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نتیجه جستجو - Opioid use disorder

تعداد مقالات یافته شده: 15
ردیف عنوان نوع
1 Assessing the impact of drug courts on provider-directed marketing efforts by manufactures of medications for the treatment of opioid use disorder
ارزیابی تأثیر دادگاه های مواد مخدر در تلاشهای بازاریابی ارائه شده توسط تولیدکنندگان دارو برای درمان اختلال استفاده از مواد مخدر-2020
Background: Opioid use disorder (OUD) has become an increasingly consequential public health concern, especially in the United States where 47,600 opioid overdose deaths occurred in 2017 (Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019). Medications for OUD (MOUD) are effective for decreasing opioid-related morbidity and mortality, including within the criminal justice system (Hedrich et al., 2012; Medications for Opioid Use Disorder Save Lives, 2019; Moore et al., 2019).While a stronger evidence base exists for agonist MOUD than for antagonist MOUD, a national study of drug courts found that half prohibited agonist MOUD (Matusow et al., 2013).Furthermore, recent media reports suggest that the pharmaceutical manufacturer of an antagonist MOUD has marketed its product towards drug court judges (Goodnough & Zernike, 2017; Harper, 2017). However, no study to date has systematically examined the relationship between MOUD marketing practices and drug courts. This ecological study examines the association at the county level between MOUD manufacturer payments to prescribers and drug court locations. Method: We extracted provider-directed payments from Centers for Medicare and Medicaid Services (CMS)s Sunshine Act Open Payments data 2014–2017, isolating those records mentioning any MOUD. We compared provider-directed payments for two major MOUDs: buprenorphine and extended-release naltrexone, in counties with and without drug courts. Results: The presence of any adult drug courts in the county is associated with a 7.86 percentage-point increase in the likelihood of providers in that county receiving any MOUD-related payments (about 22.46% of the sample mean, p<0.001) and with a 10.70% increase in the amount of these payments per 1000 county residents (p<0.001). The association between other forms of drug courts such as juvenile drug courts and Driving-Under-the-Influence courts (DUI) courts are less significant and slightly smaller in magnitude compared to those of adult drug courts. We did not find significant difference between payments by the manufacturer of Vivitrol and manufacturers of Zubsolv, Bunavail, and Suboxone (oral forms of buprenorphine). Conclusions: Our results show an ecological association at the county level between MOUD manufacturer payments to prescribers and drug court presence. However, we did not examine a causal association between these variables.
مقاله انگلیسی
2 Comparing views on civil commitment for drug misuse and for mental illness among persons with opioid use disorder
مقایسه دیدگاه ها در مورد تعهد مدنی برای سو مصرف مواد و بیماری روانی در بین افراد مبتلا به اختلال استفاده از مواد افیونی-2020
Despite the growing use of civil commitment for drug use disorders, little is known about attitudes among individuals who might be subject to civil commitment. This study examined attitudes of persons with opioid use disorder toward civil commitment for drug misuse and for psychiatric illness. Consecutive persons entering a brief, inpatient opioid detoxification (n = 254) were surveyed regarding their attitudes about civil commitment for mental illness and for drug use, and responses were compared by commitment type and by individual history of being civilly committed for opioid misuse. Participants endorsed high support for civil commitment (both psychiatric and drug misuse-related) when used to address risk of harm to self, to others, and of criminal activity. Respondents were more likely to support civil commitment for psychiatric disorders than for drug misuse, expressing higher support for civil commitment in general, higher agreement with the criteria used to justify civil commitment, and greater perceived efficacy of commitment. Individuals previously committed for opioid misuse were less likely to support drug misuserelated commitment on the basis of its perceived efficacy. These results suggest individuals with opioid use disorder hold more favorable views toward civil commitment for mental health disorders than for drug misuse, and reinforce the need for more research on the procedures and outcomes related to civil commitment for drug misuse.
