Journal of addictive diseases
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Registry data on methadone reveal that QTc-prolongation is reported more often among opioid-dependent patients than chronic pain patients. This suggests that opioid treatment programs may be an important venue for implementing arrhythmia risk-reduction strategies. An electrocardiography-based strategy in the opioid treatment program setting demonstrated a reduction in the QTc-interval among patients with marked QTc-prolongation. ⋯ Therefore, we performed qualitative interviews among opioid treatment program staff to determine the barriers and benefits of implementation. Overall, the program was well received by staff; however, a need for training and algorithms was identified. No patient was denied access to care.
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This study explores strategies that Suboxone misusers utilize while in drug treatment. Ethnographic interviews were conducted with 14 patients who had cycled in and out of Suboxone treatment. ⋯ Many patients suggest that they manage their opiate/opioid dependency through a sequential use of Suboxone and heroin to avoid withdrawal and to continue their misuse of opiates/opioids. Results are discussed in conjunction with the difficulties inherent to substance abuse treatment and suggestions for improvement are offered.
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Recovery is being used as a conceptual fulcrum for the redesign of addiction treatment and related support services in the United States. Efforts by policy, research, and clinical leaders to define recovery and calls for assertive models of long-term recovery management raise critical questions about how transformation efforts of recovery-focused systems will affect the pharmacotherapeutic treatment of opioid addiction and the status of patients participating in such treatment. This article highlights recent work advocating a recovery-oriented approach to medication-assisted treatment.
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The National Alliance for Medication Assisted Recovery has started projects to address the stigma that impacts medication-assisted treatment. The Certified Medication Assisted Treatment Advocate Program trains patients and professionals for advocacy in seminars and conferences. ⋯ Stop Stigma Now will create a national public relations campaign to overcome ignorance and stigma. These projects have the potential to end stigma and elevate medication-assisted treatment to its rightful place as the gold standard of treatment.
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Illicit use of opiates is the fastest growing substance use problem in the United States, and the main reason for seeking addiction treatment services for illicit drug use throughout the world. It is associated with significant morbidity and mortality related to human immunodeficiency virus, hepatitis C, and overdose. Treatment for opiate addiction requires long-term management. ⋯ Although no direct comparisons between extended-release naltrexone injections and either methadone or buprenorphine exist, indirect comparison of retention shows inferior outcome compared with methadone and buprenorphine. Further work is needed to directly compare each medication and determine individual factors that can assist in medication selection. Until such time, selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication.