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Article
Publication date: 5 December 2016

David Kingsley Payler

The purpose of this paper is to examine whether it is possible to switch patients from heroin or methadone to buprenorphine without needing to experience symptoms of withdrawal?

Abstract

Purpose

The purpose of this paper is to examine whether it is possible to switch patients from heroin or methadone to buprenorphine without needing to experience symptoms of withdrawal?

Design/methodology/approach

Review of author’s experience in 1980s where three patients transferred to 4 mg buprenorphine from 40 ml (1mg/ml) methadone without symptoms of withdrawal. Review of literature where patients were transferred to buprenorphine without waiting for withdrawal symptoms to occur. Presentation of six case histories in author’s clinic.

Findings

Provided the buprenorphine is commenced at a very low dosage, is gradually increased and the heroin/methadone is reduced over a period of time, it is possible to change from heroin or methadone without inducing withdrawal symptoms. It is not necessary to stop the heroin/methadone and wait for withdrawal symptoms to occur.

Research limitations/implications

Due to the author’s retirement in October 2015 further research into the production of a template which could be used universally has not yet been possible.

Practical implications

Transferring patients from heroin and methadone to buprenorphine has often been difficult. Waiting for withdrawal symptoms to occur has often resulted in treatment failure. The method described eliminates the problem for patients.

Social implications

Patients find the method is more acceptable and allows normal functioning.

Originality/value

Confirmation that the findings of the original case histories from 1980s were valid. The value to the treatment service should be considerable in simplifying the prescribing practice.

Details

Drugs and Alcohol Today, vol. 16 no. 4
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 1 February 2009

C. N. E. Tompkins, N. M. J. Wright, M. G. Waterman and L. Sheard

The United Kingdom Ministry of Justice recently highlighted the extent of buprenorphine (Subutex) misuse in English andWelsh prisons, naming it the third most misused drug…

Abstract

The United Kingdom Ministry of Justice recently highlighted the extent of buprenorphine (Subutex) misuse in English andWelsh prisons, naming it the third most misused drug overall. Yet little is known regarding how illicit buprenorphine is obtained in prison and what influences prisoners to use it. Qualitative research was used to explore prison drug using practices. Thirty men who were former prisoners with a history of injecting drug use were interviewed in depth about their illicit prison drug use, including buprenorphine. Interviews were conducted over 18 months, from August 2006 to January 2008 and were analysed using Framework. The misuse of Subutex by snorting emerged as a significant theme. Accounts suggested that the diversion of prison prescribed Subutex was widespread and prisoners used various tactics to obtain the medication. Various complex and interlinked reasons were given to explain why Subutex was snorted in prison. The main motivation for snorting was to experience a prolonged euphoric opiate effect, believed to help to combat the boredom of being in prison. The price of illicit Subutex in prison was linked to its availability, but it was generally cheaper than heroin, thus contributing to its use. Participants’narratives identified the belief that snorting Subutex in prison was not risk free, but risks were lower than continuing to use other drugs, particularly injecting illicit opiates. The implications of prison Subutex misuse for prisoners, prison medical services, commissioners, and prescribing policy and practice are discussed.

Details

International Journal of Prisoner Health, vol. 5 no. 2
Type: Research Article
ISSN: 1744-9200

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Book part
Publication date: 9 October 2012

Helena Hansen and Samuel K. Roberts

Purpose – To compare the histories of two opioid medications that are pharmacologically similar but subject to contrasting regulations in their use in treatment of opiate…

Abstract

Purpose – To compare the histories of two opioid medications that are pharmacologically similar but subject to contrasting regulations in their use in treatment of opiate dependence in the United States – methadone and buprenorphine – in order to analyze the role of racial imagery and racial politics in the legalization and clinical promotion of their use.

Methodology/approach – Historical methods of archival analysis of published articles and unpublished governmental records were used in researching methadone. Ethnographic methods of participant observation and semistructured interviews were used in researching buprenorphine.

