Harm reduction and abstinence-based models for treatment of substance use disorders during the COVID-19 pandemic : a global perspective

M.F. is an employee of the US Federal Government and is supported by National Institutes of Health (NIH) intramural funding (ZIA-DA000635 and ZIA-AA000218), outside of this research.The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area.Publisher PDFPeer reviewe

Depot buprenorphine during COVID-19 in Australia: Opportunities and challenges

The COVID-19 pandemic has presented challenges for traditional models of opioid use disorder treatment worldwide. Depot buprenorphine became available in Australia shortly before the height of the COVID-19 pandemic. This timing provided us an opportunity to examine the utilization and uptake of depot buprenorphine, and to understand the particular benefits and implementation challenges associated with this new formulation of opioid agonist treatment

The Methamphetamine-Associated Psychosis Spectrum: a Clinically Focused Review

© 2018 Springer Science+Business Media, LLC, part of Springer Nature. Methamphetamine use is a global concern, and methamphetamine-associated psychosis (MAP) is a particular harm resulting from regular use of the drug that causes significant distress and burden on health and social services. This paper aims to provide a clinically focussed and up-to-date overview of the prevalence, risk factors, and clinical and cognitive features of MAP. The prevalence of MAP ranges between 15 and 30% in recreational settings and up to 60% in some inpatient treatment settings, with up to a third of people with MAP later diagnosed with persistent psychotic disorders. The frequency of methamphetamine use and severity of dependence are the most consistent risk factors for MAP, but other predictors such as genetic vulnerability, a family history of psychotic illness, or trauma also play a role. People with MAP can vary in their presentation, from brief delusional experiences, to persistent psychosis characterised by first-rank symptoms and cognitive impairment. Contemporary conceptualisations of MAP need to incorporate this spectrum of clinical presentations in order to inform clinical decision-making, service provision, and research directions

Prescribed sedative and other psychotropic medication use among clients attending alcohol and other drug treatment

© 2018 Australasian Professional Society on Alcohol and other Drugs Introduction and Aims: Prescribed psychotropic medications contribute to overdose mortality among people with alcohol and other drug (AOD) disorders. We report on prescribed psychotropic medication use among AOD treatment service attendees, focusing on sedative drugs. Design and Methods: Prospective multi-site naturalistic outcome study in residential and outpatient AOD treatment facilities in Victoria and Western Australia. A convenience sample of 480 people (57% male; mean age 36.1) entering treatment were surveyed, of whom 313 (65%) were followed up by telephone interview after a median of 377 days. Participants’ prescribed psychotropic medication use was ascertained by self-report at baseline and follow-up. Results: At baseline, 41% of participants reported prescribed sedative medication (benzodiazepine, zopiclone or zolpidem) use within the past month, including prescriptions to treat withdrawal symptoms. At follow-up, the cohort reported a reduced rate of past month prescribed sedative use (23%; P < 0.001) and this rate did not significantly differ between those who continued to use their primary drug of concern and those who were abstinent at follow-up (P = 0.08). Among those with opioids as their primary drug of concern, one-third were still being prescribed a sedative at follow-up (P > 0.99 for change from baseline). At baseline, 40% of participants were prescribed an antidepressant and 13% an antipsychotic medication, which remained similar at follow-up (45% and 13%, respectively). Discussion and Conclusions: The high level of prescribed sedative drug use reported by people receiving AOD treatment is a serious public health concern given the increasing incidence of drug overdose deaths in Australia

Protocol for the methamphetamine approach-avoidance training (MAAT) trial, a randomised controlled trial of personalised approach bias modification for methamphetamine use disorder

BACKGROUND: Globally, methamphetamine use has increased in prevalence in recent years. In Australia, there has been a dramatic increase in numbers of people seeking treatment, including residential rehabilitation, for methamphetamine use disorder (MUD). While residential rehabilitation is more effective for MUD than withdrawal treatment (i.e. "detoxification") alone, relapse rates remain high, with approximately half of rehabilitation clients using methamphetamine within 3 months of rehabilitation. "Approach bias modification" (ABM) is a computerised cognitive training approach that aims to dampen automatically triggered impulses to approach drugs and drug-related stimuli. ABM has been demonstrated to reduce alcohol relapse rates, but no randomised controlled trials of ABM for MUD have yet been conducted. We aim to test whether a novel "personalised" form of ABM, delivered during rehabilitation, reduces post-treatment methamphetamine use, relative to a sham-training control condition. Secondary outcomes will include dependence symptoms, cravings, and approach bias. METHODS: We aim to recruit 100 participants attending residential rehabilitation for MUD at 3 sites in the Melbourne metropolitan area. Participants will complete baseline measures of methamphetamine use, craving, dependence severity, and approach bias before being randomised to receiving 6 sessions of ABM or "sham" training. In the active condition, ABM will be personalised for each participant, using those methamphetamine images that they rate as most relevant to their recent methods of methamphetamine use as "avoidance" images and using positive images representing their goals or healthy sources of pleasure as "approach" images. Approach bias and craving will be re-assessed following completion of training, and methamphetamine use, dependence, and craving will be assessed 4 weeks and 3 months following discharge from residential treatment. DISCUSSION: This study is the first randomised controlled trial of ABM for MUD and also the first ABM study to test using a personalised set of both approach and avoid images for ABM training. If effective, the low cost and easy implementation of ABM means it could be widely implemented as a standard part of MUD treatment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000072910. Registered on 30 January 2020 (prospectively registered): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378804&isReview=true

Key implementation factors in telemedicine-delivered medications for opioid use disorder: a scoping review informed by normalisation process theory.

Telemedicine could improve access to medications for opioid use disorder (MOUD). Telemedicine-delivered MOUD (TMOUD) has expanded substantially in response to the restrictions imposed by the COVID-19 pandemic on in-person clinical contact, yet this expansion has not happened consistently across all health systems and countries. This Review aims to understand key factors in TMOUD implementation that might explain variations in uptake. We did a scoping review using three English language databases for articles reporting on the implementation of TMOUD services. 57 peer-reviewed articles were identified, subjected to open coding and thematic analysis, and further interpreted through normalisation process theory (NPT). NPT was originally used to evaluate telehealth innovations and has been applied extensively to describe, assess, and develop the implementation potential of a broad range of complex health-care interventions. By categorising our findings according to the four core NPT constructs of coherence, cognitive participation, collective action, and reflexive monitoring, we aim to rationalise the current evidence base to show the workability of TMOUD in practice. We find that variations in TMOUD models in practice depend on organisations' attitudes towards risk, clinicians' tensions around giving up control over standard practices, organisation-level support in overcoming operational and technological challenges, and evaluation methods that might neglect a potential widening of the digital divide

sj-docx-1-anp-10.1177_00048674231201541 – Supplemental material for Economic evaluations of alcohol pharmacotherapy: Systematic review of economic evaluations of pharmacotherapy for the treatment of alcohol use disorder

Supplemental material, sj-docx-1-anp-10.1177_00048674231201541 for Economic evaluations of alcohol pharmacotherapy: Systematic review of economic evaluations of pharmacotherapy for the treatment of alcohol use disorder by Benjamin Higginbotham, Joahna Kevin Perez, Eva Louie, Paul S Haber, Dan Lubman, Shalini Arunogiri, Mary Lou Chatterton and Kirsten C Morley in Australian & New Zealand Journal of Psychiatry</p