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Opioid substitution treatment enrollment and outcomes in California: 1991–2011
Abstracts / Drug and Alcohol Dependence 140 (2014) e86–e168
motivational intervention may be sufficient for substantially reducing unmotivated, non-treatment seeking individuals use of ecstasy. Financial support: Australian Government Department of Health and Ageing under the National Psychostimulants Initiative. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.458 Opioid substitution treatment enrollment and outcomes in California: 1991–2011 Bohdan Nosyk 1,2 , E. Evans 2 , Libo Li 2 , Darren Urada 2 , M.J. Milloy 1 , Evan Wood 1 , R. Rawson 2 , Y. Hser 2 1 BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada 2 UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States
Aims: To provide a descriptive analysis of the opioid substitution treatment (OST) delivery system, we examine trends in demographic and drug use characteristics of patients accessing OST in California over the past 20 years. Methods: Statewide administrative data was obtained from the California Alcohol & Drug Data System (CADDS; 1991–2005) and California Outcome Measurement System (CalOMS; 2006–2011) on all patients admitted to publicly funded OST programs from 1991 to 2011. Univariate trends in demographic, drug use characteristics and treatment outcomes were considered. Cochran-Armitage tests were applied to confirm observed trends. Results: The study sample consisted of 240,225 individuals and 689,192 treatment episodes. Individuals had a median 2 (IQR: 1–5) OST episodes during the study period. The annual number of new OST admissions peaked in 1994 (51,902) and fell to 18,480 in 2011; within these years, detoxification treatment admissions fell from 88.0% to 41.4% (p < 0.01). Overall, rates of retention in treatment at 3 and 12 months during the study period were 32.2% and 18.1%, respectively; among maintenance-oriented treatment admissions, these rates were 70.5% and 44.1%. Among client characteristics, prescribed opioids have been more frequently reported as the primary drug of abuse in recent years, reaching 24.0% of all admissions in 2011; injection as the primary route of administration has subsequently fallen to 62.0% in 2011 from a high of 94.8% in 1992. The proportion of admissions by individuals aged 25 and under has increased from 15.9% in 2003 to 31.7% in 2011 (p < 0.01). Finally, rates of Hepatitis C Virus and HIV testing were relatively constant at 24% and 70%, respectively, from 2006–2011. Conclusions: Both the mode of OST delivery and client demographics have shifted substantially in California over the past 20 years. Monitoring and evaluation efforts are necessary to inform health system innovation and reform. Financial support: NIDA Grant No. R01DA031727 (PI:Nosyk). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.459
e163
Evaluation of opioid withdrawal after maintenance on extended-release tramadol Paul A. Nuzzo 1 , Sharon L. Walsh 1,2,3 , Shanna Babalonis 1,3 , A. Siegel 2 , C.L. Campbell 4 , Michelle R. Lofwall 1,2,3 1 Center on Drug and Alcohol Research, University of Kentucky College of Medicine (UK COM), Lexington, KY, United States 2 Psychiatry, UK COM, Lexington, KY, United States 3 Behavioral Science, UK COM, Lexington, KY, United States 4 Cardiology, UK COM, Lexington, KY, United States
Aims: The aim was to evaluate whether abrupt cessation of dosing with extended-release (ER) tramadol produced evidence of opioid withdrawal. Methods: This was an inpatient, double blind, randomized, three-arm, placebo-controlled trial. Key eligibility criteria included: age 18–55 years old, short-acting prescription opioid use >20 of the last 30 days, and meeting DSM-IV criteria for current opioid dependence with observed withdrawal. After random assignment to ER tramadol (0, 100 or 300 mg bid for 7 days; n = 12/group), all groups crossed over to placebo for 6 additional days of monitoring. Four breakthrough withdrawal medications were available. Primary outcomes were: (1) number of breakthrough withdrawal medication doses taken and (2) subject-rated opioid withdrawal. Secondary outcomes included observer-rated withdrawal ratings, physiologic and cognitive measures, and serious adverse events. Results: Amount of breakthrough withdrawal medication differed significantly among groups (p < 0.001) over the 6-day placebo-dosing period whereby the 600 mg tramadol group requested significantly more rescue doses on days 2–4 (Dunnet p < 0.05) versus the placebo-assigned group. Specifically, more acetaminophen was used in the 600 mg transfer group than placebo on days 2–4 (Dunnet p < 0.05). There were no statistically significant increases on subject-rated withdrawal measures. Observer-rated withdrawal scores for the 600 mg group increased modestly from days 2–3 and then decreased to values similar to the 200 mg and placebo groups. There were no serious adverse events. Conclusions: Abrupt cessation of repeated dosing with ER tramadol 600, but not 200 mg, produced opioid withdrawal as evidenced primarily by increased use of rescue medications. Financial support: NIDA R01 DA027068 (MRL), T32 DA007304 and NCRR and NCATS UL1RR033173. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.460
motivational intervention may be sufficient for substantially reducing unmotivated, non-treatment seeking individuals use of ecstasy. Financial support: Australian Government Department of Health and Ageing under the National Psychostimulants Initiative. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.458 Opioid substitution treatment enrollment and outcomes in California: 1991–2011 Bohdan Nosyk 1,2 , E. Evans 2 , Libo Li 2 , Darren Urada 2 , M.J. Milloy 1 , Evan Wood 1 , R. Rawson 2 , Y. Hser 2 1 BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada 2 UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States
Aims: To provide a descriptive analysis of the opioid substitution treatment (OST) delivery system, we examine trends in demographic and drug use characteristics of patients accessing OST in California over the past 20 years. Methods: Statewide administrative data was obtained from the California Alcohol & Drug Data System (CADDS; 1991–2005) and California Outcome Measurement System (CalOMS; 2006–2011) on all patients admitted to publicly funded OST programs from 1991 to 2011. Univariate trends in demographic, drug use characteristics and treatment outcomes were considered. Cochran-Armitage tests were applied to confirm observed trends. Results: The study sample consisted of 240,225 individuals and 689,192 treatment episodes. Individuals had a median 2 (IQR: 1–5) OST episodes during the study period. The annual number of new OST admissions peaked in 1994 (51,902) and fell to 18,480 in 2011; within these years, detoxification treatment admissions fell from 88.0% to 41.4% (p < 0.01). Overall, rates of retention in treatment at 3 and 12 months during the study period were 32.2% and 18.1%, respectively; among maintenance-oriented treatment admissions, these rates were 70.5% and 44.1%. Among client characteristics, prescribed opioids have been more frequently reported as the primary drug of abuse in recent years, reaching 24.0% of all admissions in 2011; injection as the primary route of administration has subsequently fallen to 62.0% in 2011 from a high of 94.8% in 1992. The proportion of admissions by individuals aged 25 and under has increased from 15.9% in 2003 to 31.7% in 2011 (p < 0.01). Finally, rates of Hepatitis C Virus and HIV testing were relatively constant at 24% and 70%, respectively, from 2006–2011. Conclusions: Both the mode of OST delivery and client demographics have shifted substantially in California over the past 20 years. Monitoring and evaluation efforts are necessary to inform health system innovation and reform. Financial support: NIDA Grant No. R01DA031727 (PI:Nosyk). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.459
e163
Evaluation of opioid withdrawal after maintenance on extended-release tramadol Paul A. Nuzzo 1 , Sharon L. Walsh 1,2,3 , Shanna Babalonis 1,3 , A. Siegel 2 , C.L. Campbell 4 , Michelle R. Lofwall 1,2,3 1 Center on Drug and Alcohol Research, University of Kentucky College of Medicine (UK COM), Lexington, KY, United States 2 Psychiatry, UK COM, Lexington, KY, United States 3 Behavioral Science, UK COM, Lexington, KY, United States 4 Cardiology, UK COM, Lexington, KY, United States
Aims: The aim was to evaluate whether abrupt cessation of dosing with extended-release (ER) tramadol produced evidence of opioid withdrawal. Methods: This was an inpatient, double blind, randomized, three-arm, placebo-controlled trial. Key eligibility criteria included: age 18–55 years old, short-acting prescription opioid use >20 of the last 30 days, and meeting DSM-IV criteria for current opioid dependence with observed withdrawal. After random assignment to ER tramadol (0, 100 or 300 mg bid for 7 days; n = 12/group), all groups crossed over to placebo for 6 additional days of monitoring. Four breakthrough withdrawal medications were available. Primary outcomes were: (1) number of breakthrough withdrawal medication doses taken and (2) subject-rated opioid withdrawal. Secondary outcomes included observer-rated withdrawal ratings, physiologic and cognitive measures, and serious adverse events. Results: Amount of breakthrough withdrawal medication differed significantly among groups (p < 0.001) over the 6-day placebo-dosing period whereby the 600 mg tramadol group requested significantly more rescue doses on days 2–4 (Dunnet p < 0.05) versus the placebo-assigned group. Specifically, more acetaminophen was used in the 600 mg transfer group than placebo on days 2–4 (Dunnet p < 0.05). There were no statistically significant increases on subject-rated withdrawal measures. Observer-rated withdrawal scores for the 600 mg group increased modestly from days 2–3 and then decreased to values similar to the 200 mg and placebo groups. There were no serious adverse events. Conclusions: Abrupt cessation of repeated dosing with ER tramadol 600, but not 200 mg, produced opioid withdrawal as evidenced primarily by increased use of rescue medications. Financial support: NIDA R01 DA027068 (MRL), T32 DA007304 and NCRR and NCATS UL1RR033173. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.460