Category: Primary care

How Cochrane Keeps the Addiction Science in Check

Science isn’t infallible. Humans make mistakes even in this highly sophisticated method of understanding the world around us. Thanks God, addiction researchers get a chance to correct their error. If they publish a big error, the publication may be withdrawn. In smaller cases, the publisher issues a correction. It is interesting to see how such a correction has been issued following publication of our Cochrane systematic review of literature which. Probably this helped to keep the addiction science in check. See it for yourself below.

August 2011: “Alcohol-related brief intervention in patients treated for opiate or cocaine dependence: a randomized controlled study”

Before our review included this study, the authors reported the following figures in tables 3 and 7.

November 2011: “Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: a Cochrane review”

 Our review was published in November 2011 and re-stated the findings of the above study as: higher rates of decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment as usual group– See more at: http://summaries.cochrane.org/CD009269/ADDICTN_which-talking-therapies-counselling-work-for-drug-users-with-alcohol-problems#sthash.RcVZGdQA.dpuf

August 2013 “Correction: Alcohol-related brief intervention in patients treated for opiate or cocaine dependence: a randomized controlled study”

After the publication of our review, the authors corrected their figures in tables 1 and 5. The care-as-usual treatment for the control group was no longer stronger than the experimental intervention, the “alcohol-related brief intervention.”

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A note on causality in science

Because causal relationships are hard to prove (i.e. cause -> effect), majority of scientific publications rely on correlations. An example of a correlation is a relationship between shorter living expectancy and male gender. Men die younger than women. Although there are many plausible explanations, we cannot pinpoint a single cause.  Similarly, if an article gets corrected following a review in a major synthesis of scientific evidence – the Cochrane review – it may be a pure coincidence or it may be a consequence of the review. 

Substance Abuse Treatment, Prevention and Policy is an open-access peer-reviewed online journal that encompasses all aspects of research concerning substance abuse, with a focus on policy issues. Text taken from www.substanceabusepolicy.com

Cochrane Collaboration hosts the largest database of systematic reviews to inform healthcare decisions. Cochrane reviews are the jaguars of medical evidence synthesis. Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. Cochrane is a not-for-profit organisation with collaborators from over 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Text taken from www.cochrane.org

Finding the Evidence for Talking Therapies: Article in the Forum magazine

In an attempt to prove that counseling works for reducing drinking in concurrent problem alcohol and illicit drug users, I ended up on a journey through research and review. Read the full article in the November issue of the Forum Magazine (Volume 31, Issue 10)

Figure 1. Photo of the article in the Forum
 

This article was inspired by an essay which won the 4th place in the 2014 Aindreas McEntee prize of the Irish Medical Writers. The competition is open to members of Irish Medical Writers, a group of doctors and journalists specialising in healthcare. Parts of it were posted in my September post here.

The Forum magazine is the official journal of the Irish College of General Practitioners ICGP. Published monthly by MedMedia since 1991, it is Ireland’s premier journal of medical education. Text taken from: http://www.icgp.ie/go/library/library_home/

Founded in 1984, the Irish College of General Practitioners or ICGP is the recognised national professional body for general practice training in Ireland.

 

How to go about getting a postdoc position? Finding funding

There probably isn’t a simple answer to this question. Everybody has a different experience. My path was one of finding my own funding to do what I liked. Other people get postdocs via other routes, but I’d hope that my story bellow illustrates one of the paths people can take.

My mentor helped me identify funding calls and write funding applications. Then, I applied for everything and some of the applications were successful. Keeping up with the current funding calls via Research Newsletters and email alerts, such as Find A Phd, helped me too. I met the collaborators for my projects at conferences and seminars.

 
My experience is from Ireland, although I have a Slovakian PhD in Social Psychology(04/2011).
First, as a Research Assistant, I applied for and was successful with getting a Cochrane Training Fellowship to complete a Cochrane Systematic review over two years – 2 days p/week – from the Health Research Board Ireland (2010-12). The fellowship examined psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. The absence of evidence on the subject helped us to identify priorities for research.  To find out more about the Cochrane Systematic reviews of literature, go to: www.cochranecollaboration.org
Towards the end of my two-year Cochrane Fellowship, my Irish supervisors offered me two complementary part-time postdoc positions, both of which I accepted. The first was a three-year position in emergency medical science research. The second was a one-year position developing new projects in primary care settings and supervising medical students (2012-13). From a personal perspective, teaching literature reviews to medical students taught me how to address a training gap through addiction research education for medical students.
At the same time, I applied for two other grants. First was a three-year feasibility study in primary care from Health Research Board Ireland (Co-applicant). Second, an INVEST drug abuse fellowship from the National Institute for Drug Abuse – NIDA (Fellow). The feasibility study was a direct result of our efforts to highlight the problem of alcohol consumption among people receiving methadone treatment. We’ve trained family physicians in psychosocial interventions for concurrent problem and drug use disorders. Hence the title for the PINTA study.
Both were successful. Thanks to the patience and flexibility of my supervisors, I was able to combine and merge all of these opportunities. The INVEST postdoctoral fellowship was a six months job in at Oregon Health and Science Universityin Portland, OR, studying implementation of alcohol SBIRT in primary- versus secondary-care based opioid agonist treatment (2013). Our poster at the Annual Symposium of the Society for the Study of Addiction described qualitative component of the study. Training health care professionals in delivering alcohol SBIRT is feasible and acceptable for implementation among opioid agonist patients; however, it is not sufficient to maintain a sustainable change. After INVEST, I returned back to my composite Irish postdoc.
Eight months after the return back to Ireland, and one year before the end of my three-year Irish postdoc, I received another fellowship from the Irish Research Council. This International Career Development Award is co-funded by a European Union scheme called Marie Sklodowska Curie Actions. To improve the addiction medicine education for doctors (BEAMED), I’ll do an external and independent evaluation of the addiction medicine fellowship and plan a similar training in Ireland (2014-17). To learn more about the Marie Cure awards, go to: http://ec.europa.eu/research/mariecurieactions/

Mentoring in Addiction Health Services Research: Transitions are not always smooth

What makes a good mentor? What are the criteria for a mentor/mentee working relationship? Is it the number or similarity of their publications on their CVs? Is it the academic profile at the institution homepage?  The answers probably vary depending on time, place, personalities and expertise. Read more about my most recent mentoring experience below.

October 15th, the AddictionHealth Services Research conference launched a new AHSR Mentor/Mentee Program.  This program provided early career investigators an informal opportunity to connect with senior researchers/faculty/administrators.  Through this program, the early career researchers had an opportunity to establish connections, gather feedback on their research goals, or ask questions pertinent to their work.  All AHSR presenters and registered attendees were welcome to participate.


All of the mentors had substantial expertise. Some have been working on integrating addiction treatment with primary care and medical care since the mid-1990s.  Others worked with large data sets and traditional claims and utilization analysis.  Others analyzed the quality and quantity of addiction treatment services for veterans.  There were experts on person centered care, the criminal justice system and treatment for incarcerated individuals, and on organizational change.
The goals of the program were to connect senior researchers with new/young researchers to improve dialogue in the field, foster open relationships (with the potential for future work projects), and share knowledge. The program participants:
  • read the circulated list of Mentors (with links to additional information on their research).
  • nominated their top three Mentor selections to ensure a reasonable number of requests across Mentors.
  • received a reply with the Mentor contact information to setup a meeting time.

A Mentor/Mentee Meeting Room at the conference was available throughout the event.  No booking was required.
The program gave me valuable time with an expert, a research leader, who would otherwise be unavailable to talk and advice. During this time, we came up with a mission statement and a plan for the transition to my new fellowship at the University of British Columbia in Canada. The plan is to use the mission statement for contacts with people whose work I admire, or would like to work with. Informational interviews with these people will help me orientate in the new environment and move my career forward.

I’m a psychologist who’s trained in science and is interested in improving addiction health services through practical implementation research. I’m a scientist interested in communicating with the public, arts and blending the scientist-artist career. In this Canadian fellowship, I’m studying ways of how to integrate addiction medicine education into the training for medical doctors.


The Addiction Health Services Research Conference (AHSR) is an annual meeting which embraces the challenge, celebrates success, and leads the way toward more effective implementation science. Text taken from: http://www.ahsr2013.com/about.php

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’ReillyMairead 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.