buprenorphine and Anxiety-Disorders

Opioids have been used for centuries to treat a variety of psychiatric conditions with much success. The so-called "opium cure" lost popularity in the early 1950s with the development of non-addictive tricyclic antidepressants and monoamine oxidase inhibitors. Nonetheless, recent literature supports the potent role of methadone, buprenorphine, tramadol, morphine, and other opioids as effective, durable, and rapid therapeutic agents for anxiety and depression. This article reviews the medical literature on the treatment of psychiatric disorders with opioids (notably, methadone and buprenorphine) in both the non-opioid-dependent population and in the opioid-dependent methadone maintenance population. The most recent neurotransmitter theories on the origin of depression and anxiety will be reviewed, including current information on the role of serotonin, N-Methyl d-Aspartate, glutamate, cortisol, catecholamine, and dopamine in psychiatric disorders. The observation that methadone maintenance patients with co-existing psychiatric morbidity (so called dual diagnosis patients) require substantially higher methadone dosages by between 20% and 50% will be explored and qualified. The role of methadone and other opioids as beneficial psychiatric medications that are independent of their drug abuse mitigating properties will be discussed. The mechanisms by which methadone and other opioids can favorably modulate the neurotransmitter systems controlling mood will also be discussed.

Topics: Anxiety Disorders; Brain; Buprenorphine; Comorbidity; Depressive Disorder; Diagnosis, Dual (Psychiatry); Dose-Response Relationship, Drug; Humans; Methadone; Narcotics; Opioid-Related Disorders; Receptors, Neurotransmitter

Successful implementation can increase the availability of evidence-based treatments but continued patient access can be threatened if there is not deliberate focus on sustainment. Real-world examples are needed to elucidate contributors to sustainability.. We examined sustainability of outcomes of a study which tested a 12-month external facilitation intervention. The study evaluated change in access to medications for opioid use disorder (MOUD) in Veterans Health Administration (VHA) facilities in the lowest quartile of MOUD prescribing.. Convergent mixed-methods design.. Thirty-nine providers and leaders from eight VHA facilities.. Thirty-minute post-implementation telephone interviews explored whether barriers identified pre-implementation were successfully addressed, the presence of any new challenges, helpfulness of external facilitation, and plans for sustaining MOUD access. Interviews were analyzed using a rapid turn-around approach. VHA administrative data were used to characterize the facilities and assess their ratio of patients with an OUD diagnosis receiving MOUD (MOUD/OUD ratio) at the end of a 9-month sustainability period.. Commonly reported contributors to sustained MOUD access included national attention on the opioid epidemic, accountability created by study participation, culture shift in MOUD acceptability, leadership support, and plans to build on initial progress. Frequently reported barriers included staffing issues and lack of MOUD-devoted time; the need to overhaul existing policies, practices, and/or processes; and fear and anxiety about MOUD prescribing. All facilities either maintained MOUD/OUD ratio improvement (n = 2) or further improved (n = 6) at the end of sustainability. Facilities with the highest and lowest ratio at the end of sustainability used a team-based approach to MOUD delivery; however, organizational setting differences may have impacted overall MOUD access.. Ensuring stable and consistent staff, and sufficient time dedicated to MOUD are critical to sustaining access to evidence-based treatment in low-adopting facilities. This study highlights the importance of investing in local, system-level changes to improve and sustain access to effective treatments.

Topics: Anxiety; Anxiety Disorders; Buprenorphine; Fear; Humans; Leadership; Opioid-Related Disorders

This retrospective study describes the role of behavioral health in an addiction medicine program integrated in a primary care clinic, and evaluates retention, substance use, and mental health symptoms for patients in a rural underserved community.. Data were abstracted from records of patients referred for buprenorphine treatment of opioid use disorder (N = 101; 45% female, 23% Native Hawaiian or Pacific Islander, Mage = 42.5, SD = 12.75). Among patients prescribed buprenorphine (n = 61), most had comorbid substance-related diagnoses (72% with tobacco use, 75% with at least one other substance use disorder) and non-substance-related mental health diagnoses (77%), most commonly depression and anxiety. Integrated sessions with a behavioral health provider and a buprenorphine-waivered prescriber occurred weekly to monthly. Participants completed depression and anxiety questionnaires (Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7) and provided urine samples at each visit.. Most patients (72%) were retained for at least 3 months, with early dropout associated with higher initial depression and anxiety scores. Inconsistent urine drug tests (i.e., those positive for illicit/nonprescribed substances) were significantly more common at treatment initiation (74%) than during the most recent visit (43%, p < .001), and were associated with baseline substance and other mental health factors, as well as shorter treatment duration. Generalized estimating equations models suggested time-based improvements in depression and anxiety symptoms, especially for patients retained for at least 3 months.. Integrating wraparound addiction treatment within a rural primary care setting is feasible and associated with improved mental health and retention outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Topics: Addiction Medicine; Adult; Anxiety Disorders; Buprenorphine; Depressive Disorder; Female; Humans; Male; Middle Aged; Narcotic Antagonists; Opioid-Related Disorders; Primary Health Care; Retrospective Studies; Rural Health

