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Journal articles on the topic 'Opioid substitution treatment program'

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Author: Grafiati

Published: 10 December 2022

Last updated: 28 January 2023

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1

Stubley, Carolyn, and Garth Popple. "Providing therapeutic community initiatives for individuals on opioid substitution treatment." Therapeutic Communities: The International Journal of Therapeutic Communities 38, no. 2 (June 12, 2017): 79–86. http://dx.doi.org/10.1108/tc-04-2016-0009.

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Purpose Developing therapeutic community (TC) programs in Australia for individuals on opioid substitution treatment (OST) has been a process spanning 16 years for the We Help Ourselves (WHOS) organization. Supported reduction of OST and stabilization services for those remaining on OST are offered to this population and continue to break down barriers of discrimination in offering the same services to all drug using populations. The paper aims to discuss these issues. Design/methodology/approach A number of research projects have been undertaken with the WHOS Opioid Treatment Program (OTP) TC services profiling clients accessing the services; looking at health benefits whilst in the programs; looking at retention and completion rates and conducting an evaluation post-treatment for one of the two programs currently being offered. Findings The excerpts from the research findings are presented identifying the complexity of individuals accessing WHOS services; highlighting the benefits for individuals on OST and assessing the effectiveness of the TC model for the client groups. Originality/value Working with multiple complex needs clients on OST in a residential TC environment offers many challenges and opportunity to work with an array of issues that present before during and after the residential stay. Provision of a history and overview of the WHOS OTP TC services and recent enhancements to these programs highlight a continuum of care for the individual on OST.

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Bond, Alyson J., and John Witton. "Perspectives on the Pharmacological Treatment of Heroin Addiction." Clinical Medicine Insights: Psychiatry 8 (January 1, 2017): 117955731773732. http://dx.doi.org/10.1177/1179557317737322.

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Opioids are very addictive drugs because of their powerful effects on reward and pain pathways in the brain. Opioid addiction is currently a worldwide problem and injecting heroin presents serious health risks including death from overdose. The increase in the nonmedical use of prescription opioids and the increase in overdose deaths are worrying trends in North America. There is therefore an increasing need for access to effective treatments. The 2 major drug treatments, methadone and buprenorphine, have proven efficacy but are not necessarily administered in the most effective doses or under optimum conditions. Alternative approaches such as slow-release oral morphine, tincture of opium, and the use of the opioid antagonist naltrexone to maintain abstinence are used seemingly effectively in some countries but have yet to be fully evaluated in randomized controlled trials. Heroin-assisted treatment has proven to be a valuable and effective treatment when administered in specialized clinics but is only appropriate for those who have failed to improve on optimal methadone or buprenorphine maintenance. Recent innovations and substitution treatment as an alternative to incarceration are described. Drug treatment of opioid addiction is most effective when administered as part of a therapeutic program as demonstrated in the initial methadone evaluations and the more recent trials with heroin-assisted treatment.

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Springer, MD, Sandra A., and Robert D. Bruce, MD. "A pilot survey of attitudes and knowledge about opioid substitution therapy for HIV-infected prisoners." Journal of Opioid Management 4, no. 2 (January 30, 2018): 81. http://dx.doi.org/10.5055/jom.2008.0012.

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A majority of inmates in the state of Connecticut Department of Corrections use opioids or are opioid dependent before incarceration. None of the state’s prisons offer opioid substitution therapy other than for detoxification or maintenance therapy for women during pregnancy. On release to the community, most prisoners relapse to drug use and this has been associated with higher recidivism rates, and less adherence to antiretroviral medications for HIV-infected persons. Nationally and internationally, methadone (METH) and buprenorphine (BUP) have been found to decrease relapse to drug use, decrease recidivism rates, improve adherence to antiretroviral medications, decrease HIV-risk taking behaviors, and improve mortality. However, the general knowledge about opioid substitution therapy among correctional facility staff has been reported as substandard. This pilot study compiled results of answers to anonymous surveys from 27 individuals who work directly with inmates in a patient-care capacity for the Connecticut Department of Corrections (CT DOC) and CT DOC case-management referral program (Project TLC) in the year 2006. The surveys included questions regarding current attitudes and knowledge about opioid substitution therapy for prisoners. A minority of respondents refer released prisoners with a history of opioid dependency to METH or BUP treatment. The majority of correctional workers and case-management referral workers did not have knowledge about BUP or METH’s ability to improve health and decrease HIV risk taking behaviors. This study found that more education of individuals treating and caring for HIV-infected opioid dependent prisoners is needed.

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Vaidya, Leepa, Rajan Sharma, Lumeshwor Acharya, Nirmal Lamichhane, and Ravi Raj Timasina. "Adherence to Buprenorphine Maintenance Treatment Program in Western Nepal." Medical Journal of Pokhara Academy of Health Sciences 2, no. 2 (December 31, 2019): 205–8. http://dx.doi.org/10.3126/mjpahs.v2i2.28192.

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Background: Opioid use is a serious global problem and the problem is increasing over years. Buprenorphine has been approved as a substitution therapy in Nepal, but there are few long-term studies of its effectiveness. Aim: This study aimed to assess the 1-year efficacy of buprenorphine and reasons for dropout. Materials and Methods: This study was conducted at Western Regional Hospital, Pokhara from 29th August 2016 to 31st August 2017. The Buprenorphine Maintenance Treatment Program (BMT) was started on 29th August 2016 and all the clients enrolled in the program within 1 year of starting BMT were included in the study. Results: 75% of the enrolled clients dropped out in 1-year period. Conclusion: Adherence to Buprenorphine was better in flexible dose adjustment group. Combination of buprenorphine and psychosocial treatment would have been related with better outcome.

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Banaszak, Maria. "Voice in the discussion about the goals and methods of treatment in Poland of people addicted to opioids." Problemy Opiekuńczo-Wychowawcze 570, no. 5 (May 31, 2018): 3–13. http://dx.doi.org/10.5604/01.3001.0012.1360.

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For several years, a debate has been taking place in Poland on the effectiveness and appropriateness of using various methods of treating addiction to psychoactive substances. On one side there are representatives of rehabilitation centres with the assumptions of the therapeutic community, on the other side, advocates of substitution treatment, based on the paradigm of harm reduction. Substitute programs are usually conducted in outpatient clinics. Representatives of stationary treatment are accused that the endeavour of total abstinence is too difficult for patients to achieve; Substitutive programs are criticized for sustaining patients' addiction. At the bottom of the dispute, however, there are two logical errors. First, outpatient and stationary treatments are not competing because they meet the needs of different groups of clients and should be targeted at people who are at a different stage of addiction development. Secondly, non-counselling is the most appropriate place for substitution programs. Around the outpatient clinics, especially those who have a methadone program in their offer, are gathering patients in advance stages of addiction. The contact with people who do not take drugs in a problematic way has many negative consequences. In addition, it has been scientifically proven that benefiting from substitution programs results in harm reduction, but they are not accompanied by significant changes in social and emotional functioning. An optimal solution would be to reorganize substitution treatment and divide it into two streams, depending on the individual goal of the patient - those interested in the low-threshold goal - methadone prescription in out-of-ward care, and for those seeking actual change and abstinence – incorporating substitution programs into the therapeutic community.

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Le, Phuong-Phi, Annette Braunack-Mayer, and Caroline Laurence. "Collaborative pharmacist prescribing within the opioid substitution treatment program in South Australia: Patient and pharmacist views." Research in Social and Administrative Pharmacy 14, no. 2 (February 2018): 187–95. http://dx.doi.org/10.1016/j.sapharm.2017.02.017.

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7

Torrens, Marta, Francina Fonseca, Claudio Castillo, and Antònia Domingo Salvany. "Opioid substitution treatment in Spain: 20 years of experience in harm reduction programs." Drug and Alcohol Dependence 156 (November 2015): e223. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.601.

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Pahuja, Erika, Santosh Kumar, Ajay Kumar, Fareed Uzzafar, Siddharth Sarkar, Narayana Manjunatha, Yatan Pal Singh Balhara, C. Naveen Kumar, and Suresh Bada Math. "Collaborative Video Consultations from Tertiary Care Based Telepsychiatrist to a Remote Primary Care Doctor to Manage Opioid Substitution Therapy Clinic." Journal of Neurosciences in Rural Practice 11, no. 03 (June 12, 2020): 498–501. http://dx.doi.org/10.1055/s-0040-1713293.

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AbstractOpioid use is a major problem in India and has high morbidity and mortality with a prevalence of 2.06%. There is a huge treatment gap for opioid use disorders (OUDs). Due to limited mental health resources and limited psychiatric training of medical practitioners in OUDs, a significant proportion of patients do not receive appropriate medical intervention. This article demonstrates how a primary care doctor working in a remote opioid substitution therapy (OST) clinic received assistance from the optional opioid module of clinical schedule for primary care psychiatry (CSP) and collaborative video consultation (CVC) module to address specific difficulties of patients already on Buprenorphine OST and improve the quality of care, thereby reducing chances of relapses. CVC module is a part of one-year digitally driven primary care psychiatry program designed by National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. The opioid module was designed by NIMHANS, Bengaluru in collaboration with the All India Institute of Medical Sciences (AIIMS), New Delhi These observations warrant replication of this approach across diverse settings and at a larger scale to explore and evaluate its impact and effectiveness.

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Katt, Mae, Claudette Chase, Andriy V. Samokhvalov, Elena Argento, Jürgen Rehm, and Benedikt Fischer. "Feasibility and Outcomes of a Community-Based Taper-to-Low- Dose-Maintenance Suboxone Treatment Program for Prescription Opioid Dependence in a Remote First Nations Community in Northern Ontario." International Journal of Indigenous Health 9, no. 1 (June 9, 2013): 52. http://dx.doi.org/10.18357/ijih91201212394.

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<p>Objective: Non-medical prescription opioid use (NMPOU) is a major health problem in North America and increasingly prevalent among First Nations people. More than 50% of many Nishnawbe Aski Nation communities in northern Ontario report NMPOU, resulting in extensive health and social problems. Opioid substitution therapy (OST) is the most effective treatment for opioid dependence yet is unavailable in remote First Nations communities. Suboxone (buprenorphine and naloxone) specifically has reasonably good treatment outcomes for prescription opioid (PO) dependence. A pilot study examining the feasibility and outcomes of a community-based Suboxone taper-to-low-dose-maintenance program for PO-dependent adults was conducted in a small NAN community as a treatment option for this particular setting.</p><p>Design: Participants (N = 22, ages 16–48 years) were gradually stabilized on and tapered off Suboxone (provided on an outpatient and directly-observed basis) over a 30-day period. Low dose maintenance was offered post-taper to patients with continued craving and relapse risk; community-based aftercare was provided to all participants. Results: Of 22 participants, 21 (95%) completed the taper phase of the program. Fifteen (88%) of 17 participants tested by urine toxicology screening had no evidence of PO use on day 30. No adverse side effects were observed. All but one of the taper completers were continued on low-dose maintenance. Conclusion: Community-based Suboxone taper-to-low-dose-maintenance is feasible and effective as an initial treatment for PO-dependence in remote First Nations populations, although abstinence is difficult to achieve and longer term maintenance may be required. More research on OST for First Nations people is needed; existing OST options, however, should be made available to First Nations communities given the acute need for treatment.</p>

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Bilban, Marjan, Andrej Kastelič, and Lijana Zaletel-Kragelj. "Ability to Work and Employability of Patients in Opioid Substitution Treatment Programs in Slovenia." Croatian Medical Journal 49, no. 6 (December 2008): 842–52. http://dx.doi.org/10.3325/cmj.2008.49.842.

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Talal, Andrew H., Phyllis Andrews, Anthony Mcleod, Yang Chen, Clewert Sylvester, Marianthi Markatou, and Lawrence S. Brown. "Integrated, Co-located, Telemedicine-based Treatment Approaches for Hepatitis C Virus Management in Opioid Use Disorder Patients on Methadone." Clinical Infectious Diseases 69, no. 2 (October 17, 2018): 323–31. http://dx.doi.org/10.1093/cid/ciy899.

