Predictors of transitions across stages of heroin use and dependence prior to treatment-seeking among people in treatment for opioid dependence

Larance, Briony; Gisev, Natasa; Cama, Elena; Nelson, Elliot C.; Darke, Shane; Larney, Sarah; Degenhardt, Louisa

doi:10.1016/j.drugalcdep.2018.03.056

Cited by 21 publications

(16 citation statements)

References 71 publications

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“…On the other hand, the mean age at onset of heroin exposure (35.6 years) was much older than in a previous study in Australia (18 years). 43 However, previous studies have also reported an older age at onset of heroin use ranging from 25 to 30 years in Taiwan, 44 , 45 which is closer to our report. Differences in social culture may contribute to the difference between Taiwan and other countries.…”

Section: Discussionsupporting

confidence: 87%

Predictors of sleep disturbance in heroin users receiving methadone maintenance therapy: a naturalistic study in Taiwan

Li¹,

Chung²,

Wu³

et al. 2018

NDT

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IntroductionSleep disturbance is a major health concern for heroin users receiving methadone maintenance treatment (MMT). The present study was aimed to investigate the predictors for new-onset clinically predominant sleep disturbance (CPSD) among heroin users receiving MMT.MethodsThis 2-year retrospective study included 152 individuals (127 males and 25 females) with heroin use disorder who visited our MMT clinics for the first time. A univariate Cox proportional hazards regression model (Cox model) was used to estimate the potential factors of subsequent CPSD, followed by a multivariate Cox model to identify significant predictors of CPSD after adjusting for other covariates.ResultsTwenty-nine (19.1%) participants developed CPSD during the 2-year period. After forward selection in the Cox model, earlier age at onset of heroin exposure (OR=0.95; P=0.044), lower attendance rate (OR =0.04; P=0.03), greater maximum dose of methadone (OR =1.01; P=0.022), and shorter time to maximum methadone dose (OR =0.98; P=0.007) were significantly associated with new-onset CPSD.ConclusionWe identified predictors that were significantly associated with new-onset CPSD, and clinicians should be aware of sleep disturbance in heroin users receiving MMT with these risk factors. Future studies are necessary to verify our findings and extend the applicability.

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Section: Discussionsupporting

confidence: 87%

Predictors of sleep disturbance in heroin users receiving methadone maintenance therapy: a naturalistic study in Taiwan

Li¹,

Chung²,

Wu³

et al. 2018

NDT

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“…Research on trajectories of drug use has most often considered the transition between use and dependence 1,2 or focused on specific populations such as people in treatment for DUDs 3–5 .…”

Section: Introductionmentioning

confidence: 99%

Association of Cohort and Individual Substance Use With Risk of Transitioning to Drug Use, Drug Use Disorder, and Remission From Disorder

et al. 2019

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Importance: Limited empirical research has examined the extent to which cohort-level prevalence of substance use predicts onset of and transitioning into greater involvement in drug use. Objective: To use cross-national data to examine time-space variation in cohort-level drug use to predict onset and transitions across stages of drug use, abuse, dependence, and remission. Design, Setting and Participants: The World Health Organization World Mental Health Surveys carried out cross-sectional general population surveys in 25 countries using a consistent research protocol and assessment instrument. A total of 90,027 adults from representative household samples were interviewed face-to-face in the community in relation to drug use disorders. The surveys were conducted between 2001 and 2015. Data analysis performed from July 2017 to July 2018. Main outcomes and Measures: Data on timing of onset of lifetime drug use, DSM-IV drug use disorders, and remission from these disorders was assessed using the Composite International Diagnostic Interview. Associations of cohort-level alcohol prevalence and drug use prevalence were examined as predictors of these transitions. Results: Among the 90,027 respondents (48.1% [SE 0.2%] men; mean [SE] age, 42.1 [0.1] years), one in four respondents (24.8%; SE 0.2) reported either illicit drug use or extra-medical use of prescription drugs at some point in their lifetime, but with substantial time-space variation in this prevalence. Among users, 9.1% (SE 0.2) met lifetime criteria for abuse and 5.0% (SE 0.2) dependence. Individuals with polydrug use had an increased risk of both abuse and dependence and reduced probability of remission from abuse. Birth cohort prevalence of drug use was significantly associated with both initiation and illicit drug use transitions. For example, after controlling for individuals’ experience of substance use and demographics, for each additional 10% of an individual’s cohort using alcohol or drugs, a person’s odds of initiating drug use increased by 28% and 12% respectively (OR 1.28 (95%CI:1.26–1.31) and 1.12 (95%CI:1.11–1.14)). Conclusions and Relevance: Birth cohort substance use predicts drug use involvement over and above the effects of individuals’ own history of alcohol and other drug use. This has important implications for understanding the causal pathways into and out of problematic drug use.

