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Ed Day - One of the best experts on this subject based on the ideXlab platform.
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The impact of employment on perceived recovery from Opiate dependence
Drugs and Alcohol Today, 2018Co-Authors: Elizabeth Lowe, Shabana Akhtar, Oliver Emmerson, Thomas James Parkman, Ed DayAbstract:Less than 15 per cent of people starting Opiate Substitution Treatment (OST) in England are employed, but few gain employment during Treatment. Increasingly punitive approaches have been tried to encourage individuals with substance dependence into employment in the hope of facilitating recovery. It is not clear which factors are associated with the successful maintenance of employment whilst receiving OST, and whether this group can be said to be “in recovery”. The paper aims to discuss these issues.,A cross-sectional study of the OST population in one English region was conducted between January and April 2017. Measures of physical health, employment patterns, drug use, mental health, recovery capital, and dependence severity were administered to 55 employed and 55 unemployed clients.,Those in employment had higher levels of “recovery capital”, better physical and mental health, fewer drug problems, and less severe dependence, despite reporting heroin use at a similar level. Three variables were significantly associated with employment: longest period of employment (OR=1.01, p=0.003); number of chronic medical conditions (OR=0.44, p=0.011); and number of days of psychological problems in the last month (OR=0.95, p=0.031).,These results suggest that abstinence may not be required in order to maintain stable employment when OST is in place. Different Treatment strategies are required for clients receiving OST already in employment compared with those who are unemployed.,This is the first UK study to the author’s knowledge to focus on people receiving OST who are also in employment.
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A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in Opiate Substitution Treatment services
BMC Psychiatry, 2018Co-Authors: Ed Day, Alex Copello, Deborah Bamber, Charlotte Powell, Sanju George, Jennifer L. Seddon, Marilyn Christie, Carmel Bennett, Shabana Akhtar, Andrew BallAbstract:Background Approximately 3% of people receiving opioid Substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing Treatment. Involvement of families and wider social networks in supporting psychological Treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. Methods A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit Opiate use in the past 28 days to one of three Treatments: 1) Treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after Treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, Treatment satisfaction, social network size and support). Results A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial Treatment intervention sessions was low across all three arms (44% overall). Conclusions Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at Treatment sessions makes it uncertain whether an adequate dose of Treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. Trial registration ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in Opiate Substitution Treatment services
BMC psychiatry, 2018Co-Authors: Ed Day, Alex Copello, Jennifer Seddon, Marilyn M. Christie, Deborah Bamber, Charlotte Powell, Sanju George, Carmel Bennett, Shabana Akhtar, Andrew BallAbstract:Approximately 3% of people receiving opioid Substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing Treatment. Involvement of families and wider social networks in supporting psychological Treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit Opiate use in the past 28 days to one of three Treatments: 1) Treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after Treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, Treatment satisfaction, social network size and support). A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial Treatment intervention sessions was low across all three arms (44% overall). Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at Treatment sessions makes it uncertain whether an adequate dose of Treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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Predicting health-related quality of life (EQ-5D-5 L) and capability wellbeing (ICECAP-A) in the context of Opiate dependence using routine clinical outcome measures: CORE-OM, LDQ and TOP