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Abstract Background Despite high hepatitis C virus (HCV) prevalence, opioid use disorder (OUD) patients on methadone rarely engage in HCV treatment. We investigated the effectiveness of HCV management via telemedicine in an opioid substitution therapy (OST) program. Methods OUD patients on methadone underwent biweekly telemedicine sessions between a hepatologist and physician assistant during the entire HCV treatment course. All pretreatment labs (HCV RNA, genotype, and noninvasive fibrosis assessments) were obtained onsite and direct-acting antivirals were coadministered with methadone using modified directly observed therapy. We used multiple correspondence analysis, least absolute shrinkage and selection operator, and logistic regression to identify variables associated with pursuit of HCV care. Results Sixty-two HCV RNA–positive patients (24% human immunodeficiency virus [HIV] infected, 61% male, 61% African American, 25.8% Hispanic) were evaluated. All patients were stabilized on methadone and all except 4 were HCV genotype 1 infected. Advanced fibrosis/cirrhosis was present in 34.5% of patients. Of the 45 treated patients, 42 (93.3%) achieved viral eradication. Of 17 evaluated patients who were not treated, 5 were discontinued from the drug treatment program or did not follow up after the evaluation, 2 had HIV adherence issues, and 10 had insurance authorization issues. Marriage and a mental health diagnosis other than depression were the strongest positive predictors of treatment pursuit, whereas being divorced, separated, or widowed was the strongest negative predictor. Conclusions HCV management via telemedicine integrated into an OST program is a feasible model with excellent virologic effectiveness. Psychosocial and demographic variables can assist in identification of subgroups with a propensity or aversion to pursue HCV treatment.

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Deacon, Rachel M., Susan Hines, Kenneth Curry, Maggie Tynan, and Carolyn A. Day. "Feasibility of ambulatory withdrawal management delivered in a NSW drug health service and correlates of completion." Australian Health Review 38, no. 2 (2014): 186. http://dx.doi.org/10.1071/ah13014.

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Objective The aim of the present study was to assess short-term ambulatory withdrawal management (AWM) outcomes at a drug health service (DHS) in Sydney, Australia, in the absence of specific funding. Methods A clinic file audit review was conducted of patients who commenced AWM at the service during January 2009–June 2011. Successful completion was defined as daily attendance with ≤1 missed day, or transfer onto opioid substitution treatment. Results Of 110 episodes, 69 (63%) were completed. Median patient age was 35 years (range 18–71 years), and most patients (68%) were male. Patients presented primarily for cannabis (33%) or alcohol (30%) withdrawal, followed by heroin (19%) or other opioids (6%), and benzodiazepines (12%). Completion rates varied from 86% for non-heroin opioids to 31% for benzodiazepines. Older age was associated with increased completion: 76% of those aged >35 years completed compared with 50% of those ≤35 years of age. Only 46% of women who commenced withdrawal management completed compared with 71% of men. Conclusions Most people commencing AWM at the DHS completed the program, indicating AWM can be performed at public drug and alcohol clinics. Service improvements may help increase completion rates among women and patients withdrawing from benzodiazepines. What is known about the topic? WM is not a standalone treatment for substance dependence, but is commonly a first attempt at treatment. AWM is often more acceptable to patients, and cheaper, than in-patient services. What does this paper add? About two-thirds of patients entering an AWM program operating since 2001 continue to complete the program. What are the implications for practitioners? AWM can be carried out successfully through public drug and alcohol services, although clinic staff support is important.

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Khalaf, Dany, Maryse Hayek, Jules-Joel Bakhos, and Fadi Abou-Mrad. "Comparative study between prison- and community-based treatment satisfaction for opioid use disorder in Lebanon." International Journal of Prisoner Health 15, no. 2 (June 10, 2019): 138–52. http://dx.doi.org/10.1108/ijph-12-2017-0064.

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Purpose Opioid substitution treatment (OST), such as Buprenorphine, has become a well-established evidence-based approach for the treatment of inmates with opioid use disorder (OUD) in most of the developed world. However, its application in Lebanon remains mainly as a community-based intervention. The purpose of this paper is to highlight the need of its implementation within the Lebanese correctional system. Design/methodology/approach The work is a pilot cross-sectional study that compares two groups: 30 male adult prisoners with OUD convictions receiving symptomatic treatment and 30 male adult community patients with OUD receiving Buprenorphine. The objective was to measure the difference in the patients’ general perception and satisfaction of the treatments available. OUD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria and the level of satisfaction was measured by “Treatment Perceptions Questionnaire (TPQ).” Findings The prison group reported significantly lower satisfaction when compared to the community group (total TPQ mean scores: M=34.73, SD =4.12 and M=16.67, SD =4.78, respectively, with t (56.76) =15.68, p=0.000). Furthermore, age, marital status, education level and elapsed time in treatment had no significant interactions with the total TPQ score. Originality/value The major principles of the ethics of care and evidence-based safe practices will be proposed for the introduction of Buprenorphine to Lebanese prisons. This work provides an opportunity for the expansion of the Lebanese OST program and consequently other countries in the region could benefit from this experience.

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Tun, Sun, Vicknasingam Balasingam, and Darshan Singh Singh. "Factors associated with quality of life (QOL) scores among methadone patients in Myanmar." PLOS Global Public Health 2, no. 8 (August 22, 2022): e0000469. http://dx.doi.org/10.1371/journal.pgph.0000469.

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The Drug Dependency Treatment and Research Unit (DDTRU) in Myanmar established opioid substitution with methadone in 2006. Reducing HIV transmission could be affected by eliminating the unsafe needle sharing among injecting drug uses and treatment with opioid substitution. The quality of life (QOL) among the clients retained in the methadone program is important for their personal development and is an indication of the treatment efficacy. This study evaluated factors associated with the QOL of methadone patients to ensure efficient service delivery. It also identified how patients’ characteristics had differed QOL scores of respondents. This cross-sectional study was conducted in five cities with stratified random sampling. The study assessed the QOL of methadone patients in Myanmar. The study recruited 210 respondents to answer structured questionnaires for their quality of life: WHOQOL-BREF questionnaires and urine sample collection for methadone and illicit drug use. Survey responses on the QOL were transformed into 100-scale ratings, and higher QOL scores reflect better QOL. The average score of total QOL was 60.82%; precisely 60.09% in the physical domain, 63.11% in the psychological domain, 59.87% in the social relation domain, 60.41% in the environmental domain respectively. Respondents who reported illicit drug use had lower QOL scores. Statistically significant association of the QOL category of the methadone patients was identified with frequent methadone treatment episodes, the infection status of HIV, current treatment on antiretroviral therapy (ART), tuberculosis (TB) treatment history, sexually transmitted infections (STI) history in their lifetime, current work status as peer, Addiction Severity Index (ASI) for drug use, satisfaction with current marital status, satisfaction with current leisure status, history of psychological abuse within 30 days, heroin injection within 30 days, frequency of injection, and reported use of barbiturates (p<0.05). Addressing these factors will improve the treatment service intervention and the quality of life among methadone patients.

