Hospital teaching team keeps fighting opioid crisis

Overdose grafitti

Which student learns best with hospital teams fighting opioid crisis? Understanding how students learn is perhaps the most important way to improve addiction training.

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 knowledge of medical students more than of other types of students. Read more below or listen to the podcast.

Firstly, we found that both emerging and established physicians appear to be responsive to this type of training.  Secondly, the learner self-assessment can provide valuable feedback to the consultants. Then, consultants can focus more on the students who learn less.

Keep fighting opioid crisis through training

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. The addiction rotation includes full-time clinical training involving intake assessment and treatment planning. And referrals to community agencies and starting people on evidence-based medications for substance use disorders. The students take part in didactic lectures, bedside teaching, journal clubs and some prepare papers for submission to peer-reviewed journals. Each year, about 80 learners go through the program. Furthermore, learners rate their knowledge before and after the training.

At the end, all learners reported increased knowledge. One group, however, learned more than the others – the medical students. This two-year study confirms that a structured clinical training program can lead to an increased knowledge on addiction and that medical students benefit from it the most.

For more info read the full article at:

Gorfinkel, L., Klimas, J., Ahamad, K., Mead, A., McLean, M., Fairgrieve, C., Nolan, S., Small, W., Cullen, W., Wood, E., Fairbairn, N. (2019) In-hospital training in addiction medicine:  A mixed methods study of health care provider benefits and differences. Substance Abuse (Published online Jan 28) doi: 10.1080/08897077.2018.1561596

If interested, you can also read: What can hospital teams teach medical students about addiction to help curb the opioid overdose epidemic?

Hospital teaching teams confront iatrogenic opioid addiction

 

Or visit a post that talks about this research as it was presented at the Canadian Society for Addiction Medicine link here

Canadian Society of Addiction Medicine, CSAM conference

Excellent scale assesses needs across four countries

ruler

What is the smartest scale for asking clinicians about their training needs?

In a new article published by the Journal of Substance Abuse Treatment, we report findings from a study that looked at a new scale, the training needs assessment. Read more or watch podcast below:

We wanted to find out whether a new tool – Training Need Assessment – does what it’s set to do, measure training needs.

QUICK FACT:  Addiction Medicine (AM) rarely uses Training Need Assessments (TNA).

How we did the study?

We did a cross-sectional study in four countries (Indonesia, Ireland, Lithuania and the Netherlands). 483 health professionals working in addiction care completed AM-TNA. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach’s Alpha, ANOVA determined the discriminative validity.

What has the scale found?

  • Tailored training of health professionals is one of the elements to narrow the “scientific knowledge-addiction treatment” gap. Addiction Medicine (AM) rarely uses Training Need Assessments (TNA). The AM-TNA scale is a reliable, valid instrument to measure addiction medicine training needs. The AM-TNA helps to determine the profile of future addiction specialist.

The Training Need Assessment is a reliable, valid instrument to measure addiction medicine training needs.

Why is the scale important?

The AM-TNA proved reliable and valid. Additionally, the AM training needs in the non-clinical domain appeared positively related to the overall level of AM proficiency. Furthermore, researchers should study whether the AM-TNA can also measure changes in AM competencies over time and compare different health professionals. Finally, the AM-TNA assists tailoring training to national, individual and group addiction priorities.

Reference: Pinxten, W.J.L. et al. (2019) Excellent reliability and validity of the Addiction Medicine Training Need Assessment Scale across four countries.  Journal of Substance Abuse Treatment , Volume 99 , 61 – 66

For more info read the full article in the Journal of Substance Abuse Treatment 99 (2019) 61–66 https://doi.org/10.1016/j.jsat.2019.01.009

Read more about this topic in a post from 2017: What are the core skills of an addiction expert?

What are the core skills of an addiction expert?

You can also read a related post from 2015: International Society of Addiction Medicine | Congress #isam2015

International Society of Addiction Medicine | Congress #isam2015

Closing gap between workforce needs and training provision in addiction medicine

Substance use disorders represent a significant social and economic burden globally. While effective interventions exist, the overall treatment coverage remains limited, with lack of an adequately trained workforce as one of the prominent reasons.

