Can prescribers avoid contributing to opioid use disorder?
A 21 y/o has surgery for a condition expected to improve. He fills a discharge prescription for 5 days of an opioid at a standard dose. At 1-week follow-up with his family doctor for suture removal, he describes ongoing pain. Can prescribers avoid contributing to opioid use disorder? Is a renewal of opioid appropriate, potentially dangerous, or both? Read more …
Can prescribers avoid contributing to opioid use disorder?
Hospital based opioid agonist treatment
Researchers recently found that many people with co-occurring mental health and substance use disorders are admitted to inpatient psychiatric units. According to a 2019 report from the Boston’s Institute for Healthcare Improvement and The Grayken Center, “hospitals have the opportunity to make a major impact in reducing morbidity and mortality related to opioid use.” The present study, therefore, looked at patients admitted to an acute care hospital in Vancouver, British Columbia. It sought to improve our understanding of this population and the care provided so that we can improve patients’ outcomes and care experiences.
20 per cent heroin eligible, study finds
This study looked at how many, and what types of people who inject drugs (PWID), in the AIDS Care Cohort to evaluate Exposure to Survival Services Study (ACCESS), would be eligible for medical heroin in Vancouver, Canada.
Medical heroin could possibly help people who have treatment resistant opioid use disorder and who live with HIV/AIDS.
How was the study done?
We looked at how many, and what types of PWID in the ACCESS Study would be eligible for medical heroin. Participants had to meet eligibility criteria from clinical trials of medical heroin.
The ACCESS study involves people living with HIV who use illicit drugs, mostly living in Vancouver’s Downtown Eastside neighbourhood. Researchers work with participants to look at how social, economic, physical, policy, and individual factors impact the health and well-being of HIV-positive illicit drug users. ACCESS participants do an interviewer-administered survey, and a clinic visit with a study nurse, every 6 months. (text taken from: http://www.bccsu.ca/access/)
What did the study find?
478 participants said they injected opioids. 20% met the eligibility criteria for treatment with medical heroin. Those who were homeless, or were involved in the local illicit drug trade, were more likely to be eligible for medical heroin.
20% met the eligibility criteria for treatment with medical heroin and also said they were homeless and dealt drugs.
Why is the medical heroin useful?
Untreated opioid use disorder among people who live with HIV/AIDS can lead to illnesses, overdose, or death. Medical heroin can play an important role in helping people who have treatment resistant opioid use disorders and who live with HIV/AIDS.
Reference: Klimas, J., Dong, H., Fairbairn, N., Socías, E., Barrios, R., Wood, E., Kerr, T., Montaner, J., Milloy, M. (2018) Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting. Addiction Science& Clinical Practice. In Press (https://ascpjournal.biomedcentral.com/track/pdf/10.1186/s13722-017-0104-y?site=ascpjournal.biomedcentral.com)
What are the core skills of an addiction expert?
Should all medical doctors receive the same training in addiction medicine? Here’s what international experts think about core skills of and addiction specialist.
In a new article published by the Substance Abuse journal, we report on interviews with members of the International Society of Addiction Medicine who identified progression for the core skills and addiction medicine competencies at three educational levels: (i) undergraduate (ii), postgraduate and (iii) continued medical education (CME). The experts described broad ideas, such as knowledge/skills/attitudes towards addiction, for the undergraduate level. At the graduate level, they recommended knowledge of addiction treatment. Next, the experts also described specific recommendations, including the need to tailor the curriculum to national settings and different specialties. We still don’t know whether a global curriculum is needed. But a consensus on a core set of principles for progression of knowledge, attitude, and skills in addiction medicine to be developed at each educational level among medical graduates would likely have substantial value.
Why are the core skills important?
Our findings provide a consensus opinion on core skills for progression of knowledge, attitude, and competencies in addiction medicine. A panel of international scholars recommended that medical students and physicians should learn these skills throughout medical education. This is particularly important for the development of new addiction medicine curricula and enhancement of available courses. If applied, our findings would have profound effects on the quality of medical education. Better education can improve subsequent clinical care provided to people with substance use disorders worldwide.
Study title:
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