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Objectives: To prospectively assess rates of QT prolongation, arrhythmia, syncope, and sudden cardiac death (SCD) in a cohort of people with heroin dependence. Methods: To estimate rates of QT prolongation, arrhythmia, and syncope, a subcohort (n = 130) from the Australian Treatment Outcomes Study, a prospective longitudinal cohort study of 615 people with heroin dependence, underwent medical history, venepuncture, and ECG at the 18- to 20-year follow-up. To estimate rates of SCD, probabilistic matching for the entire cohort was undertaken with the Australian Institute of Health and Welfare National Death Index. Deaths were classified into suicide, accidental overdose, trauma, unknown, and disease, which were then further subclassified by probability of SCD. SCD rate was the number of possible or probable SCDs divided by total patient years from the cohort. Results: From the subcohort, 4 participants (3%) met the criteria for QT prolongation; 3 were prescribed methadone. Seven participants (5%) reported history of arrhythmia, including 2 transferred frommethadone to buprenorphine. Thirty participants (23%) reported a previous syncopal event--14 diagnosed as nonarrhythmic syncope and 13 not investigated. In the previous 12 months, 66 participants (51%) reported heroin use; 55 participants (42%) were prescribed methadone. No participant had QTc greater than 500 milliseconds. Therewere 3 possible SCDs, translating to an estimated SCD rate of 0.29 (CI: 0.05, 0.8) events per 1000 patient years.More cohort members died of overdose (n = 50), suicide (n = 11), and hepatitis C (n = 4). Conclusions: Low rates of QT prolongation, arrhythmia, syncope, and SCD in the cohort despite high rates of heroin use and methadone treatment. [ABSTRACT FROM AUTHOR]

Introduction: There is emerging evidence that posttraumatic-stress disorder may have mediating effects in development of chronic-non-cancer-pain and opioid-use-disorder independently, but its impact on the development of opioid-use-disorder in people with chronic-non-cancer pain is still unclear. Objectives: (i) Estimate the risk of opioid-use-disorder among individuals with chronic-non-cancer-pain and posttraumatic-stress disorder, relative to those with chronic-non-cancer-pain only, and (ii) identify potential correlates of opioid-use-disorder among people with chronic-non-cancer-pain and posttraumatic-stress disorder. Methods: This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Longitudinal, epidemiological, cohort, follow-up, retrospective, prospective and cross-sectional studies reporting measures of variance on the likelihood of developing opioid-use-disorder with posttraumatic-stress disorder among individuals with chronic-non-cancer-pain were identified from six-electronic databases (Medline, Embase, Evidence-based Medicine reviews, PsycINFO, Scopus and Web of Science) until December 2022. Results: Three out of the four studies, which met the selection criteria for this analysis reported statistically significant positive association between risk of developing opioid-use-disorder with posttraumatic-stress disorder among chronic-non-cancer-pain cohort (unadjusted Relative-Risk range: 1.51–5.27) but this association was not evident in the fourth study (adjusted Relative-Risk: 0.96; statistically non-significant), when adjusted for sociodemographic variables. The increased risk was noted particularly with females and chronic musculoskeletal pain conditions. Conclusions: Posttraumatic-stress disorder can increase the risk of development of opioid-use-disorder among people with chronic-non-cancer-pain and a better understanding of this relationship will help to predict and prevent the development of opioid-use-disorder and may also help in reducing the disability and burden associated with chronic-non-cancer-pain. Perspective: This review quantifies the risk of developing opioid-use-disorder in the context of posttraumatic-stress disorder among individuals with chronic-non-cancer-pain. Awareness and subsequent practice change will reduce the increasing global burden associated with the chronic-non-cancer-pain. [ABSTRACT FROM AUTHOR]

Cannabis use is common among individuals with opioid use disorder, but it remains unclear whether cannabis use is associated with an increase or a reduction in illicit opioid use. To overcome limitations identified in previous longitudinal studies with limited follow-ups, the authors examined a within-person reciprocal relationship between cannabis and heroin use at several follow-ups over 18 to 20 years. The Australian Treatment Outcome Study (ATOS) recruited 615 people with heroin dependence in 2001 and 2002 and reinterviewed them at 3, 12, 24, and 36 months as well as 11 and 18–20 years after baseline. Heroin and cannabis use were assessed at each time point using the Opiate Treatment Index. A random-intercept cross-lagged panel model analysis was conducted to identify within-person relationships between cannabis use and heroin use at subsequent follow-ups. After accounting for a range of demographic variables, other substance use, and mental and physical health measures, an increase in cannabis use 24 months after baseline was significantly associated with an increase in heroin use at 36 months (estimate=0.21, SE=0.10). Additionally, an increase in heroin use at 3 months and 24 months was significantly associated with a decrease in cannabis use at 12 months (estimate=−0.27, SE=0.09) and 36 months (estimate=−0.22, SE=0.08). All other cross-lagged associations were not significant. Although there was some evidence of a significant relationship between cannabis and heroin use at earlier follow-ups, this was sparse and inconsistent across time points. Overall, there was insufficient evidence to suggest a unidirectional or bidirectional relationship between the use of these substances. [ABSTRACT FROM AUTHOR]

There is increasing recognition that the high rates of co-occurring mental disorders among clients of substance use treatment services require alcohol and other drugs (AOD) workers to be skilled in their identification, management, and treatment. Despite advances in e-learning, to our knowledge, based on our review of the literature, there are no training programs with the capacity to build foundational knowledge, attitudes, and confidence in mental health, essential to the provision of evidence-based practice. The current study evaluated an evidence-based online program developed to address this gap, in a pre–post-design. One-hundred-fifteen Australian AOD workers completed pre- and post-training online surveys. Participants rated level of agreement with statements assessing comorbidity-related knowledge, attitudes, and confidence, which were reassessed immediately post-training. The overwhelming majority of participants found the training useful (94%), were satisfied (97%), and reported having gained knowledge that would enable them to work more effectively with comorbidity-related issues (95%); 89% reported having used skills gained in clinical practice. The starkest improvements were observed in relation to improved confidence and knowledge following training completion. Findings illustrate that online training programs, such as this could be used to improve the capacity of the current workforce, as well as the next generation of clinicians, to respond to comorbid mental health conditions. [ABSTRACT FROM AUTHOR]

Prior to being tested for HCV infection, participants were asked about their hepatitis C status, their most recent visit to a primary health care provider, whether they had a regular primary health care provider, and whether their regular provider was their opioid treatment program prescriber. Hepatitis C status was defined as active (HCV RNA-positive) or past infection (HCV RNA-negative, anti-HCV antibody-positive), not exposed (anti-HCV antibody-negative), or unknown. The likelihood of active hepatitis C was higher for participants who did not have regular general practitioners or whose primary physician was their opioid treatment program prescriber than for those with regular general practitioners who were not their opioid treatment program prescribers (15 of 51 [29%] I v i 10 of 79 [13%]; OR, 2.9; 95% CI, 1.2-7.0). [Extracted from the article]

Introduction: Trauma exposure among clients of substance use treatment services is almost universal and rates of trauma‐related symptoms are correspondingly high. This study examined one aspect of clinical care—clinical documentation—and sought to systematically assess the documentation of trauma‐related comorbidities and their treatment in a substance use treatment setting. Methods: A retrospective chart review was conducted on a sample of 300 patient records in a public substance use treatment setting. Rates of documentation of trauma‐related events, symptoms and treatment, along with variables influencing the documentation of these issues, were examined. Results: Trauma‐related documentation was present in 45.3% of records. There were documented trauma‐related symptoms in 15.3% of records, although treatment activities addressing trauma were only present in 2.3% of records. Being female (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.42, 4.69), having prior mental health treatment (OR 1.82, 95% CI 1.05, 1.12) and having more treatment sessions (OR 1.08, 95% CI = 1.05, 1.12) increased the odds of trauma‐related documentation being present, while being in the first episode of treatment (OR 0.49, 95% CI = 0.28, 0.84) decreased the odds. Discussion and Conclusions: This study highlights significant under documentation of trauma‐related comorbidities in substance‐use treatment. There is limited evidence of consideration of trauma‐related symptoms or diagnoses, and trauma‐related comorbidities are rarely included in treatment planning activities. The lack of documented trauma‐related information has important clinical and medico‐legal implications for patients, and provides evidence to suggest a lack of integration of treatment for trauma‐related disorders in substance use settings. [ABSTRACT FROM AUTHOR]

Background and Aims: The idea that cannabis is a 'gateway drug' to more harmful substances such as opioids is highly controversial, yet has substantially impacted policy, education and how we conceptualize substance use. Given a rise in access to cannabis products and opioid‐related harm, the current study aimed to conduct the first systematic review and meta‐analysis on the likelihood of transitioning from cannabis use to subsequent first‐time opioid use, opioid use disorders (OUD), dependence or abuse. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, pubMed/MEDLINE, Scopus, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials and Informit Health Collection were searched for full‐text articles assessing the likelihood of transitioning from cannabis to subsequent opioid use, and from opioid use to OUD, abuse or dependence given prior cannabis use. Analysis of subpopulations within studies were discussed narratively, and E‐values were calculated to assess the potential influence of unmeasured confounding. Findings Six studies provided relevant data from the United States, Australia and New Zealand between 1977 and 2017, a total sample of 102 461 participants. Random‐effects analysis of the adjusted pooled effect size indicates that the likelihood of transitioning from cannabis to opioid use, relative to non‐cannabis users, is odds ratio (OR) = 2.76, 95% confidence interval (CI) = 2.26–3.36, whereas the likelihood of transitioning from opioid use to OUD, abuse or dependence given prior cannabis use is OR = 2.52, 95% CI = 1.65–3.84. While the evidence was determined to be of low quality with moderate risk of bias, E‐values suggest that these findings are robust against unmeasured confounding. Conclusion: A systematic review and meta‐analysis found that while people who use cannabis are disproportionately more likely to initiate opioid use and engage in problematic patterns of use than people who do not use cannabis, the low quality of the evidence must be considered when interpreting these findings. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Over half of people presenting to alcohol/other drug (AOD) treatment services also have a mental health condition. Guidelines support numerous viable treatment options, meaning that treatment decisions need to be evidence based and patients' preferences need to be considered. Shared decision‐making (SDM) facilitates evidence‐ and preference‐based decisions and is well researched in other health‐care areas. Little is known, however, about people's attitudes towards and experience of SDM in co‐occurring AOD and mental health conditions. Design and Methods: Systematic literature review via key database searches MEDLINE, EMBASE, PsycINFO, Scopus, the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews (January 2000–July 2019). Two independent reviewers assessed study eligibility, extracted data and rated study quality using a validated tool. Results: Of 2393 articles identified, 10 studies were retained for final inclusion. The reviewed studies suggested that SDM is a well‐accepted and preferred approach to treatment decision‐making. SDM‐based interventions are viewed as feasible, acceptable and useful; are associated with improvements in the quality of the decision‐making process and the decision made; and have accrued less consistent evidence to support improvements in patient‐related outcomes (e.g. symptoms, treatment adherence/engagement). Discussion and Conclusions: This is the first rigorous synthesis of the empirical literature on SDM in co‐occurring AOD and mental health conditions. SDM remains a nascent area of research in comorbidity treatment. Preliminary evidence supports SDM's acceptability, feasibility and utility in managing mental health and AOD comorbidities. Further research is needed to build the evidence base, especially with regard to the efficacy of SDM at improving patient‐related outcomes. [ABSTRACT FROM AUTHOR]