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Opioids & SU
The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
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3368
Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial
Type: Journal Article
Year: 2019
Publication Place: England
Topic(s):
Opioids & Substance Use
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3369
Efficacy and safety of a sublingual buprenorphine/naloxone rapidly dissolving tablet for the treatment of adults with opioid dependence: A randomized trial
Type: Journal Article
Year: 2016
Abstract: This prospective, randomized, active-controlled, non-inferiority study evaluated the efficacy and safety of a sublingual buprenorphine/naloxone rapidly dissolving tablet (Zubsolv(R); buprenorphine/naloxone rapidly dissolving tablet) versus generic buprenorphine for induction of opioid maintenance among dependent adults. The study, conducted at 13 sites from June 2013 to January 2014, included a 2-day blinded induction phase and a 27-day open-label stabilization/maintenance phase. During the blinded induction, patients received fixed doses of buprenorphine/naloxone rapidly dissolving tablets or generic buprenorphine. During open-label stabilization/early maintenance, all patients received buprenorphine/naloxone rapidly dissolving tablets. The primary efficacy assessment was treatment retention at day 3; buprenorphine/naloxone rapidly dissolving tablets were considered non-inferior to generic buprenorphine if the lower limit of the 95% confidence interval for the difference between the treatments was >/=-10% in patients retained on day 3. Secondary assessments included opioid withdrawal symptoms and cravings as measured using the Clinical Opiate Withdrawal Scale, the Subjective Opiate Withdrawal Scale, and the opioid cravings visual analogue scale. Safety was also assessed. A total of 313 patients were randomly assigned to induction with generic buprenorphine or buprenorphine/naloxone rapidly dissolving tablets. The mean age was 38.4 years, and the mean duration of opioid dependence was 12.4 years. For the primary efficacy assessment, 235 of 256 patients (91.8%) were retained at day 3 and continued to the maintenance phase. The lower limit of the 95% confidence interval was -13.7; thus, buprenorphine/naloxone rapidly dissolving tablets did not demonstrate non-inferiority to generic buprenorphine, and significantly more patients who received induction with generic buprenorphine (122/128 [95.3%]) were retained at day 3 compared with those who received induction with buprenorphine/naloxone rapidly dissolving tablets (113/128 [88.3%]; 95% confidence interval: -13.7, -0.4; p = 0.040). The rates of clinical response, as measured by the Clinical Opiate Withdrawal Scale, the Subjective Opiate Withdrawal Scale, and the visual analogue scale, were comparable among patients regardless of the induction medication. Treatment with buprenorphine/naloxone rapidly dissolving tablets was generally safe and reduced the severity of withdrawal symptoms and cravings.
Topic(s):
Opioids & Substance Use
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3370
Efficacy and Safety of Screening for Postpartum Depression
Type: Journal Article
Year: 2013
Publication Place: Rockville (MD)
Abstract: To describe the benefits and harms of specific tools and strategies for screening for postpartum depression. We searched PubMed(R), Embase(R), PsycINFO(R), and the Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1, 2004, to July 24, 2012, that evaluated the performance of screening instruments for postpartum depression, potential benefits and harms of screening, and impact on appropriate postscreening actions. Two investigators screened each abstract and full-text article for inclusion; abstracted data; and performed quality ratings, applicability ratings, and evidence grading. A simulation model was used to estimate the effects of screening for postpartum depression on the overall balance of benefits and harms. Forty studies (represented by 45 articles) were identified as relevant to this review. Eighteen studies provided sensitivity and specificity data on 9 screening instruments: 11 on the Edinburgh Postnatal Depression Scale, 4 on the Postpartum Depression Screening Scale, 4 on different versions of the Beck Depression Inventory, 2 on a "two-question" screen, and 1 each on 5 other instruments. Heterogeneity in setting, patient population, and choice of threshold prevented formal synthesis. For most tests in most studies, sensitivity and specificity were in the 80-90 percent range, with higher sensitivity associated with lower specificity; the two-question screen had 100 percent sensitivity but specificities of 45-65 percent. Fifteen studies analyzed the association between risk factors and postpartum depression. Although adverse pregnancy outcomes and chronic medical conditions (low strength of evidence) and past history of depression, poor relationship quality, and poor social support (moderate strength of evidence) were all associated with an increased risk of postpartum depression, only two studies directly reported an effect on test results. (Sensitivity was nonsignificantly increased in primigravidas compared with multigravidas.) Based on two studies, there was insufficient evidence to evaluate whether timing relative to delivery, setting, or provider affected test characteristics of screening instruments. Based on five studies, there was low to moderate strength of evidence that screening resulted in decreased depressive symptoms and improved mental health; in four of these studies, improvement in depressive symptoms was not accompanied by improvement in measures of parenting stress. Rates of referral and treatment for women with positive screening results were substantially higher in two studies where screening, diagnosis, and treatment were provided in the same setting; referral rates in other studies were all 50 percent or less. Modeling suggests that serial testing with a two-question screen followed by a second more specific instrument for those who have a positive result may be a reasonable strategy to reduce false positives while minimizing false negatives. The potential effectiveness of screening for postpartum depression appears to be related to the availability of systems to ensure adequate followup of women with positive results. The ideal characteristics of a screening test for postpartum depression, including sensitivity, specificity, timing, and frequency, have not been defined. Because the balance of benefits and harms, at both the individual level and health system level, is highly dependent on these characteristics, broad consensus on these characteristics is needed.
Topic(s):
Healthcare Disparities
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Reference Links: View the PubMed citation for Efficacy and Safety of Screening for Postpartum Depression
3371
Efficacy of a systematic depression management program in high utilizers of primary care: a randomized trial
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: BACKGROUND: Approximately 25% of so-called high utilizers of medical care are estimated to suffer from depression. A large proportion of these individuals remain undiagnosed and untreated. This study aims to examine the effects of a systematic screening and collaborative treatment program on depression severity in small primary care practices of the German outpatient health care system. METHOD: High utilizers of primary care who screened positive for depressive symptoms on the Brief Psychiatric Health Questionnaire (B-PHQ) were further diagnosed using the DIA-X, a standardized diagnostic interview, performed by trained and supervised interviewers. Patients with major depression were randomized (cluster randomization by practice) to (a) a six-month treatment program of pharmacotherapy, standardized patient and provider education, and physician and patient counseling or (b) six months of usual medical care. All subjects were followed for a 12-month observation period using the 17-item Hamilton Depression Rating scale (HAMD-17) rated by the treating physicians and the B-PHQ-9 rated by the patients. RESULTS: A total of 63 high utilizer patients were included in the trial (17 male, 46 female), 19 randomized to intervention, 44 to usual care. The mean age was 49.7 (SD 13.8). Most patients had one or more somatic co-morbidities. There was no significant difference in response (defined as a decrease in the HAMD-17 sum score of at least 50%) after six months of treatment (50% vs. 42%, p = 0.961, all analyses adjusted for age) and after 12 months of treatment (83% vs. 54%, p = 0.282) between groups. Using patient self-rating assessments with the B-PHQ-9 questionnaire the intervention was superior to treatment as usual at six months (83% vs. 16%, p = 0.000).There was no significant difference in HAMD-17 depression severity at six months between the groups (10.5 (SD 7.6) vs. 12.3 (SD 7.8), p = 0.718), but a trend at 12 months (4.7 (SD 8.0) vs. 11.2 (SD 7.4), p = 0.083). Again, using B-PHQ-9 sum scores depression severity was significantly lower in the intervention group than in the treatment as usual group after six months (6.4 (SD 5.2) vs. 11.5 (SD 5.8), p = 0.020), but not at 12 months (7.9 (SD 8.7) vs. 9.0 (SD 5.2), p = 0.858). CONCLUSION: A systematic collaborating treatment program for depression in high utilizers in primary care showed superiority to treatment as usual only in terms of patients' self-assessment but not according to physicians' assessment. The advance of the intervention group at 6 months was lost after 12 months of follow-up. Overall, positive results from similar trials in the US health care systems could not be confirmed in a German primary care setting.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Efficacy of a systematic depression management program in high utilizers of primary care: a randomized trial
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View the PubMed citation for Efficacy of a systematic depression management program in high utilizers of primary care: a randomized trial3372
Efficacy of brief intervention for drug misuse in primary care facilities: systematic review and meta-analysis protocol
Type: Journal Article
Year: 2020
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Efficacy of brief intervention for drug misuse in primary care facilities: systematic review and meta-analysis protocol
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View the PubMed citation for Efficacy of brief intervention for drug misuse in primary care facilities: systematic review and meta-analysis protocol3373
Efficacy of continuing medical education to reduce the risk of buprenorphine diversion
Type: Journal Article
Year: 2011
Publication Place: United States
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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Reference Links:
View the DOI record for Efficacy of continuing medical education to reduce the risk of buprenorphine diversion
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View the PubMed citation for Efficacy of continuing medical education to reduce the risk of buprenorphine diversion3374
Efficacy of integrated interventions combining psychiatric care and nursing home care for nursing home residents: a review of the literature