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Skowronek, Rafał, and Marek Krzystanek. "Sudden death during methadone replacement therapy – case report and literature review." Archives of Forensic Medicine and Criminology 73, no. 2 (November 30, 2022): 92–101. http://dx.doi.org/10.4467/16891716amsik.22.012.16810.

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Metadon to pochodna difenylopropylaminy, wiążąca się z receptorami opioidowymi, która znalazła zastosowanie w programach leczenia zespołu abstynencji u osób uzależnionych od opioidów oraz w programach substytucyjnych. Celem pracy jest opis przypadku nagłego zgonu osadzonego w trakcie terapii substytucyjnej metadonem z praktyki opiniodawczej autorów oraz przegląd literatury. 41-letni mężczyzna obciążony wieloletnim wywiadem nadużywania substancji psychoaktywnych, zwłaszcza heroiny, odbywający karę pozbawienia wolności, po konsultacji w poradni leczenia uzależnień rozpoczął terapię zastępczą metadonem. W kolejnych dniach przyjął dwie dawki leku (po 50 mg). W nocy podczas obchodu stwierdzono zgon osadzonego. Badania toksykologiczne krwi wykazały obecność metadonu w stężeniu terapeutycznym 816 ng/ml. Obecnie uważa się, że nawet terapeutyczne stężenie metadonu zwiększa ryzyko nagłej śmierci sercowej, zwłaszcza u osób predysponowanych (np. obciążonych patologią strukturalną mięśnia sercowego, zaburzeniami rytmu pracy serca, z hipokaliemią, niewydolnością wątroby). Sudden death during methadone replacement therapy – case report and literature review Methadone is a diphenylpropylamine derivative that binds to opioid receptors and has been used in drug abstinence and substitution treatment programs. The aim of the study is to describe a case of sudden death of a prisoner during methadone substitution therapy from the authors’ medico-legal consulting practice and to review the literature. A 41-year-old male with a long history of abuse of psychoactive substances, especially heroin, serving a prison sentence, after consultation in the addiction treatment clinic, started methadone substitution therapy. In the following days he took two doses of the drug (50 mg each). The prisoner was pronounced dead during the night. Blood toxicology tests showed the presence of methadone at the therapeutic concentration of 816 ng/ml. Currently, it is believed that even the therapeutic concentration of methadone increases the risk of sudden cardiac death, especially in predisposed patients (e.g. with structural pathologies of the myocardium, cardiac arrhythmias, hypokalemia, and liver failure).

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Brinca, Joana, and Nídia Morais. "THE INFLUENCE OF SOCIAL SCIENCES ON THE PROFESSIONALIZATION OF SOCIAL WORK A CASE STUDY IN A TREATMENT TEAM WITH CONSUMERS OF PSYCHOACTIVE SUBSTANCES." Advances in Social Sciences Research Journal 6, no. 9 (September 10, 2019): 24–31. http://dx.doi.org/10.14738/assrj.69.6844.

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Speaking in social services implies talking about the social concept, which is an indissociable social issue and social problems arising from industrialization, urbanization and proletarization.According to ander-egg (1995b, pp. 152-153) "by the influence of sociology [and other social sciences], the term" social came to be used with two meanings: a generic and broad, referring to the global society [and the collective characteristics of a particular population] (...); and another restricted, alluding to particular questions of sociological analyses, such as social structure, social change, stratification, mobility and social participation ", that is, the individual in and in society. In the decade of 60 the "social" integrated as a partner the economic issue and improvement of the quality of life/social welfare. It was within this logic of thought that was associated with the concept "social sectors" (1995b, pp. 152-153) such as: education, housing, health, social security, culture, politics, employment. In turn, in the decade of 70, there is a change in the current paradigm. We witnessed a progressive passage/attempt to pass a tripartite intervention method to an integrated intervention method. That is, the positivism applied to the social sciences is questioned giving place to the emergence of other more integrated and more flexible paradigms highlighting the importance and influence of the social sciences in the analysis of contextual variables of social situations/ problem presented, as can be seen by the case study on the professional practice of the social worker in a treatment team of portugal, with consumers of psychoactive substances, under the opioid substitution program.

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Dolan, Kate, Ana Rodas, and Adam Bode. "Drug and alcohol use and treatment for Australian Indigenous and non-Indigenous prisoners: demand reduction strategies." International Journal of Prisoner Health 11, no. 1 (March 16, 2015): 30–38. http://dx.doi.org/10.1108/ijph-02-2014-0005.

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Purpose – The purpose of this paper is to compare the use of drugs and alcohol by Indigenous and non-Indigenous prisoners and examine relevant treatment in Australian prisons. Design/methodology/approach – Prison authorities were surveyed about alcohol and drug use by prisoners prior to and during imprisonment and drug and alcohol treatment programs in prison. The literature was review for information on alcohol and drug use and treatment in Australian prisons. Findings – In 2009, over 80 percent of Indigenous and non-Indigenous inmates smoked. Prior to imprisonment, many Indigenous and non-Indigenous inmates drank alcohol at risky levels (65 vs 47 percent) and used illicit drugs (over 70 percent for both groups). Reports of using heroin (15 vs 21 percent), ATS (21 vs 33 percent), cannabis (59 vs 50 percent) and injecting (61 vs 53 percent) were similarly high for both groups. Prison-based programs included detoxification, Opioid Substitution Treatment, counselling and drug free units, but access was limited especially among Indigenous prisoners. Research limitations/implications – Drug and alcohol use was a significant issue in Australian prisons. Prisoners were over five times more likely than the general population to have a substance use disorder. Imprisonment provides an important opportunity for rehabilitation for offenders. This opportunity is especially relevant to Indigenous prisoners who were more likely to use health services when in prison than in the community and given their vast over representations in prison populations. Practical implications – Given the effectiveness of treatment in reducing re-offending rates, it is important to expand drug treatment and especially culturally appropriate treatment programs for Indigenous inmates. Originality/value – Very little is known about Indigenous specific drug and alcohol programs in Australian prisons.

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Thanki, Danica, Viktor Mravčík, Vendula Běláčková, Dovilė Mačiulytė, Tomáš Zábranský, Aušra Širvinskienė, Emilis Subata, and Rocio Lorenzo-Ortega. "Prevalence of high-risk drug use and coverage of opioid substitution treatment and needle and syringe programs in Lithuania in 2015–2016: A multi-method estimation study." Journal of Substance Abuse Treatment 122 (March 2021): 108229. http://dx.doi.org/10.1016/j.jsat.2020.108229.

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Harborow, Lucy, Mary Thornton, Nicola J. Kalk, and Mike Kelleher. "Substance misuse teaching: a patient safety issue." BJPsych Open 7, S1 (June 2021): S190—S191. http://dx.doi.org/10.1192/bjo.2021.514.

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AimsClinical substance misuse presentations are commonly managed by Psychiatry Core Trainees (CTs) out of hours. However, specialist teaching is not included in the Maudsley Training Program (MTP) induction. We aimed to investigate whether this was of clinical concern and, if so identify interventions to address it.BackgroundThe association of substance misuse disorder and mental illness is widely recognised. The Adult Psychiatric Morbidity Survey 2014 reported that half of people dependent on drugs other than cannabis were receiving mental health treatment. Substance use substantially impacts clinical risk; 57% of patient suicides in 2017 had a history of substance misuse. It also effects emergency psychiatric services: 55-80% of patients detained under S136 are intoxicated. Therefore, it is imperative for patient safety that CTs can assess and manage these patients appropriately.The Royal College of Psychiatrists recognises the need for specialist substance misuse knowledge and skills, and lists this as a key ‘Intended Learning Outcome’ for CTs. Unfortunately, the availability of specialist drug and alcohol service placements for CTs has significantly declined. Only one placement is available per MTP rotation. Teaching is therefore relied upon to gain these competencies.MethodUsing a cross-sectional survey we explored CTs confidence in recognising and managing substance misuse presentations, knowledge of where to seek guidance and asked for teaching suggestions. We surveyed two CT1 cohorts in 2017 and 2019.ResultFifty-one CTs took the survey. Of these 92% did not feel prepared to manage acute substance intoxication or withdrawal and 96% would like relevant teaching at the start of CT1. Furthermore, 67% did not know where they could seek guidance.CTs felt confident at recognising and managing alcohol related presentations. However, they were less confident in recognising opioid withdrawal, how to safely prescribe opioid substitution therapy (OST), and the usual doses of OST (65%, 94%, 94% rated ‘neither confident nor not confident’ or below, respectively). CTs were not confident at recognising GBL and cannabinoid withdrawal, principles of harm minimisation, assessing readiness to change, delivering Brief Interventions and teaching patients to use Naloxone.ConclusionThe results were exceptionally similar between cohorts, demonstrating reliability of our findings and that CTs lack of substance misuse knowledge is a significant clinical concern.To address this deficit of knowledge, we are writing an introductory lecture with supporting guidance in the induction pack, developing an online video resource, and moving key substance misuse lectures to earlier in the MTP taught programme.

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Шилова, М. А., and М. Л. Доценко. "Methadone Use during HIV Infection Treatment in People who Inject Drugs." Рецепт, no. 3 (November 10, 2021): 357–62. http://dx.doi.org/10.34883/pi.2021.24.3.005.

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Высокий уровень распространенности ВИЧ-инфекции среди лиц, употребляющих инъекционные наркотики (ЛУИН), и их половых партнеров является одной из актуальных проблем для республики. Для ВИЧ-инфицированных участников программы опиоидной заместительной терапии (ОЗТ) важное значение имеет переносимость при совместном приеме лекарственных средств антиретровирусной терапии (АРТ) и метадона, а расширение масштабов применения АРТ является одним из главных приоритетов для стран региона Восточной Европы и Центральной Азии (ВЕЦА), в т. ч. для Республики Беларусь. Целью данного исследования являлась оценка влияния ОЗТ на приверженность к АРТ, а также анализ и оптимизация назначения лекарственных препаратов, применяемых для ОЗТ (метадона), у ВИЧ-инфицированных ЛУИН. Материалом исследования являлись статистические данные УЗ «Городской клинический наркологический диспансер» (N=5396) и кабинетов ОЗТ г.Минска за 2015-2019 гг.; данные медицинских карт ВИЧ-позитивных ЛУИН, принимающих ОЗТ в 2019 г. (N=91). Для анализа переносимости АРТ у ВИЧ-позитивных ЛУИН было проведено анонимное анкетирование (N=211). Создание баз данных и их обработка производилась с помощью пакетов статистических программ Microsoft Excel 2010, Statistica 10, RStudio. Для анализа лекарственных взаимодействий метадона и препаратов АРТ были использованы электронные базы данных «The Cochrane Library», «PubMed», «Medline», «Google scholar», «Medline Drug Interaction Checker». Результаты исследования показали, что доля ВИЧ-позитивных пациентов среди участников ОЗТ в г. Минске достигла 53,90% (ДИ 95% 45,69-61,95), а удельный вес участников программы ОЗТ, принимающих АРТ - 100,00% (ДИ 95% 95,65-100,00) в 2019 г. При анализе назначений лекарственных препаратов, применяемых для ОЗТ (метадона), у ВИЧ-инфицированных ЛУИН было установлено, что 89,01% ВИЧ-позитивных участников ОЗТ г. Минска потенциально могут нуждаться в коррекции назначаемых суточных доз метадона. Пациентам, которые начали принимать или изменили схему АРТ, коррекцию назначаемых доз метадона предпочтительно производить с помощью лабораторного мониторинга концентрации метадона в плазме крови пациента. Медицинским работникам консультативно-диспансерных отделений, оказывающих медицинскую помощь пациентам с ВИЧ-инфекцией, необходимо информировать медицинских работников кабинетов ОЗТ при назначении, прекращении приема препаратов АРТ, влияющих на метаболизм метадона, или изменении схем АРТ для предупреждения развития токсических эффектов, улучшения показателей удержания в программе ОЗТ и увеличения приверженности к АРТ и ОЗТ. The high level of HIV prevalence among people who inject drugs (PWID) and their sexual partners is one of the urgent challenges for the republic. For HIV-infected participants of the opioid substitution therapy (OST) program, tolerance is important when the antiretroviral therapy (ART) and methadone are co-administered. Scaling up the ART is one of the top priorities for countries in the Eastern Europe and Central Asia (EECA) region, including the Republic of Belarus. The aim of this study was to assess the impact of OST on adherence to ART, as well as to analyze and optimize the prescription of drugs used for OST (methadone) in HIV-infected PWID. The research material was the statistical data of the Healthcare Institution “City Clinical Narcological Dispensary” (N=5396) and OST offices in Minsk for 2015-2019; the data from medical records of HIV-positive PWID receiving OST in 2019 (N=91). To analyze the tolerability of ART in HIV-positive PWID, the anonymous survey was conducted (N=211). The databases were created and processed using the statistical software packages Microsoft Excel 2010, STATISTICA 10, RStudio. To analyze drug interactions between methadone and ART drugs, the electronic databases “The Cochrane Library”, “PubMed”, “Medline”, “Google scholar”, and “Medline Drug Interaction Checker” were used. The results of the study showed that the proportion of HIV-positive patients among OST participants in Minsk reached 53.90% (CI 95% 45.69-61.95), and the proportion of OST program participants taking ART was 100.00% (CI 95% 95.65-100.00) in 2019. When analyzing the prescriptions of drugs used for OST (methadone) among HIV-infected PWID, it was found that 89.01% of HIV-positive OST participants in Minsk could potentially need the correction of the prescribed daily methadone doses. For patients who have started or changed their ART scheme, it is preferable to adjust the prescribed doses of methadone using laboratory monitoring of the patient’s plasma methadone concentration. Medical staff of consultative and dispensary departments that provide medical care to patients with HIV infection should inform medical staff of OST rooms when prescribing, discontinuing the ART drugs that affect methadone metabolism, or changing the ART schemes to prevent the development of toxic effects, improve retention rates in the OST program, and increase the adherence to ART and OST.

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Hemel, Muhammad MM, Md Masud Reza, Tanveer KI Shafiq, Md Iqbal Kabir, AKM Masud Rana, and Sharful Islam Khan. "Correlates of sharing of needles and syringes among people who inject drugs in Dhaka city, Bangladesh." Journal of Infection in Developing Countries 15, no. 10 (October 31, 2021): 1497–506. http://dx.doi.org/10.3855/jidc.13629.

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Introduction: This paper examines the correlates of needle and syringe sharing among People Who Inject Drugs in Dhaka city, Bangladesh, which is currently experiencing a steep increase in HIV prevalence despite the ongoing presence of Needle Exchange Programs. Methodology: This was a retrospective chart review with cross-sectional design that extracted data from 783 male People Who Inject Drugs enrolled into five Opioid Substitution Treatment clinics in Dhaka city between April 2010 and January 2016. Data were retrieved from the program’s electronic database. Needle and syringe sharing constituted the borrowing or lending of needles and syringes from others within the past month preceding data collection. Results: Buprenorphine was the preferred injection drug and 44.6% shared needles and syringes within the past month. Multivariate analysis indicated that People Who Inject Drugs who were homeless (OR = 8.1, 95% CI = 1.4-44.9, p < 0.05), living with friends (OR = 6.8, 95% CI = 2.5-18.2, p < 0.001), injecting 2-3 times/day (OR = 4.8, 95% CI = 1.2-19.7, p < 0.05), injecting more than three times/day (OR = 4.8, 95% CI = 1.1-20.0, p < 0.05), not using condom with non-commercial female sex partners (OR = 3.3, 95% CI = 1.8-6.0, p < 0.05), bought sex from female sex workers (OR = 2.9, 95% CI = 1.0-8.3, p < 0.05), and did non-suicidal self-injury (OR = 1.8, 95% CI = 1.0-3.0, p < 0.05) were more likely to share needles and syringes. Conclusions: This study demonstrates that operating a standalone harm reduction approach that just provides sterile needles and syringes may not adequately curb needle and syringe sharing among People Who Inject Drugs.

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Nikoo, M., K. Kianpoor, N. Nikoo, S. Javidanbardan, A. Kazemi, F. Choi, M. Vogel, et al. "Opium tincture for opioid substitution treatment." European Psychiatry 64, S1 (April 2021): S171. http://dx.doi.org/10.1192/j.eurpsy.2021.455.

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IntroductionOpium tincture (OT) is widely used for opioid substitution treatment (OST) in Iran.ObjectivesTo determine if OT is a safe and effective medication for OST.MethodsOpium Trial was a multicenter, double‐blind, noninferiority randomized controlled trial, with 204 participants with opioid dependence in Iran. Participants were then randomized to OT or methadone arms with an allocation ratio of 1:1 and were followed for 12 weeks. The primary outcome was retention in treatment, compared between the two groups using both intention-To-Treat (ITT) and Per-Protocol (PP) analyses.ResultsA total of 70 participants (IT: 68.6%, PP: 69.3%) in methadone arm and 61 participants (ITT: 59.8%, PP: 60.4%) in OT arm remained in the treatment. The relative retention rate was 1.15 (0.97, 1.36) in both analyses in favour of methadone. A total of 46 out of 152 (30.3%) participants in OT arm and 83 out of 168 (49.4%) participants in methadone arm reported opioid use outside the treatment. The difference in these two proportions (OT - methadone) was 19%: (10%, 28%) in favour of OT. The proportion of patients with adverse events were not different between the two arms (P = 0.06). There was no serious AE in OT arm.ConclusionsOpium tincture is a clinically effective and safe medication, but this study could not conclude if it was as equally effective as methadone in retaining participants in treatment, but it showed that OT was superior to methadone in reducing opioid use outside the treatment.DisclosureNo significant relationships.

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S, Akhtar. "Patient Dropout From Opioid Substitution Treatment." Journal of Alcoholism, Drug Abuse and Substance Dependence 5, no. 1 (December 27, 2019): 1–6. http://dx.doi.org/10.24966/adsd-9594/100011.

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Carnwath, Tom, and John Merrill. "Dose equivalents in opioid substitution treatment." International Journal of Drug Policy 13, no. 6 (December 2002): 445–47. http://dx.doi.org/10.1016/s0955-3959(02)00073-7.

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Day, E. "Maximising the treatment outcomes of opioid substitution treatment." Evidence-Based Mental Health 13, no. 1 (February 1, 2010): 5–7. http://dx.doi.org/10.1136/ebmh.13.1.5.

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Drucker, Ernest. "Injectable heroin substitution treatment for opioid dependency." Lancet 358, no. 9291 (October 2001): 1385. http://dx.doi.org/10.1016/s0140-6736(01)06490-x.

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Kourounis, Georgios, Brian David Wensley Richards, Evdokia Kyprianou, Eva Symeonidou, Minerva-Melpomeni Malliori, and Lampros Samartzis. "Opioid substitution therapy: Lowering the treatment thresholds." Drug and Alcohol Dependence 161 (April 2016): 1–8. http://dx.doi.org/10.1016/j.drugalcdep.2015.12.021.

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Selin, Jani. "Widening the perspective on opioid substitution treatment." Addiction 112, no. 8 (January 26, 2017): 1339–40. http://dx.doi.org/10.1111/add.13725.

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McCann, David J., and Frank J. Vocci. "NIDA OPIOID TREATMENT DISCOVERY PROGRAM." Analgesia 1, no. 4 (January 1, 1995): 574–77. http://dx.doi.org/10.3727/107156995819563861.

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Torrens, M. "Opioid Substitution: More than Only Methadone!" European Psychiatry 65, S1 (June 2022): S42. http://dx.doi.org/10.1192/j.eurpsy.2022.146.

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Opioid misuse and its rising rates of morbidity and associated mortality is an increasing area of concern worldwide. The licit/illicit consumption of opioids ranging from plant-based substances and pharmaceutical drugs (particularly analgesia) to the new synthetic opioids, has brought opioid use disorder (OUD) back to the public health concerns, including not only prevention but also availability of evidence-based treatments. Agonist opioids have demonstrated by long high efficacy and effectiveness for OUD treatment. Although methadone has been the more prescribed drug in most of the countries where opioid agonist treatment is available, other agonist opioids can be prescribed. We will present a start of the art of other agonist opioids available for the treatment of OUD, emphasizing in the differences among them, in line with of personalizing treatment in addiction. We will focus on morphine slow release, buprenorphine (with or without naloxone, sublingual or long-lasting) and diacetylmorphine. Disclosure MT has been consultant/advisor and/or speaker for Gilead Sciences, Merck Sharp & Dohme Corp, Servier, Adamed, Lundbeck, Camurus, Rovi and Molteni.

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Chaar, Betty B., Holly Wang, Carolyn A. Day, Jane R. Hanrahan, Adam R. Winstock, and Romano Fois. "Factors influencing pharmacy services in opioid substitution treatment." Drug and Alcohol Review 32, no. 4 (February 26, 2013): 426–34. http://dx.doi.org/10.1111/dar.12032.

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Stöver, Heino, and Ingo Michels. "Drug use and opioid substitution treatment for prisoners." Harm Reduction Journal 7, no. 1 (2010): 17. http://dx.doi.org/10.1186/1477-7517-7-17.

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Chaar, B., H. Wang, C. Day, A. Winstock, J. R. Hanrahan, and R. Fois. "Factors Influencing Pharmacy Services in Opioid Substitution Treatment." Research in Social and Administrative Pharmacy 8, no. 6 (November 2012): e32-e33. http://dx.doi.org/10.1016/j.sapharm.2012.08.075.

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Kerr, Thomas, Alex Wodak, Richard Elliott, Julio S. Montaner, and Evan Wood. "Opioid substitution and HIV/AIDS treatment and prevention." Lancet 364, no. 9449 (November 2004): 1918–19. http://dx.doi.org/10.1016/s0140-6736(04)17490-4.

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Marsden, John, Michael Gossop, Michael Farrell, and John Strang. "Opioid Substitution: Critical Issues and Future Directions." Journal of Drug Issues 28, no. 1 (January 1998): 243–63. http://dx.doi.org/10.1177/002204269802800114.

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Opioid substitution with oral methadone is the most widely implemented treatment for heroin dependence. In Britain, a complex array of specialist and generic health care services have evolved to deliver this treatment modality. Several minority aspects of British substitution practices receive enduring international interest, including the use of heroin itself as a substitute and the prescribing of methadone in an injectable form. This paper focuses on six linked dimensions that characterize substitution services: (1) treatment providers and settings, (2) prescribing regimes and treatment goals, (3) substitute drugs, (4) dose administration, (5) dose levels, and (6) substitute formulations. Against a background of increasing central and local accountability for the quality and efficiency of specialist providers and critical attention toward their effectiveness, the strengths and weaknesses of the British approach are considered and key issues and future directions are discussed.

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Hren, R. "Cost-Effectiveness Analysis of Opioid Substitution Treatment in Slovenia." Value in Health 18, no. 7 (November 2015): A411. http://dx.doi.org/10.1016/j.jval.2015.09.980.

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Gjersing, Linn, and Anne Line Bretteville-Jensen. "Is opioid substitution treatment beneficial if injecting behaviour continues?" Drug and Alcohol Dependence 133, no. 1 (November 2013): 121–26. http://dx.doi.org/10.1016/j.drugalcdep.2013.05.022.

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Raistrick, Duncan. "Are UK opioid substitution treatment agencies fit for purpose?" Addiction 112, no. 8 (February 2, 2017): 1340–42. http://dx.doi.org/10.1111/add.13737.

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Lukey, Rebecca, Ben Gray, and Caroline Morris. "‘We’re just seen as people that give out the methadone…’: exploring the role of community pharmacists in the opioid substitution treatment team." Journal of Primary Health Care 12, no. 4 (2020): 358. http://dx.doi.org/10.1071/hc20108.

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ABSTRACT INTRODUCTIONPeople receiving opioid substitution treatment are a vulnerable population who experience significant health inequities and stigma, but have regular interactions with community pharmacists. Many pharmacists now work collaboratively with other health providers to ensure effective and safe use of medicines, as well as being involved in the prevention and management of chronic health conditions. AIMTo explore the role of New Zealand community pharmacists in the provision of opioid substitution treatment and how they perceive their role as part of the wider opioid substitution treatment team. METHODSSemi-structured video interviews with a purposive sample of 13 diverse pharmacists explored their current practices in providing opioid substitution treatment, and their perceived role in the treatment team. Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed using an inductive thematic approach. RESULTSThis study found that pharmacists are providing accessible support to a population with known barriers to accessing health care. However, participants also identified challenges with communication and a perceived lack of understanding of the pharmacist role as barriers to collaboration with the wider opioid substitution treatment team. DISCUSSIONCollaboration within health-care teams has been shown to improve health outcomes, and pharmacists are well placed to provide health-care services as well as offer valuable insight into clients’ mental and physical wellbeing. Improved communication channels that facilitate information sharing, as well as the opioid substitution treatment team’s recognition of a pharmacist’s role, may facilitate collaboration and, in turn, improve the quality of health care provided to this vulnerable population.

