drug users) and their awareness of infection. METHODS: The study was a randomized cluster controlled trial that compared a usual care group to a usual care plus HCV/HIV-REP (HCV/HIV-Reduction Education Program) group with a 24-week follow-up. The self-designed questionnaires, the HCV- and HIV-related knowledge questionnaire and the HIV/HCV infection awareness questionnaire, were used to collect the data. Four MMT clinics were selected for this project; two MMT clinics were randomly assigned to the research group, with subjects receiving their usual care plus HCV/HIV-REP, and the remaining two MMT clinics were the control group, with subjects receiving their usual care over 12 weeks. Sixty patients were recruited from each MMT clinic. A total of 240 patients were recruited. Follow-up studies were conducted at the end of the 12th week and the 24th week after the intervention. RESULTS: At baseline, the mean score (out of 20 possible correct answers) for HCV knowledge among the patients in the group receiving the intervention was 6.51 (SD = 3.5), and it was 20.57 (SD = 6.54) for HIV knowledge (out of 45 correct answers) and 8.35 (SD = 2.8) for HIV/HCV infection awareness (out of 20 correct answers). At the 12-week and 24-week follow-up assessments, the research group showed a greater increase in HCV-/HIV-related knowledge (group × time effect, F = 37.444/11.281, P < 0.05) but no difference in their HIV/HCV infection awareness (group × time effect, F = 2.056, P > 0.05). CONCLUSION: An MMT-based HCV/HIV intervention program could be used to improve patient knowledge of HCV and HIV prevention, but more effort should be devoted to HIV/HCV infection awareness. TRIAL REGISTRATION: Protocols for this study were approved by institution review board (IRB) of Shanghai Mental Health Center (IRB:2009036), and registered in U.S national institutes of health (http://www.clinicaltrials.gov, NCT01647191 ). Registered 23 July 2012.


Assuntos
Usuários de Drogas/educação , Infecções por HIV/prevenção & controle , Hepatite C/prevenção & controle , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Educação de Pacientes como Assunto , Adulto , Conscientização , China/epidemiologia , Análise por Conglomerados , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Eficiência Organizacional , Feminino , HIV/fisiologia , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Hepacivirus/fisiologia , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/normas , Prevalência , Inquéritos e Questionários , Resultado do Tratamento
10.
Artigo em Inglês | MEDLINE | ID: mdl-31390750

RESUMO

Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%-89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%-89% of the tapering phase increased the odds of heroin abstinence.


Assuntos
Dependência de Heroína/tratamento farmacológico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Adulto , China , Feminino , Humanos , Modelos Logísticos , Masculino , Metadona/administração & dosagem , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Neonatal Netw ; 38(3): 160-169, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470383

RESUMO

Tens of thousands of infants are impacted yearly by prenatal opioid exposure. The term neonatal opioid withdrawal syndrome (NOWS) is now replacing the more familiar term neonatal abstinence syndrome (NAS). Ongoing debate continues related to standard regimens for treatment of this oftentimes perplexing condition. Historically, treatment has focused on pharmacologic interventions. However, there is limited research that points to nonpharmacologic methods of treatment as viable options, whether alone or in addition to pharmacologic interventions. This article, utilizing a review of pertinent literature, outlines the physical aspects of NOWS, including its pathophysiology and the resulting physical clinical signs. In addition, we present an overview of how age-appropriate, nonpharmacologic interventions, centered on developmental care, may be a valuable approach to organize and prioritize routine care for these infants, their families, and the health care team facing the challenges of NOWS. Finally, the need for further research to better define evidence-based standards of care for these infants and their families is discussed.


Assuntos
Síndrome de Abstinência Neonatal/diagnóstico , Síndrome de Abstinência Neonatal/enfermagem , Enfermagem Neonatal/normas , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/enfermagem , Guias de Prática Clínica como Assunto , Efeitos Tardios da Exposição Pré-Natal/tratamento farmacológico , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez
12.
BMJ Case Rep ; 12(7)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31371332

RESUMO

Currently, North America is facing a national opioid overdose crisis. Opioid use disorder (OUD) is a chronic, relapsing condition requiring varying intensities of treatment. Injectable opioid agonist therapy (iOAT) is an effective, high-intensity treatment option for people who are unsuccessful on conventional oral opioid agonist treatments (eg, methadone, buprenorphine). This case highlights the effectiveness of the provision of iOAT in a low-barrier setting. More specifically, we discuss a patient with severe OUD and untreated HIV infection, who was disengaged from medical care and, consequently, was prescribed iOAT in a supportive housing setting.