Findings – Contrasting uses of racial imagery played a major role in shaping the current regulatory differences between the two treatments. The association of methadone with black and Latino heroin users has contributed to its increased federal regulation, while the association of buprenorphine with white, middle class prescription opioid users enabled its use in deregulated private physicians’ offices.

Originality/value of paper – Advocates of biomedicalization of behaviors and conditions thought of as social or moral, such as addiction, argue that biomedicalization reduces the stigma of the condition and imply that, in turn, it also reduces the racial inequalities associated with the condition. This study of the biomedicalization of treatment for opioid dependence indicates that the very process of biomedicalization depended on heightened racial imagery associated with each treatment and ultimately intensified, rather than reduced, the stigma of addiction for black and Latino low-income patients.

Details

Critical Perspectives on Addiction
Type: Book
ISBN: 978-1-78052-930-1

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Book part
Publication date: 17 October 2011

Julie Netherland

Neuroscientific technologies have begun to change the ways in which we understand, respond to, and treat drug addiction. According to addiction researchers, neuroscience…

Abstract

Neuroscientific technologies have begun to change the ways in which we understand, respond to, and treat drug addiction. According to addiction researchers, neuroscience marks a new era because of its potential to locate the causes of addiction within the brain and to treat addiction through altering neurochemistry. However, little is known about how addiction neuroscience and new neurochemical treatments shape individuals' experience of addiction and constitute new arrangements of knowledge and power that shape subjectivity and governance. This chapter addresses these domains by drawing on an analysis of scientific literature about addiction neuroscience and qualitative interviews with people being treated for addiction with buprenorphine, a pharmaceutical treatment for opioid dependence. The chapter charts four major themes in the addiction neuroscience literature (pleasure and the limbic system, rationality and the role of the prefrontal cortex, theories of plasticity, and the role of volition) and explores how each of these is incorporated, adapted, or rejected by individuals being treated for addiction with a pharmaceutical. This analysis demonstrates how neuroscientific ideas are mediated by the lived experiences of those being treated under a neuroscientific model. It also suggests that while neuroscientific interventions, like pharmaceuticals, shape the experience of those being treated for addiction, so too do many other forces, including social circumstances, moral frameworks, the drive for autonomy, and the quest to be “normal.”

Details

Sociological Reflections on the Neurosciences
Type: Book
ISBN: 978-1-84855-881-6

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Article
Publication date: 26 August 2014

Farrukh Alam and Peter Barker

The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world…

Abstract

Purpose

The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight on current opioid dependence treatment in the UK.

Design/methodology/approach

Project Access UK, a national survey deployed across multiple regions in England, Wales and Scotland, collected data on the perspectives of patients receiving medication-assisted treatment (MAT) for opioid dependence (n=248), out-of-treatment opioid users (n=196), and physicians (n=100).

Findings

Both patients and users reported multiple prior episodes of MAT and detoxification. Among patients, 57 per cent reported continuing illicit drugs use in addition to their treatment, 25 per cent had misused (injected or snorted) and 30 per cent had diverted (sold or given away) prescribed opioid medications. Diverted medications were currently being used by 26 per cent of out-of-treatment users; of these, 21 per cent used methadone. Supervised dosing was rated as the condition of treatment with the biggest impact on daily life. Daily supervision was a requirement for 44, 34 and 23 per cent of patients receiving methadone, mono-buprenorphine and buprenorphine-naloxone, respectively.

Practical implications

Interruptions to opioid dependence treatment in various forms can hamper the recovery of opioid-dependent patients. The benefits of MAT may not be fully realised if treatment is interrupted due to compliance failure, or inflexible treatment programmes leading to premature treatment exit. These findings serve to highlight areas in which treatment disruption can potentially be addressed.

Originality/value

Consideration of these findings may aid in the optimisation of treatment delivery practices to better meet the UK policy of recovery, and ultimately improve patient outcomes.

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Article
Publication date: 28 February 2019

Dany Khalaf, Maryse Hayek, Jules-Joel Bakhos and Fadi Abou-Mrad

Opioid substitution treatment (OST), such as Buprenorphine, has become a well-established evidence-based approach for the treatment of inmates with opioid use disorder…

Abstract

Purpose

Opioid substitution treatment (OST), such as Buprenorphine, has become a well-established evidence-based approach for the treatment of inmates with opioid use disorder (OUD) in most of the developed world. However, its application in Lebanon remains mainly as a community-based intervention. The purpose of this paper is to highlight the need of its implementation within the Lebanese correctional system.

Design/methodology/approach

The work is a pilot cross-sectional study that compares two groups: 30 male adult prisoners with OUD convictions receiving symptomatic treatment and 30 male adult community patients with OUD receiving Buprenorphine. The objective was to measure the difference in the patients’ general perception and satisfaction of the treatments available. OUD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria and the level of satisfaction was measured by “Treatment Perceptions Questionnaire (TPQ).”

Findings

The prison group reported significantly lower satisfaction when compared to the community group (total TPQ mean scores: M=34.73, SD =4.12 and M=16.67, SD =4.78, respectively, with t (56.76) =15.68, p=0.000). Furthermore, age, marital status, education level and elapsed time in treatment had no significant interactions with the total TPQ score.

Originality/value

The major principles of the ethics of care and evidence-based safe practices will be proposed for the introduction of Buprenorphine to Lebanese prisons. This work provides an opportunity for the expansion of the Lebanese OST program and consequently other countries in the region could benefit from this experience.

Details

International Journal of Prisoner Health, vol. 15 no. 2
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 17 August 2011

Alexander Johnstone, Tim Duffy and Colin Martin

Buprenorphine (Subutex) was piloted in two Scottish prisons between 2004 and 2006 and consequently used within other penal establishments in Scotland. This 2007…

Abstract

Purpose

Buprenorphine (Subutex) was piloted in two Scottish prisons between 2004 and 2006 and consequently used within other penal establishments in Scotland. This 2007 qualitative study aimed to explore the use of Subutex and its associated effects on 14 participants on detoxification programmes.

Design/methodology/approach

All participants were male, aged from 21 to 44 years with prison sentences ranging from a few months to life imprisonment. Buprenorphine was unavailable to female prisoners at the time of this study. Participants were recruited from seven Scottish prisons. All 14 participants were on detoxification programmes, each was prescribed Subutex, and each was selected from a larger investigation that included both those undergoing detoxification and maintenance (n=21). All participants had previously also used methadone on previous detoxification programmes.

Findings

It can be concluded that the majority of detoxification participants within this study indicated that Subutex was a more effective treatment than methadone as it helped reduce craving, eased the process of withdrawal and improved sleeping patterns. In addition, the majority of participants noted higher levels of motivation and the ability to set goals towards obtaining an improved quality of life.

Originality/value

This study provides an alternative perspective to the use of Subutex within prison settings, when compared with results from previous quantitative studies reported. The study also highlights inconsistencies drawn from studies in this area, which may be an artefact of study design. It is recommended that further qualitative studies be conducted to explore further this alternative perspective. Finally, the issue of methodological approach taken should be addressed within the context of a related, but independent, research forum.

Details

International Journal of Prisoner Health, vol. 7 no. 4
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 1 March 2007

James Shearer, Alex D. Wodak and Kate A. Dolan

The study evaluated the introduction of naltrexone in an Australian prison system for imprisoned male heroin users. Treatment outcomes were analysed for two sub‐samples…

Abstract

The study evaluated the introduction of naltrexone in an Australian prison system for imprisoned male heroin users. Treatment outcomes were analysed for two sub‐samples taken from an unsuccessful randomised controlled trial. The first sample comprised 68 participants who were randomly allocated to naltrexone treatment. The second sample comprised 47 participants who commenced opioid pharmacotherapy during the study period. Thirteen per cent of subjects started naltrexone, with only 7% retained in treatment at six months. Six‐month retention was significantly lower in naltrexone compared to methadone (p = 0.0007). Poor patient acceptability and retention did not support oral naltrexone maintenance in this treatment group.

