Search

Introduction: Opioid agonist treatment (OAT) is an effective treatment for opioid dependence syndrome in adults. However, studies on effectiveness of OAT in adolescents are limited; existing studies show varying retention rates. The present study aimed to assess OAT retention rates in adolescent patients with opioid dependence syndrome registered in a community drug treatment clinic in Delhi, India, and to analyse factors associated with retention at 1 year. Methods: Retrospective cohort study. All adolescents (n = 130) aged 10–19 years, started on OAT from January 2020 to July 2022 were included. Baseline and follow‐up data was extracted from online record system maintained at the clinic. OAT retention rates at different timepoints were assessed. Multivariable logistic regression was used to discern factors associated with one‐year retention. Results: The participants' mean age was 16.9 (SD 1.4) years. Mean age of starting opioids was 14.9 (SD 2.2) years; 29.5% (n = 38) injected opioids. The 6‐, 12‐, 18‐ and 24‐month retention rate on OAT was 64.4%, 45.6%, 38.7% and 29% respectively. The retention rates with buprenorphine and methadone were comparable. Multivariate logistic regression showed retention for less than 12 months to be significantly associated with younger age of starting heroin, involvement in illegal activities, absenteeism from school and substance use in family. Discussion and Conclusions: The 12‐month retention rates on OAT in adolescents is comparable to retention rates in adults. Various factors associated with early age of onset of opioid use are also associated with lower retention rates on OAT. [ABSTRACT FROM AUTHOR]

Objective To assess the implementation of a mobile dispensing service to improve opioid users' access to methadone maintenance therapy. Methods In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service. Findings The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9- month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients' adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites. Conclusion It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic. Distribution mobile de methadone a Delhi, en Inde: etude de la mise en oeuvre Objectif Analyser la mise en oeuvre d'un service de distribution mobile destine a ameliorer l'acces des consommateurs d'opiaces au traitement de maintien a la methadone. Methodes En mars 2019, nous avons commence la distribution mobile de methadone dans une agglomeration urbaine defavorisee a Delhi, en Inde. Le medecin restait au centre communautaire de prise en charge de la toxicomanie pour assurer les services cliniques, tandis que l'infirmiere circulait dans une ambulance reconvertie pour fournir de la methadone. Nous avons demande aux patients d'identifier les responsables au sein de la communaute, afin de les inclure dans le processus de sensibilisation et de determiner quand et ou organiser la distribution. Nous avons mene un examen retrospectif des dossiers regroupant les donnees du programme, recoltees lors de la prestation des services cliniques. Enfin, nous avons compare le nombre de patients enregistres pour le traitement a la methadone, leur maintien et leur adhesion au traitement sur des periodes de 12 mois, avant et apres la mise en oeuvre de la distribution mobile. Resultats Le nombre de patients inscrits a la clinique en vue de recevoir un traitement est passe de 167 durant l'annee precedant la mise en oeuvre a 671 l'annee suivante. Un pourcentage nettement plus eleve de patients ont maintenu leur traitement 3, 6 et 9 mois apres l'avoir entame; le taux de maintien apres 9 mois etait de 19% (32/167 patients) avant la mise en oeuvre, et de 45% (44/97 patients) apres celle-ci. Aucune difference notable n'a ete constatee entre les deux periodes au niveau de l'adhesion des patients au traitement. Plusieurs defis se sont presentes: proposer des heures de distribution qui conviennent aux patients exercant un emploi, et apaiser les inquietudes de la communaute locale installee a proximite des lieux de distribution. Conclusion Il est possible de distribuer de la methadone par l'intermediaire d'une equipe mobile dans un environnement urbain, et les taux de maintien du traitement sont meilleurs que ceux observes dans une clinique fixe. Distribucion movil de metadona en Delhi (India): investigacion sobre su implementacion Objetivo Evaluar la implementacion de un servicio de distribucion movil para mejorar el acceso de los usuarios de opioides a la terapia de mantenimiento con metadona. Metodos En marzo de 2019, iniciamos la distribucion movil de metadona en una localidad urbana desfavorecida de Delhi (India). El medico solo estaba disponible en la clinica principal de tratamiento de medicamentos de la comunidad para los servicios clinicos, mientras que la enfermera dispensaba la metadona desde una ambulancia transformada. Involucramos a los pacientes en la identificacion de los lideres de la comunidad para la sensibilizacion y en la decision del lugar y los horarios de distribucion. Realizamos una revision retrospectiva de los datos del programa recogidos durante la prestacion de los servicios clinicos. Se comparo el numero de pacientes registrados para la terapia con metadona y su retencion y adherencia al tratamiento en periodos de 12 meses antes y despues de la implementacion del servicio movil. Resultados El numero de pacientes registrados para recibir tratamiento en la clinica aumento de 167 en el ano anterior a la implementacion a 671 en el ano posterior. Una proporcion significativamente mayor de pacientes siguio con el tratamiento a los 3, 6 y 9 meses de su inscripcion; las tasas de retencion a los 9 meses fueron del 19% (32/167 pacientes) y del 45% (44/97 pacientes) en el ano anterior y posterior a la implantacion, respectivamente. No hubo diferencias significativas en el cumplimiento terapeutico de los pacientes entre los dos periodos. Los desafios incluyeron la provision de un horario de distribucion adecuado para los pacientes con empleo y las preocupaciones de la comunidad local cercana a los lugares de distribucion. Conclusion Es factible la distribucion de metadona por un equipo movil en un entorno urbano, con mejores tasas de retencion en el tratamiento en comparacion con la distribucion a traves de una clinica fija., Introduction Although opioids are the second most commonly used group of illicit drugs worldwide, they cause the most harm to the health of users. Opioids account for 66% of the [...]

Background: People with Substance Use Disorder have higher adverse outcomes associated with COVID-19 infection that can be reduced with COVID-19 vaccines. Various factors influence the acceptability of COVID-19 vaccines. We assessed COVID-19 vaccine-related knowledge, attitude, and beliefs in patients on Opioid Agonist Treatment (OAT) from a community clinic in an urban impoverished area in Delhi, India. Methods: Cross-sectional design. We interviewed 200 adult males using a structured questionnaire. Results: The participants' mean age was 27.4 (SD 6.8) years; majority (68%, n = 136) had less than 10 years of schooling. While family members of 77% (n = 154) of the participants were vaccinated for COVID-19, only 32% (n = 64) of the participants had been vaccinated with at least a single dose. 43% (n = 86) felt they are ineligible for vaccine due to their addiction or their ongoing addiction treatment (46.5%, n = 93). Though the majority (78.5%, n = 157) were willing to get vaccinated, they had not done so due to concerns, such as fear of vaccine-related adverse-effects (35%). Conclusions: COVID-19 vaccination rates in individuals with opioid dependence are much lower compared to the general population. There are several misconceptions related to COVID-19 vaccinations in this population that needs to be addressed to achieve universal vaccination against COVID-19 infection. [ABSTRACT FROM AUTHOR]

Various factors limit the acceptability of methadone as an opioid agonist treatment (OAT), in which case, buprenorphine becomes the preferred alternative. The classical approach is to gradually taper methadone to a low dose and buprenorphine is initiated after some opioid-free period, which generally takes weeks. A novel approach known as ’microdosing’ or the ’Bernese method’ might serve as a valuable alternative. We describe two cases where the patients were successfully transitioned from methadone to buprenorphine using this method. [ABSTRACT FROM AUTHOR]

Background and Aims: Assessment of the severity of substance use disorders (SUDs) in a culture-sensitive manner can help gauge the current condition of the substance user and assess change with time. The present study aimed to develop a scale for the assessment of the severity of SUDs in the Indian clinical context. Methods: Based upon the review of literature on previously available instruments and a consultative meeting of experts, a clinician-rated scale was developed that finally comprised 41 items. A briefer 5-item scale with current and lifetime versions was also developed. The scales were applied to patients with SUDs at six different clinical sites. Results: The instrument was applied to 720 patients (98.2% males, mean age: 34.6 years). The Cronbach's alpha of the full scale was 0.852. The inter-rater reliability Pearson correlation coefficient of the full-scale was r = 0.821 (P < 0.001), and the intra-class correlation coefficient single measure was 0.800 (95% confidence interval: 0.724-0.956). A four-factor solution was suggested to be the most tenable. The mean application duration of the full scale was 13.4 minutes, and that of the briefer version was 2 minutes. Conclusion: This validated scale could be a potentially useful assessment measure for the severity of SUDs in the Indian context. The utility lies in the simplicity of administration and scoring and the balance between brevity and thorough assessment. [ABSTRACT FROM AUTHOR]

Background. Untreated co-occurring substance use and substance use disorders (SUDs) in patients with medical conditions may be associated with unfavourable medical outcomes. Understanding the prevalence of substance use and SUDs among patients admitted to hospital for medical illness may help in developing appropriate strategies to manage SUDs in this population and improve the outcomes of medical illness. We assessed the prevalence of substance use and SUDs among patients admitted for medical illnesses and the association between substance use and medical illness. Methods. This cross-sectional study was done in an inpatient setting in a multidisciplinary teaching medical institution in India. Using systematic sampling, adult patients admitted in various departments for at least 24 hours were interviewed using standard instruments by psychiatrists trained in the study methodology. Results. Two hundred and ninety patients participated. Their mean (SD) age was 42.2 (15.6) years. One hundred and nine participants (37.6%) reported lifetime use of any psychoactive substance, with tobacco being the most common substance used (91, 31.4%), followed by alcohol (69, 23.8%) and cannabis (12, 4.1%). Lifetime alcohol use was significantly associated with diseases of the circulatory system. Lifetime use of any substance or of alcohol, and current use of any substance or tobacco were significantly associated with injuries, poisoning and other consequences of external causes. Conclusions. A large proportion of patients hospitalized for medical illness reported the use of psychoactive substances or had SUDs. The use of some of these substances was also associated with injuries as well as diseases of the circulatory system. [ABSTRACT FROM AUTHOR]

Background: About one-fourth of individuals who are dependent on opioids use opioids through injecting route. Most of such individuals start using opioids through noninjecting route much earlier before they transition to injecting opioids. It is important to identify important factors that delineate individuals who inject opioids from those who use opioids through other routes, which was the objective of the present study. Methods: This was a cross-sectional study design. Four hundred treatment-naïve opioid users with opioid dependence were selected using a snowballing sampling technique. The drug use details, family relations, social and occupational functioning, and peer network history were assessed using a self-developed questionnaire and the use of structured instruments such as the Leeds Dependence Questionnaire Scale, High-Risk Behavior Scale, and Functional Status Questionnaire Scale. Comorbid psychiatric symptoms were assessed using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Ask Suicide-Screening Questions was used for assessing different domains of suicidality. Results: The mean age of the participants was 26 (standard deviation = 6) years. One-third (n = 136) of these were injecting opioid users (injecting drug users [IDUs]) and the remaining were taking opioids through other routes (non-IDUs). In multivariate analysis, IDUs (as compared to non-IDUs) had higher rates of family history of opioid use (odds ratio [OR] =3.53, 95% confidence interval: 1.17–8.69), incarceration history (OR = 2.16, 1.78–3.11), lower employment (OR = 0.53, 0.31–0.84), more people with <5 years of education (OR = 4.31, 2.60–12.73), lower age of starting opioid use (OR = 0.44, 0.26–0.69), more concurrent sedative use (OR = 5.60, 4.34–7), more self-harm attempts history (OR = 1.88, 1.16–3.2), larger peer groups (OR = 1.89, 1.11–2.63), and greater involvement in selling illegal drugs (OR = 1.81, 1.49–3.67). Conclusions: Various factors are significantly associated with using opioids through injecting route in individuals with opioid dependence. These factors can help identify individuals with opioid dependence who are likely to transition to injecting opioids. [ABSTRACT FROM AUTHOR]

Addiction medicine is a rapidly growing field with many young professionals seeking careers in this field. However, early-career professionals (ECPs) face challenges such as a lack of competency-based training due to a shortage of trainers, limited resources, limited mentorship opportunities, and establishment of suitable research areas. The International Society of Addiction Medicine (ISAM) New Professionals Exploration, Training & Education (NExT) committee, a global platform for early-career addiction medicine professionals (ECAMPs), conducted a two-phase online survey using a modified Delphi-based approach among ECAMPs across 56 countries to assess the need for standardized training, research opportunities, and mentorship. A total of 110 respondents participated in Phase I (online key informant survey), and 28 respondents participated in Phase II (online expert group discussions on three themes identified in Phase I). The survey found that there is a lack of standardized training, structured mentorship programs, research funding, and research opportunities in addiction medicine for ECAMPs. There is a need for standardized training programs, improving research opportunities, and effective mentorship programs to promote the next generation of addiction medicine professionals and further development in the entire field. The efforts of ISAM NExT are well-received and give a template of how this gap can be addressed. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) has added gaming disorder to ICD-11 as a clinical condition associated with distress or interference with personal functioning. This inclusion leads to clinical and public health benefits, such as harmonising terminology, offering clinical landmarks and improving monitoring capabilities and data comparability. Training health professionals to identify and manage gaming disorder is a key challenge for countries. In the present paper we compiled opinions from different countries around the globe on their state of preparedness and needs to tackle this issue. The global views on the topic feed arguments for developing an evidence-based and cross-cultural training tool for gaming disorder management by health professionals. [ABSTRACT FROM AUTHOR]

Background: Integrating mobile technologies in healthcare (mHealth) is helpful to manage various medical conditions. mHealth applications can bridge the gap in the management of patients with opioid use disorder (OUD). Research evaluating the feasibility of mHealth to address OUD is limited in developing countries. We aimed to assess the digital capacity and interest in mHealth interventions in patients maintained on opioid agonist treatment (OAT). Methods: 150 patients on OAT from a community drug treatment clinic in New Delhi, India, were included. We assessed the participants on their pattern of mobile and Internet use and their willingness to use mHealth technology to access health information and services related to OUD. Results: 88% of participants (n = 132) owned a mobile phone at assessment; 2.7% (n = 4) had never used a mobile phone in their lifetime. 70% (n = 105) participants had Internet access. 80% (n = 120) of participants showed interest in receiving text messages related to the management of OUD. 60% of participants showed a willingness to download and use applications for monitoring their substance use. Conclusions: In India, there is an interest among people on OAT to use mHealth interventions to manage their substance use. This population also has access to mobile phones and the necessary knowledge to install and run applications needed for various mHealth interventions. [ABSTRACT FROM AUTHOR]

Cannabis use is highly prevalent globally, yet little is known about primary cannabis use disorder patients, especially in India. The present study's objective was to assess clinical profile, internalized stigma, and pathways to care among this population in India. A total of thirty patients with cannabis use disorder were recruited over a nine-month period using an exploratory cross-sectional design. Assessments were undertaken using a semi-structured proforma, Internalized Stigma of Mental Illness (ISMI) – Hindi version, and WHO – Mental Health Encounter Form. Data was analyzed using SPSS V20.0. All participants were males, with a mean age of 24.57 (7.76) years. Marijuana (ganja) was the commonest form of cannabis consumed (n = 26; 86.7%). The mean duration of cannabis use and dependence was 5.03 (3.69) and 3.98 (3.22) years. The most common reason for seeking treatment was family pressure (n = 21; 70%). The mean score of ISMI-Hindi was 2.66 (0.55), suggesting moderate internalized stigma. Most participants' first treatment contact was a psychiatrist at a tertiary care de-addiction center (n = 29; 96.7%). This study highlights the need for interventions to reduce stigma in patients with cannabis use disorder patients. [ABSTRACT FROM AUTHOR]

Byline: Roshan. Bhad, Nandita. Hazari Sir, Apropos, the article titled 'Nicotine Replacement Therapy (NRT) for Palliation of Nicotine Abstinence Syndrome-Is it Worth?' in Indian Journal of Palliative Care (May − [...]

India has a huge burden of substance use disorder (SUD). The national response to the problem of SUD has been to support addiction treatment centers either in government hospitals or in nongovernmental settings. The existing number of addiction treatment facilities is less compared to the burden of substance use in India. The existing models of treatment in India place undue emphasis on inpatient treatment of SUD. Community-based treatment aims to bring the treatment of SUD closer to the patients in their community. Community-based treatment of SUD utilizes existing services available in the community by establishing an integrated network of community-based services. There have been different models of community-based care for the management of SUD in India. Most of them, however, address short-term withdrawals and do not provide long-term treatment in community. National Drug Dependence Treatment Centre, AIIMS, New Delhi, has been providing community-based treatment for SUD since the 1990s. Two of the three community drug treatment clinics (CDTCs) are in operation for more than 5 years now and cater to the population residing within a defined catchment area. The CDTCs use infrastructure available in the community to operate the clinics. The clinics are run daily by a team of nursing staff, while the doctor is available only twice a week. A menu of options, ranging from short-term treatment to long-term agonist maintenance treatment is provided in the clinic. Both pharmacotherapy and psychosocial interventions are provided. Each clinic caters to hundreds of patients through these facilities. There is a need to expand CDTCs in India considering their cost-effectiveness, acceptability, and overall effectiveness, especially in urban colonies with higher substance-related problems. [ABSTRACT FROM AUTHOR]

Substance use disorders in the elderly population can be assessed through scales and questionnaires. These scales are used for not only screening for substance use disorders but also for assessment for improvement with time and/or intervention. Validity parameters of these scales help us know how do they perform during application in the clinical or community setting. The objective of the review was to (1) review available validated screening tools for substance use disorders, (2) summarize elderly-focused studies, and (3) provide recommendations for use in clinical care. We aimed to review the validated scales of substance use disorders in the geriatric population. We looked at PubMed and Web of Science databases for identifying English language peer-reviewed publications that reported at least one validity parameter for scale in geriatric patients with substance use disorders. We identified 22 studies, with majority of them focusing on alcohol use disorder. Alcohol Use Disorder Identification Test and Cut Down, Annoyed, Guilty, and Eye-Opener Questionnaire (CAGE) were the most common scales used in the population. While most of the studies reported acceptable area under receiver operator curve, sensitivity, and specificity, some of the studies reported lower sensitivity/specificity at optimal cutoff. Validity parameters of various scales have been assessed in the geriatric population. Using suitable cutoffs, they can be useful in the screening of elderly individuals with substance-related problems, so that due evaluation and care can be provided. More instruments need to be assessed for validity to diagnose tobacco use disorders, benzodiazepine use disorders, and other substance use disorders. [ABSTRACT FROM AUTHOR]

Addictive disorders have become increasingly common in India. The health consequences of addictive disorders are immense, and the need for specialized addiction treatment and training far exceeds the capacity and human resources that currently exist. At the same time, increasing demand and treatment gap, need for specialized care, and the emerging sector of medical tourism in the country open avenues for superspecialty training in addiction psychiatry as an attractive career option for Indian psychiatrists. Human resource development and capacity building in the addiction psychiatry field in India is the need of the hour. In the present article, we describe the existing scenario and challenges related to addiction psychiatry training among postgraduate psychiatry trainees and psychiatrists in India and scope for the future. [ABSTRACT FROM AUTHOR]

Chronic pain is associated with higher rates of psychiatric comorbidity, including substance use disorders. Patients with chronic pain often require opioids for their pain relief. Often, clinicians are reluctant to prescribe opioids to patients with chronic pain due to fear of patients becoming dependent on opioids. Diagnosing opioid addiction in chronic pain with comorbid prescription opioid use is challenging, as some of the symptoms of addiction overlap with those of physical dependence. A 28-year-old female presented with a history of recurrent abdominal pain beginning at the age of 16 years. The patient was diagnosed with chronic pancreatitis and was prescribed tramadol orally or injections for pain. The patient started experiencing craving with repeated administration of tramadol. She started using it daily and increased her dose to about 6-7 ampoules per day. She also developed complications due to injections. She was not able to work due to her pain, as well as injection use. She would go to multiple chemist shops for getting herself injected with tramadol injections. She also developed depressive symptoms in this period. Due to abdominal pain, the patient was admitted in the gastroenterology ward, from where she was shifted to the psychiatry ward for the management of opioid misuse and depressive symptoms. The patient was diagnosed to be suffering from opioid dependence syndrome with depressive episodes, for which she was provided tablet buprenorphine 14 mg/day dose along with tablet sertraline 150 mg/day. The case demonstrates several challenges in the diagnosis and management of opioid dependence and chronic pain when they occur simultaneously. [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]