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.
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
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.
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:
|photocredit: Wolters Kluwer
Training in addiction medicine gives clinicians early intervention tools, prevents the escalation of addiction and prevents costly and lengthy treatment. The problem is that very little information exists on the treatment workforce. It seems that most health systems do not have enough providers trained in addiction medicine to reduce the public health consequences of this increasing societal problem. In 2014, the Boston-based Advocates for Human Potential, Inc., developed a so-called Provider Availability Index
. It measures the gap between the need for and availability of trained healthcare providers, but similar efforts have not been done in Canadian setting. This paper briefly describes mathematical estimates of the number of skilled addiction care providers in British Columbia, Canada, and offers recommendations for steps that can be taken immediately to increase provider availability. The article was published ahead of print in the Journal of Addiction Medicine on May 13, 2016 and the suggested citation is:
McEachern, J., Ahamad, K., Nolan, S., Mead, A., Wood, E., & Klimas, J. (9000). A needs assessment of the number of comprehensive addiction care physicians required in a canadian setting. J Addict Med, Publish Ahead of Print. doi:10.1097/adm.0000000000000230
April 4: Methadone is a medication used in treatment of people with dependence from heroin or other opioids. Many people who take it drink too much alcohol. We don’t know whether it’s because or in spite of taking this medication. We wanted to know the impact of enrolment in methadone treatment on the onset of heavy drinking among people who use heroin.
Our approach: We analysed information from thousands of interviews from long-term, community-based studies of people who inject drugs in Vancouver, Canada, between December 1, 2005 and May 31, 2014.
What have we found: In total, 357 people who use heroin were included in this study. Of these, 58% enrolled in methadone at some point between 2005-2014, and 32% reported starting to drink heavily. Those who started the treatment said they drank less compared to those who did not start it. It didn’t even make them start drinking faster than those who did not start taking methadone. People who started drinking heavily when they enrolled in methadone were younger than those who did not start drinking heavily. They also used more cannabis.
What does this mean: It is clear that many people in the methadone treatment have problems with alcohol. It seems that they do not drink because they take this medication which may even appear to decrease the initiation of heavy drinking. Our findings suggest younger age and cannabis use may predict heavy drinking. These findings could help inform on-going discussions about the effects of opioid agonist therapy on alcohol consumption among people who use heroin.
This blog is based on article was Accepted for publication in the European Addiction Research Journal on January 31, 2016. The full title of the article is: The Impact of Enrolment in Methadone Maintenance Therapy on Initiation of Heavy Drinking among People who Use Heroin. The authors of the article are following:
Please join us on Tuesday, October 27 for this month’s edition of the “What’s New in Addiction Medicine?” lecture series.
This (free) event features a presentation by Dr. Jan Klimas and will be held between 12-1pm. The talk is entitled “Methadone and Alcohol Don’t Mix” and will be hosted at St. Paul’s Hospital in the Hurlburt Auditorium (2nd floor). A light lunch will be provided.
We strongly encourage guests to RSVP as soon as possible to ensure sufficient food and space. (Please note that you will not need to bring your registration ticket(s) to the event.)
To RSVP, please click here. (If you are experiencing any difficulty accessing the link, please type bit.ly/WNAM23 into your browser or email Cameron Collins at the address listed below.)
Please don’t hesitate to forward this email on to anyone who you think may be interested in this lecture or the series more broadly. A calendar of upcoming presentations is available here.
If you have any questions about event logistics, please DO NOT respond to this email. Instead, contact Cameron Collins ([email protected]).