Persistence of heroin use despite methadone treatment: Poor coping self‐efficacy predicts continued heroin use

Aim. To evaluate the association between coping self‐efficacy and persistent use of heroin by patients enrolled in a methadone treatment program. Design and Methods. Cross‐sectional survey. One hundred and ninety‐one patients attending outpatient methadone clinics in South‐East England, United Kingdom. Validated questionnaires were used to assess drug use (Maudsley Addiction Profile), alcohol use (Alcohol Use Disorders Identification Test), mental health (Hospital Anxiety and Depression Scale) and coping self‐efficacy (brief 8‐item Drug Taking Confidence Questionnaire). Results. Half of the participants (95/191) reported heroin use in the preceding 14‐day period. Heroin use during methadone treatment was associated with financial problems (P = 0.008), spending time with other drug users (P < 0.001), cocaine use (P = 0.002), low mood (P = 0.002) and dissatisfaction with the daily methadone dose (P = 0.014). Compared with ‘Heroin‐abstinent’ patients, the ‘Heroin’ group reported significantly lower mean coping self‐efficacy scores (t = 9.8, d.f. = 182, P < 0.001, effect size 1.17). After correcting for the effects of co‐variants in a logistic regression model, the main determinants of persistent heroin use were ‘coping self‐efficacy’[B ?0.05; standard error (SE) 0.008; Wald 36.6; odds ratio (OR) 0.95, 95% confidence interval (CI) 0.94, 0.97; P < 0.001] and ‘dissatisfaction with methadone dose’ (B 0.93; SE 0.46; Wald 4.1; OR 2.5, 95% CI 1.03, 6.25; P = 0.042). Satisfaction with methadone dose showed no association with self‐efficacy. Discussion and Conclusions. While heroin use during methadone treatment can partly be explained by inadequate dosing, our data suggest a more complex picture with significant contribution from poor coping self‐efficacy. Efforts aimed at enhancing and maintaining the patients' self‐efficacy and social skills are likely to improve heroin and other drug use outcomes with added benefits for treatment completion rates and the throughput of methadone programs.[Senbanjo R, Wolff K, Marshall EJ, Strang J. Persistence of heroin use despite methadone treatment: Poor coping self‐efficacy predicts continued heroin use. Drug Alcohol Rev 2009]     

Predictors of Illicit Drug Use Among Prisoners

Background: The United States of America currently has the highest incarceration rate in the world, and approximately 80% of incarcerated individuals have a history of illicit drug use. Despite institutional prohibitions, drug use continues in prison, and is associated with a range of negative outcomes. Objectives: To assess the relationship between prison drug use, duration of incarceration, and a range of covariates. Results: Most participants self-reported a history of illicit drug use (77.5%). Seven percent reportedly used drugs during the previous six months of incarceration (n = 100). Participants who had been incarcerated for more than a year were less likely than those incarcerated for longer than a year to report using drugs (OR = 0.50; 95% CI = 0.26–0.98). Participants aged 37–89 were less likely than younger prisoners to use drugs (OR = 0.39; 95% CI = 0.19–0.80). Heroin users were twice as likely as nonheroin users to use drugs (OR = 2.28; 95% CI = 1.04–5.03); crack cocaine users were also twice as likely as participants with no history of crack cocaine usage to report drug use (OR = 2.53; 95% CI = 1.13–5.69). Conclusions: Correctional institutions should be used as a resource to offer evidence-based services to curb drug usage. Drug treatment programs for younger prisoners, heroin and crack cocaine users, and at the beginning of a prisoner's sentence should be considered for this population.     

