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The use of chemical graph theory has been increased in almost every field of science in the last two decades. The graph invariants called topological descriptor are the numbers used to understand the physical and chemical properties of compounds. The use of narcotics causes many health and social issues in society. Narcotic drug addiction results in decreased pain perception, euphoria, dizziness, physical dependence, decreased breathing, and sleepiness in people. The overuse of narcotics may cause death. For the care and treatment of drug addictions, special health institutes provide proper medicines. The structures of narcotic drugs are explored with the help of degree-based graph invariants. In this article, we used degree-based topological indices to estimate the properties of narcotic drugs. Moreover, we have obtained that the topological indices utilize the antinarcotics drugs have a very strong correlation with the physicochemical properties mentioned in this manuscript. [ABSTRACT FROM AUTHOR]

Introduction: Medications for addiction treatment (MAT) are the evidence-based standard of care for treatment of opioid use disorder (OUD), but stigma continues to surround their use. We conducted an exploratory study to characterize perceptions of different types of MAT among people who use drugs. Methods: We conducted this qualitative study in adults with a history of non-medical opioid use who presented to an emergency department for complications of OUD. A semi-structured interview that explored knowledge, perceptions, and attitudes toward MAT was administered, and applied thematic analysis conducted. Results: We enrolled 20 adults. All participants had prior experience with MAT. Among participants indicating a preferred treatment modality, buprenorphine was the commonly favored agent. Previous experience with prolonged withdrawal symptoms upon MAT discontinuation and the perception of "trading one drug for another" were common reasons for reluctance to engage in agonist or partial-agonist therapy. While some participants preferred treatment with naltrexone, others were unwilling to initiate antagonist therapy due to fear of precipitated withdrawal. Most participants strongly considered the aversive nature of MAT discontinuation as a barrier to initiating treatment. Participants overall viewed MAT positively, but many had strong preferences for a particular agent. Conclusion: The anticipation of withdrawal symptoms during initiation and cessation of treatment affected willingness to engage in a specific therapy. Future educational materials for people who use drugs may focus on comparisons of respective benefits and drawbacks of agonists, partial agonists, and antagonists. Emergency clinicians must be prepared to answer questions about MAT discontinuation to effectively engage patients with OUD. [ABSTRACT FROM AUTHOR]

This paper draws upon the notion of slow emergency as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health-sector representatives throughout the island during and after Hurricane María. We conducted participant observation and qualitative interviews with chronic disease patients (n = 20) health care providers and administrators (n = 42), and policy makers (n = 5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after María experienced bureaucratic red tape as a manifestation of the colonial legacies of disaster management and health care. They describe a precarious existence in perpetual 'application pending' status, waiting for services that were not forthcoming. Drawing on ethnographically informed case examples, we discuss the effects of these bureaucratic barriers on persons with three chronic conditions: renal disease, opioid dependency, and HIV/AIDS. We argue that while emergency management approaches often presume a citizen-subject with autonomous capacity to prepare for presumably transient disasters and envision a 'post-disaster future' beyond the immediate crisis, Puerto Rican voices draw attention to the longer, sustained, slow emergency of colonial governance. [ABSTRACT FROM AUTHOR]

In this essay we want to foreground a question: what happens to 'addiction' when we take seriously cultural scripts informing its trajectories? Can this bring us to unthink addiction as problematic notion and move it onto new paradigms that fit better the now acknowledged fluidity and pluralistic episteme of 'addiction' and more broadly of chronic life conditions? Indeed, 'addiction' has become a pivotal concept in the contemporary world. A powerful diagnostic framework in interpreting human behaviour, for some 'addiction' has become the 'new normal' with chronic relations with different things such as food, sex, gambling, and mind-altering substances touching upon the lifestyle of a majority of individuals, making everyone 'addicts in practice'. Perhaps this has something to do with the constituent force that 'habit' – as in 'addiction' – has in defining our present and future. Though 'addiction' goes beyond the question of mind-altering drugs, the politics of 'addiction' is intimately tied to substances such as opioids and opiates, cocaine, cannabis, and psychedelics that have been the object of durable systemic political control and security repression. Contextually the line between licit/illicit substances is softening and blurring, the 'dual' purpose that drugs serve is now recognised in scientific and popular analysis moving the question of 'addiction' beyond the medicine/drug dichotomy. Yet, culture is generally absent in understanding 'addiction.' When it is referred to, this happens in diminutive terms limited to Anglo-American modern culture. Culture matters and it matters with different weights and measures as it moves across the world. There are cultural environments of health informed by practices and epistemologies of well-being that have evolved in lines opposites from or only intersecting with the Anglo-American, and generally Western, world. Exploring these spaces and cultural scripts enables our scholarship on drugs and 'addiction' to move the barycentre of discussion towards novel considerations around the historical trajectories and potential futures of our diagnostic terms and policy interventions. [ABSTRACT FROM AUTHOR]

Background: Opioids are effective analgesics for cancer pain and refractory non-cancer pain. Although they are essential medication, problematic issues on aberrant behavior and adverse events have rapidly emerged as social problems in Korea. This study aimed to describe the mechanisms, efficacy, and adverse events, especially how to deal with opioid dependency. Current Concepts: Opioid-induced aberrant behavior includes physical and psychological dependences (addiction), abuse, and diversion (giving prescribed opioids to another person). Most physicians are unfamiliar with how to handle patients presenting these problematic issues. Physical and psychological dependences develop through different pathophysiologic mechanisms, i.e., noradrenergic and dopaminergic pathways, respectively. Motivational enhancement therapy, psychosocial support, substitution therapy with buprenorphine, and adjunctive medications, including alpha-2 adrenergic agonist, antidepressants, and non-steroidal antiinflammatory drugs, are the mainstay of treatment for opioid dependency. Constipation, nausea/vomiting, drowsiness/sedation, delirium, itching sensation, voiding difficulty, dry mouth, opioid-induced hyperalgesia, and respiratory depression are well-known physical side effects of opioid consumption. Discussion and Conclusion: Research on the development history, epidemiology of opioid dependency, and its treatment are warranted to avoid an opioid crisis in Korea. Above all, thorough knowledge for physicians and patients is urgently needed. [ABSTRACT FROM AUTHOR]

Patient and public involvement is widely thought to be important in the improvement of health care delivery and in health equity.Purpose: The article examines the role of experiential knowledge in service co-production in order to develop opiate substitution treatment services (OST) for high-risk opioid users.Method: Drawing on social representations theory and the concept of social identity, we explore how experts' by experience and registered nurses' understandings of OST contain discourses about the social representations, identity, and citizenship of the participants and the effects these may have on developing or hindering inclusive and bottom-up forms of patient and public involvement.Results: The meeting sessions that potentially offer room for creativity and problem-solving fail to provide any new propositions for fixing the system. The health care professionals primarily identify themselves as regulators who protect the correctness of their actions and show little interest in considering experiential knowledge on opioid addiction. Conclusion: The participation of patients has been one of the prominent reforms implemented in health care. The goal of client-centered thinking is often emphasised; however, the implementation is not simple due to the strongly institutionalised knowledge and related working patterns and practices in health care. [ABSTRACT FROM AUTHOR]

What is known and objective: Opioid Use Disorder (OUD) has a high mortality rate and affects millions of people worldwide. Many organizations and societies develop Clinical Practice Guidelines (CPGs) to serve as a framework for healthcare providers to decide and support best practice to manage and treat OUD. However, not all CPGs sufficiently address all the important aspects of optimal care for managing OUD. This study aims to review current CPGs for management of OUD, evaluate their methodological quality and summarize their recommendations. Methods: We conducted this systematic review according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA). Various databases were searched for CPGs and Appraisal of Guidelines for Research and Evaluation (AGREE‐II) instrument was used to assess the methodological quality. We also summarized the treatments plans of CPGs across continuum of care (diagnosis and assessment, treatment initiation, pharmacotherapy and psychosocial). Results: This review included 28 CPGs of varying qualities. CPGs from high‐income countries and international organizations rated high for their methodological quality. Most CPGs scored high for the scope and purpose domain and scored low for applicability domain. Recommendations for the continuum of care for OUD varied across CPGs. Buprenorphine was recommended in most of the CPGs, followed by methadone. Recommendations for psychosocial interventions also varied, with cognitive behaviour therapies and counselling or education being the common recommendations in many CPGs What is new and conclusion: We found most CPGs have scope and purpose and clarity of presentation. However, the methodological rigour and applicability scored low. CPGs need to frame health questions in a comprehensible manner and provide an update as evidence grows. It is important for CPG developers to consider methodological quality as a factor when developing CPG recommendations. [ABSTRACT FROM AUTHOR]

Background and Objectives: Large-scale prospective case series of tapentadol abuse or dependence in India is not available. Hence, we aimed to study the prevalence and profile of tapentadol users in a treatment-seeking population. Materials and Methods: The study had prospective and retrospective arms. We collected 8-month prospective data by face-to-face interviews (n = 70) and 8-year retrospective data from case notes (n = 26) with either tapentadol misuse/abuse or dependence in patients attending a de-addiction center. Results: The prevalence of tapentadol abuse or dependence was 25% among the pharmaceutical opioid users. Concurrent use of other opioids was seen in >80% of participants of both the arms. Major sources of tapentadol were chemists (without a prescription) (53%) and doctors (prescriptions) (40%). Patients in the tapentadol dependence group had a significantly higher dose, duration, and pharmaceutical opioid use. Conclusion: India needs awareness promotion, training, availability restriction, and provision of treatment for tapentadol abuse or dependence. [ABSTRACT FROM AUTHOR]

Identifying clinical differences between opioid users (OU) and alcohol and other drug users (AOD) may help to tailor treatment to OU, particularly among the majority of OU who are not on opioid agonist treatments. Given the dearth of research on these differences, this study explored gender differences in demographic and clinical characteristics between OU and AOD. Participants (N = 506) were from a multisite, randomized controlled clinical trial of an Internet-delivered psychosocial intervention conducted in 2010–2011. Logistic regression models explored differences in demographic and clinical characteristics by substance use category within and between women and men. Women OU were more likely to be younger, White, employed, benzodiazepine users, and less likely to have children or use cocaine and cannabis than women AOD. Men OU, compared to men AOD, were more likely to be younger, White, younger at first abuse/dependence, benzodiazepine users, and reported greater psychological distress, but were less likely to be involved in criminal justice or use stimulants. Interactions by gender and substance use were also detected for age of first abuse/dependence, employment, and criminal justice involvement. These findings provide a nuanced understanding of gender differences within substance use groups to inform providers for OU seeking treatment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to describe the creation and outcomes of a collaborative model and care facility for opioid overdose and addiction treatment based on compassion, patience, and respect: The Maryhaven Addiction Stabilization Center (MASC). Approach: MASC was created with the vision to serve clients who have recently overdosed on opioids. In this article, the research, planning, building, and implementation of an opioid treatment center composed of an admission and triage unit, inpatient withdrawal management unit, and inpatient residential unit are described. A multi‐agency and multi‐disciplinary approach were used to immediately engage patients and connect them to treatment for opioid addiction. Findings: Implementation of a collaborative model of care offers patients who overdose on opioids with immediate access to admission for treatment. This has resulted in significantly higher numbers of patients seeking and staying in treatment. Conclusions: Through multi‐agency collaboration and a shared commitment to addressing the challenges of the opioid epidemic in innovative ways, more patients who are struggling with addiction have increased opportunities to engage in treatment and move towards recovery. Clinical Relevance: Clinicians, first responders, and communities can employ MASC principles to guide their approaches to serve patients who have recently overdosed on opioids or who are in active addiction. [ABSTRACT FROM AUTHOR]

Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18–60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking. [ABSTRACT FROM AUTHOR]

Background: Natural opiate users constitute a large proportion of opioid dependent individuals in India, and enjoy socio-cultural sanction in certain parts of the country. However, no study has assessed the pathways to care among this population in India. Objective: To assess the pathways to care among treatment-seeking natural opiate dependent individuals. Method: This cross sectional, explorative study was conducted at a tertiary care drug treatment centre located in North India. A total of 125 male participants aged >18 years, seeking treatment for natural opiate dependence from our outpatient clinic were included. A semi-structured proforma and WHO mental health encounter form was applied to assess socio-demographic, treatment details and pathways to care. Results: The mean age was 46.17 (±11.98) years. Poppy husk (phukki/doda/posht) was the most common primary natural opiate used (84%). First point of treatment contact was addiction psychiatrist (n = 90; 72%) in majority. First time treatment seeking was either by self-referral (60.8%) or referral by relatives and friends (24.8%) with mean time lag of 18.63 years after the onset. Conclusion: Natural opiates dependent patients seek treatment late in the course of their illness, often directly from a tertiary addiction treatment centre. Barriers to seek treatment needs to be addressed. [ABSTRACT FROM AUTHOR]

Self-help groups and medications (buprenorphine, methadone, and naltrexone) both play important roles in opioid addiction treatment. The relative use of these two treatment modalities has not been characterized in a national study. Using national treatment data, we found that self-help groups were rarely provided in conjunction with medication treatment: Among all adult discharges from opioid addiction treatment in the period 2015-17, 10.4 percent used both self-help groups and medications, 29.2 percent used only medications, 29.8 percent used only self-help groups, and 30.5 percent used neither self-help groups nor medications. Use of self-help groups without medication is most common in residential facilities, among those with criminal justice referrals, and among uninsured or privately insured patients, as well as in the South and West regions of the US. These subgroups may be important targets for future efforts to identify and overcome barriers to medication treatment and create multimodal paths to recovery. [ABSTRACT FROM AUTHOR]

In 1929, the U.S. federal government approved two ground-breaking programs designed to treat drug addiction. Emerging at a time when many began to worry about a supposed rising tide of drug use across the country, the establishment of narcotic hospitals at Lexington, Kentucky and Fort Worth, Texas marked a watershed moment in the treatment of addiction. This article traces the institutional history of one of those facilities, the Fort Worth Narcotic Farm, and the experiences of the men who found themselves under its care. It argues that, on the surface, the creation of the farm model seemed like a hopeful alternative to strict incarceration models. Its creation reflected shifting notions of addiction: namely, that addiction is not simply a crime, but it is also a disease with serious public health implications. Yet, the establishment of the hospital as places to both treat and punish addicts was their inherent and fundamental flaw. Central to this was the concept of the "prisoner-patient," a person forced to undergo treatment as a result of criminal charges. Not only did patients express their frustration with the prison-like setting at Fort Worth, but recidivism rates remained high throughout the facility's operation. Ultimately, lawmakers and politicians would use these recidivism rates as part of a broader push for more punitive drug legislation in the post-World War II period. By placing the history of addiction into conversation with mass incarceration studies, this article shows that the roots of the punishment model employed in the last quarter of the twentieth century were interwoven into seemingly "progressive" treatment models dating back to at least the 1930s. Indeed, the very failures of early addiction treatment models that arose by mid-century helped to justify an expanding criminal justice model in the post-1960s era. [ABSTRACT FROM AUTHOR]

Nurses are very likely to encounter patients every day with treated and untreated addiction. Substance use disorders are reviewed, using opioid abuse as the exemplar, including risk factors and nursing implications. Nurses who take the time to listen to the background story may be able to initiate an intervention that guides the patient toward a path of recovery. [ABSTRACT FROM AUTHOR]

Inappropriate and excessive opioid prescribing practices for treatment of chronic nonmalignant pain contributed to rising rates of opioid related mortality. Effective and widely available opioid addiction treatment resources are needed to ensure successful resolution of the "opioid epidemic". This chapter outlines the basic pathophysiology of addiction as well as principles of opioid addiction management focusing on the pharmacological and nonpharmacological aspects of care. Pharmacological treatment focuses on opioid substitution therapy, with aim at prevention of opioid cravings and opioid withdrawal symptoms. Nonpharmacological treatment involves psychological and supportive approaches to addiction such as group meetings, psychological counseling, and mindfulness training. [ABSTRACT FROM AUTHOR]

