Effectiveness of pharmacotherapies in increasing treatment retention and reducing opioid overdose death in individuals recently released from prison: A systematic review

Background: Opioid dependence is common amongst the prison population, with increased risk of fatal overdose in the immediate post-release period. Aim: The study aimed to review the effectiveness of pharmacotherapies (Methadone (METH), Buprenorphine (BUP), levo-alpha acetyl methadol (LAAM), Naltrexone (NLT) and Naloxone (NLX)) in reducing overdose deaths and increasing treatment retention in opioid dependent prisoners on release. Methods: A systematic review of studies on recently discharged opioid dependent prisoners receiving METH, BUP, LAAM, NLT and/or NLX was conducted. Factors of interest regarded post-release treatment retention, non-fatal overdoses (NFODs), overdose mortality, and continued heroin and/or other illicit drug use. Searches were conducted using MESH terms; opioid related disorder, prisoner, NLT, NLX, METH, BUP, LAAM, overdose. Exclusion criteria were applied as per PRISMA guidelines. Quality, outcome and risk of bias assessments were applied across studies. Results: Eight randomised control trials (RCT), one non-randomised trial and five observational studies formed the data set. Agonist Opioid Treatment (AOT) (METH, BUP, LAAM) initiated pre-release was associated with significant post-release treatment retention on discharge into the community, and post-release reduction in heroin use. Prisoners on BUP or METH on discharge had significantly reduced mortality risks in the immediate four weeks post-release. There was insufficient evidence supporting a reduction in NFODs and continued other illicit drug use. Conclusions: The review underscores the need for prisoners on AOT to be supported with continued treatment on release into the community. Further research is warranted to investigate potential utility of long-acting NLT formulations and take-home NLX (THN) in pre-release opioid dependant prisoners. © 2017, Pacini Editore S.p.A. All rights reserved

Prevalence and risk factors for hepatitis C viral infection amongst a cohort of irish drug users attending a drug treatment centre for agonist opioid treatment (AOT)

Background: Injecting drug use (IDU) is a major driver of the European hepatitis C virus (HCV) epidemic. National data on prevalence of HCV amongst Irish drug users remains confined to certain treatment sites and prison settings. Aim: To examine the prevalence of HCV infection and risk factors associated with infection among the 228 patients attending agonist opioid treatment (AOT) in a clinic in Dublin. Methods: A retrospective cross-sectional study was conducted using data collected from Health Research Board (HRB) forms and standardised written and electronic assessment forms routinely completed on treatment initiation. Results: The prevalence of HCV infection was 63.6% (n= 145) with no significant gender difference (p=0.717). Patients who were infected with HCV were older than those uninfected (41.1 ± 7.5 years versus 37.5 ± 8.5 years; p = 0.001), with prevalence significantly lower in younger adults (p=0.002). Multivariate analysis identified age of first drug use (p=0.002) and first injection (p=0.001), type of first drug used; cannabis (p=0.015), heroin (p=0.014) and cocaine (p=0.018) and early age of AOT entry (p=0.001) as the most significant risk factors for HCV infection in this cohort. Those with no IDU had decreased odds of being HCV positive by 91.1%. Conclusion: Data for this Irish sample indicates high prevalence of HCV infection, and the need to consider age of first drug onset and injecting use, particular drug types and earlier commencement of AOT to inform targeted HCV treatment and prevention interventions in Ireland. © Icro Maremmani

A Mathematical Study of the One-Dimensional Keller and Rubinov Model for Liesegang Bands

Our purpose is to start understanding from a mathematical viewpoint experiments in which regularized structures with spatially distinct bands or rings of precipitated material are exhibited, with clearly visible scaling properties. Such patterns are known as Liesegang bands or rings. In this paper, we study a one-dimensional version of the Keller and Rubinow model and present conditions ensuring the existence of Liesegang bands

Exploring Irish Travellers’ experiences of Opioid Substitute Treatment: A Phenomenological Study

The Irish Travelling community are identified “as a people with shared history, culture and traditions including, historically, a nomadic way of life”. The core of Travelling culture is strong family bonds which support resilience, however changing social circumstances and dislocation have contributed to significant mental and physical health issues accompanied by a steep rise in substance abuse and addiction. Aim: To explore and describe Irish Travellers’ experiences of drug use and opioid agonist treatment (OAT), with a view to improving service delivery and expanding the limited research base. Methods: A phenomenological approach using semi-structured interviews was conducted with seven opioid dependent Irish Travellers (two females/five males) currently on OAT at an outpatient clinic in Dublin, Ireland. Results: All participants described the complexities arising from drug use, with significant life events often accompanied by depression and drug use (street, prescribed and over the counter) as a means of self-medication. Barriers to accessing treatment included shame and stigma, fears around being shunned by the community, and a negative attitude towards OAT. All participants and particularly women reported that stigma related physical violence came from community elders if suspected of drug use or association with drug users. Despite initial strong reservations about OAT, experiences were largely positive with acceptance by and support from staff viewed as instrumental. Conclusions: The development of culturally appropriate, gender sensitive and integrated OAT and mental health support services, designed with input from addiction and mental health specialists, alongside community members is warranted

Optimizing Treatment in Opiate Dependency: results from a national key stakeholder and expert focus group in Ireland

Background: Treatment for opioid dependence in Ireland is provided predominantly by general practitioners (GP) who have undergone additional training in opioid agonist treatment (OAT) and substance misuse. The National Methadone Treatment Programme (MTP) was introduced in 1998, and was designed to treat the opioid dependent population and to regulate the prescribing regimes at the time. The past two decades have seen the increased prescribing of methadone in primary care and changes in type of opioid abused, in particular, the increased use of over the counter (OTC) and prescription medications. Despite the scaling up of OAT in Ireland, drug related deaths however have increased and waiting lists for treatment exist in some areas outside the capital, Dublin. Two previous MTP reviews have made recommendations aimed at improving and scaling up of OAT in Ireland. This study updates these recommendations and is the first time that a group of national experts have engaged in structured research to identify barriers to OAT delivery in Ireland. The aim was to explore the views of national statutory and non-statutory stakeholders and experts on current barriers within the MTP and broader OAT delivery structures in order to inform their future design and implementation. Methods: A single focus group with a chosen group of national key stakeholders and experts with a broad range of expertise (clinical, addiction and social inclusion management, harm reduction, homelessness, specialist GPs, academics) (n=11) was conducted. The group included national representation from the areas of drug treatment delivery, service design, policy and practice in Ireland. Results: Four themes emerged from the narrative analysis, and centred on OAT Choices and Patient Characteristics; Systemic Barriers to Optimal OAT Service Provision; GP Training and Registration in the MTP, and Solutions and Models of Good Practice: Using What You Have. Conclusion: The study identified a series of improvement strategies which could reduce barriers to access and the stigma associated with OAT, optimise therapeutic choices, enhance interagency care planning within the MTP, utilise the strengths of community pharmacy and nurse prescribers, and recruit and support methadone prescribing GPs in Ireland

Irish General Practitioner (GP) Perspectives Toward Decriminalisation, Legalisation and Cannabis for Therapeutic Purposes (CTP)

Cannabis is the most prevalent illicit drug used globally. Regulatory debate in Ireland on the decriminalisation of cannabis and legalisation for therapeutic purposes (CTP) is on-going. The study aimed to investigate Irish general practitioner (GP) attitudes toward decriminalisation of cannabis and assess levels of support for CTP. An online survey was administered to all GPs in the Irish College of General Practitioner (ICGP) database. A content analysis was conducted on open-ended survey questions, with five themes emerging. GPs were concerned around early onset of use and intergenerational impacts, vulnerabilities to drug induced psychosis, patient self-medication with cannabis and potential for misuse of prescribed cannabis. The study reflects concerns around the mental health consequences of cannabis use and potential for misuse in the event of legalisation, and the need for product regulation and an enhanced evidence base to support treatment decision making. Further research and medical education is warranted. © 2016, Springer Science+Business Media New York

Chasing the rainbow: pleasure, sex-based sociality and consumerism in navigating and exiting the Irish Chemsex scene

Club drug use among gay, bisexual and other men who have sex with men is increasingly normalised within sexual contexts and is associated with increased sexual risk behaviours. The term Chemsex is used to describe sexualised drug use lasting several hours or days with multiple sexual partners. A small pilot study, underpinned by interpretative phenomenological analysis (IPA), was conducted in Dublin, Ireland. Interviews were conducted with 10 men who were experiencing physical and emotional health problems as a consequence of their participation in sexualised drug use and wished to exit the Chemsex scene. Interviews explored experiences of sexualised drug use, motives to partake, the organisation of Chemsex parties and group connectivity, drugs used, harm reduction, pleasure and consequences of participation over time. Four basic themes emerged from the analysis: social and cyber arrangements within the Dublin Chemsex scene; poly drug use and experiences of drug dependence; drug and sexual harm reduction within the Chemsex circle of novices and experts; and sexualised drug use, escapism and compulsive participation. Two higher-order themes were also apparent: first, the reinforcing aspects of drug and sexual pleasure; and second, the interplay between excess drug consumption and sex, and drug dependence. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group

Overdose risk perceptions and experience of overdose among heroin users in Cork, Ireland. Preliminary results from a pilot overdose prevention study

Background. Opioid overdose is the primary cause of death among injecting drug users (IDU). Overdose is generally not sudden, occurs over one to three hours, and often in the presence of bystanders. This presents a unique window of opportunity to intervene. Aim. Successful overdose prevention training includes appropriate clinical and non-clinical responses. The study aimed to investigate Irish IDU experience of overdose, and need for education and resuscitation skills programming. We report on pilot findings. Methods. Phase One assessed service user experience of overdose, substances used, setting for overdose, and awareness of appropriate non-clinical responses (n=52). Phase two implemented an educational intervention at two Cork addiction service sites. This involved assessing service user awareness of appropriate non-clinical methods to manage overdose and their interest in receiving resuscitation training (n=26). Phase three piloted a resuscitation skills training intervention for staff, family and IDU consisting of instruction on how to recognise and prevent overdose, appropriate response techniques; rescue breathing, and calling emergency services (n=26). Results. The findings illustrated the majority had experienced overdose, described the main substances involved, the settings, the responses employed, and the perceptions of risk. The need for education equipping IDU with overdose prevention and management skills was identified. Awareness of appropriate responses (correct emergency numbers, recovery and resuscitation skills) improved following the educational and skills training interventions Conclusions. Continued efforts in Ireland to integrate culturally specific overdose prevention into agonist opioid treatment services, prison discharge, homeless primary health and needle and syringe exchange are warranted