An exploratory study of OxyContin use among individuals with substance use disorders

This study surveyed 422 individuals being treated in a substance abuse treatment program that offers various levels of care in order to learn about OxyContin use among this population. Focus areas included exposure and use of OxyContin, how this medication was obtained, reasons for initial use, and whether users of OxyContin were drug naive or experienced users of opiate or non-opiate drugs. Whether OxyContin users who previously had never used opiates would report migrating to heroin was also explored. Findings revealed that 48% of the population had used OxyContin and of this population, only 1% had no history of prior substance use. Seventy percent of this sample obtained them from friends and 14% obtained them directly from physicians. Many reported that their friends obtained their OxyContin from physicians, bringing the percentage of people who directly or indirectly obtained OxyContin through a physician to 37%. While most users of OxyContin had a history of past opiate use, a small percentage had not, and of this later group, 73% migrated to using heroin. The majority of individuals who obtained OxyContin from a physician had a history of recreational or problematic opiate or non-opiate drug use. Finally, over time, 90% had stopped using this drug, although other drug use continued.     

Heroin snorters versus injectors: comparison on drug use and treatment outcome in age-matched samples

Drug use histories and treatment outcomes were compared for age, race and gender-matched samples of intravenous (IV; n = 28) versus intranasal (IN; n = 28) opiate abusers entering a 3-day inpatient detoxification unit. Data were derived from the Addiction Severity Index (ASI) interview. Both groups reported daily heroin use prior to detoxification, but IV users reported more days of alcohol and multiple drug use during the past 30 days. Despite age matching, IV users also started using alcohol at an earlier age and accumulated more lifetime months of regular alcohol, cocaine and multidrug use. IV users were more likely to enter treatment following the detox, but no significant outcome differences were noted at 1 and 3 months post-detoxification. The results show that intravenous, as compared to intranasal, opiate users have both a more severe pattern and a more extensive history of the use of non-opiate drugs.     

Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives

Abstract

Aims: Patient-reported outcomes have become an important source of information to guide service provision. Although opiate substitution treatment (OST) is an evidence-based and widely available intervention for opiate dependent individuals, evaluation studies have primarily focused on objective outcome indicators rather than on clients’ perspectives and personal experiences. This study aims to assess opiate users’ satisfaction with various aspects of substitution treatment and their subjective experiences and expectations regarding the provision of psychosocial support. Methods: The study sample consisted of 77 opiate-dependent individuals who had been involved in OST for at least three months in some cities in Belgium. Qualitative interviews were used to explore clients’ subjective experiences, in addition to some quantitative measures. Findings: About half of the respondents recently received some form of psychosocial support and they were generally satisfied about these services. However, the number of persons who wanted psychosocial support clearly outnumbered those actually receiving these services. Respondents stressed the importance of building trusting relationships with OST staff. Also, the need for more flexible and individualised support was emphasised. Conclusions: Compared with other stakeholders’ perspectives or traditional outcome indicators, service users’ subjective experiences shed an alternative light on the impact of opiate dependence and OST on individuals’ daily lives. This information should be incorporated in individual treatment planning and when designing and evaluating OST services.     

Treatment pathways and longitudinal outcomes for opiate users: Implications for treatment policy and planning

The aim is to model treatment pathways and outcomes of opiate users at intake and at 1- and 3-year follow-up and to assess the implications of these for treatment policy. Opiate users entering a new treatment episode were recruited. Tree diagrams were used to map treatment relapse and re-entry. A within subjects repeated measures analyses of variance was conducted on each of the outcomes. The effect of being in treatment at 1-year on the 3-year outcomes was measured controlling for the value of the outcome variable at intake. A total of 404 opiate users were recruited. Follow-up interview rates were 88.4% at 3-years. Three years after intake 15% were drug free, 70% were in treatment and 15% were not in treatment and were using illegal drugs. Analysis revealed that there were no differences between the three outcome groups at intake. Those who were not in treatment and using at 3-years had displayed little improvement at 1-year and those who were not in treatment and not using at 3-years had displayed improvements in physical and mental health outcomes at 1-year. Regardless of treatment modality, treatment policy needs to reflect, support and encourage individuals during the treatment relapse cycle.     

Methadone combined with clonidine versus clonidine alone in opiate detoxification

The availability and use of a methadone/clonidine combination versus clonidine alone in opiate detoxification were studied. In Phase I of the study, a sequential combination of methadone followed by clonidine was utilized in those patients presenting with a primary diagnosis of opiate dependence. During the Phase II of the study, only clonidine was available. Medications were administered only if the history and clinical findings indicated impending or acute opiate withdrawal syndrome. Overall, there was no difference between the Phase I and Phase II groups when the number of opiate dependent admissions, patients completing detoxification, and the patients completing a follow-up rehabilitation program were compared. However, the patients in Phase I whose clinical symptomatology warranted the use of methadone were more likely to complete the detoxification program when compared to the patients in Phase II who received clonidine only. There was no difference between the two groups in completion of a follow-up rehabilitation. Detoxification with clonidine alone was more likely to be successful if the patient has had prior detoxification experience with methadone or if there was a secondary dependence of alcohol, sedative, or tranquilizer present coexisting with the primary opiate dependence diagnosis.     

Women opiate users' perceptions of treatment services in New York City

This paper focuses on the treatment experiences of women opiate users in New York City. Historically, drug research has used male samples, and drug treatment programs have been based upon the concerns of men. Treatment counselors and administrators are typically male, and female clients are frequently outnumbered by male clients. In addition, unique needs of women are not addressed. Primary among these needs is child care, a provision that is not a standard feature of most programs. Additionally, many women opiate users may be in dysfunctional families and/or have histories of sexual victimization that may require special counselling. Using data from 208 women drug users who had been in an opiate treatment program, this paper examines their perceptions of the extent to which these programs incorporate women's distinctive concerns and the degree to which such provisions are affected by the perceived numbers of women clients in these programs.     

An evaluation of an educational programme for multiple drink-driver offenders

The criminal records of individuals who were eligible to attend a drink-driver treatment programme were obtained for the period beginning 1978 and ending 1983. The programme was educational in focus and aimed at changing attitudes toward drinking and driving, rather than altering the actual drinking behaviour of participants. Of those eligible to attend (N = 381), 62% completed the course while 38% did not attend any sessions at all or failed to complete the programme. An examination was undertaken to examine differences between those completing the course and those not completing the course for pre- and post-test measures. Significant differences were not obtained for any pre-test measures, while differences were obtained between groups on the total number of crimes after treatment and the number of traffic-related violations at post-test, but not for any other outcome measure. Attendance at the course was not found to be related to subsequent decreases in drink-driving offences. A possible explanation of this result is that the focus of educational treatments are too broad to achieve specific behaviour change for multiple drink-driver offenders. It is accepted that the lack of a control or comparison treatment group, and the simple dependent measures employed, were important in limiting the utility of the findings presented. Some suggestions for overcoming these, and other related methodological problems in drink-driving research, are given.     

Social network correlates of self-reported non-fatal overdose

The leading cause of death among heroin users is drug overdose. The present study examined the relationship between history of self-reported drug overdoses and social network characteristics among cocaine and opiate users. Data were from cross-sectional surveys administered from March 2001 through February 2003 as part of follow-up of an experimental network oriented HIV prevention intervention. A total of 838 participants with histories of cocaine and opiate use completed the survey. Several social network variables were found to be significantly associated with drug overdose in the prior 2 years, including larger number of network members who were injection drug users and a larger number of conflictual ties among the network members. Even after controlling for age, gender, frequency of injection drug and alcohol use, and health status, network variables continued to have a strong association with history of recent overdose. These data suggest that large drug networks should be targeted for drug overdose prevention interventions.     

