Initiation and engagement as mechanisms for change caused by collaborative care in opioid and alcohol use disorders

Setodji, Claude Messan; Watkins, Katherine E.; Hunter, Sarah B.; McCullough, Colleen; Stein, Bradley D.; Osilla, Karen Chan; Ober, Allison J.

doi:10.1016/j.drugalcdep.2018.07.027

Cited by 11 publications

(6 citation statements)

References 67 publications

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“…Using mediation analysis, we found that the pathway from medication assignment (and subsequent initiation) through mediators of adherence, early illicit opioid use, depressive symptoms and pain contributed to much of the increased risk of relapse on XR-NTX versus BUP-NX for non-homeless participants, but did not substantially contribute to the reduced risk of relapse among homeless participants. Despite the importance of mediation analyses in understanding the different ways in which medications can improve patient outcomes, there have been few such analyses for OUD treatment [37,38].…”

Section: Discussionmentioning

confidence: 99%

Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables

et al. 2021

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Background and Aims A recent study found that homeless individuals with opioid use disorder (OUD) had a lower risk of relapse on extended‐release naltrexone (XR‐NTX) versus buprenorphine–naloxone (BUP‐NX), whereas non‐homeless individuals had a lower risk of relapse on BUP‐NX. This secondary study examined differences in mediation pathways to medication effect between homeless and non‐homeless participants. Design Secondary analysis of an open‐label randomized controlled, 24‐week comparative effectiveness trial, 2014–17. Setting Eight community addiction treatment programs in the United States. Participants English‐speaking adults with DSM‐5 OUD, recruited during inpatient admission (n = 570). Intervention(s) Randomization to monthly injection of XR‐NTX or daily sublingual BUP‐NX. Measurements(s) Mediation analysis estimated the direct effect of XR‐NTX versus BUP‐NX on relapse and indirect effect through mediators of medication adherence, use of illicit opioids, depressive symptoms and pain, separately by homeless status. Findings For the homeless subgroup, the protective indirect path contributed a 3.4 percentage point reduced risk of relapse [95% confidence interval (CI) = −12.0, 5.3] comparing XR‐NTX to BUP‐NX (explaining 21% of the total effect). For the non‐homeless subgroup, the indirect path contributed a 9.4 percentage point increased risk of relapse (95% CI = 3.1, 15.7) comparing XR‐NTX to BUP‐NX (explaining 57% of the total effect). Conclusions A novel approach to mediation analysis shows that much of the difference in medication effectiveness (extended‐release naltrexone versus buprenorphine–naloxone) on opioid relapse among non‐homeless adults with opioid use disorder appears to be explained by mediators of adherence, illicit opioid use, depressive symptoms and pain.

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Section: Discussionmentioning

confidence: 99%

Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables

et al. 2021

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“…Unfortunately, we did not include a control group taking other pharmacological interventions for alcohol use disorder, such as acamprosate, disulfiram, gabapentin, topiramate, or a placebo [15]. In addition, we only included male individuals, and the alcohol-use clinical outcome assessment was based on self-report only; this was based on methodology suggested in recent randomized clinical prospective studies [47][48][49][50]. Interestingly, this study genotyped 100 individuals with AUD for four genotype variants of interest [14,51,52], as well as analyzed their association with the clinical assessment measures during a standardized 12-week treatment, based on an FDA approved intervention [53] and an intention-to-treat analysis [54].…”

Section: Discussionmentioning

confidence: 99%

Exploring the Role of Alcohol Metabolizing Genotypes in a 12-Week Clinical Trial of Naltrexone for Alcohol Use Disorder

et al. 2021

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Background: The efficacy of naltrexone in the treatment of alcohol use disorder (AUD) has been associated with a set of variables not directly related with the expression of opioid receptors. All the variables have been found to be highly associated with AUD itself or more severe clinical levels of AUD. Objectives: Given the high association between alcohol metabolizing enzymes (AME) and the outcome of AUD, the present study aims to investigate the role of AME genotype variants in the treatment of AUD with naltrexone. Methods: We carried out a 12-week longitudinal clinical trial based on the treatment of AUD patients with naltrexone (N = 101), stratified by different alcohol metabolization genotypes. Genotyping was performed after the inclusion of the patients in the study, based on the individual presence of single nucleotide polymorphisms (SNPs) in the ADH (alcohol dehydrogenase)1B (ADH1B*2 and ADH1B*3), ADH1C (ADHC*1) and ALDH (aldehyde dehydrogenase) 2 (ALDH2*2) genes. The outcome of alcohol use has been monitored employing the timeline follow-back during the treatment. Results: The ADH1C*1 (Ile350Val, rs698) and ALDH2*2 (Glu504Lys, rs671) polymorphisms were associated with a better response to naltrexone treatment, whereas the ADH1B*3 (Arg370Cys, rs2066702) allelic variant showed a negative outcome. Conclusions: The present study explores a genomic setting for the treatment of AUD with naltrexone. According to our findings, the association between ADH1C*1 and ALDH2*2 variants and better outcomes suggests a successful treatment, whereas the ADH1B*3 mutated allele might lead to an unsuccessful treatment. Further studies should be performed to investigate the relationship between alcohol metabolizing genotypes, the family history of alcohol use disorders and the effect of naltrexone on the outcomes. Genotyping may be a valuable tool for precision-medicine and individualized approach, especially in the context of alcohol use disorders. The small number of subjects was the main limitation of the present study.

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“…Collaborative care can support the management of comorbidities in primary care while complex AoD issues are managed in the specialist AoD setting. This may lead to greater engagement in care and improved health outcomes (Setodji et al 2018).…”

Section: Introductionmentioning

confidence: 99%

“…It has been suggested that specialist AoD and general practice collaborative care would support AoD treatment (Samet et al 2001;Weisner et al 2001), but studies are limited. US studies have shown increased utilisation of treatment services (Setodji et al 2018) and improved abstinence (Samet et al 2003;Watkins et al 2017) following collaborative care. The use of patient-reported health and well-being outcomes is limited in these studies and it is unclear what aspect of the interventions in the heterogeneous studies led to this effectiveness (Pace and Uebelacker 2018).…”

Section: Introductionmentioning

confidence: 99%

Feasibility and outcomes of a general practice and specialist alcohol and other drug collaborative care program in Sydney, Australia

Wilson

Schulz

Mills

et al. 2022

Aust. J. Primary Health

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Alcohol and other drug (AoD) use is an important health and community issue and may be positively affected by collaborative care programs between specialist AoD services and general practice. This paper describes the feasibility, model of care and patient outcomes of a pilot general practice and specialist AoD (GP-AoD) collaborative care program, in Sydney, Australia, based on usual care data, the minimum data set, service utilisation information and the Australian Treatment Outcome Profile (ATOP), a patient-reported outcome measure. There were 367 referrals to the collaborative care program. GPs referred 210 patients, whereas the AoD service referred 157 patients. Most GP referrals (91.9%) were for AoD problems, whereas nearly half the AoD service referrals were for other issues. The primary drugs of concern in the GP group were either opioids or non-opioids (mostly alcohol). The AoD service-referred patients were primarily using opioids. An ATOP was completed for 152 patients. At the time of referral, those in the GP-referred non-opioid group were significantly less likely to be abstinent, used their primary drug of concern more days and were more likely to be employed (all P , 0.001). A second ATOP was completed for 93 patients. These data showed a significant improvement in the number of days the primary drug of concern was used (P ¼ 0.026) and trends towards abstinence, improved quality of life and physical and psychological well-being for patients in the program. There are few studies of GP-AoD collaborative care programs and nothing in the Australian context. This study suggests that GP-AoD collaborative care programs in Australia are feasible and improve drug use.

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Initiation and engagement as mechanisms for change caused by collaborative care in opioid and alcohol use disorders

Cited by 11 publications

References 67 publications

Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables

Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables

Exploring the Role of Alcohol Metabolizing Genotypes in a 12-Week Clinical Trial of Naltrexone for Alcohol Use Disorder

Feasibility and outcomes of a general practice and specialist alcohol and other drug collaborative care program in Sydney, Australia

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