Incarcerated intravenous heroin users: Predictors of post-release utilization of methadone maintenance treatment

Incarcerated intravenous heroin users have more problematic patterns of heroin use, but are less likely to access methadone maintenance treatment by their own initiative than heroin users in the community. The present study examined predictors for receiving methadone maintenance treatment post-release among incarcerated intravenous heroin users within a 24-month period. This cohort study recruited 315 incarcerated intravenous heroin users detained in 4 prisons in southern Taiwan and followed up within the 24-month period post-release. Cox proportional hazards regression analysis was applied to determine the predictive effects of sociodemographic and drug-use characteristics, attitude toward methadone maintenance treatment, human immunodeficiency virus serostatus, perceived family support, and depression for access to methadone maintenance treatment after release. There were 295 (93.7%) incarcerated intravenous heroin users released that entered the follow-up phase of the study. During the 24-month follow-up period, 50.8% of them received methadone maintenance treatment. After controlling for the effects of the detainment period before and after recruitment by Cox proportional hazards regression analysis, incarcerated intravenous heroin users who had positive human immunodeficiency virus serostatus (HR = 2.85, 95% CI = 1.80–4.52, p < .001) and had ever received methadone maintenance treatment before committal (HR = 1.94, 95% CI = 1.23–3.05, p < .01) were more likely to enter methadone maintenance treatment within the 24-month follow-up period. Positive human immunodeficiency virus serostatus with fully subsidized treatment and previous methadone maintenance treatment experiences predicted access of methadone maintenance treatment post-release. Strategies for getting familiar with methadone maintenance treatment during detainment, including providing methadone maintenance treatment prior to release and lowering the economic burden of receiving treatment, may facilitate entry of methadone maintenance treatment for incarcerated intravenous heroin users.     

A comparison of 1-year substance abuse treatment outcomes in community syringe exchange participants versus other referrals

This longitudinal cohort study of 324 consecutive admissions to methadone maintenance treatment between 08/1994 and 09/1997 compared 1-year outcomes of opioid-dependent patients referred from a syringe exchange program (SEP; n=81) versus other sources (n=243). All participants received stepped-based counseling. The Addiction Severity Index was completed upon admission. Treatment outcomes were assessed using weekly urine testing and days in treatment. GEE regression models were used to evaluate the association between baseline variables and treatment outcomes. SEP referrals were older, included more males and African Americans, reported greater unemployment and heavier heroin, cocaine, and injection drug use at admission. During treatment, SEP referrals used more opioids (OR 2.57; 95% CI 1.86-3.56) and cocaine (OR 2.77; 95% CI 1.93-3.95), and were less likely to complete 1 year (35%) compared to other referrals (56%; hazard ratio 1.88; 95% CI 1.35-2.62). Nevertheless, referral source was not significantly associated with outcome when adjusted for baseline characteristics. Greater baseline frequency of substance and injection drug use, and younger age were positively associated with ongoing opioid and cocaine use. African American race and baseline unemployment were also associated with ongoing cocaine use. Younger age and greater baseline cocaine use were associated with poorer retention at 1 year. The poorer treatment response of SEP referrals is likely due to higher baseline problem severity. Specialized interventions may be required to reduce drug use and improve retention in this population.     

Metabolic syndrome among individuals with heroin use disorders on methadone therapy: Prevalence,characteristics, and related factors

ABSTRACT

Background: Observational studies have reported a high prevalence of obesity and diabetes in subjects on methadone therapy; there are, however, limited data about metabolic syndrome. The aim of the study was to evaluate the prevalence of metabolic syndrome and related factors in individuals with heroin use disorder on methadone therapy. Methods: A cross-sectional study in individuals with heroin use disorder on methadone therapy at a drug abuse outpatient center. Medical examinations and laboratory analyses after a 12-hour overnight fast were recorded. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Results: One hundred and twenty-two subjects were included, with a mean age of 46.1 ± 9 years, a median body mass index (BMI) of 25.3 kg/m² (interquartile range [IQR]: 21.2–28), and 77.9% were men. Median exposure to methadone therapy was 13 years (IQR: 5–20). Overweight and obesity were present in 29.5% and 17.2% of the participants, respectively. Metabolic syndrome components were low high-density lipoprotein (HDL) cholesterol (51.6%), hypertriglyceridemia (36.8%), high blood pressure (36.8%), abdominal obesity (27.0%), and raised blood glucose levels (18.0%). Abdominal obesity was more prevalent in women (52% vs. 20%, P = >0.01) and high blood pressure more prevalent in men (41.1% vs. 22.2%, P = .07). Prevalence of metabolic syndrome was 29.5% (95% confidence interval [CI]: 16.6–31.8). In the multivariate logistic regression analysis, BMI (per 1 kg/m² increase odds ratio [OR]: 1.49, 95% CI: 1.27–1.76) and exposure time to methadone therapy (per 5 years of treatment increase OR: 1.38, 95% CI: 1.28–1.48) were associated with metabolic syndrome. Conclusions: Overweight and metabolic syndrome are prevalent findings in individuals with heroin use disorder on methadone therapy. Of specific concern is the association of methadone exposure with metabolic syndrome. Preventive measures and clinical routine screening should be recommended to prevent metabolic syndrome in subjects on methadone therapy.     

