Category: Primary care

Does alcohol use change after shift to Methadose?

alcohol drink, methadose
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.

switch
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.

Conclusion

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.

Naloxone and Irish Primary Care Practitioners

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.

Reference:
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

Hospital teaching teams confront iatrogenic opioid addiction

What can hospital teams teach medical students about addiction to help curb the opioid overdose epidemic?

In a new article published by the Substance Abuse journal,  we report findings suggesting that the completion of an elective with a hospital-based Addiction Medicine Consult Team appeared to improve medical trainees’ knowledge which can help routinely establish clinical training teams elsewhere. 


We found that both emerging and established physicians appear to be responsive to this type of training.  The learner self-assessment can provide valuable feedback to the consultants, who can then focus more on the un-improved areas.

The study sample was drawn from medical students, residents and physicians who took part in a month-long rotation with a hospital-based addiction medicine consult team in Vancouver, Canada. Each year, approximately 60 learners go through the programme. Learners are asked to do a before and after self-assessment of their knowledge on addiction. The addiction rotation consisted of 4-12  weeks of full-time clinical training involving intake assessment, treatment planning, referrals to community agencies and starting people on evidence-based medications for substance use disorders. The learners take part in didactic lectures, bedside teaching, journal clubs and some prepare papers for submission to peer-reviewed journals. 

At the end of the learners reported increased knowledge in all but one of the areas of teaching focus, including opioid use disorders;  this increase was statistically significant. These preliminary, first-year results suggest that a structured clinical  training program could lead to an increased knowledge on addiction.

For more info read the full article “Impact of a Brief Addiction Medicine Training Experience on Knowledge Self-assessment among Medical Learners” at: to: http://www.tandfonline.com/doi/full/10.1080/08897077.2017.1296055

Two birds with one stone: physicians training in research

Combined training in addiction medicine and research is feasible and acceptable for physicians – a new study shows; however, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required.

Addiction care is usually provided by unskilled lay-persons in most countries. The resulting care is inadequate, effective treatments are overlooked and millions of people suffer despite recent discovery of new treatments for substance use disorders. In rare instances when addiction care is provided by medical professionals, they are not adequately trained in caring for people with substance use disorders and, therefore, feel unprepared to provide such care.  Physician scientists are the bridge between science and practice. Despite large evidence-base upon which to base clinical practice, most health systems have not combined training of healthcare providers in addiction medicine and research. 
In recent years, new programmes have emerged to train the comprehensive addiction medicine professionals internationally.

We undertook a qualitative study to assess the experiences of 26 physicians who completed such a training programme in Vancouver, Canada. They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick’s model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software. We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training.  Competing priorities, to include clinical and family responsibilities, hindered training.

Read more here: http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0862-y
Klimas, J., McNeil, R., Ahamad, K., Mead, A., Rieb, L., Cullen, W., Wood, E., Small, W. (2017) Two birds with one stone: Experiences of Combining Clinical and Research Training in Addiction Medicine. BMC Medical Education, 17:22

General practice is a key route for distribution of naloxone in the community

Naloxone
Naloxone is an antidote to opioid overdose also known as Narcan.

Irish family doctors in training want Narcan to be more available and want to distribute it.    

We poled 136 Irish family doctors attending a training conference. They were in their third and final years of residency.

photocredit: oxywatchdog.com

We found that trainees have real experience of the problem at an early phase of their careers, and
trainees are conscious of the needs of people with opioid use disorders and the potential of family medicine to meet these needs, but trainees receive little structured preparation for this role.

Irish family doctors in training are keen to distribute Naloxone in the community.

More people die in Ireland due to opioid overdoses than in car accidents.
Naloxone can save lives. Ireland has approximately 640 doctors in specialist training for family medicine at any time. Although 60% of them have administered Naloxone to a person in overdose, only 13% of their training clinics prescribe methadone to people with opioid use disorders.

Reference:
Klimas, J., Tobin, H., Egan, M., Barry, T., Bury, G. (2016) General Practice – a key route for distribution of naloxone in the community. Experience, interest and training needs in Ireland. J Int Drug Policy, 38:1-3