World over, recent initiatives have been taken to improve the training in addiction medicine; however, further efforts are required in building curricula that are internationally applicable. Here, we present a recent paper published in the British Journal of Psychiatry – International, https://www.cambridge.org/core/journals/bjpsych-international

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Do more drug tests improve addiction treatment?

testing flasks

Frequent drug tests in addiction treatment have become a common practice despite proven benefits of such testing. When do tests become the end instead of the means to health and wellness?

In a previous post, I have explained how there was no agreement on the frequency of drug testing in Canada. Not until March 2018, when the British Columbia Centre on Substance use released the National guidelines for opioid use disorder. This article looks at the scientific evidence (or the lack of it) for frequent drug testing in addiction treatment. Read more or watch podcast below:

What is the study about?

We wanted to find out whether frequent urine drug tests correspond with better outcomes of treatment with opioid agonists such as methadone or buprenorphine.

How we did the study ?

We looked at the scientific literature from 1995 up until the end of 2017.

Then, we wanted to see how often the screening should be done while in the opiod agonist treatment. In the study, we included people of any gender, age or ethnicity.

Frequent drug tests lack evidence

We found only one higher quality studies with patients from USA

The study compared weekly and monthly urine drug testing with take-home doses of opioid agonists

Our review identified an urgent gap in research evidence underpinning an area of clinical importance and that is routinely reported by patients as an area of concern

Why is the study important?

 

Opioid use disorder is a chronic condition impacting the reward, motivation and memory pathways of the brain (ASAM, 2017).

Opioid agonist therapy is a first-line treatment for opioid use disorder.

The frequency and role of urine drug screening in opioid agonist treatment has received little research attention.

Although prior evidence suggests that testing frequency reflects philosophy and practice context, rather than differences in patient characteristics or clinical need, frequent urine testing remains under-researched.

What for?

Finally, the editorial of the Canadian Journal of Addiction featured this study as important for bringing additional management aspects for consideration:

Reference:

McEachern J, Adye-White L, Priest KC, Moss E, Gorfinkel L, Wood E, Cullen W, Klimas J: Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy. International Journal of Drug Policy 2019, 64:30-33.

If you enjoyed reading this piece, you may wish to read the previous article on this topic here, or here.

Updating alcohol Cochrane literature review

Cochrane

Updating Cochrane systematic reviews makes them most useful and fresh for readers. We updated our review on concurrent alcohol and drug problems again.

Cochrane podcast

Which new studies we found?

We found seven studies that examined 825 people with drug problems. Six of the studies were funded by the National Institutes for Health or by the Health Research Board; one study did not report its funding source.

One study focused on the way people think and act versus an approach based on Alcoholics Anonymous. It aimed to motivate the person to develop a desire to stop using drugs or alcohol.

Three studies looked at a counselling style for helping people to explore and resolve doubts about changing their behaviour (group, individual and intensive formats). Their controls were education, or less intensive counselling, or assessment-only.

Two Irish studies and one Swiss study looked at practices that aimed to identify an alcohol problem and motivate the person to do something about it versus usual treatment.

This study has been made into a podcast available at Cochrane.org news item at https://www.cochrane.org/news/podcast-which-talking-therapies-work-people-who-use-drugs-and-also-have-alcohol-problems

and a Network news item https://mhn.cochrane.org/news/podcast-which-talking-therapies-work-people-who-use-drugs-and-also-have-alcohol-problems Listen to the podcast below:

Updating Cochrane Review – Key results

The Swiss and Irish studies were directly compared. They took place in general practices (one trial) or methadone clinics (two trials). They included 170 participants with a mean age of 37 years. All participants had positive alcohol screening test upon entry to the trial. At the end, the scores between groups were similar (average difference in scores: -0.6, 1.7 and -2, respectively).
One study found that a brief motivational intervention led to a reduction of alcohol use (by seven or more days in the past month at 6 months).

It remains uncertain whether talking therapies affect drinking and drug-using in people who have problems with both alcohol and other drugs. We lack high quality studies.

Cited cochrane review: Klimas J, Fairgrieve C, Tobin H, Field C-A, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews 2018, Issue 11

Read a summary of the previous version of this review here

Which talking therapies work for drug users with alcohol problems? A Cochrane update