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PharmacoEconomics Sep 2016The economic costs associated with opioid misuse are immense. Effective interventions for opioid use disorders are available; however, given the scarce resources faced... (Review)
Review
BACKGROUND
The economic costs associated with opioid misuse are immense. Effective interventions for opioid use disorders are available; however, given the scarce resources faced by substance use treatment providers and payers of all kinds, evidence of effectiveness is not always sufficient to encourage adoption of a given therapy-nor should it be. Economic evaluations can provide evidence that will help stakeholders efficiently allocate their resources.
OBJECTIVE
The purpose of this study was to review the literature on economic evaluations of opioid use disorder interventions.
METHODS
We performed a systematic review of the major electronic databases from inception until August 2015. A sensitive approach was used to ensure a comprehensive list of relevant articles. Given the quality of the existing reviews, we narrowed our search to studies published since 2007. The Drummond checklist was used to evaluate and categorize economic evaluation studies according to their quality.
RESULTS
A total of 98 articles were identified as potentially relevant to the current study. Of these 98 articles, half (n = 49) were included in this study. Six of the included articles were reviews. The remaining 43 articles reported economic evaluation studies of interventions for opioid use disorders. In general, the evidence on methadone maintenance therapy (MMT) supports previous findings that MMT is an economically advantageous opioid use disorder therapy. The economic literature comparing MMT with other opioid use disorder pharmacotherapies is limited, as is the literature on other forms of therapy.
CONCLUSION
With the possible exception of MMT, additional high-quality economic evaluations are needed in order to assess the relative value of existing opioid use disorder interventions.
Topics: Cost-Benefit Analysis; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Research Design
PubMed: 27002518
DOI: 10.1007/s40273-016-0400-5 -
American Journal of Public Health Apr 2022To determine how harm reduction should be applied in low-resource countries such as Vietnam by exploring the perspectives of people who use drugs (PWUD), health care...
To determine how harm reduction should be applied in low-resource countries such as Vietnam by exploring the perspectives of people who use drugs (PWUD), health care professionals, and policymakers regarding methadone treatment and harm reduction strategies. We conducted 2 qualitative studies in Vietnam between 2016 and 2021. We interviewed 62 PWUD and 22 experts in drug policy development and drug treatment programs, conducted observations at methadone clinics and harm reduction program meetings, and analyzed drug policy documents. PWUD considered methadone treatment only as a transition to a drug-free life. Policymakers deemed harm reduction ineffective and continued to enforce arrest and incarceration of PWUD. Drug intervention programs are not yet geared to providing specialized services. Effective communication strategies and information on evidence-based harm reduction models are inadequate to help policymakers make the right decisions. Harm reduction principles have not been fully adopted in Vietnam. A harm reduction strategy based on a more humanistic approach that goes beyond a biomedicalized approach is urgently needed in Vietnam and other countries in the Global South. (. 2022;112(S2):S182-S190. https://doi.org/10.2105/AJPH.2022.306764).
Topics: Harm Reduction; Humans; Methadone; Policy Making; Public Policy; Vietnam
PubMed: 35349313
DOI: 10.2105/AJPH.2022.306764 -
Anesthesiology May 1989A double-blind study of patients selected at random compared the analgesic and adverse effects of intrathecal methadone (1 mg) with those of intrathecal morphine (0.5... (Clinical Trial)
Clinical Trial Comparative Study
A double-blind study of patients selected at random compared the analgesic and adverse effects of intrathecal methadone (1 mg) with those of intrathecal morphine (0.5 and 1 mg). The study was conducted on 30 patients who underwent major orthopedic or urologic surgery. The intrathecal opioid was administered at the end of surgery, and assessments began 1 h thereafter and continued for 20 h. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. Intrathecal morphine (0.5 and 1 mg) provided effective and prolonged analgesia. Methadone, however, was unable to ensure the same degree of analgesia; consequently, the median pain scores were consistently higher following methadone than morphine (0.5 and 1 mg) (P less than 0.05). The time to the onset of discomfort severe enough to require supplemental morphine was longer after intrathecal morphine than that following methadone (24 and 29 h with morphine 0.5 and 1 mg; 6.5 h with methadone; P less than 0.05). Respiratory depression (increases PaCO2) was not associated with methadone and morphine 0.5 mg but was common following morphine 1 mg (P less than 0.05). Facial pruritus was unique to intrathecal morphine. Urinary retention requiring bladder catheterization was more frequent following morphine than methadone, although this was not statistically significant. Nausea and vomiting were common to all groups. Intrathecal morphine (0.5 and 1 mg) provides superior postoperative analgesia to 1 mg methadone. Various explanations for the observed differences between the drugs are discussed, including the possibility that the dose of methadone used in the subarachnoid space was inadequate and that a larger dose might have produced an effect equal to that of morphine.