The current epidemic of opioid addiction has arguably been the most recalcitrant in the nation's history and the first to involve substantial numbers of adolescents. The country has embarked on a public health response, including increasing access to addiction treatment. However, the treatment infrastructure, which was initially created in the 1970s, is ill equipped for meeting the needs of adolescents and young adults, who are often cared for in pediatric primary care. In this article, I review the development of the current treatment system, examine shortfalls in regard to youth-specific needs, and propose suggestions for addressing the current crisis while simultaneously preparing to address future epidemics of addiction by enabling pediatricians to better manage substance use disorders in primary care. [ABSTRACT FROM AUTHOR]

Background/Aims American Indian adults have some of the highest alcohol abstinence rates compared to the overall US population. Despite this, many American Indian people are more likely to concurrently use alcohol and illicit drugs and are less likely to participate and remain in outpatient treatment for alcohol and other drug use compared to the general US population. There is limited knowledge about effective interventions targeting alcohol and drug co-addiction among American Indian adults. Contingency management is a behavioral intervention designed to increase drug abstinence by offering monetary incentives in exchange for drug and alcohol negative urine samples. We aim to evaluate and describe a culturally tailored contingency management intervention to increase alcohol and other drug abstinence among American Indian adults residing in a Northern Plains reservation. Methods This 2 × 2 factorial, randomized controlled trial currently includes 114 American Indian adults with alcohol and/or drug dependence who are seeking treatment. Participants were randomized into one of four groups that received (1) contingency management for alcohol, (2) contingency management for other drug, (3) contingency management for both substances, or (4) no contingency management for either substance. We present descriptive, baseline data to characterize the sample and describe the modified contingency management approach that is specific to the community wherein this trial was being conducted. Results The sample is 49.1% male, with an average age of 35.8 years (standard deviation = 10.4 years). At baseline, 43.0% of the sample tested positive for ethyl glucuronide, 50.9% of participants self-reported methamphetamine as their most used drug, 36.8% self-reported cannabis, and 12.3% self-reported prescription opiates as their most used drug. Among randomized participants, 47.4% tested positive for cannabis, 28.1% tested positive for methamphetamine, 16.7% tested positive for amphetamines, and 2.1% tested positive for opiates. Conclusion This is the first study to examine a culturally tailored contingency management intervention targeting co-addiction of two substances among American Indian adults. By establishing a tribal–university partnership to adapt, implement, and evaluate contingency management, we will increase the literature on evidence-based addiction treatments and research, while improving trust for addiction interventions among American Indian communities through ongoing collaboration. Moreover, results have implications for the use of contingency management as an intervention for co-addiction in any population. [ABSTRACT FROM AUTHOR]

Objective: The present study evaluated rates of co-occurring current psychiatric and substance use disorders in a sample of opioid-dependent treatment-seeking injection drug users referred from syringe exchange. Methods: Participants (N = 208) completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-R to assess current (within the past year) psychiatric and substance use disorders and the two most commonly diagnosed personality disorders (antisocial and borderline personality disorders). Results: Forty-eight percent of the sample had a current Axis I psychiatric disorder, and 67% had a co-occurring current substance use disorder. Posttraumatic stress disorder (21%), major depression (17%), and bipolar I (12%) were the most prevalent Axis I psychiatric disorders, and cocaine use disorder (53%) was the most commonly co-occurring substance use disorder. Women were more likely to have diagnoses of most anxiety disorders and less likely to have diagnoses of alcohol use disorder or antisocial personality disorder. The presence of a personality disorder was associated with higher rates of cocaine and sedative use disorder. Conclusions: Findings suggest the importance of evaluating and treating co-occurring psychiatric and substance use disorders in the treatment of injection drug users with opioid dependence. [ABSTRACT FROM AUTHOR]

In the midst of a national opioid crisis, Baltimore City witnessed 393 deaths from drug and alcohol overdose in 2015. With an estimated 25 000 residents who are addicted to heroin or other opioids, Baltimore has been profoundly affected by the opioid epidemic. Other resources have commented on federal, state-based, and provider responses to the opioid crisis. This article examines what may be done at the city level based on the experiences of the Baltimore City Health Department. Local jurisdictions must play a critical role in addressing the U.S. opioid crisis through public health coalitions, overdose prevention, treatment expansion, and anti-stigma education. [ABSTRACT FROM AUTHOR]

It is imperative that dance/movement therapists on inpatient psychiatric units recognize the gravity of our nation’s opioid epidemic and take vital steps toward filling the treatment gap. Dance/movement therapists can enhance treatment linkage by keeping the issue on the radar, openly identifying substance use issues during DMT groups, proactively dialoguing in the role of liaison, and mobilizing treatment response before the patient’s discharge. These steps may increase likelihood of treatment referrals upon discharge or release, and contribute to the healing of the nation’s opioid crisis. [ABSTRACT FROM AUTHOR]

In the current epidemic of opioid use disorders, there is both a scientific and ethical imperative to develop effective medical and behavioral treatments for opioid addiction. Research in subject populations with active and ongoing drug addictions bring unique ethical considerations and challenges. Sponsors, researchers, and institutional review board (IRB) members should be familiar with these unique ethical and medical issues as they design, review, and conduct research planned for this population. Issues include those of informed consent and decision-making capacity of research participants, compensation for participation and concerns about undue inducement, forces that threaten the voluntary nature of research participation including the scarcity of available drug treatment programs, and ensuring that participants are aware of and understand risks that may continue after research participation such as increased risk of overdose after research-mandated drug abstinence. This manuscript discusses the current thinking on these issues. [ABSTRACT FROM AUTHOR]

In 1940 Mexico implemented a new revolutionary strategy in its fight against drug trafficking and addiction with a policy that legalized the sale of morphine to opiate addicts. While this approach to drug addiction was not entirely new or unique, it was strongly opposed by the United States, which responded by declaring an embargo on narcotic shipments to Mexico. As a result, Mexico was forced to abandon the plan just a few months after it was implemented. Often seen as a moment when Mexico might have gone in a different, less prohibitionist drug-policy direction, this episode has been overwhelmingly interpreted as an early and striking example of U.S. drug-control imperialism in Latin America. While such interpretations are not incorrect, they have missed an equally critical element of the story—a series of catastrophic diplomatic failures on the Mexican side which undermined various opportunities Mexico had to salvage the policy in some form. The episode thus stands in contrast to more well-known diplomatic challenges during the period in which Mexico’s diplomats have been lauded for outmaneuvering their U.S. and European counterparts. [ABSTRACT FROM PUBLISHER]

Under the leadership of Drs. Vincent P. Dole, Marie Nyswander, and Mary Jeanne Kreek, in collaboration with the psychologist, Norman Gordon and sociologist, Herman Joseph at The Rockefeller University beginning in the 1960s, the first medical treatment for heroin addiction was developed. Drs. Dole, Nyswander and Kreek also developed the first hypothesis of opiate addiction as a metabolic disease. This biological revolution challenged beliefs about addiction, spurred further research and challenged legal positions of the judiciary and the broader criminal justice system (Dole & Nyswander, 1967). [ABSTRACT FROM PUBLISHER]

In this paper, we claim that we can only seek to eradicate the stigma associated with the contemporary opioid overdose epidemic when we understand how opioid stigma and the epidemic have co-evolved. Rather than conceptualizing stigma as a parallel social process alongside the epidemiologically and physiologically defined harms of the epidemic, we argue that the stigmatized history of opioids and their use defines the epidemic. We conclude by offering recommendations for disrupting the burden of opioid stigma. [ABSTRACT FROM AUTHOR]

Background and Aims In a recent randomized trial, patients with opioid dependence receiving brief intervention, emergency department (ED)-initiated buprenorphine and ongoing follow-up in primary care with buprenorphine (buprenorphine) were twice as likely to be engaged in addiction treatment compared with referral to community-based treatment (referral) or brief intervention and referral (brief intervention). Our aim was to evaluate the relative cost-effectiveness of these three methods of intervening on opioid dependence in the ED. Design Measured health-care use was converted to dollar values. We considered a health-care system perspective and constructed cost-effectiveness acceptability curves that indicate the probability each treatment is cost-effective under different thresholds of willingness-to-pay for outcomes studied. Setting An urban ED in the United States. Participants Opioid-dependent patients aged 18 years or older. Measurements Self-reported 30-day assessment data were used to construct cost-effectiveness acceptability curves for patient engagement in formal addiction treatment at 30 days and the number of days illicit opioid-free in the past week. Findings Considering only health-care system costs, cost-effectiveness acceptability curves indicate that at all positive willingness-to-pay values, ED-initiated buprenorphine treatment was more cost-effective than brief intervention or referral. For example, at a willingness-to-pay threshold of $1000 for 30-day treatment engagement, we are 79% certain ED-initiated buprenorphine is most cost-effective compared with other studied treatments. Similar results were found for days illicit opioid-free in the past week. Results were robust to secondary analyses that included patients with missing cost data, included crime and patient time costs in the numerator, and to changes in unit price estimates. Conclusion In the United States, emergency department-initiated buprenorphine intervention for patients with opioid dependence provides high value compared with referral to community-based treatment or combined brief intervention and referral. [ABSTRACT FROM AUTHOR]

Background and Aims Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in opiate substitution treatment (OST) programmes. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta-analytical reviews find no benefit for manual-based treatments beyond 'routine counselling'. Analysis We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high-quality psychosocial treatment alongside medication. In so doing, we consider the nuances and limitations of the evidence and the organizational barriers to transferring it into routine practice. Conclusion The evidence base for psychosocial interventions in opiate substitution treatment (OST) services can be interpreted both positively and negatively. Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial treatment in OST programmes is the most pragmatic approach. Greater attention should be paid to elements common to all psychological treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer-led interventions. [ABSTRACT FROM AUTHOR]

Background. Detoxification programmes seek to implement the most secure and compassionate ways of withdrawing from opiates so that the inevitable withdrawal symptoms and other complications are minimized. Once detoxification has been achieved, the next stage is to enable the patient to overcome his or her drug addiction by ensuring consumption is permanently and completely abandoned, only after which can the subject be regarded as fully recovered. Methods. A systematic search on the common databases of relevant papers published until 2016 inclusive. Results and Conclusion. Our study of the available oral treatments for opioid dependence has revealed that no current treatment can actually claim to be fully effective. These treatments require daily oral administration and, consequently, regular visits to dispensaries, which in most cases results in a lack of patient compliance, which causes fluctuations in drug plasma levels. We then reviewed alternative treatments in the available scientific literature on polymeric sustained release formulations. Research has been done not only on release systems for detoxification but also on release systems for giving up the habit of taking opioids. These efforts have obtained the recent authorization of polymeric systems for use in patients that could help them to reduce their craving for drugs. [ABSTRACT FROM AUTHOR]

Background/Aim. Although the characteristics of the treatment are the most researched determinants of quality of life of opiate addicts, it is indisputable that there is a certain influence of the characteristics of addicts and addiction, too. The aim of this study was to determine which addicts characteristics, as well as the characteristics of the addiction and treatment have predicative influence on the quality of life of the opiate addicts treated in the methadone maintenance program and those treated with buprenorphine. Methods. The epidemiological cross-sectional study was carried out in 2013 at the Clinical Center Niš, on a total of 64 opiate addicts, both sexes, aged 18 and older (32 addicts in the methadone program, chosen by random selection, and 32 addicts treated with buprenorphine, matched by sex and age). Necessary data were collected in a "face to face" interview with the examinees, based on the autonomous kind of a questionnaire, together with the use of the standardized World Health Organization (WHO) instruments: for health status, for the level of severity of addiction and for the quality of life measuring) based on which the health index (EQ-5D), Addiction Severity Index (ASI) and the quality of life index (WHOQOL-BREF) were calculated. The data were described by the methods of descriptive statistics, while the differences between groups were analyzed by applying χ2 and t-test. Multiple regressions were used to determine the predictors. Results. The addicts in the methadone program showed much worse perception of quality of life than those treated in another way, although, according to the values of quality of life, they did not differ significantly. The most numerous predictors of the level of quality of life were health characteristics, characteristics of the socioeconomic position of the examinees, as well as different consequences of addiction. The influence of treatment was less noticeable. Participating in the methadone program had predicative influence on perception and the level of quality of life of the addicts in mental area and that of the environment. The influence of the characteristics of methadone treatment in physical and social area was insignificant. Conclusion. Variations in the perception and level of the quality of life of opiate addicts in different areas cannot be explained using only one predictor. The number of determining variables is large, and its impact complex. [ABSTRACT FROM AUTHOR]

Background and Aims Recently, there has been a growing interest in using opium tincture (OT) for treating opioid dependence in certain regions. We aimed to assess the evidence on its safety and efficacy for this indication. Methods We searched several databases (CENTRAL, Medline, EMBASE, Web of Science, PsychINFO, ProQuest Dissertation and Theses Database, Iran Medex, and who.int/trialsearch) with no language or publication date limitations. Two reviewers selected randomized controlled trials (RCT), cohort/case-control/cross-sectional studies and case-series on safety or efficacy of OT for treating opioid dependence and then extracted reported measures of mentioned outcomes from selected studies. We used the Effective Public Health Practice Project (EPHPP) Quality Assessment tool for appraisal. Results From nine selected studies; in three RCTs and one cohort analytical analysis on detoxification, 110 patients were treated with 15-140 morphine equivalents/day (mEq/d) of OT; in four prospective and one retrospective uncontrolled case-series on long-term/maintenance treatment, 570 patients were treated with 100-400 mEq/d of OT. Only two studies on detoxification included a comparison: one concluded equal efficacy of OT and methadone in suppressing withdrawal symptoms ( P = 0.32) and the other concluded OT to be less efficacious than buprenorphine/naloxone in suppressing withdrawal [OT = 12.20, 95% confidence interval (CI) = 11.00, 13.40]; control: 5.20 (95% CI = 4.69, 5.71) and craving (OT = 303.0, 95% CI = −144.664, 750.664; control: 0.0) but not significantly different ( P = 0.26) in retaining participants in treatment. No major adverse events were reported. Conclusions Conclusive recommendations about the safety and efficacy of opium tincture for treating opioid dependence are not possible at this time. [ABSTRACT FROM AUTHOR]

The article discusses some of the effective treatments for opioid addiction including integrative treatment plan, yoga therapy and complementary and alternative medicine. It refers to cognitive–behavioral therapy (CBT), a 3- to 12-week intervention either in groups or in individual therapy which is a common component of such programs.

Importance: The effectiveness of buprenorphine treatment of opioid dependence is limited by suboptimal medication adherence, abuse, and diversion.Objective: To determine whether 6-month buprenorphine implants are noninferior to daily sublingual buprenorphine as maintenance treatment for opioid-dependent patients with stable abstinence.Design, Setting, and Participants: Outpatient, randomized, active-controlled, 24-week, double-blind, double-dummy study conducted at 21 US sites from June 26, 2014, through May 18, 2015. Outpatients were prescribed daily sublingual buprenorphine for 6 months or more, were abstinent while taking 8 mg/d or less of sublingual buprenorphine for 90 days or longer, and were determined to be clinically stable by their physician.Interventions: Participants were randomized to receive sublingual buprenorphine plus 4 placebo implants or sublingual placebo plus four 80-mg buprenorphine hydrochloride implants (expected efficacy, 24 weeks).Main Outcome Measure: The primary end point was between-group difference in proportion of responders (≥4 of 6 months without opioid-positive urine test result [monthly and 4 times randomly] and self-report). The noninferiority established for the lower bound of the 95% confidence interval was greater than -0.20 (P < .025). Secondary end points included cumulative percentage of negative opioid urine results, abstinence, and time to first illicit opioid use. Safety was assessed by adverse event reporting.Results: Of 177 participants (mean age, 39 years; 40.9% female), 90 were randomized to sublingual buprenorphine with placebo implants and 87 to buprenorphine implants with sublingual placebo; 165 of 177 (93.2%) completed the trial. Eighty-one of 84 (96.4%) receiving buprenorphine implants and 78 of 89 (87.6%) receiving sublingual buprenorphine were responders, an 8.8% difference (1-sided 97.5% CI, 0.009 to ∞; P < .001 for noninferiority). Over 6 months, 72 of 84 (85.7%) receiving buprenorphine implants and 64 of 89 (71.9%) receiving sublingual buprenorphine maintained opioid abstinence (hazard ratio, 13.8; 95% CI, 0.018-0.258; P = .03). Non-implant-related and implant-related adverse events occurred in 48.3% and 23% of the buprenorphine implant group and in 52.8% and 13.5% of participants in the sublingual buprenorphine group, respectively.Conclusions and Relevance: Among adults with opioid dependence maintaining abstinence with a stable dose of sublingual buprenorphine, the use of buprenorphine implants compared with continued sublingual buprenorphine did not result in an inferior likelihood of remaining a responder. However, the study population had an exceptionally high response rate in the control group, and further studies are needed in broader populations to assess the efficacy in other settings.Trial Registration: clinicaltrials.gov Identifier: NCT02180659. [ABSTRACT FROM AUTHOR]

Background: The study explores differences and similarities in background and problem severity among those seeking Opioid Substitution Treatment (OST), comparing those who primarily had misused "opiates", e.g. heroin, morphine and opium, with those who primarily had misused other opioids.Methods: Patients (n = 127) assessed for possible admittance in OST are compared based on the Addiction Severity Index. Two groups based on primary type of opioid misused are compared (opiates vs. other opioids).Results: In the global severity ratings there were no significant differences between the groups other than tautological artefacts concerning heroin. There were few specific differences between the groups. The opiate group more often had Hepatitis C and more often had legal problems related to financing their misuse. Injection of drugs was the main method of administration in both groups, i.e. 90 % for mostly opiates vs. 75 % for mostly other opioids. A great majority in both groups, 96 % vs. 91 %, had misused most other types of drugs. Both groups were found to have severe problems in all areas investigated.Conclusions: The study demonstrates great similarities in problem severity among those seeking OST, both those who primarily had misused opiates and those who primarily had misused other opioids. [ABSTRACT FROM AUTHOR]

Aim To document the evolution over 40 years (from 1973 to 2013) of Coolmine Therapeutic Community (Ireland's first voluntary drug treatment service) against a background of broader drug policy developments in the Republic of Ireland and elsewhere during this period. Methods Data were gathered by means of archival research within Coolmine, complemented by semi-structured interviews with former clients, current and former Coolmine management and staff, and representatives of outsider stakeholder interests. Results Coolmines's history has three phases: (1) an early and uncontentious phase, in which external authorities provided financial support for Coolmine without questioning its work practices or outcomes; (2) a middle, controversial phase, in which Coolmine struggled for survival in an external policy environment now dominated by harm reduction strategies; and (3) a final phase in which, through the use of conventional corporate governance, Coolmine management sought to repair its damaged reputation by introducing evidence-based clinical practices. Conclusions Coolmine Therapeutic Community was established when drug treatment services in Ireland were in their infancy, and its changing fortunes over subsequent decades reflected changing perceptions of what constitutes appropriate addiction treatment-and in particular the role to be played by former addicts within addiction treatment systems-as well as changing perceptions of funding relationships between statutory authorities and voluntary providers of health and social services. [ABSTRACT FROM AUTHOR]

The article discusses a study of the retention in medication-assisted treatment among patients suffering from opiate dependence. Topics covered include the medication and behavioral therapy factors associated with retention, the difference in the retention rates of patients who received a placebo and those who were treated with naltrexone or buprenorphine, and the potential of contingency management to improve the retention.

Methadone maintenance has dominated opiate addiction treatment in the United States for decades. Since 2002, opiate addiction has also been treated in general medical settings with a substance called buprenorphine. Based on interviews and participant observation conducted in northern California, this article analyzes how discourses of freedom and normalcy in patient and provider narratives reflect and affect experiences with this treatment modality. I discuss how buprenorphine treatment, in contrast to methadone maintenance, offers patients and providers a greater sense of autonomy and flexibility in how they receive and deliver treatment. It presents them with new obligations, responsibilities, and choices around care and conduct. It simultaneously perpetuates and shapes a desire to be "free" and "normal." I argue that the therapeutics of buprenorphine govern patients and providers through this desire for freedom and normalcy. Buprenorphine is thus a technology of governmentality that extends neoliberal discourses and values and produces self-governing subjects. [ABSTRACT FROM AUTHOR]

The article discusses the "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health" report which was issued by the U.S. Department of Health and Human Services' Office of the Surgeon General, and it mentions how the drug overdose death rate for teenage opioid abusers in America increased in 2015. Opioid addiction and opioid abuse treatment are examined, along with U.S. public health, early substance use initiation, and tobacco use in the country.

Background and Aims Relapse to addiction following incarceration is common. We estimated the feasibility and effectiveness of extended-release naltrexone (XR-NTX) as relapse prevention among opioid-dependent male adults leaving a large urban jail. Design Eight-week, proof-of-concept, open-label, non-blinded randomized effectiveness trial. Setting New York City jails and Bellevue Hospital Center Adult Primary Care clinics, USA. Participants From January 2010 to July 2013, 34 opioid-dependent adult males with no stated interest in agonist treatments (methadone, buprenorphine) received a counseling and referral intervention and were randomized to XR-NTX ( n = 17) versus no medication ( n = 17) within one week prior to jail release. Intervention XR-NTX (Vivitrol®; Alkermes Inc.), a long-acting injectable mu opioid receptor antagonist. Measures The primary intent-to-treat outcome was post-release opioid relapse at week 4, defined as ≥10 days of opioid misuse by self-report and urine toxicologies. Secondary outcomes were proportion of urine samples negative for opioids and rates of opioid abstinence, intravenous drug use (IVDU), cocaine use, community treatment participation, re-incarceration and overdose. Findings Acceptance of XR-NTX was high; 15 of 17 initiated treatment. Rates of the primary outcome of week 4 opioid relapse were lower among XR-NTX participants: 38 versus 88% [ P<0.004; odds ratio (OR) = 0.08, 95% confidence interval (CI) = 0.01-0.48]; more XR-NTX urine samples were negative for opioids, 59 versus 29% ( P<0.009; OR = 3.5, 95% CI = 1.4-8.5). There were no significant differences in the remaining secondary outcomes, including rates of IVDU, cocaine use, re-incarceration and overdose. Conclusion Extended-release naltrexone is associated with significantly lower rates of opioid relapse among men in the United States following release from jail when compared with a no medication treatment-as-usual condition. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effectiveness of mindfulness-based group therapy (MBGT) compared to the usual opioid dependence treatment (TAU).Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS) were randomly assigned into experimental (Mindfulness-Based Group Therapy) and control groups (the Usual Treatment).The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program. Methods: The Five Factor Mindfulness Questionnaire (FFMQ) and the Addiction Sevier Index (ASI) were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. Results: The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. Conclusion: The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders. [ABSTRACT FROM AUTHOR]