BMC, 2018Co-Authors: Jasmine Peak, Ed Day, Alex Copello, Nick Freemantle, Ilias Goranitis, Emma FrewAbstract:Abstract Background Economic evaluation normally requires information to be collected on outcome improvement using utility values. This is often not collected during the Treatment of substance use disorders making cost-effectiveness evaluations of therapy difficult. One potential solution is the use of mapping to generate utility values from clinical measures. This study develops and evaluates mapping algorithms that could be used to predict the EuroQol-5D (EQ-5D-5 L) and the ICEpop CAPability measure for Adults (ICECAP-A) from the three commonly used clinical measures; the CORE-OM, the LDQ and the TOP measures. Methods Models were estimated using pilot trial data of heroin users in Opiate Substitution Treatment. In the trial the EQ-5D-5 L, ICECAP-A, CORE-OM, LDQ and TOP were administered at baseline, three and twelve month time intervals. Mapping was conducted using estimation and validation datasets. The normal estimation dataset, which comprised of baseline sample data, used ordinary least squares (OLS) and tobit regression methods. Data from the baseline and three month time periods were combined to create a pooled estimation dataset. Cluster and mixed regression methods were used to map from this dataset. Predictive accuracy of the models was assessed using the root mean square error (RMSE) and the mean absolute error (MAE). Algorithms were validated using sample data from the follow-up time periods. Results Mapping algorithms can be used to predict the ICECAP-A and the EQ-5D-5 L in the context of Opiate dependence. Although both measures can be predicted, the ICECAP-A was better predicted by the clinical measures. There were no advantages of pooling the data. There were 6 chosen mapping algorithms, which had MAE scores ranging from 0.100 to 0.138 and RMSE scores ranging from 0.134 to 0.178. Conclusion It is possible to predict the scores of the ICECAP-A and the EQ-5D-5 L with the use of mapping. In the context of Opiate dependence, these algorithms provide the possibility of generating utility values from clinical measures and thus enabling economic evaluation of alternative therapy options. Trial registration ISRCTN22608399. Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012
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Psychosocial interventions in Opiate Substitution Treatment services: does the evidence provide a case for optimism or nihilism?
Addiction (Abingdon England), 2017Co-Authors: Ed Day, Luke MitchesonAbstract:BACKGROUND AND AIMS Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in Opiate Substitution Treatment (OST) programmes. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta-analytical reviews find no benefit for manual-based Treatments beyond 'routine counselling'. ANALYSIS We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high-quality psychosocial Treatment alongside medication. In so doing, we consider the nuances and limitations of the evidence and the organizational barriers to transferring it into routine practice. CONCLUSION The evidence base for psychosocial interventions in Opiate Substitution Treatment (OST) services can be interpreted both positively and negatively. Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial Treatment in OST programmes is the most pragmatic approach. Greater attention should be paid to elements common to all psychological Treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer-led interventions.
Judit Tirado-munoz - One of the best experts on this subject based on the ideXlab platform.
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A Systematic Review and Meta-analysis of Psychosocial Interventions to Reduce Drug and Sexual Blood Borne Virus Risk Behaviours Among People Who Inject Drugs
AIDS and Behavior, 2017Co-Authors: Gail Gilchrist, Davina Swan, Kideshini Widyaratna, Julia Elena Marquez-arrico, Elizabeth Hughes, Noreen Dadirai Mdege, Marrissa Martyn-st James, Judit Tirado-munozAbstract:Opiate Substitution Treatment and needle exchanges have reduced blood borne virus (BBV) transmission among people who inject drugs (PWID). Psychosocial interventions could further prevent BBV. A systematic review and meta-analysis examined whether psychosocial interventions (e.g. CBT, skills training) compared to control interventions reduced BBV risk behaviours among PWID. 32 and 24 randomized control trials (2000-May 2015 in MEDLINE, PsycINFO, CINAHL, Cochrane Collaboration and Clinical trials, with an update in MEDLINE to December 2016) were included in the review and meta-analysis respectively. Psychosocial interventions appear to reduce: sharing of needles/syringes compared to education/information (SMD −0.52; 95% CI −1.02 to −0.03; I^2 = 10%; p = 0.04) or HIV testing/counselling (SMD −0.24; 95% CI −0.44 to −0.03; I^2 = 0%; p = 0.02); sharing of other injecting paraphernalia (SMD −0.24; 95% CI −0.42 to −0.06; I^2 = 0%; p
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A Systematic Review and Meta-analysis of Psychosocial Interventions to Reduce Drug and Sexual Blood Borne Virus Risk Behaviours Among People Who Inject Drugs.