Assuntos
Analgésicos Opioides/administração & dosagem , Programas de Troca de Agulhas/métodos , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Feminino , Infecções por HIV/psicologia , Humanos , Transtornos Relacionados ao Uso de Opioides/virologia , Resultado do Tratamento
13.
Am J Health Syst Pharm ; 76(15): 1097-1103, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31361869

RESUMO

PURPOSE: The use of buprenorphine, methadone, and long-acting naltrexone for treatment of opioid use disorder (OUD) is discussed, including a review of current literature detailing treatment approaches and action steps to optimize treatment in acute care and office-based settings. SUMMARY: The U.S. epidemic of opioid-related deaths has been driven by misuse of prescription opioids and, increasingly, illicit drugs such as heroin, fentanyl, and fentanyl analogs, necessitating a refocusing of treatment efforts on expanding access to life-saving, evidence-based OUD pharmacotherapy. Inpatient treatment of opioid withdrawal includes acute symptom control through a combination of nonopioid medications and long-term pharmacotherapy to lessen opioid craving and facilitate stabilization and recovery. Methadone and buprenorphine reduce opioid craving, increase treatment retention, reduce illicit opioid use, and increase overall survival. Buprenorphine has logistical advantages over methadone, such as greater flexibility of treatment setting and less risk of adverse effects. Studies have shown the efficacy of long-acting injectable naltrexone to be comparable to that of buprenorphine if patients are detoxified prior to initiation of therapy; however, patients with active OUD are often not able to complete the week-long period of opioid abstinence needed prior to initiation of naltrexone injections. Although buprenorphine is preferred by many patients and can be prescribed in office-based settings, there remains a paucity of physicians certified to prescribe it. CONCLUSION: Buprenorphine has become the medication of choice for many patients with OUD, but its use is limited by the low number of physicians certified to prescribe the agent. Other agents studied for treatment of OUD include methadone and naltrexone.


Assuntos
Analgésicos Opioides/efeitos adversos , Medicina Baseada em Evidências/métodos , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Buprenorfina/uso terapêutico , Prescrições de Medicamentos , Humanos , Metadona/uso terapêutico , Naltrexona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia
14.
MCN Am J Matern Child Nurs ; 44(4): 212-218, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261299

RESUMO

BACKGROUND: Recent data suggest a significant increase in use of opioids among pregnant women. In the United States, reported rates of neonatal abstinence syndrome increased from 1.5 per 1,000 to 6.0 per 1,000 live births from 2000 to 2013. Use of opioids, both pharmacologic and nonpharmacologic, during pregnancy exposes women and babies to increased risks of adverse health outcomes. Professional organizations recommend addressing the complex needs of women who use opioids during pregnancy. OBJECTIVE: The purpose is to review the role of nurses in the prenatal setting caring for pregnant women with opioid use disorder. METHODS: We conducted a literature search using the CINAHL, PubMed, and PsycInfo electronic databases through January 2018 to identify best practices for referring women to treatment from the prenatal care office. Search terms included "substance use disorder," "pregnancy," "prenatal care," "referral," and "referral pathway." RESULTS: From our search, 68 abstracts were identified as relevant for review. Eight articles were selected for the analysis based on our focus. The findings assisted in development of our recommendations for nurses. CLINICAL IMPLICATIONS: During prenatal care, nurses can screen for opioid use disorder, develop positive relationships, and refer to treatment. This care should be based on values-neutral strategies to promote healthy outcomes for pregnant women and their babies.


Assuntos
Síndrome de Abstinência Neonatal/terapia , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/terapia , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Papel do Profissional de Enfermagem/psicologia , Relações Enfermeiro-Paciente , Tratamento de Substituição de Opiáceos/tendências , Transtornos Relacionados ao Uso de Opioides/psicologia , Gravidez , Diagnóstico Pré-Natal
15.
Artigo em Inglês | MEDLINE | ID: mdl-31174363

RESUMO

Methadone maintenance treatment (MMT) requires patients to intake their daily dose in person at their clinic. Therefore, transfer services are vital for patients who need temporary leave from their primary MMT clinic. However, studies have shown that transfer patients might delay return after temporary leave, leading to missed doses and putting them at risk of increased harm. In this study, we aimed to explore the transfer rates and factors associated with MMT patients who delayed return during a transfer period. In this retrospective analysis, we used audit records from the web-based management system from six MMT clinics in Guangdong, China. Multilevel logistic regression and multilevel Poisson regression analyses were used to examine the factors associated with patients who delayed return to their primary MMT clinic. A total of 459 people used the transfer system 2940 times between January 2006 and December 2016. Of those, patients delayed return to their primary MMT clinic 1199 times (40.78%). Patients who transferred regularly had poor compliance rates with MMT treatment. Those who once dropped out from and then re-enrolled in MMT were more likely to delay return. Most patients (82.71%) who used the transfer service for "work" were more likely to prolong their delay length. The findings highlight that a more flexible transfer system would minimize inconvenience to the patients.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Adulto , Instituições de Assistência Ambulatorial , China , Feminino , Humanos , Modelos Logísticos , Masculino , Metadona/administração & dosagem , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Nurs Womens Health ; 23(4): 357-365, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31251931

