European Addiction Research
Vorberg F.a· Reimer J.a,b· Verthein U.aaCentre for Interdisciplinary Addiction Research (ZIS), University Medical Centre Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
bCentre for Psychosocial Medicine, Clinic Itzehoe, Itzehoe, Germany
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Article / Publication DetailsFirst-Page Preview
Received: May 06, 2022
Accepted: October 11, 2022
Published online: December 19, 2022
Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 5
ISSN: 1022-6877 (Print)
eISSN: 1421-9891 (Online)
For additional information: https://www.karger.com/EAR
AbstractIntroduction: After rapidly opening up a low-threshold clinic to support heavily opioid-dependent persons at the beginning of the COVID-19 pandemic in April 2020 in Hamburg (Germany), this non-interventional study evaluated the feasibility and short-term effects of opioid substitution treatment (OST). The low-threshold concept was customized for the pandemic situation and is the first of its kind in Germany. Methods: Patients who had already begun treatment were questioned in two assessments, at T1 shortly after beginning treatment and at T2 6 months later. The primary outcome criterion was their quality of life using the OSTQOL. Secondary criteria included retention rate, their mental and physical health (measured by the BSI-18 and the OTI Health Scale), social situation, drug use, COVID-19 status, and satisfaction with treatment. Results: Out of 84 patients included in the study, 51 participated in both assessments, resulting in a 6-month retention rate of 60.7%. 27.5% were females, and 72.5% were males. The feasibility question of the low-threshold OST clinic can clearly be answered positively. During the course of the study over 6 months, the situation mainly remained stable regarding quality of life, physical and mental health, and days of drug consumption. Patients significantly reduced the time they spent on the drug scene from 8.5 (SD = 7.56) to 6.1 (SD = 6.71) hours a day between the beginning of OST and T2 (p = 0.020). While 56.9% answered to be homeless at the beginning of OST, only 33.3% answered not to have found an accommodation by T2 (p = 0.012). The number of patients having contact to social workers increased from 51.0% to 74.5% (p = 0.004). Almost 2 fifths of the patients took part in PCR testing for COVID-19 (that only being done if they had symptoms), and none of the tests were positive. Discussion/Conclusions: Overall, the low-threshold OST clinic has been successfully implemented in order to help a vulnerable group of people navigate through a global pandemic and support the public health sector. Further conclusions on effects are limited by the short study period and the small number of patients, which calls for further research studies in a larger setting.
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References Ornell F, Moura HF, Scherer JN, Pechansky F, Kessler FHP, von Diemen L. The COVID-19 pandemic and its impact on substance use: implications for prevention and treatment. Psychiatry Res. 2020;289:113096. Van den Brink W, Haasen C. Evidence-based treatment of opioid-dependent patients. Can J Psychiatry. 2006 Sep;51(10):635–46. German Ministry of Health. Annual report on addiction. Berlin, Germany: BMG-D-11056; 2021 Aug. Kourounis G, Richards BDW, Kyprianou E, Symeonidou E, Malliori MM, Samartzis L. Opioid substitution therapy: lowering the treatment thresholds. Drug Alcohol Depend. 2016 Apr;161:1–8. Richert T, Johnson B. Long-term self-treatment with methadone or buprenorphine as a response to barriers to opioid substitution treatment: the case of Sweden. Harm Reduct J. 2015 Feb;12(1):12. Hall NY, Le L, Majmudar I, Mihalopoulos C. Barriers to accessing opioid substitution treatment for opioid use disorder: a systematic review from the client perspective. Drug Alcohol Depend. 20212021;221:108651. Ayres R, Ingram J, Rees A, Neale J, Beattie A, Telfer M. Enhancing motivation within a rapid opioid substitution treatment feasibility RCT: a nested qualitative study. Subst Abuse Treat Prev Pol. 2014 Nov;9:44. Nolan S, Hayashi K, Milloy MJ, Kerr T, Dong H, Lima VD, et al. The impact of low-threshold methadone maintenance treatment on mortality in a Canadian setting. Drug Alcohol Depend. 2015 Nov;156:57–61. Parsons D, Burrows D, Bolotbaeva A. Advocating for opioid substitution therapy in Central Asia: much still to be done. Int J Drug Pol. 2014;25(6):1174–7. Marks M, Scheibe A, Shelly S. High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion. Harm Reduct J. 2020;17(1):25. Harm Reduction International [Internet, 2019]. The state of harm reduction in Western Europe 2018 [cited 2022 April 5]. Available from: https://www.hri.global/files/2019/05/20/harm-reduction-western-europe-2018.pdf. Horyniak D, Higgs P, Jenkinson R, Degenhardt L, Stoové M, Kerr T, et al. Establishing the melbourne injecting drug user cohort study (MIX): rationale, methods, and baseline and twelve-month follow-up results. Harm reduction J. 2013;10(1):11. Jakubowski A, Fox A. Defining low-threshold buprenorphine treatment. J Addict Med. 2020;14(2):95–8. Johnson B, Richert T. Non-prescribed use of methadone and buprenorphine prior to opioid substitution treatment: lifetime prevalence, motives, and drug sources among people with opioid dependence in five Swedish cities. Harm Reduct J. 2019;16(1):31. Duncan DF, Nicholson T, Clifford P, Hawkins W, Petosa R. Harm reduction: an emerging new paradigm for drug education. J Drug Educ. 1994;24(4):281–90. Kapadia SN, Griffin JL, Waldman J, Ziebarth NR, Schackman BR, Behrends CN. A harm reduction approach to treating opioid use disorder in an independent primary care practice: a qualitative study. J Gen Intern Med. 2021;36(7):1898–905. German Ministry of Health. Verordnung über Abweichungen von den Vorschriften des Fünften Buches Sozialgesetzbuch, des Apothekengesetzes, der Apothekenbetriebsordnung, der Arzneimittelpreisverordnung, des Betäubungsmittelgesetzes und der Betäubungsmittel-Verschreibungsverordnung infolge der SARS-CoV-2-Epidemie [Regulation of deviations of the German Narcotics Prescription Law as a result of the COVID-19 pandemic]. Berlin, Germany; 2020. Strada L, Franke GH, Schulte B, Reimer J, Verthein U. Development of OSTQOL: a measure of quality of life for patients in opioid substitution treatment. Eur Addict Res. 2017 Nov;23(5):238–48. Spitzer C, Hammer S, Löwe B, Grabe HJ, Barnow S, Rose M, et al. [The short version of the Brief Symptom Inventory (BSI -18): preliminary psychometric properties of the German translation]. Fortschr Neurol Psychiatr. 2011 Sep;79:517–23. Darke S, Hall W, Wodaki A, Heather N, Ward J. Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index. Addiction. 1992 May;87(5):733–42. O’Connor AM, Cousins G, Durand L, Barry J, Boland F. Retention of patients in opioid substitution treatment: a systematic review. PLoS One. 2020 May;15(5):e0232086. Lambert DG. Opioids and the COVID-19 pandemic: does chronic opioid use or misuse increase clinical vulnerability? Br J Anaesth. 2020;125(4):e382–3. Eagleton M, Stokes S, Fenton F, Keenan E. Does opioid substitution treatment have a protective effect on the clinical manifestations of COVID-19? Comment on Br J Anaesth 2020; 125: e382-3. Br J Anaesth. 2021;126(3):e114–6. Tahamtan A, Tavakoli-Yaraki M, Salimi V. Opioids/cannabinoids as a potential therapeutic approach in COVID-19 patients. Expert Rev Respir Med. 2020;14(10):965–7. New York City Department of Health and Mental Hygiene. Cocaine: do you have a problem? Health Bull Volume 10, Number 6. New York City, New York, USA; 2011. Government of the United Kingdom [Internet, 2021]. Introducing Opioid Substitution Treatment (OST) [cited 2022 August 7]. Available from: https://www.gov.uk/government/publications/opioid-substitution-treatment-guide-for-keyworkers/part-1-introducing-opioid-substitution-treatment-ost. Article / Publication DetailsFirst-Page Preview
Received: May 06, 2022
Accepted: October 11, 2022
Published online: December 19, 2022
Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 5
ISSN: 1022-6877 (Print)
eISSN: 1421-9891 (Online)
For additional information: https://www.karger.com/EAR
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