Treatment with injectable hydromorphone: Comparing retention in double blind and open label treatment periods

Oviedo‐Joekes, Eugenia; Palis, Heather; Guh, Daphne; Marchand, Kirsten; Brissette, Suzanne; Harrison, Scott; Macdonald, Scott; Lock, Kurt; Anis, Aslam H.; Marsh, David C.; Schechter, Martin T.

doi:10.1016/j.jsat.2019.03.012

Cited by 26 publications

(29 citation statements)

References 25 publications

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“…In Canada, people seeking MAT for OUD have more medications to choose from, including diacetylmorphine and hydromorphone. Access to these additional treatment options, both of which have both been shown to be effective and promote treatment retention in randomized controlled trials, could help more people in the US get into and stay in recovery [46][47][48]. Both of these medications can be administered intravenously, providing another approach to MAT that can be effective when oral agents are not [49].…”

Section: Discussionmentioning

confidence: 99%

Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA

Lynch

Weber

Hedden

et al. 2021

Subst Abuse Treat Prev Policy

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Background Opioid use disorder (OUD), a chronic disease, is a major public health problem. Despite availability of effective treatment, too few people receive it and treatment retention is low. Understanding barriers and facilitators of treatment access and retention is needed to improve outcomes for people with OUD. Objectives To assess 3-month outcomes pilot data from a patient-centered OUD treatment program in Iowa, USA, that utilized flexible treatment requirements and prioritized engagement over compliance. Methods Forty patients (62.5% female: mean age was 35.7 years, SD 9.5) receiving medication, either buprenorphine or naltrexone, to treat OUD were enrolled in an observational study. Patients could select or decline case management, counseling, and peer recovery groups. Substance use, risk and protective factors, and recovery capital were measured at intake and 3 months. Results Most participants reported increased recovery capital. The median Assessment of Recovery Capital (ARC) score went from 37 at enrollment to 43 (p < 0.01). Illegal drug use decreased, with the median days using illegal drugs in the past month dropping from 10 to 0 (p < 0.001). Cravings improved: 29.2% reported no cravings at intake and 58.3% reported no cravings at 3 months (p < 0.001). Retention rate was 92.5% at 3 months. Retention rate for participants who were not on probation/parole was higher (96.9%) than for those on probation/parole (62.5%, p = 0.021). Conclusion This study shows preliminary evidence that a care model based on easy and flexible access and strategies to improve treatment retention improves recovery capital, reduces illegal drug use and cravings, and retains people in treatment.

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Section: Discussionmentioning

confidence: 99%

Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA

Lynch

Weber

Hedden

et al. 2021

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

show abstract

“…In Canada, people seeking MAT for OUD have more medications to choose from, including diacetylmorphine and hydromorphone. Access to these additional treatment options, both of which have both been shown to be effective and promote treatment retention in randomized controlled trials, could help more people in the US get into and stay in recovery (47)(48)(49). Both of these medications can be administered intravenously, providing another approach to MAT that can be effective when oral agents are not (50).…”

Section: Discussionmentioning

confidence: 99%

Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA

Lynch

Weber

Hedden

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Opioid use disorder (OUD), a chronic disease, is a major public health problem. Despite availability of effective treatment, too few people receive it and treatment retention is low. Understanding barriers and facilitators of treatment access and retention is needed to improve outcomes for people with OUD.Objectives: To assess 3-month outcomes pilot data from a patient-centered OUD treatment program in Iowa, USA, that utilized flexible treatment requirements and prioritized engagement over compliance. Methods: Forty patients (62.5% female: mean age was 35.7 years, SD 9.5) receiving medication, either buprenorphine or naltrexone, to treat OUD were enrolled in an observational study. Patients could select or decline case management, counseling, and peer recovery groups. Substance use, risk and protective factors, and recovery capital were measured at intake and 3 months. Results: Most participants reported increased recovery capital. The median Assessment of Recovery Capital (ARC) score went from 37 at enrollment to 43 (p<0.01). Illegal drug use decreased, with the median days using illegal drugs in the past month dropping from 10 to 0 (p<0.001). Cravings improved: 29.2% reported no cravings at intake and 58.3% reported no cravings at 3 months (p<0.001). Retention rate was 92.5% at 3 months. Retention rate for participants who were not on probation/parole was higher (96.9%) than for those on probation/parole (62.5%, p=0.021). Conclusion: This study shows preliminary evidence that a care model based on easy and flexible access and strategies to improve treatment retention improves recovery capital, reduces illegal drug use and cravings, and retains people in treatment.

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“…Participants of the present study had formerly taken part in the Research on the Utilization of Therapeutic Hydromorphone (RUTH) (2016–2019) study which investigated the treatment experiences and outcomes of patients receiving iOAT at a community clinic in Vancouver [ 14 ]. Participants visited this clinic daily to receive iOAT for the treatment of opioid use disorder, and beginning in 2018 patients who reported cocaine and/or methamphetamine use were offered and prescribed (if desired) dextroamphetamine for the treatment of stimulant use disorder.…”

Section: Methodsmentioning

confidence: 99%

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with patients receiving injectable opioid agonist treatment

Palis

Marchand

Peachey³

et al. 2021

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Background A high proportion of people receiving both oral and injectable opioid agonist treatment report concurrent use of stimulants (i.e. cocaine and or amphetamines), which has been associated with higher rates of continued illicit opioid use and treatment dropout. A recent randomized controlled trial demonstrated the effectiveness of dextroamphetamine (a prescribed stimulant) at reducing craving for and use of cocaine among patients receiving injectable opioid agonist treatment. Following this evidence, dextroamphetamine has been prescribed to patients with stimulant use disorder at a clinic in Vancouver. This study investigates perceptions of the effectiveness of dextroamphetamine from the perspective of these patients. Methods Data were collected using small focus groups and one-on-one interviews with patients who were currently or formerly receiving dextroamphetamine (n = 20). Thematic analysis was conducted using an iterative approach, moving between data collection and analysis to search for patterns in the data across transcripts. This process led to the defining and naming of three central themes responding to the research question. Results Participants reported a range of stimulant use types, including cocaine (n = 8), methamphetamine (n = 8), or both (n = 4). Three central themes were identified as relating to participants’ perceptions of the effectiveness of the medication: 1) achieving a substitution effect (i.e. extent to which dextroamphetamine provided a substitution for the effect they received from use of illicit stimulants); 2) Reaching a preferred dose (i.e. speed of titration and effect of the dose received); and 3) Ease of medication access (i.e. preference for take home doses (i.e. carries) vs. medication integrated into care at the clinic). Conclusion In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.

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Treatment with injectable hydromorphone: Comparing retention in double blind and open label treatment periods

Cited by 26 publications

References 25 publications

Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA

Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA

Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with patients receiving injectable opioid agonist treatment

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