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Opioid Substitution Treatment and Harm Minimization Approaches
Published in Hanna Pickard, Serge H. Ahmed, The Routledge Handbook of Philosophy and Science of Addiction, 2019
Heroin-assisted treatment embraces the practice that injection should occur in a safe setting with sanitary needles/syringes, leading to greater contact with medical personnel toward reducing morbidities of injection drug use (EMCDDA 2012). Overlap in clientele between OST and needle/syringe exchange programs for injection drug users (IDUs) presents the opportunity to integrate services (Kidorf et al. 2009; Strathdee et al. 2006). Methadone and buprenorphine also help to reduce injection drug use, HIV transmission, and hepatitis C incidence among IDUs (MacArthur et al. 2014; Tsui et al. 2014).
Epidemiological issues in mental health–substance use: a case for a life course approach to chronic disease epidemiology
Published in David B Cooper, Developing Services in Mental Health–Substance Use, 2018
Alexander Baldacchino, Ilana B Crome
In 17 Swiss centres for heroin-assisted treatment, 85 opiate-dependent individuals were assessed at entry using the Structured Clinical Interview for DSM disorders (SCID). The lifetime prevalence of comorbid AXIS I and II disorders was 86%. Most frequently, individuals were diagnosed with personality disorder (58%), mood disorders (55%) and anxiety disorders (26%).33
Substance Use Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Other treatments for opioid-addicted pregnant patients, including oral slow-release morphine, heroin-assisted treatment, and L-A-acetylmethadol (LAAM), are of historical interest only. Heroin-assisted treatment combines methadone with injectable heroin and was used in patients with a history of addiction for more than two years, failure of at least two alternative treatments, and risk of further physical or social decline. Experience with “heroin-assisted” treatment in pregnancy is limited to two case series with a total of five pregnant patients. The authors observed a higher birth weight compared to pregnant patients treated with methadone alone [103]. LAAM is a μ receptor agonist with a longer half-life than methadone. It was taken off the market in 2003 because of QT interval prolongation and the risk of potentially life-threatening ventricular arrhythmias. Clonidine, an α-agonist antihypertensive medication, has been used alone or in addition to other medications for mild withdrawal. Clonidine prevents withdrawal symptoms through its α2-agonist properties. Naltrexone is an opioid receptor antagonist. Research consists of two retrospective studies totaling 189 patients [104, 105]. Outcomes were similar to those of other MOUD but one study found an increased risk of urogenital anomalies. While evidence is insufficient to justify initiation of naltrexone during pregnancy it may be continued for those already taking it after discussion of the potential risks but will make postpartum pain management challenging since opioids will be ineffective.
Interest in treatment with injectable diacetylmorphine among people who use opioids in Baltimore City, Maryland (USA)
Published in Annals of Medicine, 2023
Sean T. Allen, Kristin E. Schneider, Saba Rouhani, Rebecca Hamilton White, Miles Morris, Jill Owczarzak, Susan G. Sherman
For persons with severe OUD who are unable to maintain utilization of methadone or buprenorphine, treatment with diacetylmorphine may be a viable alternative [30–36]. This form of MOUD, sometimes referred to as ‘heroin assisted treatment’, involves providing persons with an OUD pharmaceutical grade diacetylmorphine as an oral tablet or injectable liquid [30–36]. Treatment with diacetylmorphine has been studied for many years internationally. It was first introduced in Switzerland in 1994 and has since been made available in eight other countries [37,38]. Studies have demonstrated a myriad of benefits associated with diacetylmorphine treatment utilization, including increased treatment retention and reductions in: illicit opioid use, criminal activity, and overdose fatalities [30–37,39,40]. Unfortunately, diacetylmorphine-based treatment is not available in the US due to a range of policy and ideological barriers, including stigma, regulations that obstruct prescribing controlled substances, and cost [41].
Preliminary attitudes on medications for opioid use disorders (MOUDs) in Southeastern Switzerland and New York City
Published in Journal of Addictive Diseases, 2023
Felipe Castillo, Daniel Scalise, David Hernandez, Rahul Gupta, Cale N. Basaraba, Thomas Corbeil, Sandra D. Comer, Andres R. Schneeberger
The current opioid epidemic in the US calls for increasing efforts to curtail the number of preventable early deaths, decrease the morbidity associated with drug use, and increase the quality of life for those suffering from substance use disorders. Many interventions in the US in the past 10 years have only moved the dial slightly in the previously mentioned goals and have not prevented subsequent “waves” of the crisis from surging. At this stage, it is important to accurately identify factors such as attitudes and beliefs toward treatment options. This study assessed attitudes and beliefs in two separate samples in affluent countries in the developed world by means of a novel survey instrument. Based on this survey, attitudes on the role of Heroin-Assisted Treatment appear independent of competence in treating psychiatric disorders, how comfortable providers are with SUDS, and with the principles of addiction science. The most salient difference was seen in the attitudes toward this singular modality used in the treatment of OUD that is available as medical treatment by prescription in Switzerland and is listed by the Drug Enforcement Administration in Schedule I (no accepted medical use, a lack of accepted safety for use under medical supervision, and a high potential for abuse) in the United States. From a regulatory point of view, there are multiple barriers that would need to be addressed before HAT could be implemented in the US.
How the war on drugs impacts social determinants of health beyond the criminal legal system
Published in Annals of Medicine, 2022
Aliza Cohen, Sheila P. Vakharia, Julie Netherland, Kassandra Frederique
Meanwhile, the illicit drug supply has become increasingly unpredictable and contaminated due to drug supply disruptions, contributing to an exponential increase in drug overdose deaths [11,12]. Estimates suggest that one million people died of a drug-involved overdose between 1999 and 2020, with over 100,000 deaths occurring in a calendar year for the first time in 2021 [13,14]. Since 2015, overdose deaths have disproportionately impacted racial and ethnic minorities; Black people have had the biggest increase in overdose fatality rates, and today, Black and Native people have the highest overdose death rates across the U.S [15]. The most recent “fourth wave” of the overdose crisis can be attributed to a fentanyl-contaminated drug supply caused by drug prohibition; criminalisation that leads to stigma and fear of punishment that deters people from getting support they might need; and a lack of robust, scaled-up investment in harm reduction and evidence-based treatment services [16,17]. Although harm reduction interventions, including supervised consumption spaces (also called supervised injection facilities, drug consumption rooms, or overdose prevention centres) and heroin-assisted treatment have been widely studied and found effective outside of the U.S., these strategies have not been widely adopted in this country [18–21].