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1.
Psychiatr Serv ; 74(10): 1059-1062, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37042103

RESUMO

The use of fentanyl and its analogs is the primary driver of deaths related to the opioid overdose crisis. In fall 2021, the U.S. Drug Enforcement Administration issued its first public safety alert in 6 years to raise awareness of the escalating prevalence of fentanyl in counterfeit pills and in other opioids, such as heroin, and nonopioids, such as methamphetamine. In addition to increased public awareness, specific actions are needed to remediate the risk for fentanyl overdose. The authors endorse four principles to address the opioid overdose crisis and provide guidance for remediating its impacts: an incremental approach to behavior change or harm reduction; engagement strategies for individuals with substance use disorder; an integrated care approach to ensure better access to treatment programs and effective interventions; and vigilance among clinicians, program staff, and patients to the threat of fentanyl-adulterated drugs. The authors offer specific recommendations on how to apply these principles effectively within health care systems, communities, and law enforcement agencies across the United States.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Estados Unidos/epidemiologia , Fentanila/efeitos adversos , Preparações Farmacêuticas , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Analgésicos Opioides/efeitos adversos , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle
2.
PLoS One ; 17(10): e0274094, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36282806

RESUMO

OBJECTIVE: To understand patient experience of federal regulatory changes governing methadone and buprenorphine (MOUD) access in Arizona during the COVID-19 pandemic. METHODS: This community-based participatory and action research study involved one-hour, audio-recorded field interviews conducted with 131 people who used methadone and/or buprenorphine to address opioid use disorder at some point during COVID (January 1, 2020- March 31, 2021) in Arizona. Transcribed data were analyzed using a priori codes focused on federally recommended flexibilities governing MOUD access. Data were quantitated to investigate associations with COVID risk and services access. RESULTS: Telehealth was reported by 71.0% of participants, but the majority were required to come to the clinic to attend video appointments with an offsite provider. Risk for severe COVID outcomes was reported by 40.5% of the sample. Thirty-eight percent of the sample and 39.7% of methadone patients were required to be at the clinic daily to get medication and 47.6% were at high risk for COVID severe outcomes. About half (54.2%) of methadone patients indicated that some form of multi-day take home dosing was offered at their clinic, and 45.8% were offered an extra day or two of multi-day doses; but no participants received the federally allowed 14- or 28-day methadone take-home doses for unstable and stable patients respectively. All participants expressed that daily clinic visits interrupted their work and home lives and desired more take-home dosing and home delivery options. CONCLUSIONS: MOUD patients in Arizona were not offered many of the federally allowed flexibilities for access that were designed to reduce their need to be at the clinic. To understand the impact of these recommended treatment changes in Arizona, and other states where they were not well implemented, federal and state regulators must mandate these changes and support MOUD providers to implement them.


Assuntos
Buprenorfina , Tratamento Farmacológico da COVID-19 , COVID-19 , Transtornos Relacionados ao Uso de Opioides , Humanos , Buprenorfina/uso terapêutico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Pandemias , Arizona/epidemiologia , COVID-19/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Avaliação de Resultados da Assistência ao Paciente , Analgésicos Opioides/uso terapêutico
3.
Addiction ; 103(8): 1381-90, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18855829

RESUMO

UNLABELLED: PRIMARY AIM: Examine the effectiveness of extended cognitive behavior therapy (CBT) in promoting longer-term smoking abstinence. DESIGN: Open-label treatment phase followed by extended treatment phase. Randomization conducted prior to entry into open-label treatment phase; analysis based on intention-to-treat to avoid threat of selection bias. SETTING: Community smoking cessation clinic. PARTICIPANTS: A total of 304 adult smokers (> or = 18 years of age; > or = 10 cigarettes/day). INTERVENTION: Open-label (8 weeks): all participants received bupropion SR, nicotine patch, CBT. Extended treatment (12 weeks): participants received either CBT + voicemail monitoring and telephone counseling or telephone-based general support. MEASUREMENTS: Seven-day point prevalence abstinence, expired-air carbon monoxide. RESULTS: At week 20 follow-up, CBT produced a higher 7-day point prevalence abstinence rate: 45% versus 29%, P = 0.006; at 52 weeks the difference in abstinence rates (31% versus 27%) was not significant. History of depression was a moderator of treatment. Those with a positive history had a better treatment response at 20 weeks when assigned to the less intensive telephone support therapy (P < 0.05). CONCLUSION: The superiority of CBT to 20 weeks suggests that continued emphasis on the development of cognitive and behavioral strategies for maintaining non-smoking during an extended treatment phase may help smokers to maintain abstinence in the longer term. At present, the minimum duration of therapy is unknown.


Assuntos
Bupropiona/administração & dosagem , Terapia Cognitivo-Comportamental/métodos , Inibidores da Captação de Dopamina/administração & dosagem , Nicotina/administração & dosagem , Agonistas Nicotínicos/administração & dosagem , Abandono do Hábito de Fumar/métodos , Adulto , Monóxido de Carbono/análise , Aconselhamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Síndrome de Abstinência a Substâncias/tratamento farmacológico
4.
J Consult Clin Psychol ; 74(2): 286-94, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16649873

RESUMO

The authors present results of a randomized clinical trial of the efficacy of extended treatment with bupropion SR in producing longer term cigarette smoking cessation. Adult smokers (N = 362) received open-label treatment (11 weeks) that combined relapse prevention training, bupropion SR, and nicotine patch followed by extended treatment (14 weeks) with bupropion SR or matching placebo. Abstinence percentages were relatively high (week 11: 52%; week 25: bupropion, 42%; placebo, 38%; week 52: bupropion, 33%; placebo, 34%), but bupropion SR did not surpass placebo. Gender and baseline craving level were identified as significant, independent moderators of treatment response. Men were more likely to abstain than women (week 11: 59% vs. 43%, p = .001; week 25: 48% vs. 31%, p = .001; week 52: 39% vs. 27%, p = .01). Because most smokers suffer relapse with any current cessation treatment, the comparatively high abstinence percentages achieved in this trial are of interest.


Assuntos
Bupropiona/uso terapêutico , Abandono do Hábito de Fumar/métodos , Fumar/tratamento farmacológico , Adolescente , Adulto , Idoso , Bupropiona/administração & dosagem , Preparações de Ação Retardada/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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