Outcomes from the medication assisted treatment pilot program for adults with opioid use disorders in rural Colorado

Background As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence- based treatment to 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1005 patients receiving MOUD from the 3 participating organizations. Here we evaluate patient centered clinical and functional outcomes of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis. Methods Under state-funded law (Colorado Senate Bill 17–074), three rural agencies submitted de-identified patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index, PhQ9 and GAD-7 with McNemar-Bowker, and Wilcoxon Signed Rank tests analysis were used to measure patient outcomes across after participation in the program. . Results Patients in treatment reported using less heroin (52.1% vs 20.4%), opioids (22.3% vs 11.0%), and alcohol (28.6% vs 13.1%, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less frequency of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5% to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.

Catechol-O-Methyltransferase Activity in Individuals with Substance Use Disorders: A Case Control Study

Background Impulsivity and substance use disorders (SUD) can be related to the same environmental factors. In this study, we intended to evaluate the dopaminergic function in imprisoned SUD offenders through the determination of s-COMT activity. Methods The study included 46 male individuals from a Portuguese penal institution. The participants were assessed through a battery of standardised instruments: Psychopathy Checklist-Revised (PCL-R), Barratt Impulsivity Scale Version 11 (BIS-11), and the European version of the Addiction Severity Index (EuropASI). s-COMT erythrocyte activity was evaluated. Results Overall, 73.9% (n=34) of the individuals had Antisocial Personality Disorder (ASPD) and 58.7% (n=27) presented SUDs. We evidenced, for the first time, that, in SUD individuals, s-COMT activity is correlated with the severity of drug dependence (EuropASI) (p<0.05), and with BIS-11 factors self-control (p<0.0001) and non-planning (p=0.002). Conclusions This study opens new perspectives regarding the pharmacological intervention on drug dependence through the interference on dopamine pathways.

The Peniston & Kulkosky Treatment for Chemical Dependence: a Replication, and Assessment of the Importance of the Electroencephalograph (EEG) Biofeedback Component of the Protocol

<p>This thesis is primarily a replication of Peniston and Kulkoskys' (1989; 1990) treatment (PKT) study which reported successful outcomes for alcoholics using an alpha/theta electroencephalograph (EEG) biofeedback protocol. The PKT protocol consists of 6 temperature biofeedback sessions of training increased hand temperature, followed by 30 sessions of training, via EEG biofeedback, increases in alpha/theta band amplitude. The latter sessions included visualizations of personality and physiology changes, and visualisations of scenes where alcohol is refused. Another aim of this study was to determine whether the EEG biofeedback element of the protocol was superior in outcomes to the subject simply listening to monotonous sounds. In addition to three months of therapeutic community treatment, one experimental group of 15 subjects received the PKT protocol, the other received a modified version excluding EEG biofeedback, and a control group of 14 subjects had no additional treatment. Post-treatment follow up revealed significant improvements for all three groups in key psychometric instruments. These were the Multiaxial Personality Inventory (MCMI-II), Situational Confidence Questionnaire (SCQ), Life Purpose Questionnaire (LPQ), and, at follow up, Addiction Severity Index (ASI). The control group changed in fewer MCMI-II scales, and had a higher treatment drop out rate. At follow up the groups' abstinence rates, using Peniston and Kulkoskys' measure, were also similar. However, when more sensitive relapse measures were applied, the PKT groups' relapse results were about twice those of the control group. This was significant for male subjects' mean number of days using substances, whereas female subjects' abstinence rates were high in all three groups. This therapeutic modality enhances therapeutic community treatment outcomes in a small sample of subjects, a result not common in the literature. It merits further investigation and implementation in a New Zealand setting.</p>

The Peniston & Kulkosky Treatment for Chemical Dependence: a Replication, and Assessment of the Importance of the Electroencephalograph (EEG) Biofeedback Component of the Protocol

<p>This thesis is primarily a replication of Peniston and Kulkoskys' (1989; 1990) treatment (PKT) study which reported successful outcomes for alcoholics using an alpha/theta electroencephalograph (EEG) biofeedback protocol. The PKT protocol consists of 6 temperature biofeedback sessions of training increased hand temperature, followed by 30 sessions of training, via EEG biofeedback, increases in alpha/theta band amplitude. The latter sessions included visualizations of personality and physiology changes, and visualisations of scenes where alcohol is refused. Another aim of this study was to determine whether the EEG biofeedback element of the protocol was superior in outcomes to the subject simply listening to monotonous sounds. In addition to three months of therapeutic community treatment, one experimental group of 15 subjects received the PKT protocol, the other received a modified version excluding EEG biofeedback, and a control group of 14 subjects had no additional treatment. Post-treatment follow up revealed significant improvements for all three groups in key psychometric instruments. These were the Multiaxial Personality Inventory (MCMI-II), Situational Confidence Questionnaire (SCQ), Life Purpose Questionnaire (LPQ), and, at follow up, Addiction Severity Index (ASI). The control group changed in fewer MCMI-II scales, and had a higher treatment drop out rate. At follow up the groups' abstinence rates, using Peniston and Kulkoskys' measure, were also similar. However, when more sensitive relapse measures were applied, the PKT groups' relapse results were about twice those of the control group. This was significant for male subjects' mean number of days using substances, whereas female subjects' abstinence rates were high in all three groups. This therapeutic modality enhances therapeutic community treatment outcomes in a small sample of subjects, a result not common in the literature. It merits further investigation and implementation in a New Zealand setting.</p>

Suicide Probability Among Tramadol Addicts

Background The magnitude of the problem of substance use in Egypt has been growing lately. Substance use disorders have been associated with depression and suicide, as well as impulsivity and specific personality traits. Suicide is closely linked to the substances use. Therefore it is very important to confirm the factors that affect the possibility of suicide. Aim of the Work This study aimed at evaluating suicide risk and its correlation with each of personality disorders and severity of addiction in a sample of 72 tramadol addicts from outpatient clinic of Institute of psychaitry Ain Shams University hospitals. Patients and Methods This is a descriptive Cross sectional study conducted in outpatient clinic of Institute of psychaitry Ain Shams University hospital. The present study aimed at analyzing the demographic data of 72 tramadol addicts, over six months period from January 2018 to August 2019. The severity of the addiction problem among those patients was assessed using Addiction Severity Index (ASI), suicidal probability was assessed using suicide probability scale (SPS), Structured Clinical Interview for DSM-VI Axis II (SCID-II) for assessing personality disorders and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I). Results The results showed that 32 (44.44%) of the patients had a risk of suicide probability. Also there was a statistically significant difference between risk of suicidal probability and personality disorders especially antisocial personality. It was found that the need for more power for work and pleasurable effects were the most risk factors for tramadol addiction. Conclusion Suicide probability was found to be (44.44%) among the studied tramadol addicts. The risk of suicide probability among them was found to be significant in each of the following: antisocial personality disorder, longer duration of addiction, being single and positive family history of addiction. Attention should be paid to include the assessment of suicidal risk as part of routine assessment of addicts.

Individual Characteristics And The Gateway Hypothesis Among Drug User Patient In Indonesia

Drug abuse has become severe not just in the world but also in Indonesia. To address this problem, public policies and researcher try to understand the drug use pattern. One of the famous concept in drug use pattern is gatheway hypothesis. The gateway hypothesis refers to the pattern of substance use initiate softer drug lead to the harder drug. However, many literature shows drug use pattern is not just gateway pattern, there is reversal pattern and using both gateway and reversal pattern. Many studies have discussed the relationship between drug use and individual characteristics. However, few of them are relatively link between individual characteristics and the sequential order in drug use. The purpose of this study is to evaluate how individual characteristics are associated with the gateway pattern and other pattern for different types of drugs. We use a secondary dataset of individual drug user patients from the Rehabilitation Center of National Narcotics Board aged 14–67 years assessed using the Addiction Severity Index (ASI), employing probit and multinominal logit model. Duration are associated with initial soft drug user with gateway pattern. While alcohol use and have high education level related with initial hard drug user with reversal pattern. Interestingly, duration and alcohol use correlated with initial intermediate drug user with all kind of pattern. Prevention and intervention efforts should be targeting high-risk characteristics of people at an initial stage of drug use and progression to the next stage.

Effectiveness of E-SBIRT intervention in community healthcare institution in China: study proposal for a randomised controlled trial

BackgroundMany studies have demonstrated the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) in addressing substance use problem. However, owing to the shortage of counsellors, it has not been widely used in China. With the development of smart medicine, we developed a web-based electronic SBIRT (E-SBIRT) program and explored the effectiveness of E-SBIRT in reducing substance use in China.MethodsA randomised controlled trial will be conducted in primary healthcare institutions. Four primary healthcare institutions will be selected and randomly divided into an intervention group and a control group (each institution will recruit 60 participants, and in total, 240 participants will be recruited). The control group will get a pamphlet of drug abuse prevention, and the intervention group will get the E-SBIRT intervention and the pamphlet. Both groups will receive baseline and follow-up assessment at 1 and 3 months after the intervention. The primary outcome is the change in scores on the Alcohol, Smoking and Substance Use Involvement Screening Test, and the secondary outcomes include changes in motivation, depression, anxiety, positive/negative emotion, self-esteem, addiction knowledge and addiction severity index.ConclusionsIf the ‘E-SBIRT’ program is found to be effective, it will be an accessible, affordable and widely implementable intervention to help participants at moderate risk of substance use to reduce their consumption. The potential benefit is to provide early intervention to high-risk patients in time and reduce the harmful consequences to individuals and society.Trial registration numberNCT03452241.

Impulsivity and Compulsivity and Their Relationship with Non-Adherence to Treatment in the Prison Population

The main challenge of interventions in penitentiary institutions is the re-education and reintegration of inmates, i.e., that inmates have the intention and ability to live law-abiding lives. Therefore, an increase in self-control or, on the contrary, the decrease or elimination of impulsive versus compulsive behaviors becomes necessary. This study aimed to evaluate the role of impulsivity versus compulsivity in treatment adherence in the prison population. The study included 134 men from the Penitentiary Center of Granada who were divided into two groups. Group 1 was considered treatment adherent, and Group 2 was considered non-adherent to treatment. The following instruments were used: Symptom Inventory (SCL-90-R), Addiction Severity Index (EuropASI), Impulsivity Scale (UPPS-P), and Compulsive Belief Questionnaire (OBQ-44). Statistically significant differences were found in impulsivity in the dimensions of negative urgency, sensation seeking, and positive urgency, with higher scores in all cases for the non-adherent group than for the adherent group. We also found statistically significant differences in responsibility/inhibition, perfectionism/uncertainty, and importance/control, with higher scores for the non-adherent group compared to the adherent group. Treatment adherence is inversely related to impulsive and compulsive behaviors.

Outcomes from the Medication Assisted Treatment Pilot Program for Adults With Opioid Use Disorders in Rural Colorado

Background. As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence based treatment 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1,005 patients receiving MOUD from the 3 participating organizations. Here we evaluate the impact of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis on patient centered clinical and functional outcomes. Methods. Under state-funded law, three rural agencies submitted patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index with McNemar-Bowker and t tests were used to measure program impact. Results. Patients in treatment reported using less heroin (13.0 vs. 3.7 days), opioids (3.7 vs. 1.9 days), and alcohol (3.2 vs 0.7 days, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less days of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5 % to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions. This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.