Optimising treatment in opioid dependency in primary care: results from a national key stakeholder and expert focus group in Ireland

Hout, Marie Claire Van; Crowley, Des; McBride, Aoife; Delargy, Ide

doi:10.1186/s12875-018-0792-8

Cited by 10 publications

(10 citation statements)

References 36 publications

(29 reference statements)

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“…Methadone is the most common form of OST in Ireland, and is available free of charge to all persons undergoing OST for opioid dependence [6]. In 1998 the Misuse of Drugs (Supervision of Prescription and Supply of Methadone) Regulations were introduced in Ireland, which involved the establishment of a national register, the Central Treatment List (CTL).…”

Section: Introductionmentioning

confidence: 99%

Do interruptions to the continuity of methadone maintenance treatment in specialist addiction settings increase the risk of drug‐related poisoning deaths? A retrospective cohort study

et al. 2020

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Aims To examine the risk of mortality associated with interruptions to the continuity of methadone maintenance treatment (MMT), including transfers between services, in opioid‐dependent individuals attending specialist addiction services. Design Retrospective cohort study using addiction services and primary care dispensing records, the National Methadone Register and National Drug‐Related Death Index (NDRDI). Setting Geographically defined population in Dublin, Ireland. Participants A total of 2899 people prescribed and dispensed methadone in specialist addiction services between January 2010 and December 2015. There were five exposure groups: weeks 1–4 following transfer between treatment providers; weeks 1–4 out of treatment; weeks 5–52 out of treatment; weeks 1–4 of treatment initiation; and weeks 5+ of continuous treatment (reference category). Measurements Primary outcome: drug‐related poisoning (DRP) deaths. Secondary outcome: all‐cause mortality (ACM). Mortality rates calculated by dividing number of deaths (DRP; ACM) in exposure groups by person‐years exposure. Unadjusted and adjusted Poisson regression (covariates age, sex, incarceration, methadone dose and comorbidities) estimated differences in mortality rates. Findings There were 154 ACM deaths, 55 (35.7%) identified as DRP deaths. No deaths were observed in the first month following transfer between treatment providers. The risk of DRP mortality was highest in weeks 1–4 out of treatment [adjusted relative risk (aRR = 4.04, 95% confidence interval (CI) = 1.43–11.43, P = 0.009] and weeks 1–4 of treatment initiation (ARR = 3.4, 95% CI = 1.2–9.64, P = 0.02). Similarly, risk of ACM was highest in weeks 1–4 out of treatment (ARR = 11.78, 95% CI = 7.73–17.94, P < 0.001), weeks 1–4 of treatment initiation (aRR = 5.11, 95% CI = 2.95–8.83, P < 0.001) and weeks 5–52 off treatment (aRR = 2.04, 95% CI = 1.2–3.47, P = 0.009). Conclusions Interruptions to the continuity of methadone maintenance treatment by treatment provider do not appear to be periods of risk for drug‐related poisoning or all‐cause mortality deaths. Risk of drug related poisoning and all‐cause mortality deaths appears to be greatest during the first 4 weeks of treatment initiation/re‐initiation and after treatment cessation.

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Section: Introductionmentioning

confidence: 99%

Do interruptions to the continuity of methadone maintenance treatment in specialist addiction settings increase the risk of drug‐related poisoning deaths? A retrospective cohort study

et al. 2020

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“…Estimates of HCV antibody prevalence among PWID range from 52% in England 19 to up to 80% in Ireland and Spain 22–25 . All four countries provide a number of options for OST, although in Ireland methadone is the almost universally prescribed formulation and buprenorphine/naloxone is currently available on a limited named patient basis only 26 . Access to DAA therapies for HCV treatment has been expanding in recent years in all four countries.…”

Section: Introductionmentioning

confidence: 99%

Integrating hepatitis C care for at-risk groups (HepLink): baseline data from a multicentre feasibility study in primary and community care