Studies on sexual functioning of populations with substance use disorders (SUDs) are mostly conducted with male substance users. We have very limited information about the sexuality and related factors in women with opioid use disorder (OUD).. We aimed to evaluate the relationship between childhood traumatic experiences (CTEs) and sexual dysfunctions (SDs) of women with OUD and to compare it with a sample of women who do not have SUD.. Participants included 51 outpatient women with OUD who were on opioid maintenance treatment (OMT) with Buprenorphine/Naloxone and 48 women without SUD. Participants were evaluated by a semi-structured sociodemographic form, the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI).. In women with OUD; CTQ-28, BDI, STAI, and GRISS scores were significantly higher. In the partial correlation analysis, sexual abuse was found to be significantly correlated with nonsensuality, avoidance and total GRISS score. In stepwise regression model, sexual abuse was found to predict SDs together with depression.. CTE, SD, depression, and anxiety rates were higher in the women with OUD. Especially childhood sexual abuse was associated with SDs in this group. Sexual abuse was predicting SDs together with depression. Further investigation of different characteristics of women with SUD may give an opportunity to clinicians to have a better understanding for adaptable treatment strategies.

Topics: Adult; Anxiety Disorders; Buprenorphine; Case-Control Studies; Child; Child Abuse, Sexual; Depressive Disorder; Drug Therapy, Combination; Female; Humans; Middle Aged; Naloxone; Opioid-Related Disorders; Psychiatric Status Rating Scales; Regression Analysis; Sexual Dysfunctions, Psychological; Surveys and Questionnaires

Amongst people on opioid maintenance treatment (OMT), chronic hepatitis C (HCV) is common but infrequently treated. Numerous barriers, including misuse of alcohol may limit efforts at anti-viral treatment. The aim of this study was to define barriers, including alcohol misuse, to the effective treatment of HCV amongst OMT recipients. Ninety-four OMT patients completed the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). A semi-structured interview was used in 53 subjects to assess alcohol use in detail, psychological health, discrimination and access to HCV treatment. Feasibility of brief intervention for alcohol misuse was assessed. Of the screening participants, 73% reported they were HCV positive. Of the detailed interview participants, 26% reported no drinking in the past month, but 53% scored 8 or more on AUDIT and 42% exceeded NHMRC drinking guidelines. Twenty subjects received brief intervention and among 17 re-interviewed at one month, alcohol consumption fell by 3.1 g/day (p = 0.003). Severe or extremely severe depression, stress and anxiety were found in 57%, 51% and 40% of interviewees respectively. Episodic heavy drinking, mental health problems, perceived discrimination, limited knowledge concerning HCV were all common and uptake of HCV treatment was poor. Brief intervention for alcohol use problems was acceptable to OMT patients, and warrants further study.

Topics: Adolescent; Adult; Alcoholism; Antiviral Agents; Anxiety Disorders; Australia; Buprenorphine; Comorbidity; Cross-Sectional Studies; Depressive Disorder, Major; Drug Therapy, Combination; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Hepatitis B, Chronic; Hepatitis C, Chronic; Humans; Male; Mass Screening; Methadone; Middle Aged; Narcotics; Opioid-Related Disorders; Patient Acceptance of Health Care; Patient Satisfaction; Psychotherapy, Brief; Substance Abuse, Intravenous

Sociodemographic, toxicologic, and psychopathologic characteristics of 22 buprenorphine addicts and 45 heroin addicts admitted for inpatient detoxification were compared. Although the buprenorphine addicts were older, clinically significant differences were not apparent. The availability of buprenorphine may be the main reason for its abuse.

Topics: Adult; Age Factors; Anxiety Disorders; Buprenorphine; Depressive Disorder; Female; Heroin Dependence; Hospitalization; Humans; Male; Personality Inventory; Psychiatric Status Rating Scales; Substance Abuse, Intravenous; Substance-Related Disorders