Do people drink more when they switch to Methadose? It is 10 times more concentrated than methadone – proven treatment of opioid use disorder. We did not find more drinking after the switch. But others found changes in opioid use patterns coinciding with the change.
We talked to 787 people receiving methadone for opioid use disorder in Vancouver, Canada. Our new study followed them as they switched from methadone (1mg/mL) to Methadose (10mg/mL). We asked whether their drinking has changed after the switch – between 2013 and 2015. 16% said they drank too much at least once in the last six months. Those who drank too much were not more likely to do so after the shift to Methadose. The Substance Use& Misuse journal has published the study this week. Persons on methadone for opioid use disorder may report going through opioid withdrawal and increasing their illicit opioid use when switched to Methadose. We need to understand impacts of these changes on other forms of drug use. Careful and planned information about upcoming changes may help people cope with the potential risks better.
In sum, change is the law of life. Those who do not change do not survive in nature. For complex systems, such as health care, change management is the key to success. Healthy, happy and satisfied patients are healthcare’s success best proof. If they self-report negative experiences following methadone changes, their opinions should inform change management in order to build a better, patient-centered care. Their opinions, together with our findings, could help future formulary decisions in addiction treatment. Various methadone formulations may have little short-term impact on heavy alcohol use. Let’s evaluate the long-term impact.
We wanted to know what General Practitioners’ (GP) views and experiences of opioid addiction, overdose care and naloxone provision are. Naloxone is an antidote to opioid overdose, also known as Narcan.
How was the study done?
We sent 448 GPs an anonymous postal survey.
They all had students on placements from University College Dublin in Ireland.
Over 75% of GPs had patients who used illicit opiates, and 25% prescribed methadone to treat opioid use disorders.
What did the study find?
We found that two thirds of GPs were in favour of a project to increase naloxone availability in the community; almost one third would take part in such a scheme. Intranasal naloxone was much preferred to single, or multiple dose, intramuscular naloxone. Few GPs objected to wider naloxone availability.
Irish primary care doctors are keen to distribute Naloxone in the community.
Why is the study important?
Every year, more people die in Ireland due to opioid overdoses than in car accidents.
Over 200 overdose deaths occur annually in Ireland. Overdose prevention and management, including naloxone provision, should be a priority for healthcare services. Naloxone is an effective treatment and is now being considered for wider lay use. This study showed that general practitioners commonly provide healthcare for patients with opiate use disorder and want more naloxone in this setting.
Barry, T., Klimas, J., Tobin, H., Egan, M., Bury, G. (2017) Opiate Addiction and Overdose: Experiences, Attitudes and Appetite for Community Naloxone Provision. British Journal of General Practice. In press http://bjgp.org/content/early/2017/02/27/bjgp17X689857/tab-article-info
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.
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:
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.
Literary editors who helped
Andrew Skelly, The Medical Post http://www.canadianhealthcarenetwork.ca/physicians/magazines/the-medical-post/
Adam Nanji, Vancouver is Awesome http://vancouverisawesome.com/
Emily Stringer, Emerge 16 https://www.amazon.com/emerge-16-Writers-Studio-Anthology-ebook/dp/B01MG027DA/
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.
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 Practice, 11, 17. http://doi.org/10.1186/s13722-016-0065-6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5146864/
So there he was, with the boy’s head in his hands. The boy was 12, but looked no more than 10 years old. He was deeply jaundiced and in a heroin withdrawal. It was 1981; Fergus O’Kelly was a family physician in the inner city Dublin, Ireland.