مقاله انگلیسی
3 Cost-effectiveness analysis of a large jail-based methadone maintenance treatment continuation program in New Mexico
تجزیه و تحلیل مقرون به صرفه بودن یک برنامه ادامه درمان نگهداری متادون مبتنی بر زندان در نیومکزیکو-2020
The U.S. has the second-highest incarceration rate in the world and spends more than $80 billion annually to house inmates. The clinical research literature suggests that methadone maintenance treatment (MMT) is an effective method to treat opioid use disorders (OUD) and that jails are a potentially valuable environment to implement MMT. Currently, jail-based MMT is rarely implemented in practice, due in part to resource limitations and other economic considerations. The primary goal of this study was to perform a cost-effectiveness analysis (CEA) of jail-based MMT using data from a unique MMT continuation program located in a large urban jail in New Mexico. Recidivism data were collected for a three-year period both before and after incarceration, and quasi-control groups were constructed from both substance-using and general populations within the jail. Base models show that inmates enrolled in jail-based MMT exhibited significantly fewer days of incarceration due to recidivism (29.33) than a group of inmates with OUDs who did not receive MMT. Economic estimates indicate that it cost significantly less ($23.49) to reduce an incarcerated day using jail-based MMT than incarceration per se ($116.49). To mitigate potential sample selection bias, we used both propensity-score-matching and difference- in-differences estimators, which provided comparable estimates when using the OUD non-MMT comparison group. Difference-in-differences models find that, on average, MMT reduced recidivism by 24.80 days and it cost $27.78 to reduce an incarcerated day using jail-based MMT. Assuming a willingness to pay threshold of the break-even cost of reducing one incarcerated day, we estimate a 93.3% probability that this MMT program is cost-effective. Results were not as strong or consistent when using other comparison groups (e.g., alcohol-detoxified and general-population inmates). Overall, results suggest that it costs substantially less to provide jailbased MMT than incarceration alone. Jail administrators and policymakers should consider incorporating MMT in other jail systems and settings.
Keywords: Opioid use disorder | Methadone maintenance | Cost-effectiveness analysis | Jail | Recidivism
مقاله انگلیسی
4 The Negative Affect of Protracted Opioid Abstinence: Progress and Perspectives From Rodent Models
تأثیر منفی پرهیز از مصرف مواد افیونی طولانی: پیشرفت و چشم انداز مدل های جوندگان-2020
Opioid use disorder (OUD) is characterized by the development of a negative emotional state that develops after a history of long-term exposure to opioids. OUD represents a true challenge for treatment and relapse prevention. Human research has amply documented emotional disruption in individuals with an opioid substance use disorder, at both behavioral and brain activity levels; however, brain mechanisms underlying this particular facet of OUD are only partially understood. Animal research has been instrumental in elucidating genes and circuits that adapt to long-term opioid use or are modified by acute withdrawal, but research on long-term consequences of opioid exposure and their relevance to the negative affect of OUD remains scarce. In this article, we review the literature with a focus on two questions: 1) Do we have behavioral models in rodents, and what do they tell us? and 2) What do we know about the neuronal populations involved? Behavioral rodent models have successfully recapitulated behavioral signs of the OUD-related negative affect, and several neurotransmitter systems were identified (i.e., serotonin, dynorphin, corticotropin-releasing factor, oxytocin). Circuit mechanisms driving the negative mood of prolonged abstinence likely involve the 5 main reward–aversion brain centers (i.e., nucleus accumbens, bed nucleus of the stria terminalis, amygdala, habenula, and raphe nucleus), all of which express mu opioid receptors and directly respond to opioids. Future work will identify the nature of these mu opioid receptor–expressing neurons throughout reward–aversion networks, characterize their adapted phenotype in opioid abstinent animals, and hopefully position these primary events in the broader picture of mu opioid receptor–associated brain aversion networks.
Keywords: Mood | Mu opioid receptor (MOR) | Neural circuits | Opioid use disorder (OUD) | Opioid withdrawal | Rodent behavior
مقاله انگلیسی
5 Prevalence and socio-demographic correlates of law enforcement involvement among treatment-seeking adult males with opioid use disorder
شیوع و همبستگی های اجتماعی و جمعیت شناختی مشارکت نیروی انتظامی در بین مردان بالغ متقاضی درمان مبتلا به اختلال مصرف مواد افیونی-2020
Aim: Use of various substances, including opioid use is often associated with coming in contact with the lawenforcement agencies. Data are scarce on the unique socio-demographic and clinical correlates from the Indian population. The current study aims to explore the clinical and socio-demographic correlations of law enforcement involvement among treatment-seeking adult males with opioid use disorder.
Method: We screened adult males presenting for the treatment of opioid use disorder at the outpatient department of a tertiary care hospital in North India. We measured law enforcement involvement by asking if the patient was ever apprehended by police, had any pending legal case against them, had any history of drug trafficking, or had any history of incarceration. We divided the entire study population based on law enforcement involvement versus no involvement. We compared both the groups in terms of socio-demographic and other clinical parameters. Binary logistic regression analysis was carried out to find the independent predictors of law enforcement involvement in this population.
Results: Out of a total of 204 patients with opioid use disorder, sixty-two participants (30.4%) had a history of law enforcement involvement, with all 62 of them being apprehended by the police at least once, 27 (13.2%) had a history of incarceration, 13 (6.4%) had a criminal case pending and 3 (1.5%) had a history of peddling drugs. We found out that high-risk sexual behavior, injecting drug use, and urban residence were associated with involvement with law enforcement.
Conclusion: Getting involved with the law- enforcement agencies among patients with opioid use disorders may be associated with high-risk behaviors. Legal involvement among opioid-dependent individuals may also be an impediment to the treatment processes, especially when such patients are incarcerated.
Keywords: Substance use | Opioid use | Criminal activities | Justice system | Economic burden | India | Correlation
مقاله انگلیسی
6 “You are not clean until youre not on anything”: Perceptions of medicationassisted treatment in rural Appalachia
"شما تمیز نیستید تا وقتی که در هر چیزی هستید": برداشت از درمان با کمک دارو در دهستان آپالاچیا-2020
Background: Medication-assisted treatment (MAT) is an evidence-based strategy to treat opioid use disorder (OUD). However, MAT-related stigma reduces MAT uptake, which is particularly low in rural areas. To date, perceptions and attitudes towards MAT in rural settings have not been described. Objective: This qualitative study aims to characterize perceptions and attitudes towards MAT and the environmental factors contributing to these views in Appalachian Ohio. Methods: From February to July 2018, semi-structured interviews were conducted with 34 stakeholders (12 healthcare professionals, 12 substance use treatment providers, 7 law enforcement agents and judicial officials, and 3 members of relevant organizations) in three rural counties in Appalachian Ohio. Interviews were transcribed, coded, and analyzed to characterize the risk environment and participants’ perceptions and attitudes towards MAT. Results: Participants expressed or described pervasive MAT-related stigma in the region. Participants consistently described three elements of the environment affecting stigma: (1) a “conservative” culture in which abstinence is necessary to be in recovery successfully, (2) fear of medication diversion and abuse, and (3) drug court policies that keep MAT out of the criminal justice system. Conclusion: MAT-related stigma will need to be addressed to tackle the opioid epidemic through evidence-based treatment effectively.
Keywords: Medication-assisted treatment | Opioid use disorder | Stigma | Appalachia | Rural | Risk environment
مقاله انگلیسی
7 A Scoping Review of Barriers and Facilitators to Implementation of Medications for Treatment of Opioid Use Disorder within the Criminal Justice System
مروری گسترده از موانع و تسهیل کننده های اجرای داروها برای درمان اختلال استفاده از مواد افیونی در سیستم عدالت کیفری-2020
Background: Policies aimed at addressing the high rates of opioid overdose have prioritized increasing access to medications for treatment of opioid use disorder (MOUD). Numerous barriers exist to providing MOUD within the criminal justice system and/or to justice-involved populations. The aim of this study was to conduct a scoping review of the peer-reviewed literature on implementation of MOUD within criminal justice settings and with justice-involved populations. Methods: A systematic search process identified 53 papers that addressed issues pertaining to implementation barriers or facilitators of MOUD within correctional settings or with justice-involved populations; these were coded and qualitatively analyzed for common themes. Results: Over half of the papers were published outside of the U.S. (n = 28); the most common study designs were surveys or structured interviews (n = 20) and qualitative interviews/focus groups (n = 18) conducted with correctional or treatment staff and with incarcerated individuals. Four categories of barriers and facilitators were identified: institutional, programmatic, attitudinal, and systemic. Institutional barriers typically limited capacity to provide MOUD to justice-involved individuals, which led to programmatic practices in which MOUD was not implemented following clinical guidelines, often resulting in forcible withdrawal or inadequate treatment. These programmatic practices commonly led to aversive experiences among justice-involved individuals, who consequently espoused negative attitudes about MOUD and were reluctant to seek treatment with MOUD following their release to the community. Facilitators of MOUD implementation included increased knowledge and information from training interventions and favorable prior experiences with individuals being treated with MOUD among correctional and treatment staff. Few systemic facilitators to implementing MOUD with justiceinvolved individuals were evident in the literature. Conclusion: Barriers to implementing MOUD in criminal justice settings and/or with justice-involved populations are pervasive, multi-leveled, and inter-dependent. More work is needed on facilitators of MOUD implementation.
Keywords: opioid use disorder | medication | criminal justice system | implementation | barriers | facilitators
مقاله انگلیسی
8 Developing interagency collaboration to address the opioid epidemic: A scoping review of joint criminal justice and healthcare initiatives
در حال توسعه همکاری بین سازمانی برای رسیدگی به اپیدمی مواد مخدر: یک بررسی گسترده از ابتکارات مشترک کیفری و بهداشت و درمان-2020
Background: With the current opioid epidemic impacting well over half of all counties across the United States, initiatives that encourage interagency collaboration between first responder organizations appear necessary to comprehensively address this crisis. Police, fire, and emergency medical services (EMS) are in a unique position to identify substance users and provide necessary resources to initiate treatment, yet there is not sufficient evidence of joint collaborative programs between law enforcement/first responders and healthcare providers. Methods: In this scoping review we examine the current state of joint criminal justice and healthcare interventions, specifically, opioid and substance use pre-arrest initiatives via emergency first responders and police officers. We relied on data from the last 10 years across three major databases to assess the extent of criminal justice (CJ) and healthcare collaborations as a response to individuals with opioid use disorder (OUD). We specifically focused on interventional programs between criminal justice first responders (pre-arrest) and healthcare providers where specific outcomes were documented. Results: We identified only a small number (6) of studies involving interventions that met this criteria, suggesting very limited study of joint interagency collaboration between law enforcement first responders and healthcare providers. Most had small samples, none were in the southern states, and all but one were initiated within the last 5 years. Conclusions: Although studies describing joint efforts of early intercept criminal justice responses and healthcare interventions were few, existing studies suggest that such programs were effective at improving treatment referral and retention outcomes. Greater resources are needed to encourage criminal justice and healthcare collaboration and policies, making it easier to share data, refer patients, and coordinate care for individuals with OUD.
Keywords: Opioid use disorder | First responder | Interagency collaboration | Mortality
مقاله انگلیسی
9 Statewide collaborative partnerships among American Indian and Alaska Native (AI/AN) communities in California to target the opioid epidemic: Preliminary results of the Tribal Medication Assisted Treatment (MAT) key informant needs assessment
مشارکت های مشترک ایالتی بین جوامع بومی سرخپوستان آمریکا و آلاسکا (کالیفرنیا) برای هدف گیری اپیدمی مواد مخدر: نتایج اولیه ارزیابی نیازهای مخبر کلیدی درمان دارویی قبیله ای (MAT)-2020
American Indian and Alaska Native (AI/AN) communities have disproportionately been impacted by the opioid epidemic with the second highest opioid-related overdose death rates compared to other ethnic groups. The diversity among California AI/AN tribes, including regional differences in economic opportunities, tribal affiliation and organization, resources and infrastructure, requires a strong community-based partnership approach to assess global statewide patterns in service availability, acceptability, and utilization, as well as capturing the unique challenges and service needs within each region. This article describes a statewide communitybased needs assessment of strengths and weakness among key informants in CA to identify facilitators and barriers to treatment of substance use disorders (SUD) and opioid use disorders (OUD). We conducted structured interviews of 21 healthcare professionals from Urban Indian Health Programs, Tribal clinics and communitybased organizations throughout California. The interview assessed (1) barriers to accessing services; (2) risk factors; (3) protective factors; (4) community substance use description; (5) SUD and OUD services available; and (6) service system needs. Findings indicate an overall increase in SUD and OUD in AI/AN communities. Key informants discussed the importance of comprehensive and culturally centered care, wrap-around services, such as treatment of mental health issues alongside substance abuse, and the need for AI/AN-specific treatment facilities that integrate traditional and cultural activities into western health services.
Keywords: American Indian/Alaska Native | Medication-assisted treatment | Opioid use disorder | Substance use disorder | Traditional healing
مقاله انگلیسی
10 Treating opioid use disorders in the criminal justice system with pharmacotherapy
درمان اختلالات استفاده از مواد افیونی در سیستم عدالت کیفری با دارو درمانی-2020
Background: People who suffer from opioid use disorders (illicit and prescription opioids) are disproportionately involved in criminal activities and a high percentage of those incarcerated suffer from these disorders. Despite the established efficacy of pharmacotherapy for opioid use disorders this intervention is infrequently offered to criminal justice populations. This review sets out to understand the nature of the relationship between opioid use disorders and criminal offending and the efficacy of pharmacotherapy in reducing both relapse and criminal recidivism, with a view to informing policy and practice. Methods: A narrative review of the published literature in the area of opioid use, criminal offending, and pharmacotherapy efficacy, was undertaken. Results: The evidence shows that (1) there is a high prevalence of opioid misuse in the criminal offending population; (2) criminal recidivism amongst those with an opioid use disorder is high (3) pharmacotherapy proves effective for opioid use disorders during and after incarceration, and (4) pharmacotherapy for offending populations decreases both relapse to drug-taking and criminal recidivism. Conclusion: The findings show that responding to opioid use disorders in the criminal justice system with pharmacotherapy is warranted.
Keywords: Substance use disorders | Opioid use disorders | Criminal offending | Treatment | Policy
مقاله انگلیسی
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