RESUMO

The growing incidence of neonatal abstinence syndrome (NAS) among newborns is a public health crisis that is a sequela of the national opioid crisis. When fetuses are exposed to opioids in utero, whether through prescription pain medication, illicit substances, or supervised medication-assisted opioid treatment, neonates can experience withdrawal symptoms shortly after birth. Opioid withdrawal manifests with symptoms of central nervous system and autonomic nervous system dysfunction. Treatment of NAS begins with nonpharmacologic interventions, and if a neonate requires more intensive treatment, care will escalate to include pharmacologic treatments, including morphine, methadone, and buprenorphine. When pharmacologic therapy begins, nonpharmacologic intervention is not ceased; rather, the two are used in conjunction in an attempt to reduce the amount of medication required for successful treatment. Herein we review nonpharmacologic nursing interventions, discuss the most common pharmacologic treatments for NAS, and present practice implications for nurses who work with childbearing families.


Assuntos
Síndrome de Abstinência Neonatal/tratamento farmacológico , Tratamento de Substituição de Opiáceos/métodos , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Masculino , Metadona/uso terapêutico , Morfina/uso terapêutico , Síndrome de Abstinência Neonatal/fisiopatologia , Tratamento de Substituição de Opiáceos/tendências , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/prevenção & controle , Resultado do Tratamento
18.
Basic Clin Pharmacol Toxicol ; 125(3): 253-258, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31188528

RESUMO

Urine tests are the commonly accepted methods to control abstinence and adherence to treatment of patients who undergo methadone maintenance treatment (MMT). Depending on various national guidelines and accessibility of techniques, only selected psychoactive substances are routinely tested in urine of MMT patients. In general, they belong to the few groups of compounds: THC, cocaine, amphetamines, opiates, PCP and benzodiazepines. It is, however, well known that patients enrolled in such replacement programmes take psychoactive substances that are not routinely detected by the toxicology laboratories, to escape unexpected tests. Here, we report semiquantitative detection of legal highs taken by the MMT patient, using high-pressure liquid chromatography coupled to the flowing atmospheric pressure afterglow ion source (LC-FAPA-MS). To demonstrate effectivity of this technique, the data were confirmed by quantitative analysis using LC-ESI-MS/MS. In the analysed sample of MMT patient, a mixture of psychoactive compounds was found, namely 3-MMC (3-methylmethcathinone), pentedrone and methcathinone and determined at the concentrations of 670; 50 and 0.2 µg/mL, respectively. Such fast analytical technique may be useful for the efficient control of substances taken intentionally by MMT patients.


Assuntos
Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Psicotrópicos/urina , Detecção do Abuso de Substâncias/métodos , Cromatografia Líquida de Alta Pressão/métodos , Feminino , Humanos , Limite de Detecção , Metanfetamina/análogos & derivados , Metanfetamina/urina , Metilaminas/urina , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/urina , Cooperação do Paciente , Pentanonas/urina , Propiofenonas/urina , Espectrometria de Massas em Tandem/métodos
20.
AIDS Behav ; 23(11): 3175-3183, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31154559

RESUMO

Social media can potentially serve as a platform to coordinate medical care among fragmented health sectors. This paper describes procedures of using social media to enhance antiretroviral therapy (ART) and methadone maintenance treatment (MMT) providers' virtual network for integrated service for HIV-positive people who inject drugs (PWID) in Vietnam. A total of 88 ART and MMT treatment providers participated in person group sessions followed by online virtual support to improve service integration. In-person reunions were held to reinforce Facebook participation and network activities. Content analysis was used to identify keywords and topic categories of the online information exchange. Both MMT and ART providers were actively engaged in online communications. Referral and treatment adherence were the two most frequently discussed topic areas by both the MMT and ART providers. Frequent cross-agency connections were observed. Online provider networks and communities could be built and useful to support treatment providers to improve service integration.


Assuntos
Antirretrovirais/uso terapêutico , Prestação Integrada de Cuidados de Saúde/métodos , Infecções por HIV/psicologia , Redução do Dano , Acesso aos Serviços de Saúde , Metadona/uso terapêutico , Mídias Sociais , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Atitude do Pessoal de Saúde , Infecções por HIV/tratamento farmacológico , Humanos , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologia , Vietnã
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