Riogh

Swan

McCombe

et al. 2019

Journal of Antimicrobial Chemotherapy

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Objectives To examine HCV prevalence and management among people who inject drugs (PWID) attending primary care and community-based health services at four European sites using baseline data from a multicentre feasibility study of a complex intervention (HepLink). Methods Primary care and community-based health services in Dublin, London, Bucharest and Seville were recruited from the professional networks of the HepLink consortium. Patients were eligible to participate if aged ≥18 years, on opioid substitution treatment or at risk of HCV (i.e. injecting drug use, homeless or incarcerated), and attended the service. Data on patient demographics and prior HCV management were collected on participants at baseline. Results Twenty-nine primary care and community-based health services and 530 patients were recruited. Baseline data were collected on all participants. Participants’ mean age ranged from 35 (Bucharest) to 51 years (London), with 71%–89% male. Prior lifetime HCV antibody testing ranged from 65% (Bucharest) to 95% (Dublin) and HCV antibody positivity among those who had been tested ranged from 78% (Dublin) to 95% (Bucharest). Prior lifetime HCV RNA testing among HCV antibody-positive participants ranged from 17% (Bucharest) to 84% (London). Among HCV antibody- or RNA-positive participants, prior lifetime attendance at a hepatology/infectious disease service ranged from 6% (London) to 50% (Dublin) and prior lifetime HCV treatment initiation from 3% (London) to 33% (Seville). Conclusions Baseline assessment of the HCV cascade of care among PWID attending primary care and community-based health services at four European sites identified key aspects of the care cascade at each site that need to be improved.

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“…The Irish government introduced opiate substitution therapy (OST) and needle exchange programmes in Ireland in 1989 in response to an increasing HIV prevalence in PWID. OST is now provided nationally through a network of specialised HSE outpatient treatment clinics/satellite clinics, specially trained level 1 and 2 general practitioners in the community and prisons [ 23 ]. All OST patients are registered on a central treatment list (CTL).…”

Section: Introductionmentioning

confidence: 99%

“…All OST patients are registered on a central treatment list (CTL). The number of clients on this list has increased each year since 2006 and there are now over 10,000 people on OST in Ireland [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C virus infection in Irish drug users and prisoners – a scoping review

Crowley¹,

Murtagh

Cullen

et al. 2019

BMC Infect Dis

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Background Hepatitis C infection is a major public health concern globally. In Ireland, like other European countries, people who use drugs (PWUD) and prisoners carry a larger HCV disease burden than the general population. Recent advances in HCV management have made HCV elimination across Europe a realistic goal. Engaging these two marginalised and underserved populations remains a challenge. The aim of this review was to map key findings and identify gaps in the literature (published and unpublished) on HCV infection in Irish PWUD and prisoners. Methods A scoping review guided by the methodological framework set out by Levac and colleagues (based on previous work by Arksey & O’Malley). Results A total of 58 studies were identified and divided into the following categories; Epidemiology, Guidelines and Policy, Treatment Outcomes, HCV-related Health Issues and qualitative research reporting on Patients’ and Health Providers’ Experiences. This review identified significantly higher rates of HCV infection among Irish prisoners and PWUD than the general population. There are high levels of undiagnosed and untreated HCV infection in both groups. There is poor engagement by Irish PWUD with HCV services and barriers have been identified. Prison hepatology nurse services have a positive impact on treatment uptake and outcomes. Identified gaps in the literature include; lack of accurate epidemiological data on incident infection, untreated chronic HCV infection particularly in PWUD living outside Dublin and those not engaged with OST. Conclusion Ireland like other European countries has high levels of undiagnosed and untreated HCV infection. Collecting, synthesising and identifying gaps in the available literature is timely and will inform national HCV screening, treatment and prevention strategies. Electronic supplementary material The online version of this article (10.1186/s12879-019-4218-6) contains supplementary material, which is available to authorized users.

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Optimising treatment in opioid dependency in primary care: results from a national key stakeholder and expert focus group in Ireland

Cited by 10 publications

References 36 publications

Do interruptions to the continuity of methadone maintenance treatment in specialist addiction settings increase the risk of drug‐related poisoning deaths? A retrospective cohort study

Do interruptions to the continuity of methadone maintenance treatment in specialist addiction settings increase the risk of drug‐related poisoning deaths? A retrospective cohort study

Integrating hepatitis C care for at-risk groups (HepLink): baseline data from a multicentre feasibility study in primary and community care

Hepatitis C virus infection in Irish drug users and prisoners – a scoping review

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