Higher buprenorphine dose associated with increased treatment retention at low threshold buprenorphine clinic: A retrospective cohort study.

INTRODUCTION: Controversy exists regarding effective sublingual buprenorphine dosing for treatment of opioid use disorder (OUD), leading to dose caps of 16 mg per day. The Project Connections at Re-Entry (PCARE) program is a low-threshold buprenorphine clinic that provides medication for OUD to vulnerable populations in Baltimore City. OBJECTIVES: To compare retention in care based on treatment dose of buprenorphine, and to examine associated population characteristics. METHODS: This analysis includes clinical patients who received buprenorphine treatment at PCARE between January and July 2021. The study categorized patients into two dosing groups (16 mg or >16 mg). We conducted chi-square tests of independence for categorical variables and independent sample t-tests for continuous variables to evaluate any significant differences in demographic and clinical characteristics by dosing category. To examine differences in 30- and 90-day retention, we conducted multivariable logistic regression analyses with the outcome variable defined as successful retention (at 30 and 90 days, respectively) controlling for demographic and clinical characteristics. RESULTS: In the study period, 566 patients received buprenorphine treatment at the PCARE van. Patients were primarily male (70.9 %), Black (89.4 %), had a mean age of 46.3 years (SD = 11.5), and a mean opioid use of 22.1 years (SD = 13.5). The majority had previous criminal justice involvement (73.9 %), Medicaid insurance coverage (75.4 %), and were unemployed (69.6 %). Nearly half of the sample had reported a previous overdose event (48.4 %). The study found no significant demographic differences between patients receiving 16 mg of buprenorphine per day compared to patients receiving >16 mg. Patients receiving >16 mg had significantly higher rates of treatment retention at 30 and 90 days: 95.4 % vs 86.7 % (p = 0.001), and 82.7 % vs. 67.6 % (p < 0.001) than those receiving 16 mg, respectively. In a multivariable logistic regression controlling for demographic and drug use characteristics, odds of 30-day (Adjusted Odds Ratio [AOR] = 3.98, 95 % Confidence Interval [CI] = 1.92, 8.74, p < 0.001) and 90-day retention (AOR = 2.56, 95 % CI = 1.55, 4.22, p < 0.001) were greater among patients receiving >16 mg daily compared to 16 mg. CONCLUSIONS: In this study examining patients with OUD in a low-threshold buprenorphine clinic, we observed higher rates of treatment retention with buprenorphine doses >16 mg.

Infective endocarditis in people who inject drugs: A scoping review of clinical guidelines.

BACKGROUND: The incidence of infective endocarditis (IE) among people who inject drugs (PWID) is rising worldwide. Multiple clinical guidelines differ on the management of this condition, and few guidelines comment on treatment for primary substance use disorder (SUD). A comprehensive comparison of these guidelines is lacking. OBJECTIVES: To perform a critical review identifying key differences in clinical guideline recommendations for treating IE among PWID, focusing on the inclusion of recommendations for SUD treatment and the presence of stigmatizing language. ELIGIBILITY CRITERIA: Recently published, English-language, society-developed clinical guidelines for the treatment of IE among PWID. SOURCES OF EVIDENCE: PubMed, Google Scholar, and CINAHL Plus databases. CHARTING METHODS: In line with Arksey and O'Malley's framework, a scoping review was adapted using Joanna Briggs Institute and PRISMA-ScR guidelines. Two reviewers independently performed database searches for clinical guidelines published between 2007 and 2020 that commented on the management of IE among PWID. RESULTS: Ten clinical guidelines were included in the final analysis. Treatment recommendations varied with some societies proposing nonstandard care due to concern for return to drug use. Three guidelines include reference to addiction treatment. Only one guideline specifies the use of opioid agonist therapy for treating opioid use disorder and identifies the benefits of an addiction specialist consultation. Acute withdrawal management is not mentioned in any guideline. All guidelines utilized stigmatizing language to describe PWID. CONCLUSIONS: Most guidelines do not address SUD treatment, despite its effectiveness in reducing adverse health outcomes. Future guidelines should address SUD treatment using patient-first language.

Self-report of domestic violence and forced sex are related to sexual risk behaviors in a sample of juvenile detainees.

BACKGROUND: Justice-involved youth have higher rates of sexually transmitted infections (STIs), and a higher prevalence of the associated sexual risk behaviors. Sexual risk behaviors are also associated with alcohol and drug use. Research suggests that a history of trauma is an important predictor of alcohol and drug use in youth offenders, and therefore is a likely contributor to sexual risk behavior in this population. The objective of this analysis is to determine the association of trauma, specifically, domestic violence and forced sex, to six sexual risk behaviors and a history of chlamydia among detained youth. METHODS: The analysis uses data from a convenience sample of detainees assenting to HIV testing conducted December 2016 - August 2017 using the state-certified Voluntary Counseling Testing and Referral (VCTR) process. RESULTS: Of the 379 youth that received VCTR at the facility, 308 (81.3%) were used in this analysis. Report of domestic violence was significantly associated with sex under the influence of alcohol and was also significantly associated with sex under the influence of marijuana. Forced sex was associated with a sexual partner of unknown HIV status. CONCLUSIONS: Traumatic experiences were related to sexual risk behaviors in this analysis, and substance use was strongly implicated in the association. Trauma is known to be a catalyst to sexual risk behaviors, substance use, and delinquency in adolescence. Results support the findings of other investigators and re-iterate the need for trauma-informed interventions that can improve the life trajectories of detained youth.