objectives · web viewauthor(s): dr. sonali jhanjee, rakesh lal, ashwani mishra, deepak yadav...
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Poster 2016
# Title Author
P1 Factors associated with risk of transition to injecting among men using opioids through non-injecting routes: a multi-site study from North India
AMBEKAR, AtulNew Delhi [email protected]
P2 The effect of e-cigarette on the smoking behavior of adolescents BAEK, Young-KyungIncheon, [email protected]
P3 Psychoactive substance use and treatment needs among undergraduates in a Nigerian university
BELLO, Abidemi OlubunmiIlishan [email protected]
P4 Psychometric Properties of Alcohol Smoking and Substance involvement screening test (Assist V3.0) among University students
BELLO, Abidemi OlubunmiIlishan [email protected]
P5 Satisfaction with Like in Opiate Substitution Treatment CERNOVSKY, ZackLondon [email protected]
P6 Testosterone suppression in opiate substitution treatment CERNOVSKY, ZackLondon [email protected]
P7 Study of Critical Period to Intervene Smoking Behavior among adolescents DOO, Jeong-HunIncheon [email protected]
P8 Comparison of characteristics of tramadol-dependent patients to heroin-dependent patients
EL MAGD, SamirCairo, [email protected]
P9 Relationship of ADHD symptoms with severity dissociative experiences in a sample of inpatients with alcohol use disorder
EVREN, CuneytIstanbul [email protected]
P10 Direct or detailed questions which should be asked in large population survey for tobacco use/tobacco dependence assessment
JENA, Pratap KumarBhubaneswar, [email protected]
P11 Community based study of tobacco use characteristic in women JHANJEE, SonaliNew Delhi [email protected]
P12 Patterns and psychosocial consequences of cannabis use in treatment nonseekers in a community setting in Delhi, India
JHANJEE, SonaliNew Delhi [email protected]
P13 Calcium/Calmodulin-dependent Protein Kinase IV Gene Polymorphisms in Korean Alcohol-dependent Patients
JUNG, Woo-YoungPusan, [email protected]
P14 Relationship between trait emotional intelligence and tobacco use among school going students
KHAN, Luqman MunawarPunjab [email protected]
P15 A Randomized trial of probuphine implants in adults stabilized on sublingual buprenorphine
KIM, SonniePrinceton [email protected]
P16 A need for a Standardized Addiction Medicine Curriculum: an Expert Consultation
KLIMAS, JanVancouver [email protected]
P17 From Pre-contemplation to Action during Acute hospitalization for patients with infectious complications of injection drug addiction: recognizing and responding to a devastating epidemic
KOIVU, SharonLondon [email protected]
P18 Street Level Workers at Risk Community Response KOIVU, SharonLondon [email protected]
P19 Clinical characteristics of alcohol related criminals in Korea LEE, Kye-Seong
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Incheon [email protected]
P20 Increasing access to medical detox services for First Nations and Inuit: a novel collaboration between Onen’to:kon Healing Lodge, Health Canada and Hopital Saint-Luc du CHUM
MARSAN, Stephanie Montreal [email protected]
P21 The role of family in patient retention: a residential addiction treatment context McPHERSON, CarsonVancouver Island, [email protected]
P22 Diabetes and Substance Use Disorder: Is there any association? MEHTA, GauravNewmarket [email protected]
P23 Application of GIS for understanding Epidemiology of Substance Use in India MISHRA, Ashwani KumarDelhi [email protected]
P24 Differences in care and needs in the opioid dependent population in Northern vs Southern Ontario
MORIN, KristenSudbury [email protected]
P25 First year outcomes in dually diagnosed patients receiving injectable Naltrexone at discharge from private residential treatment
MORSE, SiobhanBrentwood [email protected]
P26 Implementation of a Standardized Clinical Screening Battery for an Inpatient and Outpatient Concurrent Disorders Program: Initial Findings
RAYMOND, HollyHamilton [email protected]
P27 Non-opioid protocol for outpatient opioid detoxification and transition to agonist treatment
RUDOLF, VaniaSeattle [email protected]
P28 Adherence among opioid dependent patients treated with buprenorphine in a length of treatment study
ZAH, VladimirMississauga [email protected]
P29 Patient characteristics among opioid dependent buprenorphine treated patients in a length of treatment study
ZAH, VladimirMississauga [email protected]
P30 CIWA-Ar protocol versus scheduled benzodiazepine during alcohol detoxification, a retrospective study
ZEEUWS, DieterBrussels, [email protected]
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POSTERS
P1: Factors associated with risk of transition to injecting among men using opioids through non-injecting routes: A multi-site study from North India
Author(s): Atul Ambekar, Tuleshwar Singh, Ashwani Mishra, Ravindra Rao, Alok AgrawalNational Drug Dependence Treatment Centre, Dept. of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029, India Email [email protected]
Introduction People Who Inject Drugs (PWID), mostly begin drug-use with non-injecting drugs. Factors associated with transition to injecting from non-injecting route are poorly studied.
ObjectiveTo analyse the factors associated with self-report of likelihood to start injecting drugs among non-injecting opioid users.
Methodology Cross section study. IRB clearance obtained. After informed consent we interviewed people (n=752 males) who use non-injecting opioids (oral/smoking), with a semi-structured questionnaire. Sample recruited in non-biased purposive manner from various cities in north India. Data collected on socio-demographic, drug-use practices and likelihood to start injecting. To the question “are you likely to start injecting?”, factors associated with the response ‘yes’, were analysed.
Results Mean age 31.2 years (SD 9.1). Rates of opioid use were: 34% - heroin chasing; 42% - oral pharmaceutical opioids; 25% - oral opium. About 49% had PWID as peers; 40% had seen someone inject, and 35% received offer to inject drugs. Ninety-two (12%) reported ‘yes’ to question whether it was likely that they could start injecting. Following factors were significantly associated with this self-reported likelihood (pearson’s chi-square; p<0.05): “knowing an IDU personally”, “witnessing an act of injection”, “history of having received an offer to inject”, and beliefs that injections “act faster” and “are cheaper.”
Conclusion Many non-injecting opioid users are at risk of switching to injecting route and get exposed to injecting. Unfortunately interventions that may enable them to make informed choices do not reach this group. Apart from addiction-treatment, Harm-reduction messages must reach this group too, to prevent the risk of transition.
Learning Objectives:1. Understanding that non-injecting opioid users are at risk of switch to injecting route of drug intake and there
may be certain factors associated with this risk 2. Scope of Harm reduction services need to be expanded to include not just people who inject drugs, but
those who use drugs through oral / smoking routes too.
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P2: The effect of e-cigarette on the smoking behavior of adolescents.
Author(s): Youn-Kyung Baek, Sung-Me Jo, Na-rae Lee, Jin- Hee kim, Do-hui Kim, Su-Hyun Jo, Kye-Seong Lee M.D., Young-Hoon Chon M.D.Incheon Chamsarang Hospital, Wonchang-ro 240beon-gil 9, Seo-gu, Incheon, Korea. 22783Email: [email protected]
The study was conducted to find the effect of e-cigarette on the smoking behavior of adolescents. Out of total 1410 in 7 middle and high school students reported self-administered questionnaire developed to evaluate smoking and e-cigarette status.144(10.2%) students reported smoking experience of past year and 73(5.2%) students had e-cigarette experiences. Among 73 students who reported e-cigarette experience, 68 students(3.2%) also smoke and only 5 students reported exclusive e-cigarette use. The mean amount of smoking per day was 5.66±5.0 cigarettes. Even though 60(56%) students reported they smoke e-cigarette below 10 puffs at a time, but 31(29%) students smoke more than 20 puffs and 18(16.2%) students said e-cigarette is hard to stop puff. 64(44.4%) smoker students had begun to use e-cigarette to quit smoking. Most of students(94.1%) have used e-cigarette to quit smoking but 88% of respondents thought e-cigarette does not helpful to quit smoking. Among the students who use e-cigarette to quit smoking, 40(44.4%) students smoke again, 16(17.8%) students using both, merely 2(2.2%) students smoke e-cigarette only. Interestingly, 6(6.7%) students answered quit both of them though, rate of quit smoking of whom did not experience e-cigarette was much higher as 17(31.5%) smoker students had quit smoking.
One of two smoke students has tried e-cigarette at least once, and the purpose of use e-cigarette was to quit smoking. But e-cigarette does not helpful to quit smoking rather e-cigarette has higher risk of abuse and seems to enhance nicotine dependence of smoking.
Learning Objectives:1. We will learn about the behavior of young people use electronic cigarettes.2. We will learn about the effects of using electronic cigarettes to youth smoking behavior
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P3: Psychoactive substance use and treatment needs among undergraduates in a Nigerian University
Auhtor(s): Abidemi Bello, Peter Onifade, Increase Adeosun, Taiwo Williams, Elizabeth Okonkwo, Olugbenga Ajayi, Sotunsa John and Olusegun Baiyewu Babcock University Teaching Hospital, Ilishan, Ogun State, NigeriaEmail [email protected]
Objectives: Use of psychoactive substances among adolescents and young adults is a universal problem and contributes enormous health burden. Many studies have determined the prevalence rate of psychoactive substances among university students but there is paucity of data on the degree of involvement in substance use and corresponding treatment needs of the students. This study aimed to determine prevalence rate of substance use and treatment needs of the students in a Nigerian university.
Methodology: This was a cross-sectional survey of substance use in students of a Nigerian university. The World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test was used in November 2013 to determine the substance use prevalence, the risk levels of substance use and the corresponding treatment needs among 5938 undergraduates. The study was approved by the university’s research ethics committee.
Results: The mean age of the participants was 19 years (sd=2). The commonly ever-used substances were alcohol (32.5%), Tobacco products (3.8%), Amphetamine or other stimulant (2.9%), Opioids (2.5%) and Marijuana (1.8%); while the commonly used substances in the past three months were alcohol (11.4%), Opioids (1.4%), Marijuana (1.2%) and Tobacco products (1.1%). None of students who participated used any drug at high risk level which required referral for intensive treatment, but 188 (3.2%) used at least one substance at moderate risk level.
Conclusions: At least 188 (3%) students needed secondary intervention against substance use. Those who were at moderate risk of multiple substances might need more than brief intervention.
Learning Objectives1. To determine the prevalence rate of psychoactive substance use and the degree of involvement among University undergraduates.2. To determine the treatment needs of the students involved in psychoactive substances in a Nigerian university.
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P4: Psychometric Properties of Alcohol Smoking and Substance Involvement Screening Test (Assist V3.0) Among University Students
Author(s) Name : Dr. Abidemi Olubunmi Bello, Onifade Peter, Abiodun Olumide, Sotunsa John, Ladipo Oluwakemi and Adesanya OchezeBabcock University Teaching Hospital, Ilishan, Ogun State, NigeriaEmail [email protected]
Objectives: This study aimed to determine the reliability of the self-report instrument and its validity against urine drug test (UDT).
Methodology: This study of diagnostic accuracy was conducted among students of Babcock University, Nigeria, in 2013. The study was approved by the university’s research ethics committee. Each student had urine drug test in addition to an interview with the use of Alcohol Smoking and Substance Involvement Screening Test (ASSIST) on the same day. The laboratory officers and the interviewers were blind to the results of each other.
Results: The 2797 participants were mostly 18-20 years (61.2%) and females (65.1%), Urine of 0.1% tested positive to cannabis and Methamphetamine, 0.4% to Opiates. The three-month self-report gave the prevalence rates of Amphetamine Type Stimulants, Opioids, Diazepam, Cannabis and cocaine at 1.2%, 2.6%, 1.4%, 1.0%, and 0.3% respectively. Against the urine drug test, ASSIST had low sensitivity and high specificity. Its diagnostic accuracy was greater than 95%. Eleven domains of ASSIST had internal correlation coefficients of greater than 0.7.
Conclusions: The ASSIST version 3 has acceptable psychometric properties and is valid for use among university students. Because it is able to detect students who had not used drug recently enough to be picked by UDT and because it is able to determine level of risk and treatment needs of the students, it is recommended as an essential part of drug use screen program in the university. It is also recommended that UDT, or better still, hair drug analysis be done alongside ASSIST administration.
Learning Objectives
1. To determine the psychometric properties of Alcohol Smoking and Substance Involvement Screening Test (Assist V3.0) among University undergraduates.
2. To determine the reliability of the self-report and its validity against urine drug test.
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P5: Satisfaction with Life in Opiate Substitution Treatment
Author(s): Gamal Sadek, Zack Cernovsky, Paul Istasy, Yves Bureau, Simon Chiu.Professor of Psychiatry, Western University, London ON; 98 Greenbrier Crescent, London, ON N6J 3X9 Email: [email protected]
Objective. Opiate substitution treatment aims at restoring an adequate satisfaction in life. We evaluated to what extent chronic pain and concurrent substance abuse interfere with this goal.Method. Sixty patients (mean age 37.9, SD=9.3; 32 males, 28 females) underwent urine tests for cocaine, benzodiazepines, oxycodone, and for other opiates, and completed Pavot’s Temporal Satisfaction With Life Scale (TSWLS). This scale consists of 15 items of which 5 assess the satisfaction with one’s past, 5 with the present, and another 5 with the future. The patients also completed 3 items from the Brief Pain Inventory (scales from 0 = no pain to 10 = extreme pain) to assess their average level of pain, the worst pain, and the least pain.Results. Only 4 patients (6.7 %) rated their worst pain at zero, i.e., as absent. The average pain in this sample was 4.2 (SD=2.7), the worst pain 6.3 (SD=3.2), and the least pain was 2.6 (SD=2.3). Our patients’ average satisfaction score (59.8, SD=19.6) was significantly lower than in Pavot’s normative sample of 294 adults (70.8, SD=14.8, t=4.1, df=72.8, p<.001). A significant inverse correlation (r=.31, p=.008) was found between the total satisfaction score and the sum of all pain ratings. The satisfaction score was not significantly related to concurrent substance abuse (p>.05).Conclusions. Pain is prevalent among our patients and its management remains an important clinical issue.
Reference. Pavot W, Diener E, Suh E The temporal satisfaction with life scale. Journal of Personality Assessment, 1998, 70(2), 340-354.
Learning Objectives:1. Chronic pain is prevalent among patients in opiate substitution treatment2 The pain interferes with the satisfaction in life of patients in opiate substitution treatment.
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P6: Testosterone suppression in opiate substitution treatment
Author(s): Simon Chiu, Gurpreet Sidhu, Heinz Mayr, Zack Cernovsky , Katrina Warren, Yves BureauProfessor of Psychiatry, Western University, London ON; 98 Greenbrier Crescent, London, ON N6J 3X9 Email: [email protected]
Objective. Suboxone is theoretically less likely to suppress testosterone than methadone in opioid dependent patients. We examined related hormonal measures and their clinical correlates. Method. We compared laboratory measures of total testosterone, free testosterone, LH, FSH, and prolactin of 33 male methadone maintenance patients (mean age = 38.6 years, SD=10.0) with those of 31 male suboxone patients (mean age=40.7 years, SD=11.3) in opiate substitution treatment. The two groups did not significantly differ in age, height, and weight (t-tests, p>.05, 1-tailed).Results. Our methadone patients did not significantly differ (t-tests, ns, 1-tailed) from their suboxone counterparts in their laboratory mean values of any of the 5 hormonal measures. All average hormonal values for these two groups of patients were within the normal reference range, except for below normal levels of free testosterone (122.6 pmol, SD=100.5 for those on methadone and 163.2 pmol, SD=145.7 for those on suboxone). Longer duration of opiate use was significantly associated with lower total testosterone (r =-.41, p< .05, 1-tailed) in our methadone patients, but not in suboxone patients (r =-.03, p= .445, 1-tailed). No significant correlations were noted of the duration of opiate use to the other hormonal measures (p>.05, 1-tailed).Conclusions. Group averages of hormonal values were within normal both in methadone and suboxone patients, except for free testosterone which was below normal in both groups. Longer duration of opiate use was significantly associated with lower total testosterone in methadone patients, but not in suboxone patients.