CANADIAN ILLICIT OPIATE USERS’ VIEWS ON METHADONE AND OTHER OPIATE PRESCRIPTION TREATMENT: AN EXPLORATORY QUALITATIVE STUDY

Although methadone treatment has been available in North America for decades, only a small proportion of opiate addicts (some 25% of estimated opiate users in Canada) are receiving methadone treatment. Many users have tried methadone treatment, often multiple times, but leave treatment prematurely. Others would not consider it as a worthwhile treatment option for themselves. This exploratory study examines regular opiate users’ attitudes towards and experiences with methadone treatment in Canada, primarily setting out to determine what makes methadone an unsuccessful or even an undesirable treatment option for considerably large groups of opiate users. This empirical effort to explore the limitations of existing methadone treatment comes at an appropriate time, when alternative forms of opiate pharmacotherapy treatment are being proposed in Canada as complementary modes of intervention that hope to address the shortcomings of methadone treatment. The rationale for this study were feasibility questions and development efforts for a clinical trial in North America evaluating the effectiveness of using injectable opioids (heroin, dilaudid) in attracting and engaging treatment-resistant opiate users into treatment. Data for this exploratory qualitative study was collected in 1999 through a series of focus groups involving 47 treatment-experienced and treatment-naive opiate users in Vancouver, Montreal, and Toronto, with the objective of identifying key themes and issues on the described topic as a basis for further systematic research.     

Canadian illicit opiate users' views on methadone and other opiate prescription treatment: an exploratory qualitative study

Although methadone treatment has been available in North America for decades, only a small proportion of opiate addicts (some 25% of estimated opiate users in Canada) are receiving methadone treatment. Many users have tried methadone treatment, often multiple times, but leave treatment prematurely. Others would not consider it as a worthwhile treatment option for themselves. This exploratory study examines regular opiate users' attitudes towards and experiences with methadone treatment in Canada, primarily setting out to determine what makes methadone an unsuccessful or even an undesirable treatment option for considerably large groups of opiate users. This empirical effort to explore the limitations of existing methadone treatment comes at an appropriate time, when alternative forms of opiate pharmacotherapy treatment are being proposed in Canada as complementary modes of intervention that hope to address the shortcomings of methadone treatment. The rationale for this study were feasibility questions and development efforts for a clinical trial in North America evaluating the effectiveness of using injectable opioids (heroin, dilaudid) in attracting and engaging treatment-resistant opiate users into treatment. Data for this exploratory qualitative study was collected in 1999 through a series of focus groups involving 47 treatment-experienced and treatment-naive opiate users in Vancouver, Montreal, and Toronto, with the objective of identifying key themes and issues on the described topic as a basis for further systematic research.     

'Treatment experienced' and 'treatment naïve' drug agency clients compared

BackgroundResearch on the prevalence and significance of previous treatment is limited, but indicates that many drug agency clients have had prior drug treatment experiences. Furthermore, treatment experienced drug users have different characteristics from treatment novices at treatment entry and poorer outcomes at follow up.MethodsData from a national longitudinal study of drug users entering treatment in Scotland were analysed using univariate and multivariate techniques to provide the first systematic comparison of treatment experienced and treatment naïve drug users in the UK. Respondents (n = 653) were interviewed on four separate occasions (treatment intake, 8 months, 16 months, and 33 months) using structured questionnaires.ResultsFive hundred and fifty-eight individuals (85.5%) had had some form of previous treatment and many reported multiple previous treatments, most commonly substitute drugs. At treatment intake, treatment experienced respondents had worse drug use and life problems than treatment novices. Very high levels of illicit drug use (>85%) were reported by both treatment experienced and treatment naïve drug users at all follow-ups, with no significant differences between the two groups at any time point.ConclusionsDrug users entering treatment in Scotland have routinely had multiple earlier treatments and report high levels of illicit drug use at follow up. Contrary to some earlier research, there is no evidence that those who are treatment experienced have worse drug use outcomes than those who are treatment naïve. Findings add to the international literature on prior treatment experiences and new treatment clients’ needs.     

Using Client's Routine Urinalysis Records From Multiple Treatment Systems to Model Five-Year Opioid Substitution Treatment Outcomes

Background: At global, national, and local level, the need for ongoing, timely and cost efficient, comprehensive drug treatment monitoring, and evaluation systems have clearly been well recognized. Objectives: To test the feasibility of linking laboratory data and client intake data and its usefulness for modeling retrospectively, for the first time, 5-year longitudinal drug treatment outcomes in an Irish opiate treatment setting. Methods: A multisite, retrospective, longitudinal cohort study was implemented to evaluate outcomes for opiate users based on 1.7 million routine urinalysis results collected from 4,518 individuals presenting for opioid substitution treatment in Ireland from January 2006 to December 2010. Results: Analysis of opiates, cocaine, benzodiazepine, and cannabis use at treatment intake, 6 months and at 1–5 year follow-ups revealed differences in urinalysis protocols; significant differences in age of first drug use between those using and not using opiates at 5 years; significant decreases in opiate use; increases in benzodiazepine use and significant increasing effects of concurrent cocaine and benzodiazepine use on the odds of using opiates. Time series analysis of weekly proportions opiate positive predicted 16% (95% confidence interval: 7%–25%) of clients would be opiate positive 5 years postinitial intake. ConclusionsImportance: Underutilized urinalysis data can be used to address the need for cost effective, efficient evidence of drug-treatment outcomes across time, place, and systems. Linking and matching the cross-sectional data across sites and times also revealed where improvements in electronic records could be made.     

Combined buprenorphine and chlonidine for short-term opiate detoxification: patient perspectives

The approval in 2003 for the use of buprenorphine in opiate addiction treatment has provided physicians with a new pharmacological tool to combat opiate addiction. We surveyed a sample of 100 inpatients who completed short-term opiate detoxification treatment utilizing a combination of buprenorphine and clonidine to assess patient perspectives regarding the usefulness and tolerability of this medication regimen and to compare it to their past opiate detox experiences, if any. Patients identified pain (63%), sleep problems (57%), and anxiety (56%) as the symptoms they perceived to be most helped with buprenorphine. Over 90% of patients with past detoxification treatments rated buprenorphine treatment to be as good as or better than their past treatments. Reports of a euphoric effect were minimal (7%) and no patients reported any generalized worsening of their opiate withdrawal symptoms. We conclude that based upon patient perspectives that combining buprenorphine with clonidine is a useful and well-tolerated medication regimen for the treatment of opiate withdrawal.     

Heroin as Evil: ecstasy users' perceptions about heroin

Information gleaned from several studies suggests that non-opiate drug users view heroin and heroin users in negative terms. The present study examines this issue in greater detail through analysis of Ecstasy users' perceptions about heroin, heroin users and injectors. The data were collected through in-depth interviews with 98 current or former users of Ecstasy who were recruited through various methods in 1997-98. The findings confirm earlier reports and suggest that Ecstasy users tend to distance themselves from heroin users. The data also show that several Ecstasy users tend to believe that bad experiences with Ecstasy can be attributed to tablets laced with heroin. Explanations for these findings are offered.     

Differences Found Between Women Injectors In and Out of Treatment: Implications for Interventions

SUMMARY

Women substance abusers, particularly those who are injecting drug users, are at high risk for HIV infection. It has been demonstrated that injecting drug users found out of drug treatment settings show different patterns of drug use and HIV risk than those who enter treatment. Previous studies, however, have not indicated the extent to which women injectors in and out of treatment exhibit these same differences. This study examines data from two studies sponsored by the National Institute on Drug Abuse to determine similarities and differences between women encountered by outreach efforts in four cities and those entering methadone treatment programs in the same cities.

The results indicate significant differences in race, drugs used (both injecting and non-injecting), injecting risk behavior, and treatment history. However, the two groups of women shared similar histories of first injecting use and sexual risk. Women who entered methadone treatment reported higher frequencies of injecting drug use and HIV risk behaviors, both direct (sharing needles) and indirect (sharing cookers, cotton, and water); yet they were also more likely to clean needles and to use new needles than the women encountered through outreach. The outreach women were more likely to be African American, to inject less than daily, and to use alcohol, crack, and non-injecting cocaine daily.

The results suggest that women injectors entering treatment and those encountered in outreach are very different in their injecting intensity and HIV risk behaviors. However, both groups are still at risk for HIV infection, particularly as a result of multiple sexual partners and little reported condom use. The need to identify the risk, reinforce risk reduction maintenance, and further develop HIV prevention strategies that successfully address both the needs of these women and the differences that exist between them will be essential to stopping the spread of HIV.     

Does concurrent cocaine use compromise 1-year treatment outcomes for opiate users?

The current study aimed to determine whether cocaine use compromises treatment outcomes for opiate users. Data were collected from 404 opiate users at treatment intake and 1-year follow-up as part of a national treatment outcome study. Because of higher intake measures, cocaine users improved in more outcomes than nonusers, but comparisons between groups found that cocaine users had more coexisting problems. Regression analysis revealed that those who used cocaine at intake were more likely to use cocaine at 1-year follow-up, to commit crime, and to be homeless. It is concluded that treatment for opiate use "works" even in the presence of concurrent cocaine use.     

In-patient detoxification procedures, treatment retention, and post-treatment opiate use: comparison of lofexidine + naloxone, lofexidine + placebo, and methadone

OBJECTIVE: In-treatment and post-treatment outcomes were compared for three detoxification procedures (lofexidine+naloxone, lofexidine+placebo naloxone, and methadone). SAMPLE AND DESIGN: The sample was 137 opiate dependent in-patients. Detoxification treatments were 6-day lofexidine+naloxone (n=45), lofexidine+placebo naloxone (n=46), or 10-day methadone reduction (n=46). A cohort study design was used with double-blind random allocation to lofexidine+naloxone versus lofexidine+placebo. Patients who did not consent to, or who were excluded from randomisation received methadone. RESULTS: Outcome differences between treatment groups at follow-up were generally associated with length of stay post-detoxification rather than detoxification procedure. Among patients who were not opiate abstinent throughout follow-up (n=85), those who received lofexidine+naloxone detoxification reported a longer interval to first heroin use, with an interaction between detoxification medication and subsequent retention in treatment also identified. CONCLUSIONS: Detoxification medication may influence medium-term opiate use outcomes via its effect upon retention in treatment.     

Prediction of long-term outcome for heroin addicts admitted to a methadone maintenance program

Ten pre-treatment and nine during-treatment variables were correlated to outcome 5 years after admission to a methadone program for 171 subjects who were in treatment for at least 6 months. The pre-treatment variables were employment, education, criminal involvement, opiate and non-opiate drug abuse, periods of abstinence, age, sex, and ethnic group. During-treatment variables were employment, arrests or incarcerations, opiate and nonopiate drug abuse, living with an addict, marital status, and months of methadone treatment. Three measures of ‘successful’ outcome were defined. In general, subjects with more involvement with criminal justice before treatment, heavy alcohol use before or during treatment, continued daily heroin use or living with an addict during treatment, or minority ethnicity were more likely to have a poor outcome. However, the correlation coefficients for even the most significant correlations were weak; the highest was r = 0.26. We conclude that none of these 19 variables provide a basis for a priori judgment about whether or not a patient applying for admission to a methadone program is likely to have a favorable long-term outcome.     

Does Concurrent Cocaine Use Compromise 1-Year Treatment Outcomes for Opiate Users?

The current study aimed to determine whether cocaine use compromises treatment outcomes for opiate users. Data were collected from 404 opiate users at treatment intake and 1-year follow-up as part of a national treatment outcome study. Because of higher intake measures, cocaine users improved in more outcomes than nonusers, but comparisons between groups found that cocaine users had more coexisting problems. Regression analysis revealed that those who used cocaine at intake were more likely to use cocaine at 1-year follow-up, to commit crime, and to be homeless. It is concluded that treatment for opiate use “works” even in the presence of concurrent cocaine use.