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“…Observation commenced on the date exactly 4 years before first entering OAT and ended on Dec 31, 2011, or the date of death, whichever was earlier. Charge rates could therefore be compared over a minimum 1-year period after initial entry into OAT (except in the case of death), while establishing a baseline charge history in the 4 years immediately before OAT entry (representing the average time lag before an individual enters treatment after becoming opioid dependent in NSW 23 ). Ongoing opioid dependence was also assumed following first entry into OAT, given that opioid dependence is a chronic relapsing disorder with low remission rates.…”

Section: Methodsmentioning

confidence: 99%

The effect of entry and retention in opioid agonist treatment on contact with the criminal justice system among opioid-dependent people: a retrospective cohort study

Gisev

Bharat

Larney

et al. 2019

The Lancet Public Health

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Summary Background Evidence on the effectiveness of opioid agonist treatment (OAT) in reducing crime is mixed. We aimed to assess the effect of OAT on crime in terms of delaying time to first charge and reducing overall charge rates, as well as the relationship between OAT retention and overall charge rates. Methods We did a retrospective cohort study of opioid-dependent people who entered OAT for the first time between Jan 1, 2004, and Dec 30, 2010, in New South Wales (NSW), Australia. We used three linked NSW and national administrative datasets. Data on OAT were obtained from the Pharmaceutical Drugs of Addiction System, data on charges were obtained from the Reoffending Database, and data on mortality were obtained from the National Death Index. The cohort was followed up until Dec 31, 2011. Time-dependent OAT exposure was modelled using Cox proportional hazards models (time to first charge) and Andersen-Gill intensity models (total charge-days). Retention in OAT was modelled using two features of treatment engagement, number of OAT episodes and proportion of follow-up time in OAT (presented in quartile groupings: lowest, low-mid, low-high, highest) using zero-inflated negative binomial regression (total charges). All models were adjusted for sociodemographic, criminographic, and treatment-related variables. Findings 10 744 new OAT entrants were included in the study. 5751 (53·5%) people were charged with an offence. In adjusted analyses, OAT was associated with an initial benefit in delaying the time to first charge (hazard ratio 0·43, 95% CI 0·33–0·55) and reducing total charge-days (0·39, 95% CI 0·30–0·52); however, these protective effects reduced over time. Total charge rates were higher as the number of OAT episodes increased (incident rate ratio [IRR] 1·13, 95% CI 1·11–1·15), and when relatively lower proportions of time were spent in OAT (IRR among the lowest three quartiles ranged from 1·11 [95% CI 1·02–1·21] to 1·22 [95% CI 1·12–1·33]). Interpretation OAT was associated with a reduction in overall charge rates and was more protective as treatment engagement increased. Maximising treatment retention is crucial to achieving long-term health and social benefits of OAT.

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Predictors of transitions across stages of heroin use and dependence prior to treatment-seeking among people in treatment for opioid dependence

Cited by 21 publications

References 71 publications

Predictors of sleep disturbance in heroin users receiving methadone maintenance therapy: a naturalistic study in Taiwan

Predictors of sleep disturbance in heroin users receiving methadone maintenance therapy: a naturalistic study in Taiwan

Association of Cohort and Individual Substance Use With Risk of Transitioning to Drug Use, Drug Use Disorder, and Remission From Disorder

The effect of entry and retention in opioid agonist treatment on contact with the criminal justice system among opioid-dependent people: a retrospective cohort study

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