Learning Objectives:1. Average levels of total testosterone, free testosterone, LH, FSH, and prolactin are not significantly different in methadone versus suboxone patients, but average level of free testosterone is below normal in both groups.2. Longer duration of opiate use in methadone patients is associated with lower total testosterone.
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P7: Study of Critical Period to Intervene Smoking Behavior among Adolescents
Author(s): Jeong-Hun Doo, Chong-Nak Son, Kye-Seong Lee M.D., Young-Hoon Chon M.D.Incheon Chamsarang Hospital Wonchang-ro 240beon-gil 9, Seo-gu, Incheon, Korea. 22783Email [email protected]
The purpose of this study was to investigate the critical period to intervene smoking behavior among adolescents. 2285 data of adolescent in middle and high school were analyzed. The study results show that the first period of smoking among adolescents is second grade of middle school on average. The adolescents whose parents are smokers are more likely to show smoking behaviors. The adolescents whose friends are smokers are more likely to start smoking by the time of second grade of middle school. So more active interventions are needed such as the education about the risk of smoking or the intervention program.
Learning Objectives:1. I want to know first period of smoking among adolescents 2. I want to explain the variable that they start smoking
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P8: Comparison of characteristics of tramadol-dependent patients to heroin-dependent patients
Author(s): Samir Fouad Abou El Magd, MD, Momtaz Mohamed Abd El Wahab M.D , Reham Abdelmaksoud Abuismail, Christine. Grella M.D , Dalia Ahmed Enaba M.D .63 Abdel Aziz Al Saad – Manial Cairo EgyptEmail: [email protected]
Objective: To evaluate the clinical characteristics of patients with current tramadol dependence disorder compared to heroin dependence disorder, examine association between sociodemographic variables and dependence disorder of each substance, identify the risk factors correlated to dependence disorder of each substance and correlate the quality of life to severity of dependence of each substance in addition to other characteristics.Method: A cross sectional observational study including 100 treatment seeking patients with either tramadol or heroin as a primary substance of dependence. Psychometric assessment included: Psychiatric assessment using MINI, Addiction severity index (ASI), assessment of Quality of life using WHO QoL BREF, motives of initial and continued substance use and history of traumatic life events. Results: Tramadol patients had lower educational level, more manual work, initiated any substance at older age, had less previous treatment trials (including inpatient admission), more seizures, more childhood trauma and less number of lifetime trauma. Heroin patients are more likely to initiate substance use at younger age, have longer history of addiction treatment, more legal complications, lifetime trauma and worse environmental quality of life. Psychiatric disorders are almost comparable between tramadol and heroin. Among tramadol patients, pleasure seeking was the strongest motive category for drug initiation, while heroin stated pain avoidance as the strongest motive for drug initiation.Conclusion: Heroin patients are worse in most of the aspects of medical, psychiatric, social and legal domains. Tramadol are more likely to suffer from seizures.
References : Babalonis, S., Lofwall, M. R., Nuzzo, P. A., Siegel, A. J., & Walsh, S. L. (2013). Abuse liability and reinforcing efficacy of oral tramadol in humans. Drug and Alcohol Dependence, 129(1), 116-124.
Hser, Y. I., Evans, E., Grella, C., Ling, W., & Anglin, D. (2015). Long-term course of opioid addiction. Harvard review of psychiatry, 23(2), 76-89.
Learning Objectives: 1. Tramadol is a substance of abuse works on opioid and monoaminergic pathway.2. Clinical profile of Tramadol-dependent patients is different from that of heroin.
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P9: Relationship of ADHD symptoms with severity dissociative experiences in a sample of inpatients with alcohol use disorder
Author(s): Cuneyt Evren 1 , Gokhan Umut2, Bilge Evren3
1 Assoc. Prof., 2 M.D., Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey 3 M.D., Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey Email: [email protected]
Aim: The aim of the present study was to evaluate relationship of ADHD symptoms with severity of dissociative experiences, while controlling the effects of anxiety, depression and childhood traumas in a sample of inpatients with alcohol use disorder (AUD).
Materials and Methods: Participants included 190 inpatients with AUD. Participants were evaluated with the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), the Adult ADHD Self-Report Scale (ASRS), and Dissociative Experiences Scale (DES).
Results: The ratio of those who receive 10 points or less from DES was 26.8%, those who receive points between 11 and 30 was 45.3% and those who receive more than 30 points was 27.9%. The latter group considered as a group with high risk of dissociative disorder. This group had higher scores from anxiety, depression, childhood trauma and ADHD scores than the other groups. Age, education, marital status and employment did not differ between the groups. ASRS total score and inattentive (IN) subscale scores were moderately correlated with DES score (r=0.552 and r=0.547 respectively), whereas hyperactive/impulsive (HI) subscale was mildly correlated with DES score (r=0.430). Severity of ADHD (particularly HI dimension) predicted the severity of dissociative symptoms even after controlling the state anxiety, depressive symptoms and childhood trauma.
Conclusion: These findings suggest that the severity of ADHD symptoms, particularly IN dimension, may be related with the severity of dissociative experiences, together with the depression and physical abuse among inpatients with AUD.
Learning Objectives:1. Severity of ADHD symptoms, particularly inattentive dimension, is related with the severity of dissociative experiences2. Severity of depressive symptoms and childhood physical abuse has important effect on this relationship
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P10: Direct or Detailed Question - which should be asked in large population survey for tobacco use / tobacco dependence assessment?
Author(s) Name: Pratap Kumar Jena, Sagarika DasKIIT School of Public Health, KIMS, Campus, KIIT University, Patia, Bhubaneswar, India-751024Email [email protected]
Introduction: Global adult tobacco survey (GATS) asks both direct (Do you currently smoke/chew tobacco?) and product wise detailed (How many of the following products do you currently smoke/chew, each day/week?) questions to assess overall burden of tobacco use and intensity of specific tobacco product use (dependence) respectively. Comparison of these estimates could assess validity of self-reported responses for tobacco (dependence) assessment.
Objective: To compare the tobacco use estimates from direct and detailed questions asked in GATS-India survey.
Methods: Estimates from detailed question on smoking (B06 & B10) and chewing (C06 & C10) tobacco were compared with estimates from direct questions on smoking (B01) and chewing (C01). Daily use is here considered as proxy indicator for tobacco dependence.
Results: Overall tobacco use, smoking and chewing tobacco use estimates were lower by 1.7%(13.32 million), 0.6%(4.97 million) and 1.2%(9.3 million) respectively in the estimates from detailed question than the direct question (Table-1). Smoking dependence and chewing dependence were lower by 0.4% and 0.8% in estimates from detailed question than direct one.
Conclusion: In absence of respondent refusal, detailed question should yield the same estimate as in direct question. Consistent lower estimates from detailed question than the direct one in GATS-India data regarding tobacco use or tobacco dependence, suggests, poor internal validity. Estimates form detailed question may be closer to truth and it should be used for more précised and conservative estimates from large population surveys on tobacco use. Further study using biomarker to validate this is recommended.
Learning Objectives:
1. Apprise the audience about the community assessment of tobacco use and tobacco dependence
2. Apprise the audience about methods for to check internal validity is large population surveys.
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P11: Community based study of tobacco use characteristics in women
Author(s): Dr. Sonali Jhanjee, Rakesh Lal, Ashwani Mishra, Deepak YadavNational Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, IndiaE-mail: [email protected]; [email protected]
Background: India has a huge problem of smokeless tobacco use in disadvantaged women and it is important to study tobacco use characteristics in this population so that urgent measures can be taken to address this issue.
Methodology: The sample of 100 women tobacco users was recruited from an urban resettlement colony in Delhi. A prior available sampling frame was utilized and the sample was selected through systematic random sampling.
Results: A total of 100 female tobacco users with a mean age of 43 ± 13 years were recruited. Majority of them were married (78%), illiterate (62%), housewives (68%) and 58% came from nuclear families. Most females were smokeless tobacco users and pan with tobacco (92.6%) was the commonest form of use. Common reason for initiation of tobacco use was as a cure for dental problems. Nearly half of women had never previously attempted to quit tobacco use and the mean number of quit attempts among those who tried to quit was very low (1.3 ±0.7). Nearly 40% reported cancer as one the major harms of tobacco use. However awareness of other harms was very low. Most women perceived self-help alone (57%) and advice and guidance only (52%) as adequate interventions to quit tobacco use.
Conclusions: There is a need to educate about harms of continued tobacco use and knowledge regarding availability of treatment should be provided. Myths regarding use of smokeless tobacco for treatment of dental problems needs to be specifically addressed.
Learning Objectives:
1. Gender specific tobacco use characteristics need to be explored in different regions of the world.2. It is important to address myths which perpetuate tobacco use in different cultures.
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P12: Patterns and psychosocial consequences of cannabis use in treatment nonseekers in a community setting in Delhi, India
Author(s): Dr. Sonali Jhanjee, Igam Bagra, Priyanka Yadav, Tuleshwar ManharNational Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India.Email: [email protected]; [email protected]
IntroductionSubjects using cannabis do not usually seek treatment and identifying people who experience acute or chronic problems with use of cannabis is important as it’s use is associated with known harmful consequences
Objective : To find patterns of use and psychosocial consequences of cannabis use in a community setting.
Methodology : A purposive sample of 30 male cannabis users residing in a urban resettlement colony were recruited. Subjects more than 18 years with current cannabis use and not dependent on any drug except cannabis and nicotine were included. Subjects were assessed cross-sectionally using Cannabis Use Disorders Identification Test (CUDIT), Marijuana Problem scale, Severity of dependence scale.
ResultsMean age(S.D) of the sample was 28±10 yrs. Half the users were unmarried, 40% were illiterate, 30% were unemployed and rest were either unskilled(33%) or semiskilled labourers(37%). A mixture of tobacco and cannabis was smoked together in a bidi. Mean age(S.D) of initiation of tobacco and cannabis use was 14±3 yrs and 17±3 yrs respectively. 80% of users smoked ganja as their preferred form of cannabis and 70% users smoked ≤ 10 bidis containing cannabis per day. The mean(S.D) scores of CUDIT and SDS were I8±4.5 and 18± 9.6 indicating definitely the presence a cannabis use disorder. Family problems, withdrawal, financial difficulties, memory loss and lowered self-esteem were the most common associated problems.
ConclusionsThe above study indicates the presence of cannabis dependence and associated psychosocial problems in these subjects with a definite need for defining preventive and treatment interventions.
Learning Objectives:1. Screening of treatment non-seeking for problematic cannabis use disorder is important.2. Studying their severity of use and psychosocial consequences may help define preventative
interventions
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P13: Calcium/Calmodulin-dependent Protein Kinase IV Gene Polymorphisms in Korean Alcohol-dependent Patients
Author(s): Woo-Young, Jung, MD,PhD.1, Sung-Gon, Kim, MD, PhD.1, Seongho Min, MD, PhD.21 Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan-Si, Republic of Korea, 2 Head & Professor Wonju Mental Health Center Department of Psychiatry Yonsei University Wonju College of Medicine, Republic of KoreaEmail: [email protected]
Objectives: The purpose of this study is to compare the frequency of Calcium/calmodulin-dependent protein kinase IV (CAMKIV) genotypes and alleles between AD and normal control subjects in Korean.
Methodology: The present study include 281 alcohol dependence patients and 139 normal control group. CAMKIV gene SNPs known to show a significant separation ratio in Asian was searched in SNP database and previous studies related with CAMKIV gene. Among these SNPs, 5 SNPs (rs25917, rs3797740, rs3733995, rs10491334, rs 117590959) was selected for the present study. PCR and RELP technique was used to analyze genotype of CAMKIV gene SNPs.
Results: Major TT genotype and T allele frequency of rs 25917 in AD patients was significantly higher than that of normal control. Major CC genotype and C allele frequency of rs 117590959 in AD patients was significantly higher than that of normal control. Major genotypes of rs25917 and rs11790959 showed a significantly higher odds ratio related with AD than minor genotypes in logistic regression adjusted by gender. In secondary analysis, major genotypes and allele frequency of rs 3797740 and rs 25917 was significantly higher than normal control in men AD patients. Contrast with men AD patients, major genotype and allele frequency of rs 117590959 was significantly higher than normal control in women AD patients.
Conclusions: The results of the present study suggest that CAMKIV may be a candidate AD gene, although further research to determine the precise relationship between CAMKIV and AD and the function of each SNP should be performed.
Learning Objectives:1. Calcium/calmodulin-dependent protein kinase IV2. Gene polymorphism in Korean alcohol dependent patients
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P14: Relationship between Trait Emotional Intelligence and Tobacco Use among school going students
Luqman Munawar Khan
House no. 275,Askari 2 , Gujranwala Cantt ,Punjab , Pakistan.
Email [email protected]
Emotional intelligence(EI) is the ability to use emotional information to guide thinking & behavior. Trait Emotional Intelligence (TEI) refers to an individual's self-perception of their emotional abilities. Previous studies have shown a negative relation between trait emotional intelligence with tobacco use in school going students thus suggesting that improvement in EI of students through awareness campaigns & curricular reforms may play an important part in decreased tobacco use.
OBJECTIVE
To determine the relationship between Trait Emotional Intelligence & tobacco use in school students between 13-18 years of age.
Methodology
After permission from school authorities 2043 private school students between 13-18 years of age who were attending the school for the past one year were included in the study. Trait Emotional Intelligence Questionnaire Short Form comprising of 30 short statements was used to calculate the Trait Emotional Intelligence of students. Questionnaire used by International Evaluation Consortium of California Tobacco Control and Education Program administered by Gallop Organization and University of California, was used in this study to assess the response on tobacco use.
Results
Out of 2043 students,1640 students completed the questionnaires. Students TEI scores & their response on tobacco use was entered in SPSS(version 21.0)Descriptive statistics were calculated. There was a negative correlation(-0.761) between TEI score & Tobacco use & the result was statistically significant (p=0.003).
CONCLUSION
Study showed a strong negative correlation between TEI score & Tobacco use. Conclusive results could be obtained if the study is done at a large scale in multiple setups & over different time periods.
Learning Objectives:
1.Trait Emotional Intelligence score of school going students between 13-18 years of age.
2.Relationship between Trait Emotional Intelligence & Tobacco Use
P 15: A Randomized Trial of Probuphine® Implants in Adults Stabilized on Sublingual Buprenorphine
Author(s): Richard N. Rosenthal, Michelle Lofwall, Sonnie Kim, PharmD, Katherine Beebe, Frank Vocci
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47 Hulfish Street, Princeton, NJ 08542 Email: [email protected]
Background: Long-acting buprenorphine implants (BI) were noninferior to daily sublingual buprenorphine 12–16 mg (SL BPN) in opioid-dependent treatment-naïve users.
Purpose/Hypothesis: This was a randomized, double-blind, noninferiority study in opioid-dependent adult outpatients clinically stabilized for ≥3 months on ≤8 mg SL BPN who were randomized 1:1 to daily SL BPN tablets plus 4 placebo implants or daily SL placebo tablets plus four 80-mg long-lasting BI.
Procedures/Data/Observations: Urine was tested at 6 scheduled monthly and 4 random visits. The primary efficacy variable was responder rate (subjects without evidence of illicit opioid use in >4 of 6 study months). Safety was assessed throughout the study. Responder rates were greater for long-acting BI (96.4%; 84/89) relative to SL BPN (87.6%; 81/84); the 2-sided 95% confidence interval (0.009, 0.167) of the proportion difference was above the predefined noninferiority margin (P<0.001 for noninferiority; p=0.034 for superiority). Of subjects receiving SL BPN, 28.1% (25/89) showed evidence of illicit opioid use compared with 14.3% (12/84) receiving BI. Study completion rates were similar (94.4% SL BPN; 93.3% BI). Of subjects receiving SL BPN, 10.1% had ≥1 severe treatment-emergent adverse event vs 3.4% receiving BI (p>0.05).
Conclusion: BI maintained treatment efficacy in clinically stable opioid-dependent adults. BI may provide superior relapse prevention relative to SL BPN in this population.
Learning Objectives:
1. Buprenorphine implants maintained treatment efficacy relative to sublingual buprenorphine in a clinically stable population
2. Buprenorphine implants may provide superior relapse prevention relative to sublingual buprenorphine in this population
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P16: A need for a Standardised Addiction Medicine Curriculum: An Expert Consultation
Klimas, J., McNeil, R., Ahamad, K., Mead, A., Rieb, L., Cullen, W., Wood, E., Small, W.Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 – 1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z 1Y6Email [email protected]
Objectives: The high prevalence of substance use disorders and associated comorbidities warrant innovative educational activities to scale up the use of novel treatments for substance use disorder and increase the health system’s capacity to deal with it. Although the large evidence-base upon which to base clinical practice keeps growing, most health systems have not invested in standardised training of healthcare providers in addiction medicine. As a result, addiction related care is often lacking, or not based on evidence or best practices. We undertook a study to assess the international expert views on the need for a standardised addiction medicine curriculum for physicians.
Methods: We interviewed experts who were also members of the International Society of Addiction Medicine (ISAM). Initially, we invited all of the international ISAM experts (N=35, http://isamweb.org/membership). Of those invited, 13 experts from 12 different countries took part in the interviews (37% response rate), conducted over Skype, email or in-person - at the conference. We content-analysed the interview transcripts, using constant comparison methodology.
Results: We identified recommendations related to the standardised addiction medicine curriculum at three educational levels: (i) undergraduate (ii) postgraduate and (iii) continued medical education (CME). The experts described broad ideas, such as basic knowledge / skills of addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific pointers, e.g., need to target curriculum for each country and medical specialty. Furthermore, there were recommendations for improvement of the education internationally, including standardisation of addiction curriculum at the national, regional, and international levels.
Conclusion: The views of international experts appear to support a standardised addiction medicine curriculum. However, significant differences exist between the extent of integration and the perceived need to unify the curriculum at under- vs. post-graduate level. While it is unclear whether a curriculum needs to be officially standardized across international boundaries, a common set of evidence-based principles would obviously have value given various areas of concern (e.g. detention camps in South East Asia, the methadone situation in Russia, etc.).
Learning Objectives:1. Describe how addiction related care is often lacking, or not based on evidence or best practices2. Understand the methodology of the project3. List the main themes from the qualitative interviews
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P17: From Precontemplation to Action during Acute Hospitalization for Patients with Infectious Complications of Injection Drug Addiction: Recognizing and Responding to a Devastating Epidemic
Author(s): Dr. Sharon Koivu849 Dufferin Avenue, London ON N5W 3J7Email: [email protected]
As prescription opioids have increased we have seen death rates increase. 1/8 of young adult deaths have been linked to prescription opioids. However this rate only refers to overdose. The actual toll is far greater.
There has also been a substantial rise in morbidity and mortality from complication of injection opioid use, particularly endocarditis. To date these illnesses and deaths have been largely overlooked. This increases marginalization and results in an inadequate medical response.
For many, the inpatient experience and complications such as withdrawal provide an intolerable environment unconducive to recovery.
By prioritizing the problem and developing a hospital-community collaborative we have been able to work with many patients through their stage of change during hospitalization.
Adapting the META:PHI Care Pathway, we are focusing on withdrawal management at the time of patient admission to hospital. Patients are therefore able to accept necessary medical treatment and consider addiction recovery. Numerous patients, often admitted precontemplative have been able to move to action initiating buprenorphine-naloxone therapy during their hospitalization with sustainable community support and follow-up at the Rapid Access Addiction medicine Clinic. This is resulting in improved outcomes.
We will share the results of our data, highlighting the impact of infectious complications of injection drug use. We will discuss the benefits of our hospital-community collaborative and consider the work we are doing to address this epidemic and the societal changes that must occur in order prevent further travesty.
Learning Objectives:
1) Examine the impact of infectious complications of injection opioid addiction.2) Examine a Hospital-Community Collaborative aimed at assisting patient’s transition from precontemplation
to action while hospitalized in acute care.
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P18: Street Level Workers at Risk Community ResponseAuthor(s): Dr. Sharon Koivu849 Dufferin Avenue, London ON N5W 3J7Email: [email protected]
Street Level Workers are at risk. They are at risk of death and morbidity. This can result from direct violence, or complication of poverty, homelessness and addiction. The Pickton Murders illustrated all too well the consequences of marginalization of the vulnerable population. In recognition of this tragedy communities are called to respond.
This presentation will describe the collective community plan that is being developed in London, Ontario.
Grounded in London’s Homeless Prevention System, the Community Plan regarding Street Level Women at Risk is aimed at supporting housing stability, sustainable exit strategies, and long term health, well-being and community belonging for women involved in survival sex work. The Model is framed in a service collaboration providing rapid response, housing with intensive in-home support, and a system of supports focussed on long term community integration and belonging.
Learning Objectives:1. Explore social determinants of health including addiction that contribute to street work2. Consider a community strategy with a housing first approach as a means to recovery
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P19: Clinical characteristics of alcohol related criminals in Korea
Author(s): Kye-Seong Lee M.D., Young-Hoon Chon M.D.Incheon Chamsarang Hospital Wonchang-ro 240beon-gil 9, Seo-gu, Incheon, Korea. 22783Email : [email protected]
ObjectivesThis study was to survey the level of alcohol use disorder(AUD) and characteristics of alcohol problems among criminals
MethodOf 5150 Questionnaire distributed at 11 probation office and 18 prison, 875 probationer and 3504 prisoner was reported self-administered questionnaire consist of general characteristics, history of crime, Alcohol Use Disorder Identification Test(AUDIT), Short Inventory of Problems(SIPS), Readiness to Change Questionnaire(RTCQ), Life Style Criminality Screening Form(LCSF).
Results566(64.7%) probationers and 1486(42.4%) prisoners reported their crime was alcohol-related. The proportion of AUD was higher in alcohol-related criminals as 38% compared 24% of alcohol-unrelated criminals. Among alcohol-related criminals almost 46.2% of prisoners and 37.2% of probationers suffer from alcohol-related impulse control problems. Over 60 % of alcohol-related crime are at least their second conviction. Almost 6 times more prisoner report their first age of drinking was before 15. The rate of prisoners who arrested before age of 20 was more than double(35.1% vs 16.6%) moreover arrest before age 15 was more than 7 times(5.9% vs 0.8%). And more than double of prisoners report experience of domestic violence. Though over 60% of subjects report they are at contemplation or actionphase, but treatment experience rate was less than 4%. ConclusionsThe scope of alcohol-related crime in Korea is huge and repetitive. Majority of criminals suffer from AUD and impulse control problems. Alcohol problem set out in younger age and brewing from family Because of denial, it seems only small portion of criminals had treatment experience.
Reference1)Raistrick D., Heather N., Godfrey C. Review of the Effectiveness of Treatment for Alcohol Problems. London: National Treatment Agency for Substance Misuse. 2006.
2) Lee KS. The Relationship of Alcohol and Crime in Korea. J Korean Med Sci 2013;28:1-3.
Learning Objectives:
1. Be aware of relationship between alcohol use and crime.2. Identify the clinical characteristics alcohol problem among criminals
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P20: Increasing access to medical detox services for First Nations and Inuit: A novel collaboration between Onen’to:kon Healing Lodge, Health Canada and Hôpital Saint-Luc du CHUM
Dr. Stéphanie MarsanEmail [email protected]
Addiction is a serious health issue affecting individuals, families, communities, and all of society. Despite the burden posed by addiction, accessing services and compassionate help can be difficult. For First Nations and Inuit communities, access to addiction treatment can be even more challenging.
In order to improve access to addiction medicine services, a novel collaboration was established between Onen’to:kon Healing Lodge, Health Canada and the Hôpital Saint-Luc du CHUM. A memorandum of understanding between the three parties describes how they will share services, resources and expertise to help treat First Nations and Inuit patients.
At the core of the collaboration is an integrated care process, with clearly established transitions between care settings. Patients are evaluated by the CHUM’s Service de médecine des toxicomanies and rapidly admitted to its 21-bed inpatient unit to undergo detox. Once stabilized, a patient is transferred to Onen’to:kon Healing Lodge to complete a 6-week, First Nations-run, treatment program that incorporates traditional First Nations healing practices and one-on-one therapy. After completing the 6-week long program, patients return to their community and are seen in follow-up at the CHUM as necessary.
Since starting the program in 2015, 12 patients, from Kahnawake and Kanesatake, were referred to the CHUM for their opioid addiction. All were stabilized on opioid replacement therapy, Methadone or Suboxone, and all continue to be followed at the outpatient clinic after completing the 6-week therapeutic program at Onen’to:kon Healing Lodge. Given the initial success, all three parties are exploring how to build on this collaboration to increase access to opioid replacement therapy for First Nations and Inuit patients residing in remote areas of northern Quebec.
Learning Objectives:
Upon reviewing this poster, participants will be able:
1. To describe the program that has been implemented. 2. To understand the importance of coordinated transitions in care for addiction treatment services in First Nations
and Inuit populations.3. To be aware of the challenges facing First Nations and Inuit communities accessing addiction treatment services.
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P21: The Role of Family in Patient Retention: A Residential Addiction Treatment Context
Author(s) Name : Carson McPherson 107 Yon Place Email. [email protected]
Objective: This study aims to examine the relationship between the addicted individual and their ability to complete treatment in a residential addiction centre when the individual’s family members or significant others participate in the therapeutic process, contrasted with those who have no family participation.
Methods: Data was analyzed from 274 patients enrolled in a residential addiction treatment program. These patients were divided into two groups, one having had family participation during treatment and the other having no family participation. These groups were analyzed for successful program completion across various characteristics.
Results: Outcome analysis reported a 9.62% increased program completion rate for those with a family member or significant other involved in a seven-day family program. Further, individuals referred to treatment from a professional source coupled with familial participation reported a 95.18% program completion rate.
Conclusion: This study provides a promising awareness of the positive relationship between the patient and family as well as the value provided by primary healthcare and workplace professionals to those recovering from addiction.
Learning Objectives:
1. Understanding the role of family involvement as it relates to completion of residential addiction treatment.2. Provide an overview of the retention rates across a variety of biopsychosocial factors when family and or
concerned significant others engage in the treatment process.
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P22: Diabetes and Substance Use Disorder, is there any association?
Author(s) :Dr Gaurav Mehta MBBS DCP PgDip(Psych) PgDip(Diabetes) MAcadMEd FRCPC FAPA CISAMSouthlake Regional Health Centre, Department of Psychiatry,5th Floor, West Building 596 Davis Drive, Newmarket, Ontario, L3Y 2P9Email: [email protected]
Rajavashisth et al 2012 showed that Cannabis use was independently linked with a decreased prevalence of Diabetes Mellitus by conducting a cross sectional study. There are theories and explanations such as immunomodulatory effects on oxidative stress and inflammation pathways to suggest that cannabis have inverse co relation with diabetes outcome.
We tried to compare prevalence of substance use disorder in diabetic population attending a tertiary care centre in the diabetic mental health clinic and compared with non-diabetic population attending the mental health outpatients department ,sample size of 50 each, from 2015-2016 .The study involved retrospective study of notes , co-founders were accounted for.
Ethical approval was taken and all necessary protocols were followed. This study is going to reveal the association between diabetes and substance use disorder.
References
1 Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III.Rajavashisth TB, Shaheen M, Norris KC, Pan D, Sinha SK, Ortega J, Friedman TC, - BMJ Open - January 1, 2012;
2 Tobacco, alcohol, and illicit drug use in adolescents with diabetes mellitus.Martínez-Aguayo A, Araneda JC, Fernandez D, Gleisner A, Perez V, Codner E, - Pediatr Diabetes - October 1, 2007; 8 (5); 265-71
Learning Objectives:
1 To understand if there is an association between diabetes and substance use disorder. 2 To identify if diabetic patients are at increased risk of substance abuse.
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P23: Application of GIS for understanding Epidemiology of Substance Use in India
Author(s) Name : Ashwani Kumar Mishra, Yatan Pal Singh Balhara, Swati Kedia Gupta, Sudhir K Khandelwal National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi-110029, INDIAEmail [email protected]
ObjectivesThe Drug Abuse Monitoring System (DAMS) provides preliminary epidemiological information on substance use among treatment seeking population at various de addiction health services. This utilizes the cross sectional assessment and data is summarized using descriptive epidemiology. However, usage of enhanced visualization methodology like Geographical Information system (GIS) is seldom used for understanding the typology of substance use, in developing country like India. GIS is potentially suited to convert the flat based cross sectional data to ‘Geo-spatial’ points, both at country and regional level. With these views in mind the present study attempts to display the epidemiology of substance use through GIS methodology.
MethodologyThe study uses the DAMS data collected from 2007 onward, and thereby use DIVA-GIS platform for conversion of various socio demographic attributes (age, education, marital status, living arrangement, employment), and different substances (tobacco, alcohol, cannabis, opium, volatile solvents, inhalants, sedatives/hypnotics, injecting drug use), to ‘Geospatial’ points. The five different thematic maps were drawn, e.g., country, regions of north; central and western; south; and eastern and north eastern for the period of data collection (2006-2015).
Results There were substantial difference in the pattern and prevalence of substance use across regions. Although, alcohol and tobacco were the most common substance of abuse, marked increasing trend was also observed for cannabis and inhalants.
ConclusionsThe GIS based information provides evidence for varying typology of substance use at country and regional level for India.
Learning Objectives:
1. Understanding the Epidemiology of Substance Use, through Drug Abuse Monitoring System
2. Conversion of Cross Sectional Data to Geo-Spatial Points through GIS Methodology
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P 24: Differences in care and needs in the opioid dependent population in Northern vs Southern Ontario
Kristen MorinEmail [email protected]
Objective: Opioid-dependence is a major health issue in Ontario, Canada; and as of 2015, there are over 42,000 people enrolled in opioid-agonist therapy (OAT). OAT is the standard of care for opioid dependence; but, there is a recognized need for access to supportive programming to address concurrent health issues, including mental health. Approximately half of patients enrolled in OAT have a co-occurring mental health related diagnosis. Recently, our group demonstrated that patients in the Northern Region of the province had better OAT treatment outcomes as compared to patients in Southern regions. The goal of this study is to characterize differences in OAT in Northern Ontario and Southern Ontario with respect to patient demographics, psychiatric diagnosis, co-morbidities and health system usage. Methodology: Data from a cohort of patients who had engaged with the mental health system and were in Methadone Maintenance Treatment and/or Buprenorphine Maintenance treatment (MMT/BMT) retrieved from the Institute of Clinical and Evaluative Sciences (ICES) database was used. Based on Ontario Health Insurance Plan billing codes from 2008 to 2014, the cohort was stratified into northern and southern Ontario and by model of care for mental health treatment. Data were analyzed descriptively and groups were compared.Results: There is a higher proportion of patients receiving MH services who are in MMT/BMT in the North (p <.001), but a higher proportion of claims for MMT/BMT in southern Ontario. The MMT cohort in Northern Ontario is younger with a higher proportion of females than the MMT cohort in Southern Ontario (p-value <.001). A higher proportion of people with acute mental illnesses are being treated in specialist care in both jurisdictions, but a higher proportion of drug addiction is being treated in primary care settings in the north. The rates of HIV in northern Ontario are higher compared to Southern Ontario (p<.001). Resource use for non-mental health issues, emergency department visits and hospitalizations are higher in the north compared to the south for patients in MMT/BMT (p <.001). Conclusion: These findings suggest that there is a difference in mental health and addiction needs and service use in northern and southern regions of the province. There is a higher proportion of MMT/BMT patients in northern Ontario, but there is a higher number of service provision in southern Ontario. There are also gender and age differences between north and south cohorts; differences in care provision; differences in co-morbidities; and differences in number of hospitalizations and emergency department visits. We encourage policy makers and planners to consider these differences to facilitate greater change in mental health and addiction outcomes in Ontario.
Learning Objectives:1. After this presentation participants will understand the current state Medication assisted Therapy for opioid
dependence in Northern Ontario2. After this presentation, participants will appreciate the barriers and enablers to service coordination for opiate
dependence in Northern Ontario
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P 25: First Year Outcomes in Dually Diagnosed Patients Receiving Injectable Naltrexone at Discharge from Private Residential Treatment
Author(s): Siobhan A. Morse, MHSA, CRC, CAI, MAC, Brioan Bride, MSW, PhD5409 Maryland Way #320, Brentwood, TN 37027, USAEmail [email protected]
The objective of this study was to examine the impact of injectable naltrexone on the post-discharge outcomes of individuals who received private, residential treatment for co-occurring substance use and mental health disorders. Participants completed a baseline instrument at intake and again at 30 days, 6-months, and 12-months post discharge that included items from the following measures: ASI Lite, Treatment Service Review, WHO Quality of Life Questionnaire, Beck Depression Inventory, Beck Anxiety Inventory, and DSM Criteria for Substance Use Disorder. In addition to 25-30 days of integrated, residential treatment for co-occurring SUD and mental health disorder, participants received an injection of naltrexone within 72 hours prior to discharge, and a prescription for 11 months of injectable naltrexone at discharge. Participants reported a reduction in substance use, particularly opiates, as well as improvement in a variety of psychosocial outcomes.
Learning Objectives:
1. Evaluate the effectiveness of injectable naltrexone following private residential treatment compared to patients not receiving injectable naltrexone
2. Evaluate patient compliance with injectable naltrexone following private residential treatment.
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P 26: Implementation of a Standardized Clinical Screening Battery for an Inpatient and Outpatient Concurrent Disorders Program: Initial Findings
Author(s): Holly Raymond, Michael Amlung, Prabjhot Saini, Jodi Younger, Iris Balodis, and James MacKillopPeter Boris Centre for Addictions Research. 100 West 5th Street; Hamilton ON L8N 3K7 CanadaEmail: [email protected]
Background and Objective: Epidemiological studies consistently reveal high rates of comorbidity between addictive disorders and other psychiatric disorders (i.e., concurrent disorders, CD). Given the substantial heterogeneity in CD, comprehensive screening of symptom profiles is critical for focused and efficient treatment. The objective of this study was to implement a standardized clinical screening battery to aid diagnosis and treatment of individuals with CD.
Methodology: Inpatient and outpatient clients in the CD program at St. Joseph’s Healthcare Hamilton completed a computerized questionnaire battery during an intake assessment. The battery comprised validated measures of substance use (e.g., alcohol, drugs, tobacco) and a range of psychiatric disorders (e.g., depression, bipolar disorder, psychosis, borderline personality, etc.). Each client’s responses are automatically scored to generate a one-page clinician report summarizing substance use and mental health status.
Results: We will present findings from an initial cohort of clients from the inpatient and outpatient CD clinics. At present, data are available for 101 outpatients. Preliminary analyses indicated significant correlations between elevated drug use severity and higher scores on each of the psychiatric scales examined, including symptoms of depression, bipolar disorder, psychosis, PTSD, and borderline personality. Multiple regression analyses indicated that depression and bipolar disorder scales accounted for unique variance in drug use severity.
Conclusions: These preliminary results may offer useful strategies for other mental health programs that seek to address CD. In addition, this approach represents a bench-to-bedside partnership between academic researchers and treatment providers that is consistent with a growing emphasis on translational research in psychiatry.
Learning Objectives:
1. Increase understanding of the scope and challenges associated with treatment for individuals with concurrent disorders2. Learn about the implementation of a standardized electronic screening battery for concurrent disorders and initial empirical findings from this project
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P27: Non-opioid Protocol for Outpatient Opioid Detoxification and Transition to Antagonist Treatment
Author(s): Vania Rudolf MD, MPHFASAM, James Walsh, MD, Paul Gianutsos, MD, MPH, Kaitlan Baston, MD , Gregory Rudolf, MD Swedish Medical Center Addiction Recovery Service, Seattle, WA Email [email protected]
Background: Successful transition from active opioid use to intramuscular extended release naltrexone (XR-NTX) depends upon effective management of opioid withdrawal symptoms. Effective therapies to facilitate induction onto antagonist treatment are greatly needed.
Objective: Using a case series design, the study examines a novel non-opioid and non-benzodiazepine approach used to transition patients from active opioid addiction to outpatient XR-NTX treatment.
Methods: Twenty opioid dependent individuals were offered a 7-10 day outpatient XR-NTX induction procedure which consisted of detoxification, home-based initiation of low dose oral naltrexone (NTX), and an in-office XR-NTX injection. Protocol medications included scheduled tizanidine, gabapentin and hydroxyzine. Treatment was supervised by daily telephone and scheduled office visits as well as in home sober support to monitor the process. Primary outcomes measured completion of outpatient detoxification and successful XR-NTX induction. Secondary outcomes were length of detoxification, length of NTX and XR-NTX initiation, opioid and other drug use measured by urine drug screen (UDS), adverse events, and engagement in chemical dependency treatment.
Results: Fourteen of the twenty subjects (70%) completed the detoxification and transitioned to XR-NTX. Mean [range] of detoxification treatment was 6.8 [5-15] days, mean time to home oral NTX was 7 [3-25] days and mean time to XR-NTX was 10 [4-25] days. No serious adverse events were reported. Treatment engagement (P=.016), rates of opioid (P < .001), and drug use for more than one substance (P=.002) significantly improved after detoxification and initiation of XR-NTX compared with baseline. Eight of the fourteen subjects (57%) received a second XR-NTX.
Conclusions: Outpatient XR-NTX induction via this novel approach was completed by most participants, suggesting feasibility for withdrawal management and transition to antagonist treatment. Further studies are needed to identify its place within the spectrum of available therapies.
References:1. Sigmon SC, Bisaga A, Nunes EV, O’Connor PG, Kosten T, Woody G. Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice. Am J Drug Alcohol Abuse 2012 May;38(3):187-99 2. Mannelli P, Wu LT, Peindl KS, Swartz MS, Woody GE. Extended release naltrexone injection is performed in the majority of opioid dependent patients receiving outpatient induction: a very low dose naltrexone and buprenorphine open label trial. Drug Alcohol Depend 2014 May
Learning Objectives:1. Learn about a novel pharmacotherapeutic combination of non-opioid and non-benzodiazepine medications used to transition patients from active opioid physiologic dependence to antagonist therapy in an outpatient office setting
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P28: Adherence among opioid dependent patients treated with buprenorphine in a length of treatment study
Author(s) Name: Vladimir Zah 1 , Nikolay Matveev1, Martina Imro1, Jane Ruby2
1) ZRx Outcomes Research Inc, Toronto, Canada2) Indivior Inc., Richmond, VAZRx Outcomes Research Inc., 3373 Cawthra Rd., Mississauga, ON L5A 2X8, CanadaEmail [email protected]
Introduction: A previous study was conducted to identify the optimal minimum length of treatment (LOT) in medically discontinued opioid dependent patients treated with buprenorphine medication assisted treatment (BMAT) in 6 time treated cohorts. 12-17 months cohort demonstrated the lowest use of Medicaid resources after treatment.
Objective: To explore the adherence patterns across the six time treated, medically discontinued patient cohort groups to identify elements for the development of unique patient profiles in successfully treated patients.
Methodology: A retrospective analysis of medication possession ratio (MPR) and proportion of days covered (PDC) across 6 LOT cohorts was conducted using Truven Health MarketScan Medicaid database from 2007–2014, 16-65years old (N=29,062). MPR and PDC values were compared across the following 6 LOT groups (months): 1) 3-5(N=495), 2) 6-8(N=372), 3) 9-11(N=257), 4) 12-17(N=417), 5) 18-23(N=289), and 6) 24+(N=804).
Results: 3-5 vs. 24+ months LOT cohort comparison demonstrated a mean MPR of 0.948(SD=0.283) vs. 0.728(SD=0.303), and a mean PDC 0.860(SD=0.155) vs. PDC=0.672(SD=0.275), respectively.Intergroup comparisons of MPR and PDC demonstrated statistically significant differences (p<0.05).The proportion of patients with a high MPR (>1.1) and PDC (>0.99) significantly decreased as LOT increased. For LOT 3-5 vs. 24+ months group the percentage of patients with high MPR decreased from 10.7% to 3.5% and the PDC decreased from 13.7% to 1.7%.
Conclusions: Both MPR and PDC decreased with longer lengths of treatment. Longer length of treatment, already associated with lower resource use and costs, were also associated with adherence and less indication of abuse and diversion.
Learning Objectives:1. Medication Possession Ratio (MPR) as a measure of adherence in successfully treated opioid dependence patient demonstrated steady decrease in proportion of patients considered potential opioid abusers as length of treatment increased. 2. Proportion of days covered (PDC) as a more conservative measure of adherence in successfully treated opioid dependence patient demonstrated steady decrease in proportion of patients considered potential opioid abusers as length of treatment increased.
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P29: Patient characteristics among opioid dependent buprenorphine treated patients in a length of treatment study
Author(s) Name: Vladimir Zah 1 , Nikolay Matveev1, Martina Imro1, Jane Ruby2
1) ZRx Outcomes Research Inc, Toronto, Canada2) Indivior Inc., Richmond, VAZRx Outcomes Research Inc., 3373 Cawthra Rd., Mississauga, ON L5A 2X8, CanadaEmail [email protected]
Introduction: Previous studies demonstrated differences in patterns of resource use and cost across the groups of patients who were medically discontinued after different lengths of treatment (LOT), with buprenorphine medicated assisted treatment (BMAT). Objective: The objective of the study was to explore similarities and differences in patient characteristics for patients medically discontinued across 6 time treated cohort groups particularly the group 12-17months, previously identified as the optimal minimum LOT. Methodology: A retrospective analysis of demographic characteristics of opioid dependent patients previously treated with BMAT and medically discontinued after 3-5, 6-11, 12-17, 18-23, and 24+ months was conducted on the Truven Health MarketScan Medicaid dataset between 2007- 2014, age of 16-65 years (N=29,062) treated with at least 2 pharmacy fills of buprenorphine (all formulations) for a minimum 3 months. Medical discontinuation was defined as either the last dose as lower than the preceding dose or lower than the average daily dose for the entire treatment period. Mean age, gender, and race were compared across all six LOT groups.Results: There were no statistically significant differences in the demographic characteristics (age, gender, or race) of controlled discontinued patients among all six LOT groups (p>0.1 for all intergroup comparisons).Conclusions: In a group of medically controlled BMAT patients where 12-17 months was previously identified as the optimal minimum length of treatment, there were no significant differences in general demographic characteristics.
Learning Objectives:1. Among patients that medically discontinue over different periods of treatment time, there was no statistical age difference.2. Among patients that medically discontinue over different periods of treatment time, there was no statistical gender or race difference.
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P30: CIWA-Ar protocol versus scheduled benzodiazepine during alcohol detoxification, a retrospective study
Author(s): Zeeuws Dieter*, Muiser Susan, Tarsimi Aïcha, Buyl Ronald, Heersema D.J, Matthys Frieda*University Hospital (UZ Brussel), Psychiatric Department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, BelgiumEmail [email protected]
Objective: At the ‘Universitair Ziekenhuis Brussel’ we altered our benzodiazepine substitution for alcohol detoxification in July 2013. The ‘individually determined fixed-schedule digressive dosing’ protocol was then replaced by the ‘symptom-triggered dosing with the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised’ (CIWA-Ar). We investigated whether this decreased the total of benzodiazepine administered and if less discharged patients were still on benzodiazepine substitution.
Methods: For this retrospective cohort study 167 patient records were reviewed in two periods; February 1st 2013 to June 30th 2013 (scheduled dosing) compared to February 1st, 2014 to June 30th 2014 (CIWA triggered dosing). We included all patients admitted for alcohol detoxification.
Results: There was a significant difference in the total amount of benzodiazepines used between the scheduled dosing group (400.18 ± 297.64 mg) and the CIWA triggered dosing group (62.5 ± 86.91 mg). There was also a significant difference in the number of patients that still needed benzodiazepine substitution at discharge (31.7% vs. 7.1%) and the duration of benzodiazepine substitution (12.80±8.91 days vs. 2.96±3.87 days). Baseline patient characteristics did not differ.
Conclusions: Introduction of the symptom-triggered protocol with CIWA-Ar led to a decrease in total benzodiazepine substitution dose and duration. Additionally, fewer patients were discharged while remaining under substitution. These findings confirm the advantage of symptom-triggered over fixed-schedule dosing for in hospital alcohol detoxification.
Learning Objectives:1. In Alcohol detoxification fewer benzodiazepines are needed with the symptom-triggered CIWA-Ar protocol2. The duration of benzodiazepine substitution is shorter when a symptom-triggered CIWA-Ar protocol is applied in alcohol detoxification.
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