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1.
Subst Abuse Treat Prev Policy ; 16(1): 22, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673847

RESUMO

BACKGROUND: In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they're financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT. CASE PRESENTATION: Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics. CONCLUSION: In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.


Assuntos
Analgésicos Opioides/uso terapêutico , Heroína/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Administração Intravenosa , Administração Oral , Analgésicos Opioides/administração & dosagem , Heroína/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
2.
Value Health ; 24(2): 158-173, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33518022

RESUMO

OBJECTIVES: The rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature. METHODS: A systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. RESULTS: The screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studies' accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. CONCLUSION: The review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research.


Assuntos
Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/economia , Custos e Análise de Custo , Humanos , Metadona/economia , Metadona/uso terapêutico , Modelos Econômicos , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , /prevenção & controle , Tratamento de Substituição de Opiáceos/economia , Tratamento de Substituição de Opiáceos/métodos , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/terapia
3.
Value Health ; 24(2): 182-187, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33518024

RESUMO

OBJECTIVE: Buprenorphine is an essential medication for the treatment of opioid use disorder (OUD), but studies show it has been underused over the last 2 decades. We sought to evaluate utilization of and spending on buprenorphine formulations in Medicaid and to evaluate the impact of key market and regulatory factors affecting availability of different formulations and generic versions. METHODS: We first identified all buprenorphine formulations approved by the Food and Drug Administration for OUD using Drugs@FDA. We then used National Drug Codes to identify each drug in the Medicaid State Drug Utilization Data and extracted annual utilization rates and spending between 2002 and 2018 by drug and according to whether a brand-name or generic version was dispensed. We compared these trends to market and regulatory factors that affected competition, which we identified through searching the Federal Register, Westlaw, PubMed, and Google News. RESULTS: Brand-name buprenorphine-naloxone sublingual tablet and film formulations (Suboxone) were dispensed 2.7 times more (n = 634 213 140) and reimbursed 4.4 times more (n = $4 440 556 473) than all other formulations combined (n = 237 769 689; $1 018 988 133). We identified numerous market and regulatory factors that contributed to an estimated 9-year delay in generic versions of the tablet formulation and 6-year delay for generic versions of the film formulation. CONCLUSIONS: Brand-name buprenorphine formulations have been widely used in Medicaid, leading to substantial costs, in part because generic versions were delayed by multiple years owing to market and regulatory factors. Timely availability of low-cost generics could have helped encourage OUD treatment with buprenorphine during the height of the opioid crisis.


Assuntos
Buprenorfina/economia , Buprenorfina/uso terapêutico , Medicaid/economia , Antagonistas de Entorpecentes/economia , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Buprenorfina/administração & dosagem , Combinação Buprenorfina e Naloxona/economia , Combinação Buprenorfina e Naloxona/uso terapêutico , Uso de Medicamentos , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Competição Econômica , Humanos , Antagonistas de Entorpecentes/administração & dosagem , Tratamento de Substituição de Opiáceos/economia , Tratamento de Substituição de Opiáceos/métodos , Patentes como Assunto , Estados Unidos
4.
Lancet HIV ; 8(2): e67-e76, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33539760

RESUMO

BACKGROUND: UNAIDS recommends integrating methadone or buprenorphine treatment of opioid use disorder with HIV care to improve HIV outcomes, but buprenorphine adoption remains limited in many countries. We aimed to assess whether HIV clinic-based buprenorphine plus naloxone treatment for opioid use disorder was non-inferior to referral for methadone maintenance therapy in achieving HIV viral suppression in Vietnam. METHODS: In an open-label, non-inferiority trial (BRAVO), we randomly assigned people with HIV and opioid use disorder (1:1) by computer-generated random number sequence, in blocks of ten and stratified by site, to receive HIV clinic-based buprenorphine plus naloxone treatment or referral for methadone maintenance therapy in six HIV clinics in Vietnam. The primary outcome was HIV viral suppression at 12 months (HIV-1 RNA ≤200 copies per mL on PCR) by intention to treat (absolute risk difference [RD] margin ≤13%), compared by use of generalised estimating equations. Research staff actively queried treatment-emergent adverse events during quarterly study visits and passively collected adverse events reported during HIV clinic visits. This study is registered with ClinicalTrials.gov, NCT01936857, and is completed. FINDINGS: Between July 27, 2015, and Feb 12, 2018, we enrolled 281 patients. At baseline, 272 (97%) participants were male, mean age was 38·3 years (SD 6·1), and mean CD4 count was 405 cells per µL (SD 224). Viral suppression improved between baseline and 12 months for both HIV clinic-based buprenorphine plus naloxone (from 97 [69%] of 140 patients to 74 [81%] of 91 patients) and referral for methadone maintenance therapy (from 92 [66%] of 140 to 99 [93%] of 107). Buprenorphine plus naloxone did not demonstrate non-inferiority to methadone maintenance therapy in achieving viral suppression at 12 months (RD -0·11, 95% CI -0·20 to -0·02). Retention on medication at 12 months was lower for buprenorphine plus naloxone than for methadone maintenance therapy (40% vs 65%; RD -0·53, 95% CI -0·75 to -0·31). Participants assigned to buprenorphine plus naloxone more frequently experienced serious adverse events (ten [7%] of 141 vs four of 140 [3%] assigned to methadone maintenance therapy) and deaths (seven of 141 [5%] vs three of 141 [2%]). Serious adverse events and deaths typically occurred in people no longer taking ART or opioid use disorder medications. INTERPRETATION: Although integrated buprenorphine and HIV care may potentially increase access to treatment for opioid use disorder, scale-up in middle-income countries might require enhanced support for buprenorphine adherence to improve HIV viral suppression. The strength of our study as a multisite randomised trial was offset by low retention of patients on buprenorphine. FUNDING: National Institute on Drug Abuse (US National Institutes of Health).


Assuntos
Buprenorfina/uso terapêutico , Infecções por HIV/tratamento farmacológico , Metadona/uso terapêutico , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Quimioterapia Combinada , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/virologia , Cooperação do Paciente/estatística & dados numéricos , RNA Viral/sangue , Distribuição Aleatória , Resultado do Tratamento , Vietnã , Carga Viral/efeitos dos fármacos
5.
South Med J ; 114(2): 70-72, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33537785

RESUMO

OBJECTIVES: This study is a follow-up to previous research regarding buprenorphine medication-assisted therapy (MAT) in Johnson City, Tennessee. For-profit MAT clinics were surveyed to determine changes in tapering practice patterns and insurance coverage during the last 3 years. METHODS: Johnson City for-profit MAT clinics; also called office based opioid treatment centers, were surveyed by telephone. Clinic representatives were asked questions regarding patient costs for therapy, insurance coverage, counseling offered onsite, and opportunities for tapering while pregnant. RESULTS: All of the MAT clinics representatives indicated that tapering in pregnancy could be considered even though tapering in pregnancy is contrary to current national guidelines. Forty-three percent of the clinics now accept insurance as compared with 0% in the 2016 study. The average weekly cost per visit remained consistent. CONCLUSIONS: The concept of tapering buprenorphine during pregnancy appears to have become a standard of care for this community, as representatives state it is offered at all of the clinics that were contacted. Representatives from three clinics stated the clinics require tapering, even though national organizations such as the American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine do not recommend this approach. Although patients who have government or other insurance are now able to obtain buprenorphine with no expense at numerous clinics, the high cost for uninsured patients continues to create an environment conducive to buprenorphine diversion.


Assuntos
/economia , Tratamento de Substituição de Opiáceos/economia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Centros de Tratamento de Abuso de Substâncias/economia , Adulto , Assistência Ambulatorial/economia , Analgésicos Opioides/economia , Analgésicos Opioides/uso terapêutico , Região dos Apalaches , Buprenorfina/economia , Buprenorfina/uso terapêutico , Feminino , Seguimentos , Hospitais com Fins Lucrativos , Humanos , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/economia , Gravidez , Complicações na Gravidez/economia , Tennessee
7.
Med Educ Online ; 26(1): 1847755, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33222656

RESUMO

Background: The opioid epidemic is a growing problem in the USA. Use of medication-assisted treatment (MAT) has been effective in treating patients with opioid use disorders (OUD) and maintaining sobriety; however, there is a significant shortage of physicians formally trained in MAT. Objective: Wayne State University School of Medicine integrated the 8-hour MAT waiver training into its Internal Medicine clerkship curriculum. The objectives of integrating this into the curriculum were to (1) introduce opioid use education during students' Internal Medicine clerkship and (2) assess whether the curriculum prepares students to feel more comfortable evaluating and treating patients with OUD. Design: MAT training specifically for medical students was provided free online by the Providers Clinical Support System (PCSS). All students on the Internal Medicine clerkship were required to complete the training. A 7-question pre-survey and post-survey assessed students' comfort in evaluating and treating OUD. Significant changes were assessed with a paired McNemar Bowker Test. Results: Medical students (n = 141) completed the pre-survey and post-survey. After the MAT training, students' perspective of their clinical knowledge about OUD, familiarity with MAT, and likelihood to utilize MAT for their patients significantly differed, with increased proportions of medical students in agreement across 6 of 7 pre-post survey items (p <.0001). Conclusions: Online MAT waiver training is a low-cost (free) way to introduce MAT education into the undergraduate clinical curriculum. Upon completing of the training, medical students self-reported improvements in their knowledge and attitudes about OUD and the different treatment options. Our hope is that MAT waiver training will allow for graduation of medical students who are ready to care for patients with OUD during residency and as practitioners upon completion of their residency.


Assuntos
Estágio Clínico/organização & administração , Medicina Interna/educação , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Currículo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Adulto Jovem
8.
J Subst Abuse Treat ; 120: 108163, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33298301

RESUMO

Historically, federal and state policies have narrowly defined treatment models that have resulted in limited access to and engagement in counseling for individuals receiving medications for opioid use disorder (MOUD; e.g., methadone and buprenorphine). In response to the coronavirus pandemic, outpatient MOUD treatment providers rapidly transitioned from traditional, in-person care delivery models to revised COVID-19 protocols that prioritized telehealth counseling to protect the health of patients and staff and ensure continuity in MOUD care. These telehealth innovations appear to mitigate many of the longstanding barriers to counseling in the traditional system and have the potential to forever alter MOUD care delivery. Drawing on data from a Rhode Island-based clinic, we argue that MOUD counseling is achievable via telehealth and outline the need for, and anticipated benefits of, hybrid telehealth/in-person MOUD treatment models moving forward.


Assuntos
Aconselhamento/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Telemedicina/organização & administração , Buprenorfina/administração & dosagem , Continuidade da Assistência ao Paciente/organização & administração , Assistência à Saúde/organização & administração , Humanos , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Rhode Island
9.
J Subst Abuse Treat ; 120: 108149, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33303086

RESUMO

The Youth Opioid Recovery Support (YORS) intervention is a novel treatment for young adults with opioid use disorder (OUD) that uses developmentally informed strategies to reduce barriers to treatment engagement. YORS strategies, such as home delivery of extended-release buprenorphine and extended-release naltrexone for OUD, are designed to increase engagement in treatment, but with the COVID-19 pandemic these strategies increase risk of virus exposure and spread to patients and staff entering homes. We present mobile van service delivery as a potential solution to continuing to provide low-barrier care for young adults with OUD while reducing risk associated with COVID-19. Initial feedback from patients and staff is positive and lays the groundwork to test feasibility and acceptability of this intervention rigorously in future work. Mobile van delivery of extended-release medications for OUD may be a promising treatment modification for mitigating risk of COVID-19, as well as a useful option for ongoing enhancement of care.


Assuntos
Buprenorfina/administração & dosagem , Unidades Móveis de Saúde , Naltrexona/administração & dosagem , Preparações de Ação Retardada , Humanos , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto Jovem
10.
Am J Public Health ; 111(2): 215-218, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33351661

RESUMO

The Buprenorphine Nurse Care Manager Initiative (BNCMI) sought to increase access to opioid use disorder treatment in underserved New York City populations by expanding buprenorphine treatment capacity in safety-net primary care clinics.During 2016 to 2020, BNCMI added 116 new buprenorphine providers across 27 BNCMI clinics, and 1212 patients were enrolled; most patients identified as Latinx or Hispanic and were Medicaid beneficiaries.BNCMI increased access to buprenorphine, reached underserved populations, and is part of the New York City Health Department's multipronged approach to reducing opioid overdose deaths.


Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Acesso aos Serviços de Saúde , Tratamento de Substituição de Opiáceos , Provedores de Redes de Segurança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Overdose de Drogas/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/enfermagem , Atenção Primária à Saúde , Saúde Pública , Adulto Jovem
11.
Cochrane Database Syst Rev ; 12: CD013217, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33348423

RESUMO

BACKGROUND: The prevalence of substance use, both prescribed and non-prescribed, is increasing in many areas of the world. Substance use by women of childbearing age contributes to increasing rates of neonatal abstinence syndrome (NAS). Neonatal opioid withdrawal syndrome (NOWS) is a newer term describing the subset of NAS related to opioid exposure. Non-pharmacological care is the first-line treatment for substance withdrawal in newborns. Despite the widespread use of non-pharmacological care to mitigate symptoms of NAS, there is not an established definition of, and standard for, non-pharmacological care practices in this population. Evaluation of safety and efficacy of non-pharmacological practices could provide clear guidance for clinical practice. OBJECTIVES: To evaluate the safety and efficacy of non-pharmacological treatment of infants at risk for, or having symptoms consistent with, opioid withdrawal on the length of hospitalization and use of pharmacological treatment for symptom management. Comparison 1: in infants at risk for, or having early symptoms consistent with, opioid withdrawal, does non-pharmacological treatment reduce the length of hospitalization and use of pharmacological treatment? Comparison 2: in infants receiving pharmacological treatment for symptoms consistent with opioid withdrawal, does concurrent non-pharmacological treatment reduce duration of pharmacological treatment, maximum and cumulative doses of opioid medication, and length of hospitalization? SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 10); Ovid MEDLINE; and CINAHL on 11 October 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster trials. SELECTION CRITERIA: We included trials comparing single or bundled non-pharmacological interventions to no non-pharmacological treatment or different single or bundled non-pharmacological interventions. We assessed non-pharmacological interventions independently and in combination based on sufficient similarity in population, intervention, and comparison groups studied. We categorized non-pharmacological interventions as: modifying environmental stimulation, feeding practices, and support of the mother-infant dyad. We presented non-randomized studies identified in the search process narratively. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Primary outcomes in infants at risk for, or having early symptoms consistent with, opioid withdrawal included length of hospitalization and pharmacological treatment with one or more doses of opioid or sedative medication. Primary outcomes in infants receiving opioid treatment for symptoms consistent with opioid withdrawal included length of hospitalization, length of pharmacological treatment with opioid or sedative medication, and maximum and cumulative doses of opioid medication. MAIN RESULTS: We identified six RCTs (353 infants) in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated between 1975 and 2018. We identified no RCTs in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. The certainty of evidence for all outcomes was very low to low. We also identified and excluded 34 non-randomized studies published between 2005 and 2018, including 29 in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated and five in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. We identified seven preregistered interventional clinical trials that may qualify for inclusion at review update when complete. Of the six RCTs, four studies assessed modifying environmental stimulation in the form of a mechanical rocking bed, prone positioning, non-oscillating waterbed, or a low-stimulation nursery; one study assessed feeding practices (comparing 24 kcal/oz to 20 kcal/oz formula); and one study assessed support of the maternal-infant dyad (tailored breastfeeding support). There was no evidence of a difference in length of hospitalization in the one study that assessed modifying environmental stimulation (mean difference [MD) -1 day, 95% confidence interval [CI) -2.82 to 0.82; 30 infants; very low-certainty evidence) and the one study of support of the maternal-infant dyad (MD -8.9 days, 95% CI -19.84 to 2.04; 14 infants; very low-certainty evidence). No studies of feeding practices evaluated the length of hospitalization. There was no evidence of a difference in use of pharmacological treatment in three studies of modifying environmental stimulation (typical risk ratio [RR) 1.00, 95% CI 0.86 to 1.16; 92 infants; low-certainty evidence), one study of feeding practices (RR 0.92, 95% CI 0.63 to 1.33; 49 infants; very low-certainty evidence), and one study of support of the maternal-infant dyad (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). Reported secondary outcomes included neonatal intensive care unit (NICU) admission, days to regain birth weight, and weight nadir. One study of support of the maternal-infant dyad reported NICU admission (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). One study of feeding practices reported days to regain birth weight (MD 1.10 days, 95% CI 2.76 to 0.56; 46 infants; very low-certainty evidence). One study that assessed modifying environmental stimulation reported weight nadir (MD -0.28, 95% CI -1.15 to 0.59; 194 infants; very low-certainty evidence) and one study of feeding practices reported weight nadir (MD -0.8, 95% CI -2.24 to 0.64; 46 infants; very low-certainty evidence). AUTHORS' CONCLUSIONS: We are uncertain whether non-pharmacological care for opioid withdrawal in newborns affects important clinical outcomes including length of hospitalization and use of pharmacological treatment based on the six included studies. The outcomes identified for this review were of very low- to low-certainty evidence. Combined analysis was limited by heterogeneity in study design and intervention definitions as well as the number of studies. Many prespecified outcomes were not reported. Although caregivers are encouraged by experts to optimize non-pharmacological care for opioid withdrawal in newborns prior to initiating pharmacological care, we do not have sufficient evidence to inform specific clinical practices. Larger well-designed studies are needed to determine the effect of non-pharmacological care for opioid withdrawal in newborns.