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Gadbois, Christine, Elizabeth D. Chin, and Lee Dalphonse. "Health Promotion in an Opioid Treatment Program." Journal of Addictions Nursing 27, no. 2 (2016): 127–42. http://dx.doi.org/10.1097/jan.0000000000000124.

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Vasiliu, Octavian. "Maintenance pharmacologic therapies for opioid use disorders: beyond opioid agonists." Romanian Journal of Military Medicine 122, no. 1 (January 8, 2019): 52–70. http://dx.doi.org/10.55453/rjmm.2019.122.1.8.

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Opioid use disorder is a worldwide challenge for an increasing number of patients, and still the therapeutic options presented in clinical guidelines for this condition are very few. The first line pharmacological therapies for opioid use disorder continue to be opioid agonists as substitution treatment, but the need to find new treatments without the effect of prolonging opioid dependence become more and more obvious. This systematic review presents the most supported by evidence pharmacological agents that can be used as monotherapy for opioid use disorder patients (i.e., naltrexone, extended release/implant and oral formulation), or as adjuvants to substitution therapy (e.g. olanzapine for aggressive behaviours, memantine or dextromethorphan for reducing inflammatory processes related to opioid use). More good quality data derived from larger, well designed trials are needed in order to find solid recommendations for non-opioid agonists in the treatment of opioid use disorder.

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Shylava, M. A., and A. V. Abramovich. "EPIDEMIOLOGICAL CHARACTERISTICS OF HIV-INFECTED DRUG USERS AT THE STAGE OF BECOMING A MEMBER OF THE OPIOID SUBSTITUTION THERAPY PROGRAM IN THE CITY OF MINSK." Vestnik of Vitebsk State Medical University 20, no. 3 (June 15, 2021): 63–70. http://dx.doi.org/10.22263/2312-4156.2021.3.63.

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Objectives. To identify the medico-social and epidemiological peculiarities of HIV-infected people injecting drugs (PWID) at the stage of joining the opioid substitution therapy (OST) program, who adopted it in 2019 in the city of Minsk. Material and methods. The data of the primary accounting documentation of the Health Care Institution «City Clinical Narcological Dispensary» and the Health Care Institution «City Clinical Infectious Diseases Hospital» of PWID HIV-infected patients were analyzed on joining the opioid substitution therapy program who adopted it in 2019 in the city of Minsk (n=91). Results. It has been found that the largest proportion of the OST program participants constituted males (73.63%) aged 36 years and older (73.62%); 64.84% of them were convicted more than 3 times, 83.52% were not officially married, 64.84% were officially unemployed. The median experience of using opioid drugs made up 21 (19-24) years. Almost ½ (46.15%) of HIV-infected drug users were members of OST program for 3 (1-5) years in 2019. Most of the OST program participants (83.52%) had up to 3 periods without drug use, while in 54.95% of them these breaks were due to serving a sentence, and in 21.98% because of undergoing rehabilitation. Lifestyle changes and socialization in society were authentically the most significant reasons and motives for the participation of PWID HIV-infected persons in the OST program in Minsk (p<0.05). The analysis of the comorbidity rate showed that all the participants in the studied group were infected with viral hepatitis C, 6.59% - with hepatitis B against the background of hepatitis C virus (HCV), and 1.01% - with hepatitis D. Conclusions. The revealed medical, social and epidemiological features of HIV-infected PWID persons at the stage of joining the opioid substitution therapy program will make it possible to increase the efficiency of providing medical care to opioid drug users with HIV infection and parenteral viral hepatites and extend the coverage of the studied contingent by this program.

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Nielsen, Suzanne, B. Larance, Nicholas Lintzeris, Emma Black, Raimondo Bruno, B. Murnion, A. Dunlop, and L. Degenhardt. "Is pain associated with illicit opioid use or aberrant opioid-related behaviors in opioid substitution treatment patients." Drug and Alcohol Dependence 140 (July 2014): e162. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.456.

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Nielsen, Suzanne, Paul Dietze, Nicole Lee, Adrian Dunlop, and David Taylor. "Concurrent buprenorphine and benzodiazepines use and self-reported opioid toxicity in opioid substitution treatment." Addiction 102, no. 4 (April 2007): 616–22. http://dx.doi.org/10.1111/j.1360-0443.2006.01731.x.

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Alam, Farrukh, Nat Wright, Paul Roberts, Sunny Dhadley, Joanne Townley, and Russell Webster. "Optimising opioid substitution therapy in the prison environment." International Journal of Prisoner Health 15, no. 4 (December 5, 2019): 293–307. http://dx.doi.org/10.1108/ijph-12-2017-0061.

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Purpose The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales. Design/methodology/approach A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017). Findings Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison. Originality/value Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

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Gowing, Linda R., Matthew Hickman, and Louisa Degenhardt. "Mitigating the risk of HIV infection with opioid substitution treatment." Bulletin of the World Health Organization 91, no. 2 (February 1, 2013): 148–49. http://dx.doi.org/10.2471/blt.12.109553.

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Castrén, Sari, Anne H. Salonen, Hannu Alho, Tuuli Lahti, and Kaarlo Simojoki. "Past-year gambling behaviour among patients receiving opioid substitution treatment." Substance Abuse Treatment, Prevention, and Policy 10, no. 1 (2015): 4. http://dx.doi.org/10.1186/1747-597x-10-4.

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O’Connor, Aisling Máire, Gráinne Cousins, Louise Durand, Joe Barry, and Fiona Boland. "Retention of patients in opioid substitution treatment: A systematic review." PLOS ONE 15, no. 5 (May 14, 2020): e0232086. http://dx.doi.org/10.1371/journal.pone.0232086.

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Gowing, L. R. "The role of opioid substitution treatment in reducing HIV transmission." BMJ 345, oct03 3 (October 3, 2012): e6425-e6425. http://dx.doi.org/10.1136/bmj.e6425.

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Suddaby, Rebecca J., Caroline J. Morris, and Ben Gray. "Role of New Zealand community pharmacists in opioid substitution treatment." Research in Social and Administrative Pharmacy 15, no. 5 (May 2019): e20-e21. http://dx.doi.org/10.1016/j.sapharm.2019.03.128.

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