Disorders - Opioid Use
Griffin, K. W., Botvin, G. J., Scheier, L. M., Williams, C.
Most universal drug abuse prevention efforts target early adolescents with the goal
of delaying or preventing the onset of substance use. The present study examined long-term follow-up data from a large-scale randomized trial of a
school-based prevention program that used cognitive-behavioral skills-training techniques to enhance social and personal competence skills and drug
refusal skills. The preventive intervention was implemented in junior high schools, and pretest data were collected from students in the classroom.
Approximately 13 years later, follow-up data were collected by mail from 2042 young adults. Rates of overall lifetime illicit drug use, as well as
lifetime marijuana use, marijuana intoxication, and lifetime non-medical pill use, were lower among students who received the prevention program
(Life Skills Training) during junior high school compared to control group participants. These findings support the hypothesis that comprehensive,
universal school-based prevention programs can produce long-term effects on illicit drug use behavior. Copyright © The Author(s) 2023.
Journal of Public Health
Research, 12(1) :
- Year: 2023
- Problem: Substance Use Disorders (any), Cannabis Use, Opioid Use, Stimulant Use
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Skills training, Other Psychological Interventions
Mirhosseini, H., Kargar,
M., Nitsche, M., Abarghouei, M. A. S., Nazari, M. A., Dastjerdi, G.
Introduction: The persistence of post-detoxification problems in drug addiction is one of the disadvantages of the ultra-rapid opioid
detoxification (UROD) method. Transcranial direct current stimulation (tDCS) has been introduced in experimental addiction treatment for some years.
Results of pilot studies suggest that it might be a promising method for addiction treatment. This study explores the adjunctive application of tDCS
during treating opiate addiction with the UROD approach. Method(s): This double-blind, sham-controlled clinical trial was carried out on patients
with substance abuse admitted to the Bahman Clinic of Yazd City in Iran (from March to September 2014). Forty participants were randomly allocated to
treatment and control groups. Two sessions of tDCS (real or sham) over dorsolateral prefrontal cortices (DLPFC) were applied, accompanied by UROD.
Withdrawal symptoms and craving were assessed by the drug desire questionnaire and objective opiate withdrawal scale before UROD and for the 24-hour
interval after. Result(s): Transcranial direct current stimulation optimized the opiate addiction treatment through craving and withdrawal syndrome
alleviation. Conclusion(s): The study results indicate that prefrontal tDCS may promote the efficacy of the UROD method in opioid addiction.
Copyright © 2023 Istanbul Tip Fakultesi Dergisi. All rights reserved.
Basic and Clinical Neuroscience, 13(6) : 799-
806
- Year: 2022
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse, Other biological interventions
Kumar, A. S., Khanra, S., Goyal, N., Dharani, R., Roy, C.
OBJECTIVE: Our study aimed to (1) examine the effect of adjunctive high-definition transcranial
direct current stimulation (HD-tDCS) in craving and withdrawal among patients with opioid use disorder on buprenorphine-naloxone, and (2) examine
effect of HD-tDCS changes in glutamate-glutamine and gamma-aminobutyric acid (GABA) at the left dorsolateral prefrontal cortex (DLPFC) among patients
with opioid use disorder on buprenorphine-naloxone.\rMETHODS: This was a pilot randomized double-blind, sham-controlled parallel-group study. A total
of 28 patients on buprenorphine-naloxone (6/1.5 mg/d) were randomly allocated into 2 groups for active and sham HD-tDCS stimulation. High-definition
transcranial direct current stimulation was administered twice daily for consecutive 5 days, from days 2 to 6. The Clinical Opiate Withdrawal Scale
(COWS), the Desire for Drug Questionnaire (DDQ), the Obsessive-Compulsive Drug Use Scale (OCDUS), and glutamate-glutamine and GABA at DLPFC via
proton magnetic resonance spectroscopy were measured at baseline and on day 7.\rRESULTS: Both active and sham groups had comparable changes in DDQ,
OCDUS (except 2 subcomponents), COWS, and glutamate-glutamine and GABA at DLPFC. In the active HD-tDCS group, statistically significant reductions
were observed in DDQ, OCDUS, and COWS but not in glutamate-glutamine and GABA.\rCONCLUSIONS: The adjunctive active HD-tDCS group showed comparable
changes in craving and withdrawal, and glutamate-glutamine and GABA at DLPFC compared with sham HD-tDCS. Craving and withdrawal but not glutamate-
glutamine and GABA at DLPFC decreased significantly with adjunctive HD-tDCS. Future studies with larger sample size and online assessment of
glutamate-glutamine and GABA would enhance our knowledge.
Journal of ECT, 38(2) : 124-132
- Year: 2022
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse, Other biological interventions
Ankit, A., Das, B., Dey, P., Kshitiz, K. K., Khess, C. R. J.
Background: Opoid use disorder
(OUD) is a global illness and reduction in craving by repeatative Transcranial Magnetic Stimulation (RTMS) is one of its management approaches.
Orbito-frontal Cortex is implicated in the several behavioral aspects of substance use including craving. Brain derived neurotrophic factor (BDNF)
has a critical role in addictive properties of drugs of use. Previous studies have shown significant improvement in craving with RTMS and
demonstrated alterations of serum BDNF levels in various substance dependent individual associated with craving. Aim(s): To examine the efficacy of
continuous Theta Burst Stimulation RTMS (CTBS-RTMS) over the right OFC as an adjunct to Naltrexone in patients of OUD and its correlation with serum
BDNF levels. Method(s): Forty patients with OUD were recruited with purposive sampling. At the end of detoxification CTBS -RTMS was applied by
dividing them into two equal groups as active and sham group using alternate allocation. Obsessive compulsive drug use scale (OCDUS) was applied and
serum BDNF level was measured overtime till the end of CTBS-RTMS session. Data was analyzed by SPSS version 25. Result(s): Both groups had shown
significant reduction in craving (OCDUS score) and serum BDNF from the baseline to 14th session of the RTMS. But there was no significant difference
when compared between the two groups. Significant correlation was observed between serum BDNF levels overtime with different clinical variables in
active group. Conclusion(s): The study adds to the literature in building an understanding of how rTMS could be used in reducing cravings for
opioids. Copyright © 2021 Taylor & Francis Group, LLC.
Journal of Addictive Diseases, 40(3) : 373-381
- Year: 2022
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Transcranial magnetic stimulation
(TMS)
Mitchell, S. G., Monico,
L. B., Gryczynski, J., Fishman, M. J., O’Grady, K. E., Schwartz, R. P.
Background: Few
published research studies have examined the effectiveness of extended-release naltrexone (XR-NTX) for the treatment of opioid use disorder (OUD)
among adolescents and young adults. Method(s): This two-group randomized controlled trial recruited 288 youth, ages 15-21, with moderate/severe OUD
from a residential addiction treatment program in Baltimore, Maryland. The study randomized the youth within the first week of treatment entry to
receive either XR-NTX or treatment-as-usual (TAU; either buprenorphine maintenance treatment or treatment without OUD medication following medically
managed withdrawal) prior to discharge, with continued treatment in the community for 6 months. However, due to various reasons spanning patients'
and caregivers' preferences and constraints, considerable participant nonadherence to randomized condition occurred (i.e., only 30% of the
participants randomized to XR-NTX received an initial injection, while 27% of participants randomized to TAU received an XR-NTX injection at
treatment discharge, instead of their assigned treatment). The study used generalized linear mixed modeling (GLiMM) to examine self-reported 90-day
opioid, cocaine, marijuana, and alcohol use as well as DSM-5 OUD criteria on \"intention-to-treat\" (as randomized), \"as-received\" (XR-NTX vs. not
XR-NTX), and \"as-medicated\" (XR-NTX vs. buprenorphine vs. no medication) bases. Result(s): The condition x time interactions in the intention-to-
treat analyses failed to reach significance for past-90-day self-reported use of illicit opioids, cocaine, marijuana, or alcohol, or in meeting DSM-5
OUD criteria at 3 or 6 months [all ps > 0.05]. However, these findings are of limited interpretive value due to participant nonadherence to their
randomized condition. When the study analyzed results by the treatment received at discharge, the \"as-received\" group x time interaction for
illicit opioid use was significant [p = .003], with the XR-NTX group reporting less opioid use in the past 90 days at 3 and 6 months. Participants
who received their first XR-NTX dose at inpatient discharge (n = 82) received, on average, 1.3 subsequent injections in the community over the 6-
month study follow-up period. Only 2 of the 82 study participants received XR-NTX continuously through the 6-month postdischarge follow-up period.
Twelve serious adverse events (SAEs) occurred during the study, but the study determined that only 1 was possibly study related (hepatitis C/elevated
liver function test results). Conclusion(s): None of the condition x time interactions in the intention-to-treat analyses reached significance.
Participants' nonadherence may have contributed to the failure to reject the null hypothesis. Irrespective of randomized condition, participants who
received XR-NTX for OUD demonstrated low retention in treatment, receiving an average of only 1.3 subsequent injections, yet reported less opioid use
at follow-up than participants who did not received XR-NTX. Treatment programs should consider XR-NTX as a treatment option for youth motivated to
receive it. Future research should focus on building developmentally informed strategies to improve uptake of and adherence to relapse prevention
medication in this population. Copyright © 2021
Journal of substance abuse treatment, 130 (no
pagination) :
- Year: 2021
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse
Fishman, M., Wenzel, K., Vo, H., Wildberger, J., Burgower, R.
BACKGROUND AND AIMS: Although medications for opioid use disorder (OUD), including extended-release naltrexone
(XR-NTX), have demonstrated effectiveness, adherence is often low. We tested the preliminary efficacy of youth opioid recovery support (YORS), a
multi-component intervention designed to improve engagement and medication adherence for young adults with OUD. DESIGN: Single-site randomized
controlled trial with 24-week follow-up. SETTING: Community substance use disorder treatment program in Baltimore, MD, USA. PARTICIPANTS: Young
adults aged 18-26 years enrolled in inpatient/residential OUD treatment intending to pursue outpatient OUD treatment with XR-NTX. Twenty-one
participants were randomized to YORS and 20 to treatment as usual (TAU). The analyzed sample was 65.8% male. INTERVENTION AND COMPARATOR: Components
of YORS include: (1) home delivery of XR-NTX; (2) family engagement; (3) assertive outreach; and (4) contingency management for receipt of XR-NTX
doses. The comparator was TAU, which consisted of a standard referral to outpatient care following an inpatient stay. MEASUREMENTS: Primary outcomes
were number of XR-NTX doses received over 24 weeks and relapse to opioid use (defined as >= 10 days of use within 28 days) at 24 weeks. FINDINGS:
Participants in the YORS condition received more XR-NTX doses [mean = 4.28; standard deviation (SD) = 2.3] compared with those in TAU (mean = 0.70;
SD = 1.2), P < 0.01. Participants in the YORS group compared with TAU had lower rates of relapse (61 versus 95%; P < 0.01). Survival analyses
revealed group differences on time to relapse with participants in TAU being more likely to relapse sooner compared with participants in the YORS
condition [hazard ratio (HR) = 2.72, 95% confidence interval (CI) = 1.26-5.88, P < 0.01]. CONCLUSION(S): The youth opioid recovery support
intervention for extended-release naltrexone adherence and opioid relapse prevention among young adults with opioid use disorder appeared to improve
treatment and relapse outcomes compared with standard treatment. Copyright © 2020 Society for the Study of Addiction.
Addiction
(Abingdon, England), 116(3) : 548-557
- Year: 2021
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse, Service Delivery & Improvement, Psychological Interventions
(any), Contingency
management, Other service delivery and improvement
interventions
Fishman, M., Wenzel, K., Scodes, J., Pavlicova, M., Lee, J. D., Rotrosen, J., Nunes, E.
Purpose: Young adults are
disproportionately affected by the current opioid crisis. Although medications for opioid use disorder are broadly effective, with reductions in
morbidity and mortality, the particular effectiveness of medications for opioid use disorder among young adults is less well understood. Method(s):
This secondary analysis compared young adults (aged 18-25 years) with older adults (aged >=26 years) in a large comparative effectiveness trial
(\"XBOT\") that randomized subjects to extended-release naltrexone or sublingual buprenorphine-naloxone for 6 months. Opioid relapse was defined by
opioid use over four consecutive weeks or seven consecutive days, using urine testing and self-report. Result(s): Among subjects in the intention-
to-treat sample (n = 570, all randomized participants), a main effect of age group was found, with higher relapse rates among young adults (70.3%)
compared with older adults (58.2%), with an odds ratio of 1.72 (95% confidence interval = 1.08-2.70), p = .02. In the per-protocol sample (n = 474,
only participants who started medication), relapse rates were higher among young adults (66.3%) compared with older adults (50.8%), with an odds
ratio of 1.91 (95% confidence interval = 1.19-3.06). Among the intention-to-treat sample, survival analysis revealed a significant time-by-age group
interaction (p = .01) with more relapse over time in young adults. No significant interactions between age and medication group were detected.
Conclusion(s): Young adults have increased rates of relapse compared with older adults, perhaps because of vulnerabilities that increase their risk
for treatment dropout and medication nonadherence, regardless of medication assignment. These results suggest that specialized, developmentally
informed interventions may be needed to improve retention and successful treatment of opioid use disorder among young adults. Copyright © 2020
Society for Adolescent Health and Medicine
Journal of Adolescent Health, 67(6) : 778-785
- Year: 2020
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse
Belokrylov, I., Artemieva, M., Bryukhin, A., Suleimanov, R., Danilin, I., Lazukova, A.
