CYP2B6 and ABCB1 genotypes predict methadone plasma exposure among patients on maintenance therapy against opioid addictions in Tanzania.

AIMS: Methadone maintenance therapy (MMT) exhibits significant variability in pharmacokinetics and clinical response, partly due to genetic variations. However, data from sub-Saharan African populations are lacking. We examined plasma methadone variability and pharmacogenetic influences among opioid-addicted Tanzanian patients. METHODS: Patients attending MMT clinics (n = 119) in Tanzania were genotyped for common functional variants of the CYP3A4, CYP3A5, CYP2A6, CYP2B6, CYP2C19, CYP2D6, ABCB1, UGT2B7 and SLCO1B1 genotypes. Trough plasma concentrations of total methadone, S-methadone (S-MTD) and R-methadone (R-MTD), with their respective metabolites, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The methadone-to-EDDP metabolic ratio (MMR) was used to categorize the phenotype. RESULTS: The proportions of MMR-predicted ultrarapid, extensive, intermediate and slow methadone metabolizer phenotypes were 2.5%, 58.2%, 23.7% and 15.6%, respectively. CYP2B6 genotype significantly correlated with S-methadone (P = .006), total methadone (P = .03), and dose-normalized methadone plasma concentrations (P = .001). Metabolic ratios of R-methadone (R-MTD/R-EDDP), S-methadone (S-MTD/S-EDDP), and total methadone (MMR) were significantly higher among patients homozygous for defective variants (*6 or *18) than heterozygous or CYP2B6*1/*1 genotypes (P < .001). The metabolic ratio for S-MTD and total methadone was significantly higher among ABCB1c.3435T/T than in the C/C genotype. No significant effect of CYP2D6, CYP2C19, CYP3A4, CYP3A5, CYP2A6, UGT2B7 and SLCO1B1 genotypes on S-methadone, R-methadone, or total methadone was observed. CONCLUSIONS: Approximately one in six opioid-addicted Tanzanian patients are methadone slow metabolizers, influenced by genetic factors. Both the CYP2B6 and ABCB1 genotypes are strong predictors of methadone metabolic capacity and plasma exposure. Further investigation is needed to determine their predictive value for methadone treatment outcomes and to develop genotype-based dosing algorithms for safe and effective therapy.

Cannabis-related treatment demand at the eve of German cannabis legalization - a 20-years trend analysis.

Post-2000, the prevalence of cannabis consumption has been rising internationally. This paper investigates whether cannabis-related treatment demand in German outpatient addiction care facilities (OACFs) has been following this trend. Treatment demand related to cannabis use disorder (CUD) for the period 2001 to 2021 was investigated using data from the nation-wide standardized German Addiction Care Statistical Service. Analyses covered all and first-time treatment admissions, demographics, and treatment outcomes. We identified years with significant changes in slope or direction of trends through joinpoint regression. Trends within the CUD client population were contrasted with trends among the entire OACF client population. CUD is the second-most common cause for OACF admissions in Germany. Between 2001 and 2021, the share of CUD-related cases among total OACF caseload increased from 7.1 to 19.9%, whereby the share of first-time treatment admissions declined from 79.6 to 55.6%. The share of CUD client population > 35 years almost tripled from 6.0 to 17.4%, that of female client population rose from 15.6 to 18.1%. From 2001 to 2007, the share of CUD-related treatments completed with improved symptomatology increased from 54.7 to 65.6%, followed by a marginal decline. CUD-related treatment demand is growing in Germany's OACFs, involving a client population that is increasingly older and more experienced with the addiction care system. As current intervention programmes mainly target adolescents and young adults who have been consuming cannabis only for a short time, adapting service offers to the changing client profiles appears paramount to improve treatment effectiveness.

The factors affecting substance abuse relapse based on theory of planned behavior in male addicts covered by addiction treatment centers in Southern Iran.