Details

International Journal of Prisoner Health, vol. 3 no. 3
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 7 September 2012

Vellingiri Raja Badrakalimuthu, Andrew Tarbuck and Ajay Wagle

The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence…

Abstract

Purpose

The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence and to compare the characteristics of this group with those aged under 50 who are enrolled in the same substitution treatment programme.

Design/methodology/approach

This is a cross sectional survey involving 92 cases in the 50 and above age group and 194 cases in the under 50 age group from community drug and alcohol services. Data were collected on demographic details, substance misuse and treatment history and progress with treatment. All the data were analysed using the Statistical Package for the Social Sciences (SPSS), version 1.1. Statistical significance between fewer than 50 and 50+ groups were assessed using Fisher's exact test.

Findings

Amongst the 92 in the group 50 years and above, 67 (average dose=63.25 mg) were on methadone maintenance (average dose=63.25 mg) and 19 (average dose=10.37 mg) on buprenorphine. In total, 11 per cent started using opiates after the age of 50. Sixty per cent used other substances out of which 31 per cent used multiple substances. Benzodiazepines, cocaine and amphetamines were the common substances of misuse. Thirty seven were infected with HCV. Comorbid rates for physical and mental illnesses were 64 per cent and 62 per cent, respectively. Nearly 86 per cent achieved good compliance with the treatment programme. Statistically higher rates of being single, lacking stable accommodation, prescription of buprenorphine, high dose prescriptions and lower rates of blood‐borne viruses, physical health and mental health, past forensic history were found in the under 50 age group compared with the 50+ age group.

Practical implications

There are a considerable number of patients above the age of 50 in maintenance treatment and they differ from the less than 50 age group. Old age and substance misuse psychiatrists should be aware of the prevalence of comorbid substance misuse, physical (including blood borne viruses) and psychiatric disorders in this population. Further research is required in this neglected area and a service provision should be based on such robust research.

Originality/value

This is the first study to the authors' knowledge that compares the demographic and treatment profiles of under 50 and over 50 years by age of patients in a methadone maintenance treatment programme. It clearly points to significant differences in the profiles based on age which will have implications for service provision which will have to take into account these age‐related differences in particular related to physical health and social needs.

Details

Drugs and Alcohol Today, vol. 12 no. 3
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 16 March 2015

Albert M. Kopak

Recent political commentary in the USA has suggested that there is great potential for current criminal justice practices designed for drug-involved offenders to be…

Abstract

Purpose

Recent political commentary in the USA has suggested that there is great potential for current criminal justice practices designed for drug-involved offenders to be significantly overhauled in the near future. It is imperative to plan for these changes by assessing how well current programs serve drug-involved criminal justice populations. The paper aims to discuss these issues.

Design/methodology/approach

This critical assessment begins with an overview of the most recent research on the prevalence and impact that substance use disorders have within the criminal justice system. Although the evidence demonstrates that relying on incarceration as a crime control method for drug-involved offenders has many shortcomings, there are innovative new programs being adopted across the country. Two of these promising programs are discussed, as well as the potential results that could be realized from integrating medication assisted treatment into appropriate criminal justice programs designed for drug-involved offenders.

Findings

Incarceration is a failed practice for attending to the underlying reasons why many drug-involved offenders become involved in criminal activities. There are encouraging new programs emerging in different parts of the USA, but the inclusion of supplemental treatment options could further promote positive outcomes.

Originality/value

The impending expansion of criminal justice programs for drug-involved offenders must consider how innovative new programs can be fused with supplemental treatment options to achieve the best results.

Details

International Journal of Prisoner Health, vol. 11 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

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