Combined effects of law enforcement and substitution treatment on heroin mortality

Introduction and Aims. To explore the combined effects of street‐level law enforcement and substitution treatment programs on drug‐related mortality, taking into account prevalence of heroin use and changes in injecting behaviour. Design and Methods. Time trend analysis using annual police reports and case register data of opioid substitution treatments in Switzerland, 1975–2007. Results. Drug‐related mortality increased during times of more intense street‐level law enforcement [odds ratio (OR) 1.32, 95% confidence interval (95% CI) 1.15–1.51], and the number of drug‐related deaths predicted the number of heroin possession offences 2 years later (r = 0.97, P < 0.001). Substitution treatment had a protective effect on drug‐related mortality (OR 0.23, 95% CI 0.18–0.30). Surprisingly, the number of drug‐related deaths was substantially biased by an oscillation period of 14 years (OR 1.24, 95% CI 1.17–1.32). Discussion and Conclusions. Our analysis revealed that the amount of police resources allocated to law enforcement was determined rationally, however, on biased grounds and with untoward consequences. Substitution treatment of heroin users reduced drug‐related mortality in the long run, but different factors masked its impact for several years. Therefore, the introduction—or the expansion—of opioid substitution treatment programs should not be promoted with the argument of an immediate reduction of drug‐related deaths in a country.[Nordt C, Stohler R. Combined effects of law enforcement and substitution treatment on heroin mortality. Drug Alcohol Rev 2010]     

Utilization of buprenorphine and methadone among opioid users who inject drugs

ABSTRACT

Background: There has been a rise in opioid abuse and related injection drug use in the United States, and treatment for opioid use disorders may be underutilized. The study aim was to describe utilization of opioid agonist therapy (OAT), and assess factors associated with utilization of OAT, among persons who inject drugs (PWID) in the Seattle metropolitan area. Methods: Data were obtained from the 2015 National HIV Behavioral Surveillance (NHBS) system among PWID in the Seattle area. Persons aged ≥18 years who injected drugs in the past year were recruited using respondent-driven sampling. Local supplemental questions assessed whether participants had received methadone or buprenorphine treatment in the past year. The analysis was restricted to participants who reported use of any opioids in the past year. Analyses compared the demographic, health insurance status, duration of injection drug use, prior history of overdose, prior receipt of hepatitis C virus/human immunodeficiency virus (HCV/HIV) testing (self-report), and screening positive for HCV/HIV via study testing between methadone- or buprenorphine-treated and untreated PWID. Multivariate logistic models were performed to assess adjusted associations with receipt of any OAT. Results: The sample included 487 PWID who used opioids in the past year, of whom 27.1% (95% confidence interval [CI]: 23.1–31.1) reported past-year treatment with methadone and 4.7% (95% CI: 2.8–6.6) reported treatment with buprenorphine. There were no significant differences in demographics among participants who did and did not report past-year OAT; however, participants who were treated with methadone were more likely to be insured and have hepatitis C. After adjustment for other covariates, having health insurance was strongly associated with receipt of OAT (adjusted odds ratio [aOR] = 18.6; 95% CI: 2.5–138.7). Conclusions: OAT, in particular buprenorphine, has been underutilized by opioid-using PWID in the Seattle area. Health insurance is a critical factor for enabling PWID to utilize OAT treatment for opioid use disorders.     