Assuntos
Tempo de Internação , Entorpecentes/efeitos adversos , Síndrome de Abstinência Neonatal/terapia , Leitos , Aleitamento Materno , Planejamento Ambiental , Humanos , Hipnóticos e Sedativos/uso terapêutico , Equipamentos para Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Síndrome de Abstinência Neonatal/tratamento farmacológico , Berçários para Lactentes , Tratamento de Substituição de Opiáceos/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
J Subst Abuse Treat ; 119: 108139, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33138924

RESUMO

The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis.


Assuntos
Analgésicos Opioides/administração & dosagem , Infecções por Coronavirus , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pandemias , Pneumonia Viral , Padrões de Prática Médica/estatística & dados numéricos , Desvio de Medicamentos sob Prescrição/estatística & dados numéricos , Analgésicos Opioides/efeitos adversos , Buprenorfina/administração & dosagem , Overdose de Drogas/epidemiologia , Humanos , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos
13.
J Subst Abuse Treat ; 119: 108154, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33032860

RESUMO

In the context of the COVID-19 pandemic and the state of emergency that the government of Spain declared, the rapid adaptation of health services is of paramount importance to preserve access to and continuity of service delivery. This research note underscores the importance of ensuring a sufficient quantity of methadone take-home doses for patients on methadone maintenance treatment (MMT) to maximize their adherence to government-imposed lockdown restrictions and social distancing measures designed to curtail the spread of SARS-CoV-2. We evaluate the impact of COVID-19 on take-home medication (number of days provided) in a methadone clinic in Barcelona (Catalonia, Spain). This work conveys that we should consider maintaining the take-home practices that we adopted in response to the pandemic, even after the pandemic has abated.


Assuntos
Infecções por Coronavirus , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pandemias , Pneumonia Viral , Instituições de Assistência Ambulatorial , Acesso aos Serviços de Saúde , Humanos , Metadona/provisão & distribução , Espanha
14.
J Addict Med ; 14(6): e290-e292, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33021554

RESUMO

: Correctional settings can be vectors of infectious diseases due to overcrowding, unsanitary living conditions, and very little capacity to engage in social distancing. In the US, COVID-19 outbreaks were first identified in the New York City and Cook County jails, with infection rates far exceeding community rates. Each day new cases are being identified across the country in correctional facilities. People who are incarcerated are at increased risk of experiencing severe COVID-19 symptoms because of the increased prevalence of other underlying illnesses. Jails and prisons have begun initiating facility-level policies to help stop the spread of COVID-19. As a result, correctional agencies have reoriented staff to stem transmission in their facilities. This could translate into limited resources for other programming such as medications for opioid use disorder (MOUD) programs. In this commentary, we highlight risk mitigation practices for delivering MOUD in correctional settings during COVID-19 and note how to ensure quality of care while still preparing for the possibility of future pandemics.


Assuntos
Infecções por Coronavirus/epidemiologia , Tratamento de Substituição de Opiáceos , Pneumonia Viral/epidemiologia , Prisões , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/métodos , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prisioneiros , Prisões/organização & administração , Telemedicina
16.
J Addict Med ; 14(6): e372-e374, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33031213

RESUMO

OBJECTIVES: To measure the change in the daily number of patients receiving buprenorphine and buprenorphine prescribers during the early phase of the COVID-19 (SARS-CoV-2) pandemic in Texas. METHODS: Counts of the number of patients filling and number of providers prescribing buprenorphine were calculated for each weekday between November 4, 2019 and May 12, 2020. The change in daily patients and prescribers between March 2, 2020 and May 12, 2020, was modeled as a change in slope compared to the baseline period using autoregressive, interrupted time series regression. RESULTS: The rate of change of daily buprenorphine prescriptions (ß = -1.75, 95% CI = -5.8-2.34) and prescribers (ß = -0.32, 95% CI = -1.47-0.82) declined insignificantly during the COVID-19 period compared to the baseline. CONCLUSIONS: Despite a 57% decline in ambulatory care utilization in the south-central US during March and April of 2020, health services utilization related to buprenorphine in Texas remained robust. Protecting access to buprenorphine as the COVID-19 pandemic continues to unfold will require intensive efforts from clinicians and policy makers alike. While the presented results are promising, researchers must continue monitoring and exploring the clinical and humanistic impact of COVID-19 on the treatment of substance use disorders.