BACKGROUND: Given the destructive nature of addiction and its relapse after quitting, the present study aimed to investigate the factors affecting substance abuse relapse based on the Theory of Planned Behavior (TPB) in male addicts covered by addiction treatment centers in Shiraz, Iran. METHODS: This cross-sectional study was conducted on 400 male addicts covered by addiction treatment centers in Shiraz, Iran, in 2021-2022. The data collection tool was a researcher-made questionnaire. Data were analyzed using SPSS-22 software through descriptive statistical methods, linear regression, and binary logistic regression. RESULTS: 190 people (47.50%) were aged 31-40 years, 265 people (66.25%) were married, 224 people (56%) lived with their spouses, and 192 people (48 percent) had their first use at the age of 16-20. The substance respondents used were methamphetamine (59.5%), heroin (53%), opium (48%), and alcohol (40%). 138 people (34.5%) had their first place of consumption at friends' houses (Tables 1 and 2). 342 people (85.5%) had a history of relapse, and 172 people (50.29%) had 1-5 relapses. Marital status, occupation, and income were among the demographic risk factors, and addicted friends and close relatives were among the behavioral risk factors for drug relapse among people with a history of relapse. Personal desire and the insistence of friends were also among the individual and interpersonal factors of drug use among participants. The regression results showed that the constructs of awareness, attitude, subjective norms, perceived behavioral control, and behavioral intention were predictors of drug relapse among addicts (P < 0.05). CONCLUSION: The current study's findings indicate that among the behavioral risk factors for drug relapse in individuals with a history of relapse are addicted friends and close relatives, while marital status, occupation, and income are among the demographic risk variables. Among the individual and interpersonal factors influencing drug usage among participants were personal desire and friends' insistence. Furthermore, the findings indicated that the TPB's structures might be used to predict drug relapse in addicts.

Potential factors affecting the impact of community reinforcement and family training. Secondary analysis of an RCT.

BACKGROUND: In addition to increasing the quality of life among concerned significant others (CSOs), Community Reinforcement and Family training (CRAFT) aim at helping CSOs motivate treatment-refusing identified patients (IPs) into treatment through a positive reinforcement process. The aim of the present study was to investigate if the following factors, measured at baseline, have an influence on IP future treatment engagement (1) Type of relation between CSO and the IP (2) The amount of time the CSO spend with the IP (3) if the IP knows that the CSOs seeks help, and (4) The CSO's own alcohol use. METHODS: A secondary analysis from the Danish CRAFT study. CSOs completed a self-administered questionnaire at baseline, after three months, and six months. To investigate the relationship between the four variables and treatment engagement, logistic regression was used. RESULTS: CSO's relation to the IP, the frequency of contact between the CSO and the IP, and the CSO's AUDIT score at the time of the baseline interview were not associated with the IP's treatment engagement. If CSO at baseline had informed the IP that the CSO participated in CRAFT, odds for IP treatment engagement were significantly higher (adjusted OR [(CI)] = 2.29 [1.13; 4.63] (p < 0.05), relative to if IP not being informed. CONCLUSIONS: CRAFT has a higher impact on the likelihood for treatment seeking, if the CSOs inform the IP about his or her own help seeking in order to change the situation. The underlying mechanism behind this is needs further investigations.

A survey of barriers and facilitators to the adoption of buprenorphine prescribing after implementation of a New Jersey-wide incentivized DATA-2000 waiver training program.

