Category: Travel

Travel posts by Jano Klimas who writes about academic mobility, hotels, B&B, jetlags and culture shock.

What do persons on methadone in primary care think about alcohol screening?

Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: Qualitative study in primary care

New Paper Out Now

Although very common, excessive drinking by people who also use other drugs is rarely studied by scientists. The purpose of this study was to find out patient’s and clinicians’ opinions about addressing this issue. All of them took part in a study called PINTA – Psychosocial interventions for problem alcohol use among problem drug users.

photocredit: emerald

Doctors reported obstacles to addressing heavy drinking and overlooking and underestimating this problem in this population.

Patients revealed that their drinking was rarely spoken about and feared that their methadone would be withheld.

Read the full article in the latest issue of the Drugs and Alcohol Today: http://www.emeraldinsight.com/loi/dat

See also my previous posts about the PINTA study:

New paper out now: Psychosocial Interventions for Alcohol use among problem drug users

2014

Beg, steel or borrow: getting physicians to recruit patients in clinical trials

Addiction Medicine Education for Healthcare Improvement Initiatives: New Paper out Now

2013

Honor pot: testing doctors’ drug counselling skills in a new pilot study in Ireland

Fidelity questions

Why Empirically Supported Psychosocial Treatments Are Important for Drug Users? New research project

Recipe for untangling complex healthcare

Physicians tackle difficult addictions

Recipe for untangling complex healthcare.

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.

photocredit: journals.cambridge.org

 

Complex interventions are best fashioned in stages, says the Medical Research Council in the U.K. They came up with a 6-step recipe for untangling complex health interventions. The recipe can help those of us who are researchers define their interventions and evaluate their implementation.

Substance use disorder treatment is a complex problem. Complex problems require complex interventions, ideally tested via randomised controlled trials.

Complex interventions are best developed in stages, using established implementation frameworks.

Starting with a historical patient case study, we explore how treatment of this challenging population group has been approached, how an evidence-based framework has informed formulation of a complex health intervention and how this has been progressed via the UK’s Medical Research Council (MRC) approach.

Read the paper in the December 2018 issue of the Irish Journal of Psychological Medicine:
Klimas, J. (2018). General practitioners tackle complex addictions: How complex interventions can assist in dealing with addiction. Irish Journal of Psychological Medicine, 35(4), 329-331. doi:10.1017/ipm.2016.30

 

http://journals.cambridge.org/action/displayIssue?jid=IPM&tab=firstview

The paper was first published online in August 2016.

The case study of the boy mentioned at the beginning was published in 1986 in this paper: RyanWJArthursYKellyMGFieldingJF (1982). Heroin abuse with hepatitis b virus associated chronic active hepatitis in a twelve-year-old child: a non-fictitious pulitzer prizeIrish Medical Journal 75166. Google Scholar

Read the full text of the case here: https://core.ac.uk/download/pdf/34711593.pdf

Finally, if you enjoyed reading this post, you can also read more about complex problems here:

Users voices: Are drug problems too complex and dynamic for single magic bullet solutions?

Changing the ways of CPDD – College on Problems of Drug Dependence – June 12-16, #CPDD2016

Change is the ultimate law of life. Those that do not change and adapt, do not survive. In the life of scientific meetings, this means constantly improving the organisation of the events and tailoring them to the changing needs of the conference delegates. This year, the annual meeting of the College on Problems of Drug Dependence (CPDD) introduced several improvements and more are on the way in next years.

cpdd logo

photocredit: cpdd.org

 

Bye Bye Tote Bags

Many of us were used to the traditional design of the CPDD tote bags. Each year had a different colour. For years when conference visited a warm region, such as Phoenix, AR, the tote bag included a special layer for keeping the contents cool. The non-bag policy brought the desired recognition of sustainability and (un-)expected diversity among the conference bags – everyone was different.

Bye Bye Printed Programs

For years, the conference book was a comprehensive bible for the conference week. Everybody read it and most followed it. Although the College printed a limited number of copies, this year, the e-programs drained participants smartphones’ batteries. What more, they offered note-taking and photograph uploading that many appreciated. Welcome to the digital age.

Hello Mentors

Since the early days, the senior delegates offered mentorship to junior delegates. Mostly informal. Following the new trends adopted at other conferences, such as AHSR or NAPCRG, the CPDD sent out emails to all Members in Training (MIT), offering to match them with a potential mentor (mentor bios included). If both parties agreed, the match-maker introduced them via email. I have learned a lot from my mentor. Especially that the decision makers may not read addiction journals, also that the team identity strengthens sense of ownership among team members and that the road to the research success can be long and winding. Let’s hope that the beneficial mentoring program continues in future.

Hello Shorter Conference

With the increasing demands on scientists’ workloads, there is a chance that the upcoming conferences will be shorter.

See also my previous blog posts about CPDD from the previous years:

2015Getting the most out of the Conference of the College on Problems of Drugs Dependence #CPDD2015

2014: 76th Annual Conference of College on Problems of Drug Dependence: Decide to be fearless& fabulous 

2013: My itinerary for the Conference – College on Problems of Drug Dependence, San Diego, June 15-20 

New paper out now: Primary care distributes life-saving medication for 17 years

The year was 1996 and Ireland was recovering from a recent heroin epidemic. Methadone, a medical replacement drug for heroin, was jut making its way into specialised clinics in Dublin.

Professor Gerard Bury and colleagues had a revolutionary idea that people who use drugs can receive agonist drugs, like methadone, from their family doctors.

photocredit: tandfonline.com/loi/igen20#.VlO9bHarTrc

The opioid agonist treatment has substantially changed the course of the drug use epidemic. Yet, many continue to die and suffer from chronic diseases. In Ireland, everybody who’s prescribed this medication has to be registered with the Central Treatment List.

In this new study, we wanted to revisit a group of people who were the first to receive their agonist medication, i.e., methadone in the primary care in Ireland.
At follow-up in 2013, 27 (27.6%) of the 98 people had died in Ireland and had relevant entries in the Register of Deaths, 19 (19.4%) were currently in OAT and the status of the remaining 52 (53%) was ‘alive,’ as per the Irish death registry.
The 52 patients ‘alive’ had left the Central Treatment List, but no further information was available on their status.

“Our inability to establish the interval data for the retention in treatment is a significant study limitation, but the overall retention of 19 out of the surviving 71 patients is comparable to previous research.”


The deceased died of multiple causes; only six had a single cause. Drug toxicity, overdose, or both, were the most common causes of death.

Cited study:
Jan Klimas, Anna Keane, Walter Cullen, Fergus O’Kelly, and Gerard Bury (2015) Seventeen year mortality in a cohort of patients attending opioid agonist treatment in Ireland. European Journal of General Practice (http://dx.doi.org/10.3109/13814788.2015.1109076)

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