AIDS and behavior, 2017Co-Authors: Gail Gilchrist, Davina Swan, Kideshini Widyaratna, Julia Elena Marquez-arrico, Elizabeth Hughes, Noreen Dadirai Mdege, Marrissa Martyn-st James, Judit Tirado-munozAbstract:Opiate Substitution Treatment and needle exchanges have reduced blood borne virus (BBV) transmission among people who inject drugs (PWID). Psychosocial interventions could further prevent BBV. A systematic review and meta-analysis examined whether psychosocial interventions (e.g. CBT, skills training) compared to control interventions reduced BBV risk behaviours among PWID. 32 and 24 randomized control trials (2000-May 2015 in MEDLINE, PsycINFO, CINAHL, Cochrane Collaboration and Clinical trials, with an update in MEDLINE to December 2016) were included in the review and meta-analysis respectively. Psychosocial interventions appear to reduce: sharing of needles/syringes compared to education/information (SMD −0.52; 95% CI −1.02 to −0.03; I2 = 10%; p = 0.04) or HIV testing/counselling (SMD −0.24; 95% CI −0.44 to −0.03; I2 = 0%; p = 0.02); sharing of other injecting paraphernalia (SMD −0.24; 95% CI −0.42 to −0.06; I2 = 0%; p < 0.01) and unprotected sex (SMD −0.44; 95% CI −0.86 to −0.01; I2 = 79%; p = 0.04) compared to interventions of a lesser time/intensity, however, moderate to high heterogeneity was reported. Such interventions could be included with other harm reduction approaches to prevent BBV transmission among PWID.
Sanju George - One of the best experts on this subject based on the ideXlab platform.
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A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in Opiate Substitution Treatment services
BMC Psychiatry, 2018Co-Authors: Ed Day, Alex Copello, Deborah Bamber, Charlotte Powell, Sanju George, Jennifer L. Seddon, Marilyn Christie, Carmel Bennett, Shabana Akhtar, Andrew BallAbstract:Background Approximately 3% of people receiving opioid Substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing Treatment. Involvement of families and wider social networks in supporting psychological Treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. Methods A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit Opiate use in the past 28 days to one of three Treatments: 1) Treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after Treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, Treatment satisfaction, social network size and support). Results A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial Treatment intervention sessions was low across all three arms (44% overall). Conclusions Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at Treatment sessions makes it uncertain whether an adequate dose of Treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. Trial registration ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in Opiate Substitution Treatment services
BMC psychiatry, 2018Co-Authors: Ed Day, Alex Copello, Jennifer Seddon, Marilyn M. Christie, Deborah Bamber, Charlotte Powell, Sanju George, Carmel Bennett, Shabana Akhtar, Andrew BallAbstract:Approximately 3% of people receiving opioid Substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing Treatment. Involvement of families and wider social networks in supporting psychological Treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit Opiate use in the past 28 days to one of three Treatments: 1) Treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after Treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, Treatment satisfaction, social network size and support). A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial Treatment intervention sessions was low across all three arms (44% overall). Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at Treatment sessions makes it uncertain whether an adequate dose of Treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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STUDY PROTOCOL Open Access
2016Co-Authors: Sanju George, Andrew Ball, Emma Frew, Nicholas FreemantleAbstract:Pilot study of a social network intervention for heroin users in Opiate Substitution Treatment: omized controlled tria
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Pilot study of a social network intervention for heroin users in Opiate Substitution Treatment: study protocol for a randomized controlled trial
Trials, 2013Co-Authors: Ed Day, Alex Copello, Jennifer Seddon, Marilyn M. Christie, Deborah Bamber, Charlotte Powell, Sanju George, Andrew Ball, Emma Frew, Nick FreemantleAbstract:Background Research indicates that 3% of people receiving Opiate Substitution Treatment (OST) in the UK manage to achieve abstinence from all prescribed and illicit drugs within 3 years of commencing Treatment, and there is concern that Treatment services have become skilled at engaging people but not at helping them to enter a stage of recovery and drug abstinence. The National Treatment Agency for Substance Misuse recommends the involvement of families and wider social networks in supporting drug users’ psychological Treatment, and this pilot randomized controlled trial aims to evaluate the impact of a social network-focused intervention for patients receiving OST.
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Social Network Support for Individuals Receiving Opiate Substitution Treatment and Its Association with Treatment Progress
European addiction research, 2013Co-Authors: Ed Day, Alex Copello, Sanju George, Minesh Karia, John Roche, Panthratan Grewal, Sayeed Haque, Gagandeep ChohanAbstract:Background/Aims: Social networks have been hypothesized to protect people from the harmful effects of stress, but may also provide dysfunctional role models and p
Andrew Ball - One of the best experts on this subject based on the ideXlab platform.
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A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in Opiate Substitution Treatment services
BMC Psychiatry, 2018Co-Authors: Ed Day, Alex Copello, Deborah Bamber, Charlotte Powell, Sanju George, Jennifer L. Seddon, Marilyn Christie, Carmel Bennett, Shabana Akhtar, Andrew BallAbstract:Background Approximately 3% of people receiving opioid Substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing Treatment. Involvement of families and wider social networks in supporting psychological Treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. Methods A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit Opiate use in the past 28 days to one of three Treatments: 1) Treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after Treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, Treatment satisfaction, social network size and support). Results A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial Treatment intervention sessions was low across all three arms (44% overall). Conclusions Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at Treatment sessions makes it uncertain whether an adequate dose of Treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. Trial registration ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in Opiate Substitution Treatment services
BMC psychiatry, 2018Co-Authors: Ed Day, Alex Copello, Jennifer Seddon, Marilyn M. Christie, Deborah Bamber, Charlotte Powell, Sanju George, Carmel Bennett, Shabana Akhtar, Andrew BallAbstract:Approximately 3% of people receiving opioid Substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing Treatment. Involvement of families and wider social networks in supporting psychological Treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit Opiate use in the past 28 days to one of three Treatments: 1) Treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after Treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, Treatment satisfaction, social network size and support). A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial Treatment intervention sessions was low across all three arms (44% overall). Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at Treatment sessions makes it uncertain whether an adequate dose of Treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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STUDY PROTOCOL Open Access
2016Co-Authors: Sanju George, Andrew Ball, Emma Frew, Nicholas FreemantleAbstract:Pilot study of a social network intervention for heroin users in Opiate Substitution Treatment: omized controlled tria
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Pilot study of a social network intervention for heroin users in Opiate Substitution Treatment: study protocol for a randomized controlled trial
Trials, 2013Co-Authors: Ed Day, Alex Copello, Jennifer Seddon, Marilyn M. Christie, Deborah Bamber, Charlotte Powell, Sanju George, Andrew Ball, Emma Frew, Nick FreemantleAbstract:Background Research indicates that 3% of people receiving Opiate Substitution Treatment (OST) in the UK manage to achieve abstinence from all prescribed and illicit drugs within 3 years of commencing Treatment, and there is concern that Treatment services have become skilled at engaging people but not at helping them to enter a stage of recovery and drug abstinence. The National Treatment Agency for Substance Misuse recommends the involvement of families and wider social networks in supporting drug users’ psychological Treatment, and this pilot randomized controlled trial aims to evaluate the impact of a social network-focused intervention for patients receiving OST.
Matthew Hickman - One of the best experts on this subject based on the ideXlab platform.
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Factors affecting repeated cessations of injecting drug use and relapses during the entire injecting career among the Edinburgh Addiction Cohort.
Drug and alcohol dependence, 2015Co-Authors: Yang Xia, John Macleod, Matthew Hickman, Lorraine Copeland, Shaun R. Seaman, Roy Robertson, Jim Mckenzie, Daniela De AngelisAbstract:Background and aims Injecting drug use is a chronic condition, with people who inject drugs (PWID) typically experiencing repeated cessations and relapses during their injection careers. We characterize patterns of ceasing and relapsing and the impact of Opiate Substitution Treatment (OST) during the entire injecting careers of PWID in the Edinburgh Addiction Cohort (EAC).
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Opiate Substitution Treatment and hcv prevention building anevidence base
Addiction, 2014Co-Authors: Peter Vickerman, Kimberly Page, Lisa Maher, Matthew HickmanAbstract:The beneficial effects of Opiate Substitution Treatment (OST) for people who inject drugs (PWID) encompass multiple domains and outcomes. This includes decreasing HIV acquisition risk by half[1], reducing drug related mortality[2, 3], possibly enhancing adherence to HIV anti-retroviral Treatment[4], diminishing crime[5] and the societal costs associated with drug use[6], increasing quality of life[5] and sometimes employment status[7, 8]. However, until recently, the evidence for OST or any harm reduction intervention reducing the risk of hepatitis C virus (HCV) acquisition was classified as insufficient[9, 10]. This situation started to change three years ago when a pooled UK analysis of selected observational studies suggested for the first time that OST could reduce HCV acquisition risk amongst PWID by over 50% and that the combination of OST and high coverage needle and syringe distribution could reduce HCV acquisition risk by up to 80%[11]. In recent months, there has been a further strengthening of the evidence base, with results from the Vancouver Injecting Drug Use Study (VIDUS) published in this issue of Addiction[12] and two other prospective studies of PWID from Australia[13] and San Francisco, in USA,[14] each reporting that OST can reduce the risk of HCV acquisition by 50–80% (Table 1). Despite a similar effect size across all four studies, an important difference between the Australian paper[13], from the HITs-c cohort, and the analyses from Vancouver and San Francisco is that White et al. only included PWID for whom OST was potentially indicated – i.e. those who reported primarily injecting heroin or other opioids[13]. In contrast, both the Vancouver and San Francisco papers were inclusive of all cohort participants, including those for whom OST may not be indicated (such as methamphetamine and cocaine injectors), so the protective effects may be under-estimated. While it is encouraging that the size of the protective effect is consistent across the studies in multiple sites, we recognise that these studies are all observational and at greater risk of selection bias and confounding than randomised controlled trials. For instance, in the Nolan study[12] there was a considerable difference in the HCV prevalence among people receiving and not receiving OST at baseline (24% vs 76%)as well as differences in drug using patterns which may suggest the difference in risk may not be entirely due to the direct effects of OST on injecting behaviours. Importantly, methadone and buprenorphine are essential medicines that cannot be randomised in future studies and so the evidence base will have to be built from non-randomised observational studies such as these. Table 1 Summary of findings from recent studies showing protective effect of OST on HCV acquisition. So what are the implications of these results for designing HCV prevention strategies? Firstly, as highlighted by a recent modelling analysis[15], OST averts infections, with projections from the UK suggesting that current high coverage levels of OST (50% of PWID are currently on OST in the UK) may have contributed to reducing the chronic HCV prevalence from 57% to 40%. OST may also have an accumulating effect – the longer the average duration on OST the greater the impact on reducing HCV risk[12] and drug related mortality[2]. Indeed, because economic analyses suggest that OST could be cost saving when societal benefits are accounted for[6], or at least highly cost-effective if just health benefits are considered[6], then it seems there should be no argument against scaling up OST in all settings. There is a long way to go until we achieve the high levels of OST coverage that currently exist in some settings such as the UK and Australia. Data from the last systematic review of intervention coverage among PWID suggested that the worldwide coverage of OST was at best 8%[16], and although many countries have since initiated OST programmes, recent data continue to show inadequate coverage of OST in most settings[17]. This raises the spectre of the potential enormous size of the global prevention gap. For example, adapted results from our previous modelling analysis[15] suggest scaling up OST worldwide could avert between 1 and 2 million HCV infections over the next 10 years if it was scaled up from less than 10% to 50% coverage (8 million) of all PWID. Although these calculations warrant more detailed modelling to capture the heterogeneities in different epidemics, they nonetheless highlight the substantial potential prevention benefit of scaling up OST. It is important to note, however, that although recent results suggest that OST is an essential component of any future HCV prevention strategy, it is not the only answer to HCV prevention. HCV prevalence remains persistently high in many countries despite high coverage of OST and needle and syringe distribution. It is likely that only by also scaling up antiviral Treatment and prophylactic vaccine development for HCV that prevalence can be significantly reduced[18, 19].
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Commentary on Nolan et al. (2014): Opiate Substitution Treatment and hepatitis C virus prevention: building an evidence base?
Addiction (Abingdon England), 2014Co-Authors: Peter Vickerman, Kimberly Page, Lisa Maher, Matthew HickmanAbstract:The beneficial effects of Opiate Substitution Treatment (OST) for people who inject drugs (PWID) encompass multiple domains and outcomes. This includes decreasing HIV acquisition risk by half[1], reducing drug related mortality[2, 3], possibly enhancing adherence to HIV anti-retroviral Treatment[4], diminishing crime[5] and the societal costs associated with drug use[6], increasing quality of life[5] and sometimes employment status[7, 8]. However, until recently, the evidence for OST or any harm reduction intervention reducing the risk of hepatitis C virus (HCV) acquisition was classified as insufficient[9, 10]. This situation started to change three years ago when a pooled UK analysis of selected observational studies suggested for the first time that OST could reduce HCV acquisition risk amongst PWID by over 50% and that the combination of OST and high coverage needle and syringe distribution could reduce HCV acquisition risk by up to 80%[11]. In recent months, there has been a further strengthening of the evidence base, with results from the Vancouver Injecting Drug Use Study (VIDUS) published in this issue of Addiction[12] and two other prospective studies of PWID from Australia[13] and San Francisco, in USA,[14] each reporting that OST can reduce the risk of HCV acquisition by 50–80% (Table 1). Despite a similar effect size across all four studies, an important difference between the Australian paper[13], from the HITs-c cohort, and the analyses from Vancouver and San Francisco is that White et al. only included PWID for whom OST was potentially indicated – i.e. those who reported primarily injecting heroin or other opioids[13]. In contrast, both the Vancouver and San Francisco papers were inclusive of all cohort participants, including those for whom OST may not be indicated (such as methamphetamine and cocaine injectors), so the protective effects may be under-estimated. While it is encouraging that the size of the protective effect is consistent across the studies in multiple sites, we recognise that these studies are all observational and at greater risk of selection bias and confounding than randomised controlled trials. For instance, in the Nolan study[12] there was a considerable difference in the HCV prevalence among people receiving and not receiving OST at baseline (24% vs 76%)as well as differences in drug using patterns which may suggest the difference in risk may not be entirely due to the direct effects of OST on injecting behaviours. Importantly, methadone and buprenorphine are essential medicines that cannot be randomised in future studies and so the evidence base will have to be built from non-randomised observational studies such as these. Table 1 Summary of findings from recent studies showing protective effect of OST on HCV acquisition. So what are the implications of these results for designing HCV prevention strategies? Firstly, as highlighted by a recent modelling analysis[15], OST averts infections, with projections from the UK suggesting that current high coverage levels of OST (50% of PWID are currently on OST in the UK) may have contributed to reducing the chronic HCV prevalence from 57% to 40%. OST may also have an accumulating effect – the longer the average duration on OST the greater the impact on reducing HCV risk[12] and drug related mortality[2]. Indeed, because economic analyses suggest that OST could be cost saving when societal benefits are accounted for[6], or at least highly cost-effective if just health benefits are considered[6], then it seems there should be no argument against scaling up OST in all settings. There is a long way to go until we achieve the high levels of OST coverage that currently exist in some settings such as the UK and Australia. Data from the last systematic review of intervention coverage among PWID suggested that the worldwide coverage of OST was at best 8%[16], and although many countries have since initiated OST programmes, recent data continue to show inadequate coverage of OST in most settings[17]. This raises the spectre of the potential enormous size of the global prevention gap. For example, adapted results from our previous modelling analysis[15] suggest scaling up OST worldwide could avert between 1 and 2 million HCV infections over the next 10 years if it was scaled up from less than 10% to 50% coverage (8 million) of all PWID. Although these calculations warrant more detailed modelling to capture the heterogeneities in different epidemics, they nonetheless highlight the substantial potential prevention benefit of scaling up OST. It is important to note, however, that although recent results suggest that OST is an essential component of any future HCV prevention strategy, it is not the only answer to HCV prevention. HCV prevalence remains persistently high in many countries despite high coverage of OST and needle and syringe distribution. It is likely that only by also scaling up antiviral Treatment and prophylactic vaccine development for HCV that prevalence can be significantly reduced[18, 19].
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Or09-4. Script in a day (scid) intervention for individuals who are injecting Opiates: results from a mixed methods feasibility randomised control trial.
Alcohol and Alcoholism, 2014Co-Authors: Angela Beattie, Matthew Barber, Elsa Marques, Rosemary Greenwood, Jenny Ingram, Rachel Ayres, Jane Neale, Avril Rees, Barbara Coleman, Matthew HickmanAbstract:Background. Opiate Substitution Treatment (OST) reduces the harm of injecting and Opiate dependence. The SCID trial tested whether offering people who inject heroin attending a low threshold agency immediate access to OST via specialist primary care increased the number in OST at 3 months, compared to offering advice and case management. Methods. Un-blinded randomised control trial with a qualitative study was conducted at Bristol Drugs Project needle exchange. A total 311/1371 individuals were eligible and 100 consented. Twenty were interviewed. Findings. Follow-up was 86%. At 3 months 51% & 47% of the intervention and control group were in OST. Opiate use reduced by 79% and 72% respectively. Physical and mental health improved but there was insufficient evidence of differences between groups. Motivation to participate concerned the need to secure Treatment. Securing OST included improvements in health, self-care, harm reduction and crime. Conclusions. Trial conduct was successful but there was insufficient evidence of an effect compared to case management. Participating in the trial enabled intervention participants to obtain Treatment for their drug use. Completing baseline questionnaires seemed to be a motivating factor for the control to seek OST from their GP. Further development and evaluation of case management approaches is warranted.
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Opiate Substitution Treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis.
BMJ (Clinical research ed.), 2012Co-Authors: Georgina J Macarthur, Peter Vickerman, Silvia Minozzi, Natasha K. Martin, Sherry Deren, Julie Bruneau, Louisa Degenhardt, Matthew HickmanAbstract:Objective To quantify the effect of Opiate Substitution Treatment in relation to HIV transmission among people who inject drugs. Design Systematic review and meta-analysis of prospective published and unpublished observational studies. Data sources Search of Medline, Embase, PsychINFO, and the Cochrane Library from the earliest year to 2011 without language restriction. Review methods We selected studies that directly assessed the impact of Opiate Substitution Treatment in relation to incidence of HIV and studies that assessed incidence of HIV in people who inject drugs and that might have collected data regarding exposure to Opiate Substitution Treatment but not have reported it. Authors of these studies were contacted. Data were extracted by two reviewers and pooled in a meta-analysis with a random effects model. Results Twelve published studies that examined the impact of Opiate Substitution Treatment on HIV transmission met criteria for inclusion, and unpublished data were obtained from three additional studies. All included studies examined methadone maintenance Treatment. Data from nine of these studies could be pooled, including 819 incident HIV infections over 23 608 person years of follow-up. Opiate Substitution Treatment was associated with a 54% reduction in risk of HIV infection among people who inject drugs (rate ratio 0.46, 95% confidence interval 0.32 to 0.67; P 2 =60%, χ 2 =20.12, P=0.010), which could not be explained by geographical region, site of recruitment, or the provision of incentives. There was weak evidence for greater benefit associated with longer duration of exposure to Opiate Substitution Treatment. Conclusion Opiate Substitution Treatment provided as maintenance therapy is associated with a reduction in the risk of HIV infection among people who inject drugs. These findings, however, could reflect comparatively high levels of motivation to change behaviour and reduce injecting risk behaviour among people who inject drugs who are receiving Opiate Substitution Treatment.