The willingness of people who inject drugs in Boston to use a supervised injection facility

ABSTRACT

Background: In Massachusetts, the number of opioid-related deaths has increased 350% since 2000. In the setting of increasing overdose deaths, one potential intervention is supervised injection facilities (SIFs). This study explores willingness of people who inject drugs in Boston to use a SIF and examines factors associated with willingness. Methods: A cross-sectional survey of a convenience sample of 237 people who inject drugs and utilize Boston's needle exchange program (NEP). The drop-in NEP provides myriad harm reduction services and referrals to addiction treatment. The survey was mostly self-administered (92%). Results: Results showed positive willingness to use a SIF was independently associated with use of heroin as main substance (odds ratio [OR]: 5.47; 95% confidence interval [CI]: 1.9–15.4; P = .0004), public injection (OR: 5.09; 95% CI: 1.8–14.3; P = .002), history of seeking substance use disorder (SUD) treatment (OR: 4.99; 95% CI: 1.2–21.1; P = .05), having heard of SIF (OR: 4.80; 95% CI: 1.6–14.8; P = .004), Hispanic ethnicity (OR: 4.22; 95% CI: 0.9–18.8; P = .04), frequent NEP use (OR: 4.18; 95% CI: 1.2–14.7; P = .02), current desire for SUD treatment (OR: 4.15; 95% CI: 1.2–14.7; P = .03), hepatitis C diagnosis (OR: 3.68; 95% CI: 1.2–10.1; P = .02), posttraumatic stress disorder (PTSD) diagnosis (OR: 3.27; 95% CI: 1.3–8.4; P = .01), report of at least 1 chronic medical diagnosis (hepatitis C, human immunodeficiency virus [HIV], hypertension, or diabetes) (OR: 3.27; 95% CI: 1.2–8.9; P = .02), and comorbid medical and mental health diagnoses (OR: 2.93; 95% CI: 1.2–7.4; P = .02). Conclusions: Most respondents (91.4%) reported willingness to use a SIF. Respondents with substance use behavior reflecting high risk for overdose were significantly more likely to be willing to use a SIF. Respondents with behaviors that contribute to public health burden of injection drug use were also significantly more likely to be willing to use a SIF. Results indicate that this intervention would be well utilized by individuals who could most benefit from the model. As part of a broader public health approach, SIFs should be considered to reduce opioid overdose mortality, decrease public health burden of the opioid crisis, and promote access to addiction treatment and medical care.     

The Cedar Project: methadone maintenance treatment among young Aboriginal people who use opioids in two Canadian cities

Introduction and Aims. The Cedar Project is a community‐based study aiming to identify variables associated with ever being on methadone maintenance treatment (MMT) among young Aboriginal people using drugs and to discuss possible barriers to MMT in this population. Design and Methods. This is a prospective cohort study with recruitment by health‐care providers, outreach, and word of mouth in Vancouver and Prince George. Participants included 605 Aboriginal participants who were age 14–30 years, reported illicit drug use in the month prior to enrolment, and provided written informed consent. Variables associated with ever being on MMT were analysed through χ²‐testing and multivariate logistic regression, limited to people reporting opioid use (n = 397). Results. Less than half of participants reporting daily injection of opioids had ever been on MMT. In adjusted multivariate logistic regression analyses, older age [odds ratio (OR) 1.17; 95% confidence interval (CI) 1.08–1.28)]; female gender (OR 3.76; 95% CI 2.00–7.07); hepatitis C antibody positivity (OR 2.76; 95% CI 1.53–4.95); and daily opioid injection (OR 2.59; 95% CI 1.46–4.61) were positively associated with ever being on MMT. Weekly or more alcohol use (OR 0.43; 95% CI 0.21–0.87) was negatively associated with ever being on MMT. Discussion and Conclusion. MMT access by young Aboriginal people is low. The associations between MMT use and other variables need further study to steer efforts directed at recruitment into MMT. The removal of barriers to MMT and inclusion of young Aboriginal people in the development of treatment programs based on Indigenous values are urgently required to help Aboriginal people who use drugs.[Yang J, Oviedo‐Joekes E, Christian KWM, Li K, Louie M, Schechter M, Spittal P. The Cedar Project: Methadone maintenance treatment among young Aboriginal people who use opioids in two Canadian cities. Drug Alcohol Rev 2011;30:645–651]     