Chronic pain is one of the most common complaints in the United States. Opioids have become a frequently prescribed treatment for patients with chronic nonmalignant pain. Concurrently, opioid use disorders have risen to epidemic levels. Studies investigating iatrogenic opioid addiction have been of limited quality. Aberrant drugrelated behaviors may be warning signs of impending addiction. Proper screening and close monitoring are essential for managing patients on opioids for chronic nonmalignant pain.Chronic pain is one of the most common complaints in the United States. Opioids have become a frequently prescribed treatment for patients with chronic nonmalignant pain. Concurrently, opioid use disorders have risen to epidemic levels. Studies investigating iatrogenic opioid addiction have been of limited quality. Aberrant drugrelated behaviors may be warning signs of impending addiction. Proper screening and close monitoring are essential for managing patients on opioids for chronic nonmalignant pain. [ABSTRACT FROM AUTHOR]

There has been a well documented increase in the use and abuse of prescription opioids and heroin in the United States and other parts of the world. There has also been an increasing focus to increase access to the use of medications (methadone, buprenorphine, Naltrexone/Vivitrol) for opioid addicted individuals under legal supervision. As policymakers engage in strategic initiatives to better prevent and effectively treat chronic opioid addiction, both in the United States and other countries, there are a number of unintended consequences, complicating how best to increase access to effective treatment. [ABSTRACT FROM PUBLISHER]

The aim of this study is to determine the factors that influence the treatment response and to contribute to the development of treatment protocols that are specific to our society. This study was conducted on 50 patients who were diagnosed with opiate addiction in the İstanbul Faculty of Medicine, Department of Psychiatry, Istanbul University. They were first interviewed at the inpatient ward during detoxification and were followed up monthly at the Addiction Outpatient Unit after discharge. During the first and the forth interview (at the end of the third month) the Addiction Severity Index (ASI), the Zuckerman-Kuhlman Personality Questionnaire, the Levenson Psychopathy Scale, the Addiction Treatment Success Factors Predicting Scale, the Visual Analog Scale, and the Perceived Stress Scale were administered. During the interviews at the first, second, and third months after discharge, the Visual Analog Scale was administered. At each visit, a urine sample was collected from the patients in order to screen for opiates, cocaine, cannabis, benzodiazepines, and amphetamines. The patients with a positive urine test result for any substance were excluded from the follow up. A total of 50 opiate addicted patients were included in the study, 82% (n = 41) of them were males, 18% (n = 9) were females, and their ages were between 20 and 69 years. We found that age, educational level, gender, type of substance use, perceived stress, medical condition, business-support status, drug and alcohol use, legal status, family and social relationships, psychiatric condition, craving, personality traits, psychopathy, and social and environmental factors did not have predictive value for short term treatment success among patients with opiate addiction. [ABSTRACT FROM AUTHOR]

Opiate addiction is a chronic disorder, accompanied by remissions and relapses. Treatment of drug addiction is a long-term process, involving multiple interventions to achieve withdrawal. The aim of the study was the evaluation of heroin addicted patients during treatment with methadone and Suboxone. Our results showed significant differences among patients receiving both types of treatment, in terms of age, duration of heroin use and history of first treatment, which were higher in methadone receiving patients. Also there are no significant differences that have been observed among patients with regard to retention over the treatment monitoring period (1 year) and relapse to heroin use. Methadone remains the most widely used substance in the treatment of opioid dependence, owing to its good acceptability by patients; at the same time, it reduces both illicit drug use and criminal activity associated with drug procurement. The treatment of a drug addict does not consist of administration of medicines alone: it requires psychological, social and medical interventions as well. [ABSTRACT FROM AUTHOR]

Addiction is a significant issue in many aspects but no explanatory closure has been attained. The overemphasis on the brain disease paradigm upheld by the National Institute on Drug Abuse may run serious risks, and the present study intends to counteract this partiality. Drawing on Ludwik Fleck’s notion of thought collectives, this article offers a close reading of the works of sociologists Bingham Dai and Alfred R. Lindesmith vis-à-vis other coeval biomedical approaches. Individuals within the same thought collective, such as Dai and Lindesmith, have different views although they share certain thought styles. As noted in this study, inter-collective communication is not typically antagonistic and may form some liaison under certain circumstances. These findings imply that communication among collectives may facilitate creative liaison, as suggested by Fleck. This study aims to enrich the understanding of addiction by coordinating biomedical and sociological sciences through minimizing, if not erasing, their intellectual antagonism and social distance. [ABSTRACT FROM PUBLISHER]