BACKGROUND: Opioid-involved overdose deaths continue to rise in the US, despite availability of highly effective treatments for opioid use disorder (OUD), in part due to the insufficient number of treatment providers. Barriers include the need for providers to gain expertise and confidence in providing MOUD to their patients who need these treatments. To mitigate this barrier, New Jersey sponsored a buprenorphine training program with financial incentives for participation, which met the then existing requirement for the DATA-2000 waiver. In a 2019 follow-up survey, participants reported on barriers and facilitators to subsequent buprenorphine prescribing. METHODS: Participants in the training program completed a 10-min electronic survey distributed via email. The survey addressed demographics, practice characteristics, current buprenorphine prescribing, and barriers and facilitators to adoption and/or scale up of buprenorphine prescribing. RESULTS: Of the 440 attendees with a valid email address, 91 individuals completed the survey for a response rate of 20.6%. Of the 91 respondents, 89 were eligible prescribers and included in the final analysis. Respondents were predominantly female (n = 55, 59.6%) and physicians (n = 55, 61.8%); representing a broad range of specialties and practice sites. 65 (73%) of respondents completed the training and DEA-registration, but only 31 (34.8%) were actively prescribing buprenorphine. The most frequently cited barriers to buprenorphine prescribing were lack of access to support services such as specialists in addiction, behavioral health services, and psychiatry. The most frequently reported potential facilitators were integrated systems with direct access to addiction specialists and psychosocial services, easier referral to behavioral health services, more institutional support, and improved guidance on clinical practice standards for OUD treatment. CONCLUSION: More than half (52.3%) of those who completed incentivized training and DEA registration failed to actively prescribe buprenorphine. Results highlight provider perceptions of inadequate availability of support for the complex needs of patients with OUD and suggest that broader adoption of buprenorphine prescribing will require scaling up support to clinicians, including increased availability of specialized addiction and mental health services.

What Is It Like to Be in Alcohol Addiction Recovery? A Dialectical Phenomenological Analysis.

INTRODUCTION: Currently, there is no scientific consensus on the concept of alcohol addiction recovery beyond substance use control. This conceptual issue challenges the implementation of therapeutic strategies and mental health policies that are unrestricted to symptomatic remission. Aiming to contribute to its definition, this study aimed to examine the recovery experience of individuals with alcohol addiction using dialectical phenomenological psychopathology (DPP) as a theoretical and methodological framework. METHODS: A dialectical phenomenological analysis was conducted through an examination of online interviews with eight Brazilian, São Paulo state citizens who were self-declared to be undergoing alcohol addiction recovery (or who declared that they had completely recovered). RESULTS: Participants' reports generated eight categories that were subdivided into two groups. The first group indicated experiential elements of recovery, such as changes in self-relation, changes in interpersonal relations, and changes in time relations, giving new meanings to suffering and alcohol use, and recovery as a continuous process. The second group referred to how the participants interpreted recovery according to their worldviews: as a spiritual experience, moral reformation, and mentality change. CONCLUSION: These categories can be understood through the lens of DPP as a process of change in the subjects' being in the world, characterized by the continued management of their existential imbalances in the dimensions of spatiality, temporality, selfhood, and intersubjectivity. The results are preliminary when it comes to conceptualizing recovery but may help future studies to develop recovery-oriented therapeutic strategies.

A quality assurance study of the development of quality of care in outpatient clinics for treatment of addiction in Greenland.

INTRODUCTION: In 2016, a new addiction treatment service, Allorfik, was introduced in Greenland. Allorfik has, throughout the implementation and after, used auditing of patient records with feedback to develop the quality of care in treatment. Audits and feedback are routinely done in each treatment center. This study wishes to investigate the development of the quality of treatment through the case notes from the journal audits. METHODOLOGY: This study is based on case notes audits from 2019, 2020 and 2021. In the audits, the focus has been on the quality of documentation and content for ten specific areas in each patient record. Each area was scored on a Likert scale of 0-4 for both outcomes. Statistical analyses were done using Stata 17, and P-values < 0.05 were considered statistically significant. We present baseline characteristics for patients and illustrate the development of quality for both outcomes as time trends with scatter plots. RESULTS: The analysis was based on data from 454 patients and audits of their case notes. The mean number of weeks in treatment is 12.72, and the mean age for the people in the audited case notes is 39. Time had a positive effect on both outcomes, and so each month, documentation increased by 0.21 points (p-value = <0.001), and content increased by 0.27 points (p-value = <0.001). CONCLUSION: For documentation and content, the quality level has increased significantly with time, and the quality of case notes is at an excellent level at the final audits of all treatment centers.

Low-Dose Initiation of Buprenorphine: A Narrative Review.

