Three-year retention in methadone opioid agonist treatment: A survival analysis of clients by dose, area deprivation, and availability of alcohol and cannabis outlets

Amiri, Solmaz; Hirchak, Katherine; Lutz, Robert; McDonell, Michael G.; McPherson, Sterling; Amram, Ofer

doi:10.1016/j.drugalcdep.2018.08.024

Cited by 26 publications

(21 citation statements)

References 38 publications

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“…One study reported on the number of treatment episodes (n = 9,555) from a population-based treatment registry, rather than the number of participants [89]. Most studies provided a gender breakdown for their sample, with a higher proportion of men in all but two studies [37,50]. The mean age of participants ranged from 22.4 years [49] to 47 years [40] Primary outcome.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The most frequently used measure of dropout was time to discontinuation of OST (n = 32), with varying thresholds applied to identify date of dropout. Almost half the studies reporting on time to discontinuation did not specify a threshold for identifying dropout (n = 13) [37,40,42,43,45,56,62,65,68,69,85,91,94]; seven studies indicated that a patient was identified as having dropped out of OST if they missed more than 30 consecutive days of treatment [53,57,60,67,74,80,92]; six studies applied a threshold of seven days [44,46,49,78,96,97], and the remaining studies applied a threshold of five days [83], ten days [51], 14 days [58,66,95], 21 days [63]and two months [59]. The other six studies reporting on dropout used a binary measure, which identified patients as having dropped out of treatment after a specific period of follow-up [38,48,55,61,79,88].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…a single treatment site/clinic, veterans only) which may undermine the external validity [35-38, 40, 42, 46, 47, 49, 61-65, 68-72, 75-79, 85, 87, 88, 91, 93]. In relation to internal validity, the risk of misclassifying the outcome was considered to be high or unclear for 17 studies [37,40,43,55,56,59,62,65,68,69,76,81,84,85,88,91,94]. As previously noted, many studies did not specify when dropout was ascertained, that is how many consecutive days without OST…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…Only one study examined area deprivation, identifying a significant association between increasing deprivation and reduced retention in MMT [37].…”

Section: Plos Onementioning

confidence: 99%

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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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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…Only one study examined area deprivation, identifying a significant association between increasing deprivation and reduced retention in MMT [37].…”

Section: Plos Onementioning

confidence: 99%

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Retention of patients in opioid substitution treatment: A systematic review

et al. 2020

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“…The local phenomenon of opioid dependent patients' SC use enables the study of SC-specific consumption determinants in a clinical sample. Of the many possible factors underlying substance use during OST -e.g., shorter treatment duration (Li et al, 2012), a medium 60-100 mg/day medication dose (Baumeister et al, 2014), low treatment attendance, drug using friends, family conflicts (Sullivan et al, 2014), male gender , younger age (Amiri et al, 2018), or the quality and supportiveness of the social network (Shen et al, 2018) -this paper focuses on the presumed impact of unresolved childhood trauma, with special emphasis placed on individual patterns of cognitive emotion regulation as related to stressful live events.…”

Section: Introductionmentioning

confidence: 99%

Childhood Trauma, Cognitive Emotion Regulation and Motivation for Behavior Change Among Clients of Opioid Substitution Treatment With and Without Past Year Synthetic Cathinone Use During Therapy

et al. 2020

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Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map

Sevigny,

Greathouse,

Medhin

2023

Campbell Systematic Reviews

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BackgroundGlobally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy‐relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms.ObjectivesThis evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps.Search MethodsWe comprehensively searched for eligible English‐language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020.Selection CriteriaThe conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population‐level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer‐term consequences (health, safety, and socioeconomic outcomes) of these laws.Data Collection and AnalysisBoth dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2.Main ResultsThe EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws—including CBDLs, IHLs, and DCLs—are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid‐related harms (3), and alcohol‐related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality.Authors’ ConclusionsMore primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer‐term—and arguably more salient—health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.

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Three-year retention in methadone opioid agonist treatment: A survival analysis of clients by dose, area deprivation, and availability of alcohol and cannabis outlets

Cited by 26 publications

References 38 publications

Retention of patients in opioid substitution treatment: A systematic review

Retention of patients in opioid substitution treatment: A systematic review

Childhood Trauma, Cognitive Emotion Regulation and Motivation for Behavior Change Among Clients of Opioid Substitution Treatment With and Without Past Year Synthetic Cathinone Use During Therapy

Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map

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