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Background Opioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. There is limited knowledge on the health-related quality of life (HRQoL) of long-term patients in OAT. This study measures HRQoL and self-perceived health of long-term patients on OAT, compares the scores to a Norwegian reference population, and assesses changes in these scores at 1-year follow up. Methods We conducted a nested prospective cohort study among nine OAT outpatient clinics in Norway. 609 OAT patients were included, 245 (40%) followed-up one year later. Data on patient characteristics, HRQoL, and self-perceived health was collected. HRQoL was assessed with the EQ-5D-5L, which measures five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) on a five-point Likert scale (from “no problems” to “extreme problems”). An UK value set was applied to calculate index values (from 0 to 1) for the EQ-5D-5L and compare them to a Norwegian reference population. Self-perceived health was measured with EQ-VAS (from 0 to 100). Results Mean (standard deviation (SD)) EQ-5D-5L index value at baseline was 0.699 (0.250) and EQ-VAS 57 (22) compared to 0.848 (0.200) and 80(19) for the Norwegian reference population. There were large variations in EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The lowest EQ-5D-5L index values were observed for female patients, age groups older than 40 years and for methadone users. At follow-up, improvements in HRQoL were observed across almost all dimensions and found significant for mobility and pain/discomfort. Mean (SD) overall index value and EQ-VAS at follow up were 0.729 (0.237) and 59 (22) respectively. Conclusion The average HRQoL and self-perceived health of OAT patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions. Around 34% had very good HRQoL, higher than average Norwegian values, and around 5% had extremely poor HRQoL.

Research into mobile health record apps has focused on narrow outcomes, such as medication adherence for persons experiencing chronic conditions. However, no review has examined their use in the context of social exclusion. Persons experiencing social exclusion (PESE) face complex health needs, limited healthcare access, and increased exposure to traumatic life experiences. It is imperative to consider a trauma-informed and integrated care approaches when developing an app for them, and they should be involved as key stakeholders to ensure equitable care. This review examined these apps' functionalities and features that support PESE in relation to their reported outcomes and the delivery of a trauma-informed and/or integrated care. A systematic search of ten databases: Web of Science Core Collection, Medline, PsycINFO, CINAHL, Cochrane, Embase, Scopus, ProQuest Dissertations and Theses A&I, Lenus and OpenGrey International were undertaken, and was supplemented with non-indexed and grey literature. Searches were undertaken in April 2024 in English with no date limit, and used the PRISMA 2020 guidelines. Studies were deemed eligible if they met the SPIDER framework criteria. One thousand three hundred and thirty-two papers were found eligible for the review, of which eleven qualified for inclusion following screening and quality assessment using QATSDD and MMAT tools. Four themes were found (supporting integrated and connected care; enhancement of user engagement and care coordination; improving data accuracy and access to care; and provision of ongoing monitoring and feedback) related to apps' functionalities and features, which in turn were linked to reported outcomes. Although a few of these apps' functionalities and features were aligned with the six principles of trauma-informed care, none of them were implemented considering a trauma-informed care and/or integrated care. This review provided insights into the complexities of implementing a mobile health record app for PESE. However, limited available data restricted a comprehensive understanding of these apps' functionalities and features in their specific implementation settings in relation to their reported outcomes. Next steps include translating these findings into survey and interview questions to identify end-user requirements for developing an app for PESE from a trauma-informed perspective to promote integrated care. PROSPERO CRD42024535090.

Background Opioid-related harms and opioid use disorder (OUD) are health priorities requiring urgent policy responses. There have been many calls for improved OUD care in primary care, as well as increasing involvement of primary care providers in countries like Canada and Australia, which have been experiencing high rates of opioid-related harms. Methods Using Starfield’s 4Cs conceptualization of primary care functions, we examined how and why primary care systems may be suited towards, or pose challenges to providing OUD care, and identified health system opportunities to address these challenges. We conducted 14 semi-structured interviews with 16 key informants with experience in opioid use policy in Canada and Australia. Results Primary care was identified to be an ideal setting for OUD care delivery due to its potential as the first point of contact in the health system; the opportunity to offer other health services to people with OUD; and the ability to coordinate care with other health providers (e.g. specialists, social workers) and thus also provide care continuity. However, challenges include a lack of resources and support for chronic disease management more broadly in primary care, and the prevailing model of OUD treatment, where addictions care is not seen as part of comprehensive primary care. Additionally, the highly regulated OUD policy landscape is also a barrier, manifesting as a ‘regulatory cascade’ in which restrictive oversight of OUD treatment passes from regulators to health providers to patients, normalizing the overly restrictive nature and inaccessibility of OUD care. Conclusions While primary care is an essential arena for providing OUD care, existing sociocultural, political, health professional, and health system factors have led to the current model of care that limits primary care involvement. Addressing this may involve structurally embedding OUD care into primary care and strengthening primary care in general.

Background Kabul has over 12,000 people who inject drugs (PWID), most of them heroin users, and opioid substitution therapy has recently been introduced as an effective method to reduce opioid use. We aimed to evaluate a pilot Opioid Substitution Therapy Pilot Program (OSTPP) in Kabul, Afghanistan, particularly to (1) describe characteristics of the participants enrolled in the program and (2) identify factors associated with client retention in the OSTPP. Findings Two cross-sectional surveys evaluated participants attending the OSTPP at baseline ( n  = 83) and 18 months after ( n  = 57). Questionnaires assessed socio-demographic, drug use behavior, and general and mental health factors. After 18 months, 57 participants remained in the OSTPP. Participants lost to follow-up were younger ( p  < 0.01) and married ( p  < 0.01) and had no family contact ( p  < 0.01). Participants at 18 months reported no criminal activity in the last month and only two (3.5 %) reported heroin use in the last month, constituting significant decreases from baseline. Conclusions While preliminary results are promising, further evaluation is needed to determine the feasibility of implementing OSTPP in this setting and effectiveness in reducing injection risk behaviors in Afghanistan.

To understand the pattern of use of opioid-substitution therapy (OST) and opioid abuse among patients on buprenorphine maintenance using urinalysis. The study was conducted at a tertiary care de-addiction center. We reviewed the laboratory record of all consecutive urine samples sent for drug analysis over a period of 1 year. In all, 179 consecutive urine samples were included in the analysis. The chi-square test was used to compare opioid abuse among those testing positive and negative for buprenorphine on urinalysis. Additionally, in order to assess the potential impact of the prescribed induction and maximum dose of buprenorphine on the findings, we carried out the independent-samples t test. Level of statistical significance was kept at P<0.05 for all the tests. Urinalysis failed to detect buprenorphine in 44.7% of the samples. Rate of detection of dextropropoxyphene was significantly higher among buprenorphine-negative samples (P<0.005). The prescribed induction dose of buprenorphine was significantly lower among those testing positive for heroin. This was found for both buprenorphine-positive (P<0.005) as well as buprenorphine-negative samples (P<0.005). These findings support the routine use of urine drug screening among individuals on OST.

Background: Opiate substitution therapy (OST) in the Ukraine was not provided until 2004. As part of the introduction of OST, the first feasibility study was conducted in 2007. Six clinics in 6 cities were involved in providing OST and collecting data. Methods: A total of 151 opiate-dependent patients were given buprenorphine as a substitute, and a survey of substance use, HIV transmission risks, and legal and social status was conducted at baseline and at 6 and 12-month follow-up. Results: Illegal substance use and illegal activities and incomes were highly reduced, whereas employment rates and psychiatric problems improved. Retention was comparatively high (79.5%) after 12 months. No significant adverse events were reported. Conclusion: A successful implementation of OST in the Ukraine is feasible.

