New study out now: Replacing heroin with alcohol upon entry to methadone?
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.
| photocredit: karger.com/EAR |
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:
Jan Klimas
Evan Wood
Paul Nguyen
Huiru Dong
M-J Milloy
Thomas Kerr
Kanna Hayashi
Irish doctors trained to save by the nose
Can junior doctors learn to spray a life-saving medication into noses of people who overdosed on opioids? A new study from Ireland attempted to answer the question.
Overdose is the most common cause of fatalities among opioid users. Naloxone is a life-saving medication for reversing opioid overdose. In Ireland, it is currently available to ambulance and emergency care services, but General Practitioners (GP) are in regular contact with opioid users and their families. This positions them to provide naloxone themselves or to instruct patients how to use it. The new Clinical Practice Guidelines of the Pre-hospital Emergency Care Council of Ireland allows trained bystanders to administer intranasal naloxone.
We describe the development and process evaluation of an educational intervention, designed to help GP trainees identify and manage opioid overdose with intranasal naloxone.
Participants (N = 23) from one postgraduate training scheme in Ireland participated in a one-hour training session. The repeated-measures design, using the validated Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales, examined changes immediately after training. Acceptability and satisfaction with training were measured with a self-administered questionnaire.
Knowledge of the risks of overdose and appropriate actions to be taken increased significantly post-training [OOKS mean difference, 3.52 (standard deviation 4.45); P < 0.001]; attitudes improved too [OOAS mean difference, 11.13 (SD 6.38); P < 0.001]. The most and least useful delivery methods were simulation and video, respectively.
Appropriate training is a key requirement for the distribution of naloxone through general practice. In future studies, the knowledge from this pilot will be used to inform a train-the-trainer model, whereby healthcare professionals and other front-line service providers will be trained to instruct opioid users and their families in overdose prevention and naloxone use.
BMC Medical Education 2015, 15:206 doi:10.1186/s12909-015-0487-y
The electronic version of this article is the complete one and can be found online at:http://www.biomedcentral.com/1472-6920/15/206
See What Happens: My First Week in the Addiction Research Paradise
Abundance of data, army of eager support staff, in-house statisticians and hi-tech infrastructure – what else could an addiction researcher dream of? The Urban Health Program at the British Columbia Centre of Excellence in HIV/AIDS offers endless opportunities for investigators. My first week in this paradise was full of awe, new learning and new people.
Starting on Tuesday, October 21st, Carmen Rock, the Project Coordinator, gave me an orientation to the Urban Health Research Initiative (UHRI), tour of office, and let me sign the confidentiality agreement. UHRI is located on the top, 6th, floor of the St Paul’s hospital, which was recently renovated to meet the needs of researchers. As we walked down the hallway, Carmen stopped for a moment and we could “hear” the data buzzing in the ether.
Chanson Brumme, Data Analyst, gave me a tour of the laboratory. More precisely, tour of laboratories. Although lab research isn’t my specialty, I soon realised the importance and extent of the blood analyses that went on around us. Robots and laboratory assistants were lifting, extracting, ejecting and processing samples taken from the research participants.
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| photo credit: uhri.cfenet.ubc.ca |
Mint Ti, Research Associate, sat down and went through a UHRI 101 tutorial with me. This introductory set of slides is available to all staff and faculty through the local intranet. Having seen the slides in advance, I was able to ask her more focused questions, such as the process of research product development and data requests to statisticians.
My last meetings of the day were with Drs. Evan Wood, Director, and Michaela Montaner, Special Projects Coordinator. Michaela’s work focuses on knowledge translation, including the Addiction Medicine education, which will be the focus of my fellowship. With Dr Wood, we were able to sketch out and quickly dip into the endless opportunities which the centre offers for investigators.
Continuing on Wednesday, October 22nd, Cody Callon, Research Coordinator, told us about the At-Risk Youth Study (ARYS), and its office systems; Amy, a Master’s student, joined us. Together, we travelled to the VIDUS (Vancouver Injection Drug Users Study) office. Elaine Fernandes, Clinical Trials Research Coordinator and Steve Kain, Nurse Coordinator, briefed us on the history of the study and new studiesthat take place in the building.
Ethnographic Tour with Ryan McNeil, Postdoctoral Research Fellow, finished my orientation on Tuesday, October 28th. Downtown Eastside (DTES) is a well-known deprived area. We walked by and talked about the key agencies and objects of the area: the Vancouver Drug Users Union (VANDU), Insite supervised injecting room and many single-room occupancy hotels SRO’s. Ryan’s radiated excitement as he described the socio-cultural phenomena happening in the area which give an ethnographer a chance to study them in vivo. Gentrification of the area is a problem for many neighbourhood citizens. The policy of the Canadian conservative government poses serious challenges for the injecting room. The authorities try to push the scene out of downtown, for example by relocating the bottle depo site. The scientists are eager to “see what happens” next.
Families of opioid users in Ireland may be given drug to stop overdose deaths
Article from The Sunday Times, 21 September 2014, p4
The department of healthis reviewing distribution of Naloxone, a drug that reverses overdose, to buddies and families of heroin users. A similar scheme is in use in Britain. The department is in discussions with the Health service executive (HSE) to make the emergency drug more widely available. Currently, it is a prescription-only medication and can only be used by the person for whom it is prescribed, or by ambulance crews and medical staff.
[…]
On July 6th, 2012, The Ana Liffey Drug Project, a national addiction service, set up a Naloxone Advisory Group. Tony Duffin, the group’s director, said that while the government’s discussions on Naloxone are welcome, it would be more beneficial to fast-track legislative changes. “I don’t know why we haven’t prioritized this in Ireland,” he said. “It’s an innocuous drug. Its only purpose is to stop opioids working. If you haven’t taken opioids, it won’t have any effect. It’s a WHO recommended medicine, so the evidence is clear. It is important that we see it widely available so we can save people’s lives.”
A [our] study* published last week, which was compiled by the medical school at UCD and the Dublin Fire Brigade recorded 496 overdoses over a 12-month period, 13 of which were fatal. The majority of these were young men on the street, including in affluent areas of south Dublin. Most overdoses occurred in daytime, with a high incidence within 1000 meters radius of addiction services. Gerard Bury, a professor in general practice at UCDand one of the authors of the research, said: “Literature from other countries shows that bystanders, peers, or family members of overdose victims are most often the initial emergency responders and are best positioned to intervene immediately when the first overdose symptoms appear. These lay persons save lives if they are provided with Naloxone.”
Bury said Naloxone in a form of intranasal spray, available in America and Scotland, may be a more effective intervention than the injectable type planned by the department. “The Department of Health statement doesn’t indicate any intention to address the issue of the intranasal route, which, they told us, contravened the current regulations,” he said. “There isn’t any of the sense of urgency which you might expect in dealing with a situation in which people are literally dying in the streets.”
To read the magazine article, go to: http://www.thesundaytimes.co.uk/sto/
Related articles:
*Cited study: Urban Overdose Hotspots: A 12-Month Prospective Study in Dublin Ambulance Services http://www.ajemjournal.com/article/S0735-6757(14)00510-5/abstractby Jan Klimas, PhD, Martin O’Reilly, Mairead Egan, Bc, Helen Tobin, BSc, Gerard Bury, MD. Published Online: July 30, 2014
See also, my previous posts summarizing the quoted study: Urban Overdose Hotspots: New Paper out Now
Dublin ambulances see an opioid overdose every day; many times near the methadone clinics. Do people shoot heroin around methadone clinics? Yes. The common sense confirms anecdotal evidence from everyday experience of clinic staff and methadone users. Although this is no rocket science for most of us, it’s much harder to prove it. Regardless of the location, the high number of overdoses in Dublin calls for an immediate distribution of the heroin antidote – Naloxone. Visit my previous post for more info on our pilot Naloxone project.
See also, my previous post on Overdose Education and Naloxone: Workshop for Family Medicine Trainees in Ireland
Overdose Education and Naloxone: Workshop for Family Medicine Trainees in Ireland
Overdose is the most common cause of deaths among heroin users. Our previous research has shown that the ambulances in Dublin see one overdose every day*. Naloxone is a life-saving nasal spray for reversing heroin overdose. It has no addictive properties, no potential for abuse and a low cost. In Ireland, it is currently used by ambulance and emergency care services as an injection into muscle, into the bone or under the skin.
Irish family doctors treat many heroin users users who are in the methadone treatment. This makes family doctors ideal to use naloxone themselves or to show patients how to use it. The new Clinical Practice Guideline of the Pre-hospital Emergency Council of Ireland advises that trained professionals can use intranasal naloxone.
Today, we ran a pilot workshop with doctors in training. It was designed to help trainees identify and manage opioid overdose with naloxone spray. The trainees listened to a short presentation, watched a video clip about how to use naloxone (Figure 1), and tried it themselves. However, they did not get the spray to take home with them.
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| Figure 1 Jano simulating overdose in a pilot educational video for general practice trainees |
23 young doctors from one postgraduate training scheme in Ireland participated in an hour long lunchtime workshop. We have asked them to self-assess their own knowledge of and attitudes towards naloxone using the validated Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales. They did the scales before and after the workshop. Another questionnaire measured the acceptability and satisfaction with workshop. The doctors gave us valuable feedback on the session which will be analysed and published in an academic paper.
The take home message from today is that adequate training is essential for distribution of naloxone through Family Practitioners. In future studies, the knowledge from this pilot may be used to inform a train-the-trainer model. Healthcare professionals and other front-line service providers may be trained to instruct heroin users and their families in overdose prevention and naloxone use. Today’s workshop was timed perfectly, because the deaths due to overdose in the country are peaking.
*Study by: Klimas, J., O’Reilly, M., Egan, M., Tobin, H., Bury, G. (2014) Urban Overdose Hotspots: A 12-Month Prospective Study in Dublin Ambulance Services. American Journal of Emergency Medicine (Online July 30) doi: 10.1016/j.ajem.2014.07.017