PURPOSE OF REVIEW: Opioid use disorder (OUD) is a chronic disorder in which a person loses control over the use of opioids, develops a compulsive behavior, and defends the use despite knowing the negative consequences. There are numerous treatments for OUD, including buprenorphine. Since it is displacing a full agonist opioid, precipitated withdrawal can occur with standard inductions involving buprenorphine. RECENT FINDINGS: Case reports have noted success with a low-dose initiation of buprenorphine, which is different from typical protocols, relatively limited by adverse effects when patients were recently administered full agonists. A cohort investigation studied the use of a transdermal patch as part of the protocol, which was fairly well tolerated. While ongoing research is being conducted on this topic, recent case studies and smaller cohort studies have demonstrated the feasibility of a trial to treat OUD with low-dose initiation of buprenorphine.

'It opened my eyes, my ears, and my heart': Codesigning a substance use disorder treatment programme.

BACKGROUND: Pregnant and parenting women have low engagement and poor retention in substance use disorder (SUD) treatment. The aim of this study was to analyse the implementation of an adapted experience-based codesign (EBCD) process involving SUD treatment staff and pregnant or parenting women with lived experience (WWLE) of SUD to launch a residential treatment service where women could coreside with their children and receive long term comprehensive treatment for dual diagnosis of SUD and mental illness. METHODS: A process evaluation was conducted utilising five data sources: two sets of semistructured interviews with WWLE and SUD treatment staff, ethnographic observation and transcripts from group events, and meeting minutes. Based on the Integrated Promoting Action on Research in Health Services framework constructs (context, recipients, facilitation, innovation) researchers applied thematic analysis to determine main themes within each construct. RESULTS: The full sample across the implementation totalled 34 individuals (WWLE = 13 and SUD staff = 21). The EBCD process engaged both cohorts and supported group cohesion and collaborative brainstorming. WWLE felt respected, emotionally safe to share, and empowered by participation. A cohesive, multidisciplinary codesign planning group, inclusive of WWLE, supported a more equitable codesign process. The need for a virtual platform due to the COVID-19 pandemic impeded human connection and relationship building. The complex environment of residential regulations and uncertainties during start-up phase of an organisation presented implementation challenges. CONCLUSION: These results highlight the feasibility of, and challenges to, effectively engaging WWLE in a codesign process. The findings also demonstrated a positive influence on WWLE's feelings of empowerment. Identified themes reinforce the purposeful components within EBCD that enhance participation, along with new insights to inform successful codesign with a vulnerable population. The author's team included a WWLE who collaborated throughout the full scope of the research process, enriching the overall research and ensuring the authenticity of the presentation of women in recovery's perspective. Utilising the codesign approach to design and implement new services should improve health equity by enhancing patient engagement and retention in care. PATIENT CONTRIBUTION: Parenting WWLE of residential SUD treatment were involved in the full scope of the research process and the implementation being evaluated. For the actual codesign work WWLE were key members of the codesign planning team that met weekly throughout the implementation to plan, implement, problem solve and adapt the process over an 18 month timeframe. As is appropriate for codesign the actual ongoing workgroup participants had average 50% WWLE participation. For the research team, this research is a culmination of the lead author's doctoral dissertation. One member of the five-person dissertation committee was a recovery coach and a WWLE. She was an active participant across the entire research process overseeing and influencing the research design, conduct of the study, analysis, interpretation of findings and approval of the final manuscript. The findings were member checked with the larger codesign planning group that had additional WWLE members.

Accuracy of the Depression, Anxiety and Stress Scale (DASS-21) for Screening on Comorbid Internalizing Disorders among Youth in Substance Use Disorder Treatment.

INTRODUCTION: Major depression, anxiety disorders, and post-traumatic stress disorder (PTSD) are among the most prevalent comorbid mental disorders in youth addiction treatment. Hence, screening for these internalizing disorders should be part of the standard routine at intake in substance use disorder treatment. We investigated the usefulness of the Depression, Anxiety and Stress Scale (DASS-21) as a screener for this purpose. METHODS: A nationally representative sample of 421 treatment-seeking youths aged 16-22 years with a primary cannabis, alcohol, cocaine, or amphetamine use disorder participated in the study. At intake, we administered the DASS-21 and the Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), as "gold standard," as part of a broader baseline assessment of the Youth in transition study [Moska et al. BMC Psychiatry. 2021;21(1):1-11]. RESULTS: At comparable sensitivity (0.80-0.84), based on the optimal cut-off value, specificity was higher for the DASS-21 total score detecting any DSM-5 internalizing disorder (0.62) than for the DASS subscales specifically detecting depression, anxiety, or PTSD (0.44, 0.49, and 0.51, respectively). Receiver operating characteristic curve analyses showed an area under the curve (AUC) value of 0.80 for the DASS total score to detect any internalizing disorder ("good discrimination"), compared with AUC values of 0.70-0.75 of the DASS depression and anxiety subscales to detect DSM-5 depression, anxiety, and PTSD ("fair discrimination"). The optimal DASS total score cut-off value of ≥44 for detecting any internalizing disorder resulted in 0.81 sensitivity, 0.62 specificity, 0.80 positive predictive value, and 0.64 negative predictive value. CONCLUSION: Given the high prevalence of comorbid internalizing disorders in youth addiction care, the need to address these comorbid disorders in treatment, and the favorable accuracy of the DASS to detect these disorders, we recommend to implement the DASS-21 as routine screener in youth addiction treatment in the Netherlands.

Family Recovery from Addiction and Trauma: An Interpretative Phenomenological Analysis of Mothers' Lived Experience.

INTRODUCTION AND AIMS: Addiction has a devastating impact in the lives of millions of people worldwide. Mothers constitute a hidden population. Previous research did not focus on mothers' experience of recovery. METHODS: An Interpretative Phenomenological Analysis was used to analyze the experiences of 10 mothers whose young adult son/or daughter was in recovery from addiction. FINDINGS: Four themes delineated mothers' lived experience of the long journey from traumatic loss and isolation to traumatic growth and connection: (a) Trauma and despair. Loss of relationships and healthy family life, (b) coping strategies, (c) finding meaning and constructing a new identity, and (d) connection and gratitude. Overall, halting the descent into despair involved a perceptual shift that restored meaning, relationships, and hope and alleviated mothers' feelings of chronic grief and distress over their adult child's addiction problems. CONCLUSIONS: Addiction can have a damaging traumatic impact on mothers which is enhanced by social and self-stigmatizing processes. Ambiguous loss can occur when one's child uses substances, as the child may be physically present yet be psychologically absent in terms of the mother (and the family). Understanding the experience of mothers may help health and social care professionals to develop compassion, patience, and empathy towards mothers of persons with addiction problems. Mental health professionals need to be aware of the devastating impact of addiction problems on all family members in order to validate their experiences and support them in recovering from trauma and loss in the family.

Opioid use disorder treatment and the role of New Jersey Medicaid policy changes: perspectives of office-based buprenorphine providers.

Background: In the US, seventy percent of drug-related deaths are attributed to opioids. In response to the ongoing opioid crisis, New Jersey's (NJ) Medicaid program implemented the MATrx model to increase treatment access for Medicaid participants with opioid use disorder (OUD). The model's goals include increasing the number of office-based treatment providers, enhancing Medicaid reimbursement for certain treatment services, and elimination of prior authorizations for OUD medications.Objectives: To explore office-based addiction treatment providers' experiences delivering care in the context of statewide policy changes and their perspectives on treatment access changes and remaining barriers.Methods: This qualitative study used purposive sampling to recruit office-based New Jersey medications for opioid use disorder (MOUD) providers . Twenty-two providers (11 females, 11 males) discussed treatment experiences since the policy changes in 2019, including evaluations of the current state of OUD care in New Jersey and perceived outcomes of the MATrx model policy changes.Results: Providers reported the MOUD climate in NJ improved as Medicaid implemented policies intended to reduce barriers to care and increase treatment access. Elimination of prior authorizations was noted as important, as it reduced provider burden and allowed greater focus on care delivery. However, barriers remained, including stigma, pharmacy supply issues, and difficulty obtaining injectable or non-generic medication formulations.Conclusion: NJ policies may have improved access to care for Medicaid beneficiaries by reducing barriers to care and supporting providers in prescribing MOUD. Yet, stigma and lack of psychosocial supports still need to be addressed to further improve access and care quality.