Type: Journal Article
Year: 2010
Publication Place: England
Topic(s):
Medically Unexplained Symptoms
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3378
Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients Receiving Opioid Therapy in Primary Care
Type: Journal Article
Year: 2016
Publication Place: United States
Topic(s):
Opioids & Substance Use
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, Measures
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Reference Links:
View the DOI record for Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients Receiving Opioid Therapy in Primary Care
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View the PubMed citation for Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients Receiving Opioid Therapy in Primary Care3380
Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: Importance: Opioid use disorder (OUD) is a significant public health problem. Supervised withdrawal (ie, detoxification) from opioids using clonidine or buprenorphine hydrochloride is a widely used treatment. Objective: To evaluate whether tramadol hydrochloride extended-release (ER), an approved analgesic with opioid and nonopioid mechanisms of action and low abuse potential, is effective for use in supervised withdrawal settings. Design, Setting, and Participants: A randomized clinical trial was conducted in a residential research setting with 103 participants with OUD. Participants' treatment was stabilized with morphine, 30 mg, administered subcutaneously 4 times daily. A 7-day taper using clonidine (n = 36), tramadol ER (n = 36), or buprenorphine (n = 31) was then instituted, and patients were crossed-over to double-blind placebo during a post-taper period. The study was conducted from October 25, 2010, to June 23, 2015. Main Outcomes and Measures: Retention, withdrawal symptom management, concomitant medication utilization, and naltrexone induction. Results were analyzed over time and using area under the curve for the intention-to-treat and completer groups. Results: Of the 103 participants, 88 (85.4%) were men and 43 (41.7%) were white; mean (SD) age was 28.9 (10.4) years. Buprenorphine participants (28 [90.3%]) were significantly more likely to be retained at the end of the taper compared with clonidine participants (22 [61.1%]); tramadol ER retention was intermediate and did not differ significantly from that of the other groups (26 [72.2%]; chi2 = 8.5, P = .01). Time-course analyses of withdrawal revealed significant effects of phase (taper, post taper) for the Clinical Opiate Withdrawal Scale (COWS) score (taper mean, 5.19 [SE, .26]; post-taper mean, 3.97 [SE, .23]; F2,170 = 3.6, P = .03) and Subjective Opiate Withdrawal Scale (SOWS) score (taper mean,8.81 [SE, .40]; post-taper mean, 4.14 [SE, .30]; F2,170 = 15.7, P < .001), but no group effects or group x phase interactions. Analyses of area under the curve of SOWS total scores showed significant reductions (F2,159 = 17.7, P < .001) in withdrawal severity between the taper and post-taper periods for clonidine (taper mean, 13.1; post-taper mean, 3.2; P < .001) and tramadol ER (taper mean, 7.4; post-taper mean, 2.8; P = .03), but not buprenorphine (taper mean, 6.4; post-taper mean, 7.4). Use of concomitant medication increased significantly (F2,159 = 30.7, P < .001) from stabilization to taper in the clonidine (stabilization mean, 0.64 [SE, .05]; taper mean, 1.54 [SE, .10]; P < .001) and tramadol ER (stabilization mean, 0.53 [SE, .05]; taper mean, 1.19 [SE, .09]; P = .003) groups and from stabilization to post taper in the buprenorphine group (stabilization mean, 0.46 [SE, .05] post-taper mean, 1.17 [SE, .09]; P = .006), suggesting higher withdrawal for those groups during those periods. Naltrexone initiation was voluntary and the percentage of participants choosing naltrexone therapy within the clonidine (8 [22.2%]), tramadol ER (7 [19.4%]), or buprenorphine (3 [9.7%]) groups did not differ significantly (chi2 = 2.5, P = .29). Conclusions and Relevance: The results of this trial suggest that tramadol ER is more effective than clonidine and comparable to buprenorphine in reducing opioid withdrawal symptoms during a residential tapering program. Data support further examination of tramadol ER as a method to manage opioid withdrawal symptoms. Trial Registration: Clinicaltrials.gov Identifier: NCT01188421.
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial
View DOI Record
View the PubMed citation for Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial