Tracking internet interest in anabolic-androgenic steroids using Google Trends

Background: There is a perception that the prevalence of anabolic-androgenic steroid (AAS) use is increasing in the UK, with consequent individual and public health risks. Nevertheless, there is a lack of real-time surveillance data to support the development of effective policy. This paper explores the potential of Google Trends to complement existing surveillance methods by analysing user generated search term data. Methods: The Google Trends web tool was used to identify patterns of UK online interest in 15 AAS from January 2011 to December 2015, with 10 ultimately suitable for further analysis. Time series analysis was applied to the data. Results: 10 steroids were ranked from most to least popular. All compounds had peaks in interest between April to July, potentially indicating a consumer driven desire to attain a desired physique in time for summer. Oral steroids were among the most searched for drugs which may have relevance for current service provision to steroid users. Conclusion: Alternative data sources such Google Trends may provide useful additional information to supplement existing surveillance data. The limitations of this method however makes cautious interpretation and triangulation with other data sources essential

Implementing buprenorphine prolonged-release injection using a health at the margins approach for transactional sex-workers

BackgroundAccess to prescribed interventions and retention in treatment services are associated with improved health outcomes and reduced premature mortality rates for people living with opioid use disorder (OUD). In Leeds, transactional sex-workers frequently cycled in and out of treatment for OUD such that they never reached a level of engagement that permitted opportunities to meet their healthcare or housing needs. Barriers to accessing care provision include an itinerant lifestyle, difficulties with travel at unpredictable hours, impacting upon adherence to medication regimens including daily supervised consumption.ObjectivesTo use a co-produced, “health at the margins” approach, to reach the sex-working population in Leeds, and support informed choices about the potential to receive buprenorphine prolonged-release injection (BPRI) as a treatment option for OUD.MethodsBPRI was introduced using a theory of change model and improvements in sex-worker care delivery was reviewed. Strategies included buprenorphine micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based and trauma-informed approach.ResultsBenefits of BPRI included removal of the need for daily pharmacy visits, reducing the risk of diversion, improved medication adherence, stability and engagement with treatment and supportive services.ConclusionBPRI may offer an additional option for pharmacological interventions for people with OUD where there may be increased barriers to accessing treatment for example due to sex-working. Strategies for effective BPRI include micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based approach

Rapid opioid overdose response system technologies

Purpose of review  Opioid overdose events are a time sensitive medical emergency, which is often reversible with naloxone administration if detected in time. Many countries are facing rising opioid overdose deaths and have been implementing rapid opioid overdose response Systems (ROORS). We describe how technology is increasingly being used in ROORS design, implementation and delivery. Recent findings  Technology can contribute in significant ways to ROORS design, implementation, and delivery. Artificial intelligence-based modelling and simulations alongside wastewater-based epidemiology can be used to inform policy decisions around naloxone access laws and effective naloxone distribution strategies. Data linkage and machine learning projects can support service delivery organizations to mobilize and distribute community resources in support of ROORS. Digital phenotyping is an advancement in data linkage and machine learning projects, potentially leading to precision overdose responses. At the coalface, opioid overdose detection devices through fixed location or wearable sensors, improved connectivity, smartphone applications and drone-based emergency naloxone delivery all have a role in improving outcomes from opioid overdose. Data driven technologies also have an important role in empowering community responses to opioid overdose. Summary  This review highlights the importance of technology applied to every aspect of ROORS. Key areas of development include the need to protect marginalized groups from algorithmic bias, a better understanding of individual overdose trajectories and new reversal agents and improved drug delivery methods.PostprintPeer reviewe

Treatments for people who use anabolic androgenic steroids: a scoping review.

BACKGROUND: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems. METHODS: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible. RESULTS: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided. CONCLUSION: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health- or drug-related journals, will support development of the evidence base

Medication-Assisted Treatment for Opioid Use Disorders 2:Detoxification

This chapter is the second of two parts describing the advantages, standards, and goals of medication-assisted treatment (MAT) for opioid use disorders. MAT is a complex biopsychosocial intervention with the provision of opioid substitution treatment (OST) at its core. These chapters aim to provide the clinician with charts, tables, and clinical guidance around the prescribing of OST within MAT. This second part (this chapter) covers the process of detoxification from OST as well as aftercare including the use of naltrexone. This chapter also looks at the care of special patient groups requiring MAT, such as those who are pregnant or who have multiple substance dependencies and gives brief guidance around the management of comorbid mental health problems. These chapters focus on the prescribing issues within MAT and are not able to cover the full scope of the social and psychological aspects of this complex intervention; clinicians are recommended to read broadly to ensure they understand the full scope of MAT, which is far more than just the prescribing of OST. Data presented here is based on clinical guidelines and the experience in treating persons with OUDs in Scotland, United Kingdom (UK), and reflects evolution in practice in response to the high levels of drug deaths and Scottish national MAT standards published in May 2021. Within the UK, the National Health Service (NHS) exists as a single-payer healthcare system, providing universal care to all residents. This of course is not the case worldwide, and there is substantial variation in availability of services between countries. Clinicians should always ensure that they are familiar with what services are available locally as well as local licensing and legal requirements around prescribing OST, as substitute medications are usually controlled drugs.</p

Medication-Assisted Treatment (MAT) 1:Opioid Substitution Therapy

This chapter is the first of two parts describing the advantages, standards, and goals of medication-assisted treatment (MAT) for opioid use disorders. MAT is a complex biopsychosocial intervention with the provision of opioid substitution treatment (OST) at its core. These chapters aim to provide the clinician with charts, tables, and clinical guidance around the prescribing of OST within MAT. This first part (this chapter) covers the assessment of patients with opioid use disorders (OUDs), initiation, titration, and maintenance with OST, as well as physical monitoring and the treatment of those with OUDs requiring admission to hospital. Data presented here is based on clinical guidelines and the experience in treating persons with OUDs in Scotland, United Kingdom (UK), and reflects evolution in practice in response to the high levels of drug deaths and Scottish national MAT standards published in May 2021. Within the UK, the National Health Service (NHS) exists as a single-payer healthcare system, providing universal care to all residents. This of course is not the case worldwide, and there is substantial variation in availability of services between countries. Clinicians should always ensure that they are familiar with what services are available locally as well as local licensing and legal requirements around prescribing OST, as substitute medications are usually controlled drugs.</p

Using microdosing to induct patients into a long-acting injectable buprenorphine depot medication in low threshold community settings : a case study

Healthcare innovation has never been more important as it is now when the world is facing up to the unprecedented challenges brought by the COVID-19 pandemic. Within addictions services in Scotland, the priority has been to tackle our rising drug related death rate by maintaining and improving access to treatment while protecting frontline workers and managing operational challenges as a result of the pandemic. We present here a case study of five patients with opioid use disorder whose treatment represents a confluence of three important Medication Assisted Treatment (MAT) service innovations. The first was a low threshold drop in and outreach MAT service to rapidly and safely initiate opiate replacement therapy (ORT). The second was the provision of a microdosing regimen to enable same day induction to oral buprenorphine while minimizing the risk of precipitated opioid withdrawals and/or treatment disengagement. The third was rapid transitioning to an injectable long-acting buprenorphine depot which reduced unnecessary face to face patient contact and treatment non-adherence. This case study of five patients highlights the valuable role that buprenorphine microdosing can play in making induction to long-acting buprenorphine depot feasible to a broader range of patients, including those on a high dose methadone treatment regime.Publisher PDFPeer reviewe