Excessive consumption of alcohol can exacerbate many problems, including hypertension, depression and anxiety. Alcohol is an important cause of many cancers, particularly those of the oropharynx, oesophagus and liver. If someone is dependent on alcohol, they will experience withdrawal symptoms within about 12 hours of stopping drinking. In mild to moderate cases, these symptoms consist of anxiety, agitation, sweating, vomiting and diarrhoea. In severe cases, the patient can become confused and experience visual hallucinations (referred to as “delirium tremens”) and can have withdrawal seizures. People who misuse drugs often lead chaotic lives and may miss appointments. This adds to the challenge of prescribing them with opiate substitution therapy. If they fail to collect their methadone or buprenorphine therapy from the pharmacy for 3 days or more, it is not safe for them to continue with the same dose, because they may have lost their tolerance.

This chapter addresses the logistics of establishing clinical videoconferencing (CV) programs and denotes commonly unforeseen barriers to implementation. The authors provide recommendations on central issues related to successful programing: where clients will be served, relationships with partner clinics, identifying program services, reviewing laws and policies, secure communication with patients, transitional programming, and recruiting clinicians.

Background Addicted patients undergoing methadone maintenance treatment are prone to several complications and the risk of relapse. Objective The present study aims to investigate the effect of cranial electrotherapy stimulation on depression, anxiety, and craving in addicted male people undergoing methadone maintenance treatment. Methods This randomized controlled trial study was conducted on 60 male patients referred to Persia addiction treatment center between 2021 and 2022. Patients were randomly divided into two equal treatment and placebo groups. The treatment group received cranial electrotherapy stimulation intervention for 48 sessions of 30 min. Depression and anxiety were evaluated using the Hamilton questionnaire before and after the intervention, and the level of craving was also evaluated with the Federdi 2008 questionnaire. Results Comparing the level of depression and anxiety before and after the intervention in both treatment and placebo groups did not show any significant difference ( p  < 0.05). Craving after the intervention was significantly different in both groups and was lower in the treatment group compared to the placebo group (33.43 versus 42.17, p  = 0.004). In the placebo group, the level of anxiety and depression, and in the treatment group, the level of depression, anxiety and craving for consumption decreased significantly after the intervention compared to before the intervention ( p  < 0.05). Conclusion Cranial electrotherapy stimulation did not have a significant effect on reducing the level of depression and anxiety of patients, but it is effective in the reduction of craving in addicted people undergoing methadone maintenance treatment. Trial registration This randomized clinical trial was registered on 2022/5/13 with clinical trial code of IRCT20210523051367N1.

RationaleMinocycline, a tetracycline antibiotic, inhibits activation of microglia. In preclinical studies, minocycline prevented development of opioid tolerance and opioid-induced hyperalgesia (OIH). The goal of this study was to determine if minocycline changes pain threshold and tolerance in individuals with opioid use disorder who are maintained on agonist treatment.MethodsIn this double-blind, randomized human laboratory study, 20 participants were randomized to either minocycline (200 mg/day) or placebo treatment for 15 days. The study had three test sessions (days 1, 8, and 15 of treatment) and one follow-up visit 1 week after the end of treatment. In each test session, participants were assessed on several subjective and cognitive measures, followed by assessment of pain sensitivity using the Cold Pressor Test (CPT). Daily surveys and cognitive measures using Ecological Momentary Assessment (EMA) were also collected four times a day on days 8 through 14 of treatment, and proinflammatory serum cytokines were assessed before and on the last day of treatment.ResultsMinocycline treatment did not change pain threshold or tolerance on the CPT. Similarly, minocycline did not change severity of pain, opioid craving, withdrawal, or serum cytokines. Minocycline treatment increased accuracy on a Go/No-Go task.ConclusionsWhile these findings do not support minocycline’s effects on OIH, minocycline may have a potential use as a cognitive enhancer for individuals with opioid use disorder, a finding that warrants further systematic studies.