A two-week pilot study of intranasal oxytocin for cocaine-dependent individuals receiving methadone maintenance treatment for opioid use disorder

About 30–60% of the patients receiving methadone for opioid use disorder (OUD) actively use cocaine. Cocaine use disorder (CUD) has no FDA-approved pharmacological treatment; existing psychosocial treatments are inadequate. Oxytocin (OT), a social neuropeptide, has preclinical promise as an adjunctive treatment for both OUD and CUD. Twenty-two individuals receiving methadone for OUD with co-occurring CUD were randomized to receive OT or placebo intranasally 40?IU twice daily for two weeks. A priori aims were feasibility and safety. Exploratory effectiveness aims included laboratory-based measures of drug craving, drug-related implicit cognition, and drug use. High retention rates (93.5%), the absence of study-related adverse events, and the fact that OT was well tolerated in this population support the feasibility of larger trials. Two weeks of OT (but not placebo) significantly reduced cocaine craving at day 15 compared to baseline (mean change?±?SD: OT?=??0.23?±?0.19, p?=?0.004; PL?=??0.16?±?0.29, p?=?0.114). For heroin craving, the placebo group reported a trend-level increase over time while the OT group remained unchanged – with medium to large effect sizes between the groups (Cohen’s d?=?0.71–0.90). OT led to a significant switch from implicit self-association with drugs to implicitly associating drugs with others (mean change?±?SD: 0.25?±?0.35, p?=?0.037) and a trend-level reduction in self-reported cocaine use over time (Z?=??1.78, p?=?0.075). Furthermore, OT significantly increased the accuracy of self-reported cocaine use when correlated with quantitative urine levels of cocaine metabolite. This proof-of-concept study provides promising early evidence that OT may be an effective adjunct to the treatment of co-occurring CUD and OUD. Further investigation with larger trials is warranted.     

Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack

AimsTo analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors in a clinical non-experimental setting.DesignRetrospective study.SettingA community drug service in London, UK.Participants325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine).MeasurementsLogistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start (or at the date of transfer to another service).FindingsFor the general model participants choosing methadone were more likely to use heroin at follow up (OR = 2.36, 95% CI: 1.40–3.17) as were daily crack users on methadone (OR = 2.62, 95% CI: 0.96–7.16).For the methadone model only daily crack use predicted heroin use at follow up (OR = 2.62, 95% CI: 0.96–7.16).For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR = 0.85, 95% CI: 0.75–0.95; OR = 1.31, 95% CI: 1.06–1.60 and OR = 6.04, 95% CI: 1.26–28.92). Both use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR = 6.68, 95% CI: 0.37–119.59; OR = 106.31, 95% CI: 3.41–3313.30) and daily (OR = 57.49 (95% CI: 2.37–1396.46; OR = 170.99 (95% CI: 4.61–6339.47) users.ConclusionsMost of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. Crack use was a significant predictor of heroin abstinence at follow up in all models, however for buprenorphine only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.     

Notes from practice: Methadone prescribing in north central London—doses,compliance, goals and treatment setting

Aims: To examine methadone prescribing in public drug treatment services in inner London; compare levels of methadone prescribing with national guidelines and surveys; investigate whether methadone reduces illicit opiate use; and compare clients treated in specialist clinics with those in shared-care in general practice.

Methods: A cross-sectional survey of four drug treatment services in north central London.

Findings: Data were collected on 715 clients. Mean methadone dose was 57.2?mg but for clients on methadone maintenance, the mean dose was 63.4?mg. Reported heroin use fell from 24.8 days in the last 30 at initial assessment to 11 days (p?<?0.001). Clients on methadone doses greater than 60?mg were more likely than those on lower doses to test negative for morphine on urinalysis (49% vs. 39.4%, p?<?0.01). Clients in GP shared-care were more likely to have been in treatment for less time, be on lower doses of methadone and have stabilization or detoxification as their treatment goal.

Conclusions: Methadone treatment is associated with a reduction in illicit opiate use but not abstinence. Inadequate doses and lack of supervised consumption may in part explain the relatively poor response to treatment. Clients in GP shared-care received substantially different treatment from those in the specialist clinics.     

Family Related Factors and Concurrent Heroin Use in Methadone Maintenance Treatment in China

Background: The use of heroin during Methadone Maintenance Treatment (MMT) is a challenging problem that contributes to poor treatment outcomes. Families may play an important role in addressing concurrent heroin use during MMT, especially in collectivist societies such as China. Objectives: In this study, we explored the relationship between family-related factors and concurrent heroin use during MMT in China. Methods: This study was conducted at 68 MMT clinics in five provinces of China. There were 2,446 MMT clients in the analysis. Demographic information, MMT dosage, family members' heroin use status, family support of MMT, family problem, and self-reported heroin use were collected in a cross-sectional survey. The most recent urinalysis of opiate use was obtained from clinical records. Results: Of the 2,446 participants, 533 (21.79%) self-reported heroin use in the previous seven days or had a positive urine morphine test result in the clinic record. Participants whose family member[s] used heroin were 1.59 times (95% CI: 1.17, 2.15) more likely to use concurrently during treatment. Those with family members who totally support them on the MMT were less likely to use (AOR: 0.75, 95% CI: 0.60, 0.94). Having more family problems was positively associated with concurrent heroin use (AOR: 2.01, 95% CI: 1.03, 3.93). Conclusions: The results highlight the importance of the family's role in concurrent heroin use during MMT programs. The study's findings may have implications for family-based interventions that address concurrent heroin use.     

One-Year and Cumulative Retention as Predictors of Success in Methadone Maintenance Treatment: A Comparison of Two Clinics in the United States and Israel

ABSTRACT

Outcome predictors between two methadone maintenance treatment clinics in Tel-Aviv, Israel, and Las Vegas, Nevada, were determined by comparing patients' characteristics. All patients admitted to the two clinics (302 from Las Vegas and 492 from Tel-Aviv) were studied with respect to variables at admission and follow-up. Las Vegas patients were older, contained more females, had more hepatitis C positive markers, and more urine analyses that were positive for cocaine, amphetamines, and tetrahydrocannabinol (THC) on admission than the Tel-Aviv patients. After 1 year, Tel-Aviv patients had higher retention (73.6% vs. 61.6%) and similar opiate abstinence (65.8% vs. 64.9%) compared to Las Vegas patients. Predictors for cumulative retention (Cox regression) for both clinics were higher methadone dosages greater than or equal to 100 mg/day (Tel-Aviv OR [odds ratio] = 2.1, 95% confidence interval [CI] = 1.6–2.9; Las Vegas OR = 1.8, 95% CI = 1.3–2.5). Also, in Tel-Aviv, predictors were no opiate use after 1 year (OR = 1.7, 95% CI = 1.4–2.2) and no benzodiazepine after 1 year, and in Las Vegas no cocaine and no amphetamines after 1 year and age less than or equal to 30 years. The two major predictors in the two clinics were successful in both outcomes: 1 year retention and opiate abstinence.     

Recent incarceration and buprenorphine maintenance treatment outcomes among human immunodeficiency virus–positive patients

Background: Opioid use disorder is a common cause of morbidity and mortality among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Buprenorphine maintenance treatment (BMT) is an effective means of therapy, but patients with recent criminal justice involvement may need more support during BMT than other patients. The authors hypothesized that recently incarcerated BMT patients who initiated treatment in primary care would have poorer treatment outcomes than those who were not recently incarcerated. Methods: Investigators analyzed data from a multisite cohort study of BMT integrated into HIV care. Patients were stratified by self-reported incarceration in the 30 days before initiation of BMT. The outcomes of interest were 6- and 12-month treatment retention and self-reported opioid use. Investigators used multivariable logistic regression and hierarchical linear model, respectively, to evaluate the association between recent incarceration and these outcomes while adjusting for potential confounding variables. Results: Among 305 BMT patients living with HIV/AIDS, 39 (13%) reported recent incarceration. Patients with recent incarceration (vs. without) were more likely to be homeless, unemployed, and previously diagnosed with mental illness. Recent incarceration was not significantly associated with differences in 6-month (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.46–1.98) and 12-month (OR = 0.57; 95% CI = 0.27–1.18) treatment retention or in self-reported opioid use (OR = 0.99; 95% CI = 0.51–1.92) after adjustment for potential confounding variables. Conclusions: Those with incarceration in the 30 days prior to BMT initiation were more likely to be homeless, unemployed, and previously diagnosed with mental illness than those without recent incarceration. However, no significant difference in self-reported opioid use or 6-month or 12-month retention in treatment was detected between those with and without recent incarceration. Future studies should confirm these findings with larger sample sizes. Encouraging formerly incarcerated individuals with opioid use disorder to initiate evidence-based treatments, including BMT, should be part of efforts to confront the opioid addiction epidemic in the United States.     

Psychological Characteristics of the Haight “Junkie”

Abstract

Interviews were conducted with a sample of jailed intravenous opioid users who were not in treatment at the time of their arrest and who were admitted to an in-jail methadone maintenance program. At release, subjects were to be referred to dedicated slots in participating community methadone programs. Virtually all subjects were daily injectors of heroin and cocaine. Although the majority of subjects had previous episodes of methadone maintenance, most reported anxieties about methadone, such as bone decalcification and possible overdosing. Women and subjects who shared needles were more likely to report fears about methadone. Only 52% of the subjects stated that they intended to report to a methadone program after their release and 45% did not expect to remain in treatment for more than one year. Subjects who stated that they were not afraid of methadone, frequently injected drugs, and rarely used crack were more likely to express intentions to enroll and remain in community methadone treatment. Ambivalence toward methadone treatment may be a result of unrealistic concerns about the side effects of methadone and personal heuristics regarding the nature of addiction and the efficacy of treatment.     

Correspondence between Oral Fluid Drug Test Results and Self-Reported Illicit Drug Use among Music Festival Attendees

Background: Use of illicit substances is often under-reported. Testing positive in oral fluid provides an objective confirmation of recent intake. Objectives: To examine the agreement between oral fluid test results and self-reported substance use among music festival attendees, and factors associated with reporting past 48?h drug use among users identified by drug testing. Methods: One thousand three hundred nine participants were recruited from six music festivals in Norway (June–August 2016). They completed a questionnaire and provided oral fluid samples analyzed for amphetamines, MDMA, tetrahydrocannabinol (cannabis), and cocaine. Additionally, their blood alcohol levels were measured. Results: Overall, 5.5% reported use of amphetamines, cannabis, cocaine, and/or MDMA during past 48?h in the questionnaire, whereas 10.8% tested positive in oral fluid. Only 16.7% of identified cocaine users and 31.1% of identified MDMA users reported past 48?h cocaine or MDMA use, respectively. Higher proportions of identified cannabis and amphetamine users reported past 48?h use (53.8% and 55.6%, respectively). Multivariable logistic regression analysis showed that among participants who tested positive, those reporting weekly illicit substance use (Adjusted Odds Ratio [AOR] 30.6; 95% Confidence Interval [CI] 6.3–147.9), and using such substances when younger than 18?years (AOR 5.0; 95% CI 1.9–13.4) were more likely to report past 48?h use. Conclusions/Importance: Oral fluid testing appears to be an important tool when studying illicit substance use among music festival attendees, as significant under-reporting was observed. Among those testing positive, regular, and experienced users were more likely to report recent use, compared to less regular and experienced users.