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The current opioid epidemic has spread rapidly through the United States, resulting in an exponential increase in opioid-associated deaths, transmission of infectious diseases, and a social crisis, which includes a sharp increase in the number of children in foster care because of parental neglect, incapacity, and/or overdose. To stem this tide, public health initiatives must address the treatment needs of more than 11 million people aged 12 years and older who misuse opioids, including the shortage of practitioners to treat those with opioid use disorder (OUD). 1,2 Currently, there are 3 highly effective medicationassisted treatments for OUD: the μ-opioid receptor agonist methadone, the antagonist naltrexone (in oral and long-acting injectable forms), and the partial agonist buprenorphine (used mainly as combination buprenorphinenaloxone). Methadone must be dispensed in a federally licensed facility, and therefore access is limited. Naltrexone requires detoxification prior to initiation, while treatment with buprenorphine can be provided without detoxification in an office-based setting. Thus, buprenorphine provides a means to rapidly expand treatment capacity. Treatment with buprenorphine has been shown to decrease illicitopioiduse,overdosedeaths,HIVandhepatitisCtransmission,andcriminalbehaviorandimprovesocialfunctioning in individuals with OUD. 1 A national movement to train physicians to provide treatment with buprenorphine, particularly among primary care physicians, has resulted in a significant increase in buprenorphine prescribing by this group. With the shift to prescribing in primary care settings, the relative percentage of prescriptions prescribed by psychiatrists declined from 92.2% in 2003 to 32.8% by 2013. 3 The increased prescribing of buprenorphine by primary care physicians is a welcome development because treatment of OUD should be shared among physicians across all specialties. However, we believe psychiatrists could do more in response to this public health crisis. General psychiatrists do not routinely incorporate addiction treatment in their practice, and a national survey of psychiatrists indicates that more than 80% were uncomfortable with providing office-based opioid treatment. 4 We believe psychiatrists are uniquely skilled and ideally suited to be leaders in treating this epidemic. Psychiatry as a field was the first to recognize the need for training in addiction within graduate medical education. In addition, psychiatrists are knowledgeable about neurobiology and psychological principles underlying behavior and the treatment of behavioral disorders. Moreover, the treatment of OUD is often complicated by the high prevalence of comorbid psychiatric disorders, which also influence adherence to buprenorphine treatment. 5
The current opioid epidemic has spread rapidly through the United States, resulting in an exponential increase in opioid-associated deaths, transmission of infectious diseases, and a social crisis, which includes a sharp increase in the number of children in foster care because of parental neglect, incapacity, and/or overdose. To stem this tide, public health initiatives must address the treatment needs of more than 11 million people aged 12 years and older who misuse opioids, including the shortage of practitioners to treat those with opioid use disorder (OUD). 1,2 Currently, there are 3 highly effective medicationassisted treatments for OUD: the μ-opioid receptor agonist methadone, the antagonist naltrexone (in oral and long-acting injectable forms), and the partial agonist buprenorphine (used mainly as combination buprenorphinenaloxone). Methadone must be dispensed in a federally licensed facility, and therefore access is limited. Naltrexone requires detoxification prior to initiation, while treatment with buprenorphine can be provided without detoxification in an office-based setting. Thus, buprenorphine provides a means to rapidly expand treatment capacity. Treatment with buprenorphine has been shown to decrease illicitopioiduse,overdosedeaths,HIVandhepatitisCtransmission,andcriminalbehaviorandimprovesocialfunctioning in individuals with OUD. 1 A national movement to train physicians to provide treatment with buprenorphine, particularly among primary care physicians, has resulted in a significant increase in buprenorphine prescribing by this group. With the shift to prescribing in primary care settings, the relative percentage of prescriptions prescribed by psychiatrists declined from 92.2% in 2003 to 32.8% by 2013. 3 The increased prescribing of buprenorphine by primary care physicians is a welcome development because treatment of OUD should be shared among physicians across all specialties. However, we believe psychiatrists could do more in response to this public health crisis. General psychiatrists do not routinely incorporate addiction treatment in their practice, and a national survey of psychiatrists indicates that more than 80% were uncomfortable with providing office-based opioid treatment. 4 We believe psychiatrists are uniquely skilled and ideally suited to be leaders in treating this epidemic. Psychiatry as a field was the first to recognize the need for training in addiction within graduate medical education. In addition, psychiatrists are knowledgeable about neurobiology and psychological principles underlying behavior and the treatment of behavioral disorders. Moreover, the treatment of OUD is often complicated by the high prevalence of comorbid psychiatric disorders, which also influence adherence to buprenorphine treatment. 5
BackgroundMental illness is one of the most severe, chronic, and disabling public health problems that affects patients’ Quality of life (QoL). Improving the QoL for people with mental illness is one of the most critical steps in stopping disease progression and avoiding complications of mental illness. Therefore, we aimed to assess the QoL and its determinants in patients with mental illness in outpatient clinics in Northwest Ethiopia in 2023.MethodsA facility-based cross-sectional study was conducted among people with mental illness in an outpatient clinic in Ethiopia. The sampling interval was decided by dividing the total study participants who had a follow-up appointment during the data collection period (2400), by the total sample size 638, with the starting point selected by lottery method. The interviewer-administered WHOQOL BREF-26 tool was used to measure the quality of life (QoL) of people with mental illness. The domains of QoL were identified, and indirect and direct effects of variables were calculated using structural equation modelling with SPSS-28 and Amos-28 software. A p-value of < 0.05 and a 95% CI were used to evaluate statistical significance.ResultsA total of 636 (99.7%) participants agreed to participate and completed the data collection. The mean score of overall QoL of people with mental illness in the outpatient clinic was 49.6 ± 10 Sd. The highest QoL was found in the physical health domain (50.67 ± 9.5 Sd), and the lowest mean QoL was found in the psychological health domain (48.41 ± 10 Sd). Rural residence, drug nonadherence, suicidal ideation, not getting counselling, moderate or severe subjective severity, family does not participate in patient care and a family history of mental illness had an indirect negative effect on QoL. Alcohol use and psychological health domain had direct positive effect on QoL. Furthermore, objective severity of illness, having low self-esteem, and having history of mental illness in the family had both direct and indirect effect on QoL. Furthermore, sociodemographic factors (rural residence, illiterate educational status, not married marital status), social support-related factors (poor self-esteem, family not participating in patient care), substance use factors (alcohol use, tobacco use) and clinical factors (high objective and subjective severity of illness, not getting counselling, suicidal ideation, higher number of episodes, comorbid illness, family history of mental illness, poor drug adherence) directly and indirectly affected QoL.ConclusionsIn this study, the QoL of people with mental illness was poor, with the psychological health domain the most affected. Sociodemographic factors, social support-related factors, drug use factors, and clinical factors, directly and indirectly affected QoL through the mediator variables of physical health domains, psychological health domains, social relation health domains, and environmental health domains. In order to improve the QoL of people with mental illnesses, we recommend that emphasis be given to addressing the QoL of those with mental illness, including the development of policy and practice responses that address the above identified factors.
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