buprenorphine and Communicable-Diseases

To characterize infections and compare obstetric outcomes in opioid-dependent pregnant women who participated in a randomized clinical trial comparing agonist medications, methadone and buprenorphine.. Incidence of infections was identified as part of the screening medical assessment. As part of a planned secondary analysis, analysis of variance and polytomous logistic regressions were conducted on obstetric outcome variables using treatment randomization condition (maternal maintenance with either methadone or buprenorphine) as the predictor variable, controlling for differences between study sites.. Six United States sites and one European site that provided comprehensive treatment to opioid-dependent pregnant women.. Pregnant opioid-dependent women (n = 131) who delivered while participating in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study.. Obstetric, infectious and other maternal medical complications captured by medical records, physical examination, blood tests and self-report. Neonatal medical complications captured by medical records.. Hepatitis C was the most common infection (32.3%), followed by hepatitis B (7.6%) and chlamydia (6.1%) among participants at study enrollment. Maternal methadone versus buprenorphine maintenance was associated with a higher incidence of preterm labor (P = 0.04) and a significantly higher percentage of signs of respiratory distress in neonates at delivery (P = 0.05). Other medical and obstetric complications were infrequent in the total sample, as well as in both methadone and buprenorphine conditions.. Buprenorphine appears to have an acceptable safety profile for use during pregnancy.

Topics: Adolescent; Adult; Analgesics, Opioid; Analysis of Variance; Buprenorphine; Communicable Diseases; Female; Humans; Incidence; Infant, Newborn; Logistic Models; Methadone; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn; Young Adult

Persons with opioid use disorder (OUD) may present with infectious complications from injection drug use; thus, infectious diseases (ID) physicians are uniquely positioned to treat OUD. Buprenorphine is safe and effective for OUD but remains underutilized. The prevalence and geographic distribution of ID physicians who are waivered to prescribe buprenorphine are unknown.. This cross-sectional study merged data from several publicly available datasets from 1 November 2021 to 15 January 2022. Our primary outcome was the proportion of ID physicians possessing buprenorphine waivers in the United States. We identified individual- and county-level characteristics associated with buprenorphine waiver possession. We then used geospatial analysis to determine the geographic distribution of waivered ID physicians.. We identified 6372 ID physicians in the United States, among whom 170 (2.7%) possessed waivers. Most ID physicians (97.3%) practiced in metropolitan counties. In our multivariable analysis, ID physicians had lower odds of having a waiver for every 10-year increase since graduating medical school (OR: .79; 95% CI: .68-.91). ID physicians practicing in counties with a higher proportion of uninsured residents had lower odds of having a waiver (OR: .75; 95% CI: .62-.90). Among counties with ≥1 ID physician (n = 729), only 11.2% had ≥1 waivered ID physician.. We found an extremely low prevalence and skewed geographic distribution of ID physicians with buprenorphine waivers. Our findings suggest an urgent need to increase the workforce of ID physicians waivered to prescribe buprenorphine and a call for increased integration of OUD education into ID training and continuing medical education.

Topics: Buprenorphine; Communicable Diseases; Cross-Sectional Studies; Humans; Opiate Substitution Treatment; Opioid-Related Disorders; Physicians; Practice Patterns, Physicians'; Prevalence; United States

Topics: Buprenorphine; Communicable Diseases; Humans; Opiate Substitution Treatment; Physicians; Prevalence; United States

Topics: Buprenorphine; Communicable Diseases; Cost Control; Delivery of Health Care, Integrated; Epidemics; Financial Support; Harm Reduction; Health Services Accessibility; Humans; Information Dissemination; Narcotic Antagonists; National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; Opioid-Related Disorders; Prior Authorization; Prisons; Program Evaluation; Rural Health Services; Stereotyping; Telemedicine; United States; United States Substance Abuse and Mental Health Services Administration

Heterogenic care of addicted detainees in the various prisons in The Netherlands triggered the National Agency of Correctional Institutions of the Ministry of Justice, to order the Dutch Institute for Health Care Improvement (CBO) to formulate the first national guideline titled 'Pharmacological care for detained addicts'. This article presents the content of this guideline, which mainly focuses on opioid-dependent addicts. In The Netherlands, approximately 50% of the detainees are problematic substance abusers, while again half of this group suffers from psychiatric co-morbidity. In addition, somatic co-morbidity, especially infectious diseases, is also common. Due to the moderate outcome seen with voluntary drug counselling regimes in prison, there is a policy shift to extent utilization of legally enforced approaches. Continuity of care is of great importance. In case of opioid addicts this, in general, means continuation of methadone maintenance treatment. Aftercare immediately after detention and optimalization of medical information transfer is crucial. This guideline aims to realize optimal and uniform management of addiction disorders in the Dutch prison system.

Topics: Buprenorphine; Communicable Diseases; Comorbidity; Continuity of Patient Care; Female; Health Policy; Health Services Accessibility; Humans; Male; Mental Disorders; Methadone; Netherlands; Opiate Substitution Treatment; Opioid-Related Disorders; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Prisoners

To retrospectively analyse injection drug users (IDUs) with complications after intra- or extra-vasal administration of dissolved tablets.. A retrospective study.. The hospital discharge registers were used to identify the patients admitted in different clinics in Helsinki University Central Hospital during 2000-2005. The patient demographics and social background were clarified. The type of the crushed drugs, the injection route and the timing of administration were registered. Medical interventions, examinations and surgical procedures were recorded.. Between January 2000 and December 2005, 24 patients had been treated on 30 occasions for manifestations caused by injecting crushed tablets. The main types of manifestations were acute limb ischaemia (16 patients) and infection (eight patients), and eight cases led to distal or proximal amputations. Men (19 of 24) were affected more frequently than were women (5 of 24). Their ages ranged between 20 and 39 years (mean: 26 years). All the patients had a previous history of intravenous drug abuse, and they lived in Greater Helsinki region. The incidence of seropositivity for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) was 33% (n=8), 88% (n=21) and 4% (n=1), respectively. The time between injection and presentation to the Emergency Department varied between 3h and 10 days (mean: 62 h). Buprenorphine was the most commonly used drug in 10 of the 24 patients, and benzodiazepine derivatives were also used in 11 of the 24 patients.. Intra- or extra-vasal administration of dissolved tablets leads to serious consequences, including limb amputations. Vascular and soft-tissue imaging may be helpful in the diagnosis. Prompt drainage of any abscess and fasciotomies for compartment syndrome treatment are essential. Controversy exists over the best medical therapy.

Topics: Adult; Amputation, Surgical; Anticoagulants; Benzodiazepines; Buprenorphine; Combined Modality Therapy; Communicable Diseases; Compartment Syndromes; Debridement; Drug Users; Embolectomy; Extremities; Fasciotomy; Female; Finland; Hospitals, University; Humans; Injections; Ischemia; Male; Retrospective Studies; Skin Transplantation; Solubility; Substance Abuse, Intravenous; Tablets; Time Factors; Treatment Outcome; Vasodilator Agents; Young Adult

Topics: Buprenorphine; Certification; Communicable Diseases; Family Practice; Humans; Information Services; Legislation, Medical; Methadone; Office Visits; Opioid-Related Disorders; Substance Abuse Treatment Centers; United States; United States Food and Drug Administration