Category: Alcohol

Annual review: Summaries, essays and productive conferences

The post on 27 deaths out of 100 people receiving methadone in primary care over 17 years was the most frequently visited of the year but also the gloomiest.
I’ve had an inspired year here at the Be-seen, with a brilliant string of posts about new research articles ranging from a progressive post from the Irish Journal of Psychological Medicine on improving writing groups for addiction researchers, to emerging treatments for cocaine addiction, and along the same theme a series covering my topic of interest in drinking by people who also use other drugs. Here’s the list of new paper summaries in chronological order:
Summaries of new papers 
* First or senior author papers
In sum, the main themes of this year were not only summaries of new papers but also essays on writing and conference reports.
Conferences April-June

With three new entries on academic and cultural meetings, these may be of great interest to my readers fascinated by communication in science and art and blending the boundaries between the two disciplines:

Write well
The fastest start is to listen to patients’ stories – make evidence based responses part of your toolkit, whether it’s responding to the iatrogenic overdose epidemic or writing effective paragraphs.  Secondly, consider making scientific writing something that sticks to the brain. Have a try at writing groups or writing classes – they can help. Have the courage to promote simplicity of writing in your field. I’m positive this is not all that I will have to say on the topic – watch this space.
Essays

Literary editors who helped
Adam Nanji, Vancouver is Awesome http://vancouverisawesome.com/
Tara Siebarth and Ashleigh VanHouten, University Affairs www.universityaffairs.ca
Stephen Strauss, Canadian Science Writers http://sciencewriters.ca/4072583
Journal editors who helped
Twelve addiction journal editors helped with publishing 16 papers:
Roger Jones, BJGP www.bjgp.org
Jeffrey Samet, Addict Sci& Clin Practice https://ascpjournal.biomedcentral.com/
Richard Saitz, J Addict Medicine www.journals.lww.com/journaladdictionmedicine/Pages/default.aspx
Richard Pates, J Substance Use www.tandfonline.com/loi/ijsu20
Tim Rhodes, J Int Drug Policy www.ijdp.org 
Michael Morgan, Addiction www.addictionjournal.org
John Lyne, Irish J Psychol Medicine www.journals.cambridge.org/article_S0790966700017535
Pedro Ruiz, Addict Disorders& Their Treatment www.journals.lww.com/addictiondisorders/Pages/default.aspx
Donata Kurpas, BMC Family Practice www.bmcfampract.biomedcentral.com
Axel Klein, Drugs and Alcohol Today www.emeraldinsight.com/toc/dat/15/4
Wim van den Brink, European Addict Research www.karger.com/EAR/
Jelle Stoffers, Eur J Gen Practice www.tandfonline.com/loi/igen20
In the meantime, I also continued to write in Slovak magazines and in my community of writers. In Slovak, I wrote for Slovo and Zpravodaj edited by Jozef Starosta and Marta Jamborova, respectively.
Early in the January and late in December, I wrote poems with my community of writers from the Thursdays Writing Collectivefacilitated by the fantastic Elee Kralji Gardiner and Amber Dawn. During the year, I wrote with the writers from the Writer’s Studio. Some of those poems landed on stage of the Vancouver Poetry Slam and on their video channel.
Thanks to all of my readers. It’s been over four years for the Be-seen blog now and I owe a lot to the editors and readers. I hope readers will continue to feel that this is a resource for them to visit and engage with.


Alcohol holding up methadone treatment

This review asked whether excessive drinking can get in the way of treating heroin addiction.

No current evidence supports the clinical requirement asking people to stop their medicines for opioid addiction if they want to enter alcohol treatment.


Although there is a lot of research behind effective strategies for the screening, diagnosis and management of an alcohol or opioid use disorder individually, less is known about how best to care for those who also use other drugs, especially since the usual treatments for opioid addiction may not be allowed in a setting of alcohol use treatment.

For example, some fellowship meetings discourage people from continuing their medication for opioid addiction (methadone).  Or some residential treatment centres require people to be “drug free” upon enrolment, which includes not using their suboxone. For safety reasons, methadone clinics reduce the dose for patients who drink excessively.

This review summarizes existing research and characterizes the prevalence, clinical implications and management options for heavy drinking among people who also use other illicit drugs.

Drinking by people using agonist medications like methadone or suboxone for opioid use disorders is common and brings along many unwanted side effects. Over time, people die.

We don’t know how to treat people who have alcohol use disorder and who also use other drugs but asking them to come off their prescribed medications isn’t based on evidence.

Nolan, S., Klimas, J., & Wood, E. (2016). Alcohol use in opioid agonist treatment. Addiction Science & Clinical Practice11, 17. http://doi.org/10.1186/s13722-016-0065-6  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5146864/

Primary care looks at drinking among persons on methadone treatment

How should primary care doctors ask their methadone patients about alcohol use?

We worked with 13 primary care doctors and divided them into two groups. We trained one group on how to ask about and advise on heavy drinking. We looked at whether trained and coached doctors managed patients who drank.
photocredit: methadoneaddiction.com


Primary care can look at drinking among persons on methadone treatment and advise on risks of heavy drinking.

We found that the trained doctors asked about and advised on heavy drinking more often than the untrained doctors. Four patients in their care drank less alcohol three months later, compared to two patients of the untrained doctors. Some doctors were reluctant to use their new learning in the practice because it was too complicated.

A bigger and simpler study must prove the positive results of this modest study

Methadone helps people with opioid use disorders use less drugs, but it doesn’t stop them from drinking. About 30% of them drink in excess of the low-risk drinking limits. Drinking makes their treatment harder and their health worse. Primary care doctors who prescribe methadone see patients weekly and can help them drink less.

Reference: Henihan, AM., McCombe, G., Klimas, J., Swan, D., Leahy, D….Cullen, W. (2016)  Feasibility of Alcohol Screening among Patients receiving Opioid Agonist Treatment in Primary Care. BMC Family Practice, 17:153




What do persons on methadone in primary care think about alcohol screening?

Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: Qualitative study in primary care

New Paper Out Now

Although very common, excessive drinking by people who also use other drugs is rarely studied by scientists. The purpose of this study was to find out patient’s and clinicians’ opinions about addressing this issue. All of them took part in a study called PINTA – Psychosocial interventions for problem alcohol use among problem drug users.

photocredit: emerald

Doctors reported obstacles to addressing heavy drinking and overlooking and underestimating this problem in this population.

Patients revealed that their drinking was rarely spoken about and feared that their methadone would be withheld.

Read the full article in the latest issue of the Drugs and Alcohol Today: http://www.emeraldinsight.com/loi/dat

See also my previous posts about the PINTA study:

New paper out now: Psychosocial Interventions for Alcohol use among problem drug users

2014

Beg, steel or borrow: getting physicians to recruit patients in clinical trials

Addiction Medicine Education for Healthcare Improvement Initiatives: New Paper out Now

2013

Honor pot: testing doctors’ drug counselling skills in a new pilot study in Ireland

Fidelity questions

Why Empirically Supported Psychosocial Treatments Are Important for Drug Users? New research project

Hepatitis C unchanged, but drinking soared

NEW PAPER OUT NOW 

What is the study about?

           We wanted to find out how many people receiving treatment for opioid addiction (methadone) have Hepatitis C and other blood borne viruses
           And whether anything changed between the years 2006 and 2013

QUICK FACT:

Over a third of people who receive methadone in primary care and who drink excessively test positive for Hepatitis C
 

asam.org

How was the study done?

           In 2013, we have done a secondary analysis of data collected during a feasibility study of an alcohol brief intervention for people attending primary care for methadone treatment
           We looked at two studies done in 2006 and 2013 and compared them

What did the study find?

           We found the proportion of patients with problem alcohol use was much higher (46% v 35%) in 2013.
           37% of people who had Hepatitis C also drank excessively
In 2013, number of people who had Hepatitis C was not different from 2006, but more people drank excessively.

Why is the study important?

           Many people who receive treatment for opioid addiction have Hepatitis C
           Treatment of Hepatitis C is expensive
           Because heavy drinking can make the treatment even more expensive, we should help people drink less
Reference: Improvements in HCV-related Knowledge Among Substance Users on Opioid Agonist Therapy After an Educational Intervention. Journal of Addiction Medicine: September/October 2016 – Volume 10 – Issue 5 – p 363–364
(http://journals.lww.com/journaladdictionmedicine/Citation/2016/10000/Commentary_on_Zeremski_et_al___2016___.11.aspx)