Implementing harm reduction kits in an office-based addiction treatment program.

BACKGROUND: The rising rates of drug use-related complications call for a paradigm shift in the care for people who use drugs. While addiction treatment and harm reduction have historically been siloed in the US, co-location of these services in office-based addiction treatment (OBAT) settings offers a more realistic and patient-centered approach. We describe a quality improvement program on integrating harm reduction kits into an urban OBAT clinic. METHODS: After engaging appropriate stakeholders and delivering clinician and staff trainings on safer use best practices, we developed a clinical workflow for universal offering and distribution of pre-packaged kits coupled with patient-facing educational handouts. We assessed: (1) kit uptake with kit number and types distributed; and (2) implementation outcomes of feasibility, acceptability, appropriateness, and patient perceptions. RESULTS: One-month post-implementation, 28% (40/141) of completed in-person visits had at least one kit request, and a total of 121 kits were distributed. Staff and clinicians found the program to be highly feasible, acceptable, and appropriate, and patient perceptions were positive. CONCLUSIONS: Incorporating kits in OBAT settings is an important step toward increasing patient access and utilization of life-saving services. Our program uncovered a significant unmet need among our patients, suggesting that kit integration within addiction treatment can improve the standard of care for people who use drugs.

Treatment System Adaptations during War: Lessons from Ukrainian Addiction Treatment Providers.

Background: The war in Ukraine has posed significant challenges to the healthcare system. This paper draws upon expert consultations, held between December 2022 and February 2023, focused on HIV/AIDS, addiction, and mental health service delivery during the first year of this war, and following the Global Mental Health Humanitarian Coalition panel discussion in May 2022. Objectives: This commentary presents the experiences of frontline healthcare workers in Ukraine, challenges, and local adaptations to meet the increased mental health needs of healthcare providers. We aimed to document the adaptations made in the addiction healthcare system and to acknowledge the changes in vulnerabilities and lessons learned. Results: Burnout among healthcare providers delivering addiction, HIV/AIDS and mental health services became more visible after the second half of 2022. Challenges included increased workload, contextual threats, lack of job relocation strategies, and money-follow-the-patient policies. Recommendations: The lessons from the first year of war in Ukraine hold significant generalizability to other contexts. These include enabling bottom-up approaches to tailoring services and allowing healthcare providers to respond to the dynamics of war in an effective and active manner. Other recommendations include departmental-specific resources and strategies, particularly as vulnerable groups and challenges are unstable in humanitarian contexts. Conclusions: Globally and in Ukraine, healthcare workers need more than applause. Along with monetary incentives, other strategies to prevent burnout, ensure sustainable capacity building, job relocation opportunities, and bespoke adaptations are imperative to protect healthcare providers' wellbeing and overall public health.

Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy.

In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.

Evaluating and comparing success rates for inpatient treatment of alcohol addiction in the Czech Republic.

OBJECTIVES: This systematic review seeks to present and compare data from studies evaluating the success of medium-term inpatient treatment of alcohol-dependent patients in the Czech Republic. Another aim was to identify the problems that make such comparisons difficult. No previous review comparing the efficiency of various therapeutic programmes has been published in the Czech Republic. METHODS: Bibliographia medica Cechoslovaca and PubMed were used to find studies published in professional medical journals since 1970 evaluating the abstinence of patients who voluntarily completed medium-term inpatient treatment of alcohol dependence. RESULTS: Medium-term inpatient treatment of alcohol addiction leads to one year of abstinence in 34% to 76% of patients. Such variance in value is largely caused by selection bias, differences in the definition of abstinence, and differences in data collection methods. CONCLUSION: The comparison of studies presented many challenges. Further steps should be taken to help compare treatment programmes in the future, as the programmes provide different therapeutic interventions of different intensities and lengths to different patients. Adequate demographic and other pretreatment characteristics data collection, detailed descriptions of therapeutic interventions, and identification of effective components of the therapeutic programme could support further research in this area, optimize existing programmes, and increase the overall treatment efficiency.

Understanding Ohio X-Waivered Advanced Practice Registered Nurses' Rate of Naltrexone Prescription for Alcohol Use Disordered Patients.

BACKGROUND: Alcohol use disorder (AUD) is overrepresented within the United States. Naltrexone, a recommended treatment for AUD, is underutilized. However, the prescribing behaviors of advanced practice registered nurses (APRNs) regarding naltrexone for AUD patients have not been studied. The purpose of our study was to explore the prescriptive practices of a sample of APRNs. AIMS: To describe and analyze survey responses of a sample of Ohio APRNs with training in medication for addiction treatment (MAT) for substance use disorders (as evidenced by DEA x-waiver receipt) regarding prescribing practices of naltrexone for AUD patients. METHOD: Public information collected from the first author's Nursing Board (list of APRNs in Ohio) was checked against the public information of x-waivered providers nationally from the Substance Abuse and Mental Health Services Administration's (SAMHSA) website. This generated a potential sample size of 824 APRNs, all of whom were sent email solicitations to complete a Qualtrics survey. After 3 weeks, 55 surveys were completed, and the data were analyzed. Descriptive statistics were generated as well as a logistic regression with five potential predictor variables against the outcome variable (defined as use of naltrexone for AUD patients). RESULTS: Years practicing as an APRN was found to negatively predict naltrexone prescribing behavior for AUD patients. Practice setting and work experience with an addiction specialist physician were not found to predict naltrexone prescribing behavior for AUD patients. CONCLUSION: Implications for further study were discussed, with emphasis on regulatory variance between states.

The Prevalence and Negative Impacts of Substance Use Disorders among People with HIV in the United States: A Real-Time Delphi Survey of Key Stakeholders.

Although HIV and substance use disorders (SUDs) constitute a health syndemic, no research to date has examined the perceived negative impacts of different SUDs for people with HIV (PWH). In May 2019, 643 stakeholders in the U.S., representing clients of AIDS service organizations (ASOs), ASO staff, and HIV/AIDS Planning Council members, participated in an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) survey focused on the prevalence and individual-level negative impact of five SUDs for PWH. The SE-RTD method has advantages over conventional survey methods by efficiently sharing information, thereby reducing the likelihood that between-group differences are simply due to lack of information, knowledge, and/or understanding. The population-level negative impacts were calculated by weighting each SUD's individual-level negative impact on indicators of the HIV Care Continuum and other important areas of life by the perceived prevalence of each SUD. Overall, we found these SUDs to have the greatest population-level negative impact scores (possible range 0-24): alcohol use disorder (population-level negative impact = 6.9; perceived prevalence = 41.9%), methamphetamine use disorder (population-level negative impact = 6.5; perceived prevalence = 3.2%), and opioid use disorder (population-level negative impact = 6.4; perceived prevalence = 34.6%). Beyond further demonstration of the need to better integrate SUD services within HIV settings, our findings may help inform how finite funding is allocated for addressing the HIV-SUD syndemic within the U.S. Based on our findings, such future efforts should prioritize the integration of evidence-based treatments that help address use disorders for alcohol, methamphetamine, and opioids.

Community Capacity Building for HIV and Addiction Service Integration: An Intervention Trial in Vietnam.

Scientific findings and policy guidelines recommend integrating HIV and drug addiction prevention and care into community-based settings. Systematic capacity-building efforts are warranted to provide technical support for community health workers and improve their confidence in the integrated service provision. An intervention trial was conducted between 2018 and 2019 with 120 community health workers (CHW) from 60 communes in Vietnam's four provinces. The 60 intervention CHW received in-person training to enhance their HIV/addiction-related service knowledge and skills. Online support groups were established between trained CHW and local HIV and addiction specialists. The intervention outcomes were assessed using mixed-effects regression models with the data collected at baseline and every 3 months for 1 year. Adjusted analyses showed that intervention CHW reported a significant increase in the interaction with other treatment providers than the control group at 6 months and remained at the 12-month follow-up. The difference in the improvement of confidence in HIV/addiction-related service delivery between the intervention and control groups was significant at 6-month but became insignificant at the 12-month. Male CHW were more confident in providing services than female CHW at baseline, and gender differences in the changing patterns were observed over time. This capacity-building intervention demonstrated promising outcomes on CHW inter-agency collaborations and confidence in service delivery. Gender divides in healthcare professionals should be attended to in future studies.

RESUMEN: Los hallazgos científicos y los protocolos recomiendan integrar la prevención del VIH y la adicción a las drogas en entornos comunitarios. Se implementan esfuerzos sistemáticos de creación de capacidad para brindar apoyo técnico a los trabajadores de salud comunitarios y mejorar su confianza en la prestación de servicios integrados. Se realizó una prueba de intervención entre 2018 y 2019 con 120 trabajadores de salud comunitarios (TSC) de 60 comunas en las cuatro provincias de Vietnam. Los 60 TSC de intervención recibieron capacitación en persona para mejorar sus conocimientos y habilidades de servicios relacionados con VIH / adicción. Se establecieron grupos de apoyo en línea entre TSC capacitados y especialistas locales en VIH y adicciones. Los resultados de la intervención se evaluaron mediante modelos de regresión de efectos mixtos con los datos recopilados al inicio del estudio y cada tres meses durante un año. Los análisis ajustados mostraron que la intervención CHW informó un aumento significativo en la interacción con proveedores de tratamiento diferentes al grupo de control a los seis meses que se mantuvo en el seguimiento a los 12 meses. La diferencia en el aumento de la confianza en la prestación de servicios relacionados con VIH / adicción entre los grupos de intervención y control fue significativa a los 6 meses, pero se volvió insignificante a los 12 meses. Los TSC masculinos tenían más confianza en la prestación de servicios que las femeninas al inicio del estudio, y se observaron diferencias de género en el cambio de patrones a lo largo del tiempo. Esta intervención de creación de capacidad demostró resultados prometedores en las colaboraciones interinstitucionales de los TSC y la confianza en la prestación de servicios. Las brechas de género en los profesionales de la salud deben ser atendidas en estudios futuros.

Age, period, and cohort effects on trends in outpatient addiction care utilization in the general Berlin population from 2008 to 2016.

BACKGROUND: The aim of this study was to decompose independent effects of age, period, and cohort on trends in outpatient addiction care utilization resulting from alcohol (AUD) and illicit substances use disorders (ISUD). Decomposing trends in addiction care utilization into their independent effects by age, period, and cohort may lead to a better understanding of utilization patterns. METHODS: Individuals seeking help in Berlin outpatient addiction care facilities between 2008 and 2016 with an age range of 18-81 years for AUD (n = 46,706) and 18-70 years for ISUD (n = 51,113) were standardized to the general Berlin population using data from the German Federal Statistical Office. Classification of utilization as AUD- (F10) or ISUD-related (F11, F12, F14, F15, F16, F18, F19) help-seeking was based on primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. Age was measured in years and period as year of data collection. Cohort was defined as the mathematical difference between period and age. Age, period, and cohort analyses were conducted using the intrinsic estimator model on AUD- and ISUD-related outpatient addiction care utilization. RESULTS: Age effects on AUD-related utilization were highest in 18- to 19-year-old and in 39- to 59-year-old individuals. ISUD-related utilization declined almost continuously with increasing age. Period effects on AUD- and ISUD-related utilization were small. AUD-related utilization was highest in cohorts born from 1951 to 1986. ISUD-related utilization increased in cohorts born between 1954 and 1973 where utilization peaked, followed by a decline of the same order. CONCLUSIONS: Age and cohort effects were the strongest drivers of trends in AUD- and ISUD-related outpatient addiction care utilization. Onset of help-seeking in earlier phases of AUD development should be enhanced as well as help-seeking for AUD and ISUD in general. The highest cohort-related rates in the baby boomer and following cohorts for AUD and ISUD underline an increased demand for addiction care.