Assuntos
Buprenorfina/uso terapêutico , Infecções por Coronavirus/epidemiologia , Política de Saúde , Antagonistas de Entorpecentes/uso terapêutico , Pneumonia Viral/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Pandemias , Padrões de Prática Médica/estatística & dados numéricos , Texas
17.
Tex Med ; 116(10): 32-35, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33126270
18.
Farm. hosp ; 44(5): 185-191, sept.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195145

RESUMO

En febrero de 2018 se publicó en la Comunidad de Madrid la Resolución 189/2018 con el objetivo de centralizar el procedimiento de adquisición, elaboración, distribución y dispensación de metadona a los Centros de Atención Integral a Drogodependientes del Servicio Madrileño de Salud bajo la responsabilidad de un servicio de farmacia hospitalaria. El servicio de farmacia hospitalaria inició esta actividad en marzo de 2018, siendo la primera vez que se centraliza en un servicio de farmacia hospitalaria la gestión integral del plan de mantenimiento con metadona para la atención de pacientes drogodependientes en la Comunidad de Madrid. Al inicio del proyecto se analizó el circuito anterior, se adaptó el laboratorio de farmacotecnia y se diseñó el procedimiento de adquisición de metadona. Se implementó una vía de comunicación con los Centros de Atención Integral a Drogodependientes, diseñándose formularios de so-licitud y se establecieron los correspondientes procedimientos de control derivados de su naturaleza estupefaciente. Se han diseñado y adjudicado, cumpliendo la Ley de Contratos de la Administración Pública, procedimientos normalizados para la adquisición de metadona, envases para la dosificación personalizada en los Centros de Atención Integral a Drogodependientes y rutas de transporte. Asimismo, se ha adjudicado un concurso para la implementación de un sistema informático de gestión y sistemas automatizados de dispensación, actualmente en vías de instalación. También se está actualizando el protocolo farmacoterapéutico del Plan de mantenimiento con metadona de la Comunidad de Madrid. En año y medio se han elaborado 5.300 litros de metadona solución y se han dispensado 2.844 prescripciones individualizadas. Disponemos de resultados de calidad percibida por los profesionales de los Centros de Atención Integral a Drogodependientes mediante una encuesta de satisfacción. La tasa de respuesta fue del 92%. El grado de satisfacción global fue: 91% muy satisfecho/bastante satisfecho y 9% satisfecho. Destaca el alto grado de satisfacción (bastante o muy satisfecho) del 81,8% con la eficacia y rapidez de la resolución de incidencias por parte de los profesionales del servicio de farmacia. Este proceso permite incorporar el conocimiento y experiencia de los farmacéuticos especialistas a este ámbito asistencial, así como aprovechar recursos, instalaciones y procedimientos ya existentes. Todo ello redunda en un abordaje eficiente, eficaz y seguro de esta actividad clínico-asistencial y posibilitar un cambio de modelo de asistencia farmacoterapéutica de los pacientes dependientes de opiáceos


In February 2018, Resolution 189/2018 was published in the Autonomous Community of Madrid with the objective of centralizing the procedure for the acquisition, preparation, distribution, and dispensing of methadone to Centres for the Comprehensive Care of Drug Addiction Patients within the Madrid Health Service under the responsibility of a Hospital Pharmacy Service. The Hospital Pharmacy Service began this activity in March 2018. This is the first time that the comprehensive management of a methadone maintenance plan has been centralized in an Hospital Pharmacy Service for the care of drug-dependent patients in the Autonomous Community of Madrid. At the beginning of the Project, the previous workflow was analysed, the pharmaceutical laboratory was adapted, and the methadone acquisition procedure was designed. A communication channel with the Centres for the Comprehensive Care of Drug Addiction Patients was implemented and application forms were designed. Corresponding control procedures were established given that the medication under consideration was a narcotic. Standard procedures for the acquisition of methadone, of containers for personalized dosing in Centres for the Comprehensive Care of Drug Addiction Patients, and transport routes were designed and contracted out through public tender in compliance with the Public Administration Contract Law. A tender has also been awarded for the implementation of a computerized management system and automated dispensing systems, which are currently undergoing installation. The pharmacotherapeutic protocol of the Methadone Maintenance Plan of the Autonomous Community of Madrid is also being updated. Over 18 months, 5,300 L of methadone solution have been prepared and 2,844 individual prescriptions have been dispensed. High levels of perceived satisfaction were reported via a questionnaire administered to the Centre for the Comprehensive Care of Drug Addiction Patients staff. The response rate was 92%. Overall satisfaction was very satisfied/quite satisfied (91%) and satisfied (9%). These results highlight the high level of satisfaction (quite satisfied or very satisfied: 81.8%) with the effectiveness and speed of resolution of incidents by the Hospital Pharma-cy Service staff. This process incorporates the knowledge and experience of hospital pharmacists into this healthcare field, as well as taking advantage of existing resources, facilities, and procedures. All these aspects lead to an efficient, effective, and safe approach to this clinical-care activity and enable a change in the pharmacotherapeutic health care model for opioid-dependent patients


Assuntos
Humanos , Tratamento de Substituição de Opiáceos/métodos , Metadona/uso terapêutico , Serviços Comunitários de Farmácia/organização & administração , Segurança do Paciente , Comprimidos/uso terapêutico , Estabilidade de Medicamentos
19.
Harm Reduct J ; 17(1): 60, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32831083

RESUMO

BACKGROUND: Caledonian Stadium, the main mass temporary shelter for homeless people in the City of Tshwane, was created as a local response to the imperatives of the novel coronavirus disease (COVID-19) National State of Disaster lockdown in South Africa. This is a case study of the coordinated emergency healthcare response provided by the University of Pretoria's Department of Family Medicine between 24 March and 6 April 2020. METHODS: This study uses a narrative approach to restory situated, transient, partial and provisional knowledge. Analysis is based on documented data and iteratively triangulated interviews on the operational experiences of selected healthcare first responders directly involved in the shelter. RESULTS: The impending lockdown generated intense interactions by UP-DFM to prepare for the provision of COVID-19 and essential generalist primary with partners involved in the Community Oriented Substance Use Programme (COSUP). With approximately 2000 people at the shelter at its peak, the numbers exceeded expectations. Throughout, while government officials tried to secure bedding, food and toilets, the shelter was poorly equipped and without onsite management. The COSUP clinical team prioritised opioid substitution therapy using methadone and COVID-19 screening over generalist healthcare to manage withdrawal and contain tension and anxiety. COSUP and its partners helped the city plan and implement the safe re-sheltering of all Caledonian residents. CONCLUSION: The Caledonian shelter is an account of organisational resilience in the face of homelessness and substance use emergencies triggered by lockdown. Through community-oriented, bottom-up self-organisation, a clinically led team navigated a response to the immediate needs of people who are homeless and/or use drugs that evolved into a more sustainable intervention. Key lessons learnt were the importance of communicating with people directly affected by emergencies, the value of using methadone to reduce harms during emergencies and the imperative of including OST in essential primary healthcare.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Redução do Dano , Pessoas em Situação de Rua , Tratamento de Substituição de Opiáceos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Adolescente , Adulto , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul , Adulto Jovem
20.
Rev. Soc. Esp. Dolor ; 27(4): 278-280, jul.-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-196845

RESUMO

Los pacientes con patología dual son especialmente complejos y realizar un buen diagnóstico diferencial es fundamental. En este caso, un cuadro de "dolor crónico" enmascara la sintomatología psiquiátrica y adictiva desde el inicio


Patients with dual diagnosis are particularly complex and do a good differential diagnosis is critical. In this case, a diagnosis of "chronic pain" masks addictive and psychiatric symptoms from the beginning


Assuntos
Humanos , Masculino , Adulto , Diagnóstico Duplo (Psiquiatria)/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Dor Lombar/tratamento farmacológico , Esquizofrenia/complicações , Diagnóstico Diferencial , Tratamento de Substituição de Opiáceos/métodos , Dor Crônica/tratamento farmacológico
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