Topics: Aged; Clinical Trials as Topic; Double-Blind Method; Humans; Injections, Spinal; Male; Methadone; Middle Aged; Morphine; Pain, Postoperative; Random Allocation; Time Factors
PubMed: 2655501
DOI: 10.1097/00000542-198905000-00005 -
Frontiers in Public Health 2023Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We...
INTRODUCTION
Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We analyzed two sources of data-social media and published literature-to categorize and quantify such barriers.
METHODS
In this mixed methods study, we analyzed social media (Reddit) posts from three OUD-related forums (subreddits): r/suboxone, r/Methadone, and r/naltrexone. We applied natural language processing to identify posts relevant to treatment barriers, categorized them into insurance- and non-insurance-related, and manually subcategorized them into fine-grained topics. For comparison, we used substance use-, OUD- and barrier-related keywords to identify relevant articles from PubMed published between 2006 and 2022. We searched publications for language expressing fear of barriers, and hesitation or disinterest in medication treatment because of barriers, paying particular attention to the affected population groups described.
RESULTS
On social media, the top three insurance-related barriers included having no insurance (22.5%), insurance not covering OUD treatment (24.7%), and general difficulties of using insurance for OUD treatment (38.2%); while the top two non-insurance-related barriers included stigma (47.6%), and financial difficulties (26.2%). For published literature, stigma was the most prominently reported barrier, occurring in 78.9% of the publications reviewed, followed by financial and/or logistical issues to receiving medication treatment (73.7%), gender-specific barriers (36.8%), and fear (31.5%).
CONCLUSION
The stigma associated with OUD and/or seeking treatment and insurance/cost are the two most common types of barriers reported in the two sources combined. Harm reduction efforts addressing barriers to recovery may benefit from leveraging multiple data sources.
Topics: Humans; Self Report; Social Media; Opiate Substitution Treatment; Opioid-Related Disorders; Methadone
PubMed: 37151596
DOI: 10.3389/fpubh.2023.1141093 -
Addiction Science & Clinical Practice Oct 2023Tent encampments in the neighborhood surrounding Boston Medical Center (BMC) grew to include 336 individuals at points between 2019 and 21, prompting public health...
BACKGROUND
Tent encampments in the neighborhood surrounding Boston Medical Center (BMC) grew to include 336 individuals at points between 2019 and 21, prompting public health concerns. BMC, the City of Boston, and Commonwealth of Massachusetts partnered in 2/2022 to offer low-barrier transitional housing to encampment residents and provide co-located clinical stabilization services for community members with substance use disorders (SUDs) experiencing homelessness.
METHODS
To meet the needs of some of the people who had been living in encampments, BMC established in a former hotel: 60 beds of transitional housing, not contingent upon sobriety; and a low-barrier SUD-focused clinic for both housing residents and community members, offering walk-in urgent care, SUD medications, and infection screening/prevention; and a 24/7 short-stay stabilization unit to manage over-intoxication, withdrawal, and complications of substance use (e.g., abscesses, HIV risk, psychosis). A secure medication-dispensing cabinet allows methadone administration for withdrawal management. Housing program key metrics include retention in housing, transition to permanent housing, and engagement in SUD treatment and case management. Clinical program key metrics include patient volume, and rates of initiation of medication for opioid use disorder.
RESULTS
Housing: Between 2/1/22-1/31/2023, 100 people entered the low-barrier transitional housing (new residents admitted as people transitioned out); 50 former encampment residents and 50 unhoused people referred by Boston Public Health Commission. Twenty-five residents transferred to permanent housing, eight administratively discharged, four incarcerated, and four died (two overdoses, two other substance-related). The remaining 59 residents remain housed; none voluntarily returned to homelessness. One hundred residents (100%) engaged with case management, and 49 engaged with SUD treatment.
CLINICAL
In the first 12 months, 1722 patients (drawn from both the housing program and community) had 7468 clinical visits. The most common SUDs were opioid (84%), cocaine (54%) and alcohol (47%) and 61% of patients had a co-occurring mental health diagnosis in the preceding 24-months. 566 (33%) patients were started on methadone and accepted at an Opioid Treatment Program (OTP).
CONCLUSIONS
During the 1st year of operation, low-barrier transitional housing plus clinical stabilization care was a feasible and acceptable model for former encampment residents, 49% of whom engaged with SUD treatment, and 25% of whom transitioned to permanent housing.
Topics: Humans; Housing; Analgesics, Opioid; Substance-Related Disorders; Case Management; Methadone
PubMed: 37884986
DOI: 10.1186/s13722-023-00420-y -
Drug and Alcohol Dependence Oct 1986Results of a previous study indicated that the opioid effects of methadone were enhanced by the concurrent administration of diazepam in methadone-maintained subjects.... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Results of a previous study indicated that the opioid effects of methadone were enhanced by the concurrent administration of diazepam in methadone-maintained subjects. To determine whether a pharmacokinetic interaction might account for this methadone-diazepam interaction, the plasma levels of methadone, diazepam and diazepam metabolites were determined in blood samples collected during that study. Five adult male patients on methadone maintenance (50-60 mg/day) were administrated single doses of placebo, diazepam (20 and 40 mg), methadone (100%, 150% and 200% of the maintenance dose), and four diazepam-methadone dose combinations (20 and 40 mg diazepam in combination with 100% and 150% of the maintenance dose). The results showed that the concurrent administration of methadone and diazepam did not significantly change the time-course or areas under the plasma concentration-time curve of methadone, diazepam or N-desmethyl-diazepam compared to the levels following the administration of either drug alone. Thus, plasma drug level analysis does not indicate a pharmacokinetic interaction between diazepam and methadone.
Topics: Adult; Chromatography, Thin Layer; Diazepam; Drug Interactions; Humans; Immunoenzyme Techniques; Kinetics; Male; Meiosis; Methadone; Nordazepam
PubMed: 3096681
DOI: 10.1016/0376-8716(86)90051-7 -
American Journal of Public Health Nov 1995One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting... (Review)
Review
One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs.
Topics: Acquired Immunodeficiency Syndrome; Drug and Narcotic Control; History, 20th Century; Humans; Methadone; Needle-Exchange Programs; Public Health; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; United States
PubMed: 7485676
DOI: 10.2105/ajph.85.11.1577 -
Adicciones 2012There is no large prospective cohort studies using different therapeutic doses and standardized distal outcomes, however there is a fair amount of evidence on the...
There is no large prospective cohort studies using different therapeutic doses and standardized distal outcomes, however there is a fair amount of evidence on the effectiveness of methadone as a long-term treatment for the addiction to opiates. Strengths include less illegal drug use, decreased criminal activity and better general functioning. Also physical and mental health seems to be more preserved and recovered. Since patients undergoing methadone treatment exhibit diminished likelihood of suffering from cardiovascular conditions, HIV, HCV, HBV and other infections, and lesser psychiatric comorbidity. This Editorial intends to define and guide the therapeutic statement to address the management of persons with opiate abuse or dependence. These proposals have been grounded in the main long-term studies, systematic analysis and meta-analytic approaches on the effectiveness of methadone. Thereby it is recommended, with the maximum level of evidence, methadone maintenance treatments in spite of its weaknesses (ie. Toxicity, cardiovascular risk, sedation problems and cognitive impairment), considering the clinical history, general health status, and willingness and preferences of the patient.
Topics: Humans; Methadone; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders; Time Factors
PubMed: 22868972
DOI: No ID Found -
CPT: Pharmacometrics & Systems... Jun 2022Obesity is an increasingly alarming public health threat, with nearly 20% of children classified as obese in the United States today. Children with obesity are commonly...
Obesity is an increasingly alarming public health threat, with nearly 20% of children classified as obese in the United States today. Children with obesity are commonly prescribed the opioids fentanyl and methadone, and accurate dosing is critical to reducing the risk of serious adverse events associated with overexposure. However, pharmacokinetic studies in children with obesity are challenging to conduct, so there is limited information to guide fentanyl and methadone dosing in these children. To address this clinical knowledge gap, physiologically-based pharmacokinetic models of fentanyl and methadone were developed in adults and scaled to children with and without obesity to explore the interplay of obesity, age, and pharmacogenomics. These models included key obesity-induced changes in physiology and pharmacogenomic effects. Model predictions captured observed concentrations in children with obesity well, with an overall average fold error of 0.72 and 1.08 for fentanyl and methadone, respectively. Model simulations support a reduced fentanyl dose (1 vs. 2 μg/kg/h) starting at an earlier age (6 years) in virtual children with obesity, highlighting the importance of considering both age and obesity status when selecting an infusion rate most likely to achieve steady-state concentrations within the target range. Methadone dosing simulations highlight the importance of considering genotype in addition to obesity status when possible, as cytochrome P450 (CYP)2B6*6/*6 virtual children with obesity required half the dose to match the exposure of wildtype children without obesity. This physiologically-based pharmacokinetic modeling approach can be applied to explore dosing of other critical drugs in children with obesity.
Topics: Adult; Analgesics, Opioid; Child; Fentanyl; Humans; Methadone; Obesity
PubMed: 35491971
DOI: 10.1002/psp4.12793 -
MedEdPORTAL : the Journal of Teaching... 2021Methadone is an effective medication for treating pain and has unique characteristics that require specialized knowledge to prescribe safely. Palliative care providers...
INTRODUCTION
Methadone is an effective medication for treating pain and has unique characteristics that require specialized knowledge to prescribe safely. Palliative care providers use methadone for analgesia in patients with a wide range of prognoses, goals of care, and comorbid conditions. New consensus guidelines for methadone use released in 2019 by the American Academy of Hospice and Palliative Medicine provide guidance for safe use in patients who have potentially life-limiting illnesses. A needs assessment of palliative care fellows and faculty at our institution highlighted lack of knowledge and confidence with regard to prescribing methadone.
METHODS
We created a virtual, flipped classroom, interactive learning module intended for palliative care fellows and practicing clinicians that emphasized updated practice recommendations. Participants took a pretest, reviewed an article and lecture, and completed practice cases prior to an interactive session conducted via videoconference. Following the session, participants completed a posttest to assess knowledge and confidence regarding the learning objectives.
RESULTS
A total of 28 clinicians at the fellow and faculty/staff levels completed the intervention during two sessions in 2020. Self-reported confidence in all educational objectives improved following the intervention. Participants demonstrated improved skill in calculating methadone doses, converting between modes of drug administration, and identifying safety guidelines during and after the intervention.
DISCUSSION
Following the intervention, participants reported improved confidence and demonstrated improved skills in prescribing methadone for pain. Additional benefits of this training model include ease of implementation, engaging format, and time and resource efficiency given its virtual format.
Topics: Faculty; Humans; Methadone; Pain; Pain Management; Palliative Care; United States
PubMed: 34395853
DOI: 10.15766/mep_2374-8265.11172