J-shaped relationship between supervised methadone consumption and retention in methadone maintenance treatment (MMT) in primary care: National cohort study

Cousins, Gráinne; Boland, Fiona; Barry, Joseph; Lyons, Suzi; Keenan, Eamon; O'Driscoll, Denis; Bennett, Kathleen; Fahey, Tom

doi:10.1016/j.drugalcdep.2016.12.009

Cited by 20 publications

(17 citation statements)

References 29 publications

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“…Therefore, the efficacy of MMT in this study was 50.5%. The efficacy of MMT was reported as 84% in the study by Wegman et al (23) and 20% -60% in the study by Cousins et al (24). In the study by Chen and Fujiwara in China, one year after the start of MMT, heroin use decreased from 100% to 17.2% and heroin injection decreased from 89.4% to 14.1% (25).…”

Section: Discussionmentioning

confidence: 96%

Follow-up Study of Drug Use, Depression, and Anxiety Reduction and Quality of Life in Addicts on Methadone Maintenance Therapy

Almasi

Hajimoradi

Mohammadi

2019

Jundishapur J Health Sci

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Background:This study aimed to evaluate reduced drug consumption, risky behaviors, depression, and anxiety and improved quality of life in addicts on methadone maintenance therapy (MMT) at baseline and six months after therapy. Methods: In this descriptive cross-sectional study, 275 addicts were selected by a random sampling method in 2017. The data collection tools consisted of four questionnaires including a demographic information questionnaire, the Beck depression inventory questionnaire, WHOQOL-26, and Spielberger Anxiety Inventory. Data analysis was done by SPSS20 software at a confidence level of 95%. Results: Based on the obtained results, after six months, MMT efficiency was 50.5% and no cases of intravenous injection were reported. The consumption of other drugs was significantly reduced (P < 0.05). The highest prevalence of depression was observed in cannabis and opium users. Depression decreased from 85.81% to 63.27%. The mean scores of quality of life and anxiety after MMT increased to 89.6 and 20.41, respectively. The most improvement was in the physical health domain (mean score of 64.11). Conclusions:The results showed improvements in all the four domains of physical health, psychological health, social relationship, and environment and reductions in depression and anxiety.

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Section: Discussionmentioning

confidence: 96%

Follow-up Study of Drug Use, Depression, and Anxiety Reduction and Quality of Life in Addicts on Methadone Maintenance Therapy

Almasi

Hajimoradi

Mohammadi

2019

Jundishapur J Health Sci

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“…There does not appear to be an accepted threshold for defining treatment dropout, studies apply various rules ranging from 30 consecutive days without a methadone or buprenorphine prescription, to 21 days, 14 days, 10 days, seven days, five days and up to two months. Furthermore, given the complexity of OST and the fact that patients often cycle in and out of treatment [106,107], the influence of different risk factors may vary over time, yet few studies consider risk factors as time varying covariates. An international consensus project, using a Delphi methodology could be organised to reach consensus regarding the most clinically appropriate definition of retention.…”

Section: Clinical Implications and Areas For Future Researchmentioning

confidence: 99%

Retention of patients in opioid substitution treatment: A systematic review

et al. 2020

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Background Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout. Methods A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided. Results 67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST. Conclusions Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.

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“…Access to daily direct supervision of consumption of OAT may therefore at times be unavailable to patients and assessment of increased risk will need to be addressed with patients. Further assessment of the impact of reduced supervision may provide services with an opportunity to re-evaluate this requirement post-COVID-19 as long-term pharmacy supervision is resource intensive and may promote dropout from treatment [26].…”

Section: Discussionmentioning

confidence: 99%

“…Supervision of OAT is recommended during induction and in the early stages of maintenance treatment [ 20 – 22 ]. Supervision improves compliance and reduces diversion, relapse to heroin and drug-related deaths (including those related to methadone) [ 26 ]. Prescribers may consider starting on lower methadone doses (e.g.…”

Section: Discussionmentioning

confidence: 99%

A national model of remote care for assessing and providing opioid agonist treatment during the COVID-19 pandemic: a report

Crowley

Delargy²

2020

Harm Reduct J

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Background: Health services globally are struggling to manage the impact of COVID-19. The existing global disease burden related to opioid use is significant. Particularly challenging groups include older drug users who are more vulnerable to the effects of COVID-19. Increasing access to safe and effective opioid agonist treatment (OAT) and other harm reduction services during this pandemic is critical to reduce risk. In response to COVID-19, healthcare is increasingly being delivered by telephone and video consultation, and this report describes the development of a national model of remote care to eliminate waiting lists and increase access to OAT in Ireland. Purpose and findings: The purpose of this initiative is to provide easy access to OAT by developing a model of remote assessment and ongoing care and eliminate existing national waiting lists. The Irish College of General Practitioners in conjunction with the National Health Service Executive office for Social Inclusion agreed a set of protocols to enable a system of remote consultation but still delivering OAT locally to people who use drugs. This model was targeted at OAT services with existing waiting lists due to a shortage of specialist medical staff. The model involves an initial telephone assessment with COVID-risk triage, a single-patient visit to local services to provide a point of care drug screen and complete necessary documentation and remote video assessment and ongoing management by a GP addiction specialist. A secure national electronic health link system allows for the safe and timely delivery of scripts to a designated local community pharmacy. Conclusion: The development of a remote model of healthcare delivery allows for the reduction in transmission risks associated with COVID-19, increases access to OAT, reduces waiting times and minimises barriers to services. An evaluation of this model is ongoing and will be reported once completed. Fast adaptation of OAT delivery is critical to ensure access to and continuity of service delivery and minimise risk to our staff, patients and community. Innovative models of remote healthcare delivery adapted during the COVID-19 crisis may inform and have important benefits to our health system into the future.

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J-shaped relationship between supervised methadone consumption and retention in methadone maintenance treatment (MMT) in primary care: National cohort study

Cited by 20 publications

References 29 publications

Follow-up Study of Drug Use, Depression, and Anxiety Reduction and Quality of Life in Addicts on Methadone Maintenance Therapy

Follow-up Study of Drug Use, Depression, and Anxiety Reduction and Quality of Life in Addicts on Methadone Maintenance Therapy

Retention of patients in opioid substitution treatment: A systematic review

A national model of remote care for assessing and providing opioid agonist treatment during the COVID-19 pandemic: a report

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