Background and aims.- Introduction. Opium dependence in many cases shows a high
resistance to most treatment methods. One of the main reasons for this situation is the low motivation of patients for treatment. Objectives.-
Identification of clinico-psychopathological and personal factors associated with low motivation for treatment in patients with opiate dependence;
the development of a psychotherapeutic technique aimed at the formation and maintenance of motivation to abandon the drug and, as a consequence,
improving the effectiveness of treatment of this contingent. Methods.- A total of 75 patients with opiate addiction were examined, all men, with an
average age of 25.6+/-3.2 years. On the basis of factorial and correlation analysis, two clinical-pathopsychological markers are established,
reliably associated with the level of motivation for treatment. The first is the degree of severity of the pathological attraction to the drug, the
second is the degree of self-awareness of the unity of I. An integrative psychotherapeutic method was developed to increase the motivation of addicts
for treatment, focused on working with the functions of selfawareness. Efficacy evaluation was conducted in a randomized controlled trial. Results.-
The use of the developed method led to more than twofold excess of the number of remissions of addiction over 1 year in the main group compared to
the control group. Conclusions.- Psychotherapy, aimed at strengthening the motivation of patients with opiate dependence on treatment, significantly
increases the effectiveness of the treatment complex.
European Psychiatry, 56(Supplement
1) : S228
- Year: 2019
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Borodovsky, J. T., Levy, S., Fishman, M., Marsch, L. A.
In the past decade, a new cohort of adolescents and young adults with opioid use disorders (OUD) has
emerged. While medications and psychosocial treatments are available, few adolescents and young adults with OUD can access and remain in treatment.
Effective, practical, and scalable treatment paradigms for this young population are needed. Buprenorphine is a medication with unique
pharmacological and regulatory characteristics that make it a promising component of adolescent and young adult OUD treatment models. Three
randomized controlled trials and multiple observational studies have evaluated the use of buprenorphine to treat this population. However, data from
these studies have not been consolidated into an up-To-date summary that may be useful to clinicians. The objective of this narrative review is to
inform clinical practice by summarizing results of primary and secondary analyses from randomized controlled clinical trials and observational
studies that have evaluated the use of buprenorphine to treat adolescents and young adults with OUD. Based on results from these studies, we
encourage the conceptualization of OUD among youth as a chronic medical condition requiring a long-Term management strategy. This includes treatment
with buprenorphine in conjunction with medication-prescribing protocols that do not necessarily require daily clinic attendance for observed
medication adherence. However, more study of treatment delivery models, addressing such issues as medication adherence and intensity requirements, is
needed to determine practices that optimize outcomes for youth. © Copyright 2018 American Society of Addiction Medicine.
Journal of
Addiction Medicine, 12(3) : 170-183
- Year: 2018
- Problem: Opioid Use
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse
Law, F. D., Diaper, A.
M., Melichar, J. K., Coulton, S., Nutt, D. J., Myles, J. S.
Buprenorphine/naloxone,
methadone and lofexidine are medications with utility in the treatment of opiate withdrawal. We report the first randomised controlled trial to
compare the effects of these two medications on withdrawal symptoms and outcome during opiate induction/stabilisation and detoxification. A double-
blind randomised controlled trial was conducted in an outpatient satellite clinic of a specialist drug service. Eighty opiate dependent individuals
meeting DSM-IV criteria for opiate dependence, using 1/2 g heroin smoked/chased or 1/4 g heroin injected or 30mg methadone, with 3 years of opioid
dependency, underwent a short-term opiate treatment programme involving induction/stabilisation on methadone 30mg or buprenorphine/naloxone 4mg/1mg,
followed by detoxification (where the methadone group was assisted by lofexidine). The main outcome measures were urine drug screens for opiates and
withdrawal and craving questionnaires. There were no overall differences in positive urine drug screens and drop-outs during any phase of the study.
During induction/stabilisation, withdrawal symptoms subsided more slowly for buprenorphine/naloxone than for methadone, and craving was significantly
higher in the buprenorphine/naloxone group (p < 0.05, 95% confidence interval -3.5, -0.38). During detoxification, withdrawal symptoms were
significantly greater and the peak of withdrawal was earlier for the methadone/lofexidine group than the buprenorphine/naloxone group (p < 0.01, 95%
confidence interval 3.0, 8.3). Methadone/lofexidine and buprenorphine/naloxone had comparable outcomes during rapid outpatient stabilisation and
detoxification in low dose opiate users. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Psychopharmacology, 31(8) : 1046-1055
- Year: 2017
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse, Other biological interventions
Marsch, L. A., Moore, S. K., Borodovsky, J. T., Solhkhah, R., Badger, G. J., Semino, S., Jarrett, K., Condon, K. D., Rossettie, K., Vincent, P., Hajizadeh, N., Ducat, E.
BACKGROUND AND AIMS: Few randomized controlled trials have evaluated buprenorphine treatment interventions for
opioid-dependent youth. Consequently, optimal administration strategies for this cohort are unclear. Our aim was to evaluate the relative efficacy of
two different buprenorphine taper lengths in promoting abstinence from illicit opioids and treatment retention among opioid-dependent youth.\rDESIGN:
A double-blind, placebo controlled, multicenter randomized controlled trial.\rSETTING: Two hospital-based research clinics (Manhattan and Brooklyn)
in New York City, USA from 2005 to 2010.\rPARTICIPANTS: Volunteer sample of 53 primarily Caucasian participants between the ages of 16 and 24 (n = 11
under age 18) who met DSM-IV opioid dependence criteria.\rINTERVENTION: Participants were assigned randomly to either a 28-day buprenorphine taper (n
= 28) or 56-day buprenorphine taper (n = 25) via a parallel-groups design during a 63-day period. Both groups received behavioral counseling and
opioid abstinence incentives. Both taper conditions had a minimum of 1 week of placebo dosing at the end of the taper.\rMEASUREMENTS: The primary
outcome was opioid abstinence measured as a percentage of scheduled urine toxicology tests documented to be negative for opioids. The secondary
outcome was treatment retention, measured as number of days attended scheduled visits.\rFINDINGS: Intent-to-treat analyses revealed that participants
who received a 56-day buprenorphine taper had a significantly higher percentage of opioid-negative scheduled urine tests compared with participants
who received a 28-day buprenorphine taper [35 versus 17%, P = 0.039; Cohen's d = 0.57, 95% confidence interval (CI) = 0.02, 1.13]. Participants who
received a 56-day buprenorphine taper were retained in treatment significantly longer than participants who received a 28-day buprenorphine taper
(37.5 versus 26.4 days, P = 0.027; Cohen's d = 0.63, 95% CI = 0.06, 1.19). Daily attendance requirement was associated with decreased abstinence and
shorter retention compared with a two to three times weekly attendance requirement, independent of taper duration. Follow-up data were insufficient
to report.\rCONCLUSION: Longer (56-day) buprenorphine taper produces better opioid abstinence and retention outcomes than shorter (28-day)
buprenorphine taper for opioid-dependent youth.
Addiction, 111(8) : 1406-15
- Year: 2016
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse, Other biological interventions
Borodovsky,
J., Marsch, L. A., Moore, S. K.
Aims: Opioid dependence among adolescents is a significant public health issue; however, few evidence-based treatment
programs for opioid-dependent youth exist. Clinical trials have shown buprenorphine (BUP) to be a promising medication for treating this cohort. To
better inform treatment strategies, outcome data were compared from three randomized trials evaluating different BUP dosing strategies. Methods: A
systematic search of the literature revealed three trials that investigated this issue: Marsch et al. (2005), Woody et al. (2008) and Marsch et al.
(2014) (unpublished).BUPduration, dosing strategies, and clinical outcomes were compared. Results: Across the trials, 241 youth aged 15-24 were
enrolled in treatment. Prevalence of injecting behavior ranged from 33% to 60% and use of heroin as the primary drug of abuse ranged from 41% to 82%
(others primarily used prescription opioids). Two studies compared different taper strategies and one study compared a taper to maintenance. All
studies provided behavior therapy. Length of treatment with BUP ranged from 14 to 84 days. BUP dose ranged from 4 to 24 mg. All studies favored
either BUP treatment (compared to non-opioid treatment) or longerBUPtreatment (compared to shorter) in promoting retention and abstinence (based on
opioid negative urinalysis). Marsch et al. (2005) (n = 36) observed 72% (28 day BUP taper) vs 39% (28 day clonidine taper) retained at 28 days and
64% vs 32% abstinent at 28 days. Woody et al., 2008 (n = 152) found 70% (12 week BUP maintenance) vs 20.5% (14 day BUP taper) retained at 12 weeks
and 57% vs 49% abstinent at 12 weeks. Marsch et al. (2014) (n = 53) found 36% (63 day BUP taper) vs 17% (28 day BUP taper) retained at 63 days and
35% vs 17% abstinent at 63 days. Conclusions: Though trial designs differ, these data suggest that longer treatment with BUP improves clinical
outcomes for opioid dependent youth. These results may guide clinicians seeking to implement science-based treatment models for this population.
Drug & Alcohol Dependence, 156 : e25
- Year: 2015
- Problem: Opioid Use
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse