AbstractProblem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention, and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, we reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n = 208) and in an opioid treatment program (n = 204) over a two-year period. In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. In the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n = 4 physicians) and the opioid treatment program (n = 11 counselors) to assess experience with and at...
Last. Jim Winkle(OHSU: Oregon Health & Science University)H-Index: 3
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AbstractBackground & aim: Six Oregon primary care clinics integrated a team-based, systematized alcohol and drug Screening, Brief Intervention, Referral to Treatment (SBIRT) process into their standard clinic workflow. Clinic staff administered screening forms and brief assessments, and clinicians were trained to perform brief interventions and treatment referrals when needed.Methods: Patient-level data from the electronic health record (EHR) were used to calculate implementation rates in each c...
Description: Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening and behavioral counseling interventions in primary care to reduce alcohol misuse. Methods: The USPSTF reviewed new evidence on the effectiveness of screening for alcohol misuse for improving health outcomes, the accuracy of various screening approaches, the effectiveness of various behavioral counseling interventions for improving intermediate or long-term health outcomes, the harms...
#2Jan Klimas(UCD: University College Dublin)H-Index: 15
Last. Walter Cullen(UCD: University College Dublin)H-Index: 24
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Background: Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. This paper aims to describe patients’ experience of, and attitude towards, screening and therapeutic interventions for problem alcohol use in primary care. Methods: This qualitative study recruited problem drug users (N = 28) from primary care based methadone programmes in the Ireland’s Easter...
Last. G. Alan Marlatt(UW: University of Washington)H-Index: 81
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Aims Despite recognition of the harms related to alcohol misuse and its potential to interfere substantially with sustained recovery from drug dependency, research evaluating drug treatment outcomes has not addressed the issue comprehensively. It has been overlooked possibly because treatment research has been framed according to the primary drug of choice, rather than investigating the interactions between different combinations of drugs and/or alcohol use. This paper reports on a systematic re...
Last. Jim Winkle(OHSU: Oregon Health & Science University)H-Index: 3
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ABSTRACT In order to successfully integrate screening, brief intervention, and referral to treatment (SBIRT) into primary care, education of clinicians must be paired with sustainable transformation of the clinical settings in which they practice. The SBIRT Oregon project adopted this strategy in an effort to fully integrate SBIRT into 7 primary care residency clinics. Residents were trained to assess and intervene in their patients’ unhealthy substance use, whereas clinic staff personnel were t...
Last. Walter Cullen(UCD: University College Dublin)H-Index: 24
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The paper by McCormick et al. (2010) provides real-world examples of best practice for implementing alcohol screening and brief intervention (SBI) in primary care. We commend the authors for that and also wish to highlight the additional challenges involved in implementing SBI in primary care among vulnerable populations, especially problem drug users. To explore the scientific evidence on implementing best practice in SBI for problem alcohol use among problem drug users, we conducted a Medline ...
Last. Adam J. Gordon(University of Pittsburgh)H-Index: 50
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ABSTRACT Effective clinical faculty are essential for disseminating substance abuse screening, brief intervention, and referral to treatment (SBIRT). The authors developed an 8-hour SBIRT training for internal medicine faculty preceptors. Trainers conducted SBIRT lectures and small-group communication practice sessions. The authors assessed participants’ (n = 27) knowledge, skills, and attitudes using an enhanced Alcohol and Alcohol Problems Perceptions Questionnaire (AAPPQ). Participants self-a...
Objectives:To study substance use and psychiatric disorders among prescription opioid users, heroin users, and nonopioid drug users in a national sample of adults.Methods:Analyses of data from the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093).Results:Four
Scotland has a new database on drugs-related deaths (DRDs). We review the prior toxicology and demography of Scotland's DRDs in 2000–2007. Each DRD was cross-classified by the presence/absence of heroin (H); methadone (M); diazepam (D); and alcohol (A). Comparisons were made by era (2000–2002, 2003–2005 and 2006–2007), sex and age-group (under 35 years and 35+ years). Data were for 1007 DRDs in 2000–2002 (180 female); 1011 in 2003–2005 (206 female); and 875 in 2006 and 2007 (149 female). DRDs ci...
Last. Nick Heather(Northumbria University)H-Index: 69
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Translational research projects based in England, New Zealand and Catalonia are described. In combination they provide real world evidence in support of the evolving discourse on translating the evidence on screening and brief intervention for problem use of alcohol so that it is acceptable and fit for routine practice. Acceptance and uptake was enhanced by encouraging primary health clinicians to use evidence-based screening and brief intervention processes which fit with the context in which t...
Last. Rita McCracken(UBC: University of British Columbia)H-Index: 3
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Background Opioid analgesics are frequently initiated for chronic and acute pain despite weak evidence of benefit, although prescribing rates of some analgesics decreased in the context of the epidemic. In some populations, up to a quarter of opioid naive persons prescribed opioids for non-cancer pain develop prescription opioid use disorder (OUD). Audit and feedback interventions rely on constructive use of routinely collected data to align professional behaviours and clinical practice with bes...
Abstract Background Immersive video (e.g. virtual reality) poses a promising and engaging alternative to standard in-person trainings and can potentially increase access to evidence-based opioid overdose prevention programs (OOPPs). Therefore, the objective of this equivalence study was to test whether the immersive video OOPP was equivalent to a standard in-person OOPP for changes in opioid overdose knowledge and attitudes. Methods A team of nurses and communication researchers developed a 9-mi...
#1Rizwana Quraishi(AIIMS: All India Institute of Medical Sciences)H-Index: 5
#2Mohit Varshney(AIIMS: All India Institute of Medical Sciences)H-Index: 4
Last. Atul Ambekar(AIIMS: All India Institute of Medical Sciences)H-Index: 14
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Background: Harmful Alcohol use is frequent among opioid dependents patients undergoing agonist maintenance treatment. The objective assessment of harmful alcohol use can be done using laboratory measures of serum biomarkers. For community-based patients, there is often a requirement of an alternative method due to lack of onsite laboratory services. The aim of the study was to examine filter paper as a matrix to measure serum biomarkers of harmful alcohol use. Methods: The initial phase involve...
: Alcohol and illicit drug abuse are major public health problems worldwide. Since alcohol is the predominant substance of choice in polydrug abusers, monitoring its use, along with urinary drug screening in patients in rehabilitation programs, appeared to be crucial in identifying patients at risk of alcohol disorders leading to impaired quality of life. Ethyl β-D-6-glucuronide, a non-oxidative, non-volatile, stable and minor direct ethanol metabolite, has a 6h to 4 day window of detection in u...
#1Jan Klimas(UBC: University of British Columbia)H-Index: 15
#2Will Small(UBC: University of British Columbia)H-Index: 49
Last. Ryan McNeil(UBC: University of British Columbia)H-Index: 25
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Background Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to e...
Last. Richard Saitz(BU: Boston University)H-Index: 66
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ABSTRACTBackground: Unhealthy alcohol use (UAU) is common among people who use other drugs; however, little information is available about UAU among patients who screen positive for drugs in primary care, where the clinical priority might be assumed to be drug use. This study aimed at describing the occurrence of UAU and its association with substance use–related outcomes in such patients. Methods: This cohort study is a secondary analysis of data from a randomized trial of brief intervention fo...
#1Jan Klimas(UCD: University College Dublin)H-Index: 15
#2Ryan McNeil(UBC: University of British Columbia)H-Index: 25
Last. Will Small(SFU: Simon Fraser University)H-Index: 49
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Background Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting.
Last. Walter Cullen(UCD: University College Dublin)H-Index: 24
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Purpose Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness. Design/methodology/approach Semi-structured interviews were conducted with 14 patients and eight genera...
#2Geoff McCombe(UCD: University College Dublin)H-Index: 6
Last. Walter Cullen(UCD: University College Dublin)H-Index: 24
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Background Identifying and treating problem alcohol use among people who also use illicit drugs is a challenge. Primary care is well placed to address this challenge but there are several barriers which may prevent this occurring. The objective of this study was to determine if a complex intervention designed to support screening and brief intervention for problem alcohol use among people receiving opioid agonist treatment is feasible and acceptable to healthcare providers and their patients in ...