Extended-release buprenorphine outcomes among treatment resistant veterans.

Background: Buprenorphine Extended-Release (BUP-XR) is an FDA approved, monthly subcutaneous injection for opioid use disorder. This formulation provides an alternative for patients who have difficulty adhering to daily sublingual buprenorphine; however, its cost may be prohibitive compared to other medication alternatives.Objectives: The objective of this project was to evaluate the effectiveness of BUP-XR and provide a rationale for its utilization in health care facilitates.Methods: Across two VA outpatient clinics, twenty-six (22 male, 4 female) clinically complex patients received at least one BUP-XR injection between December 1, 2018 and April 1, 2020. The sample was high risk for hospital admission and mortality. Data was collected retrospectively from the medical records. Outcomes examined included: medication adherence, urine drug and alcohol screenings, emergency department visits, hospital admissions, and housing status. Within-subject comparisons were made between the six month period prior to and following the first injection.Results: Treatment retention was robust, as 81% of the sample received six or more monthly BUP-XR injections. Most patients (77%) maintained 300 mg dosage and a majority (70%) missed or were late for at least one injection. BUP-XR was associated with reduction in: emergency department visits, days of hospitalization, non-prescribed opioid use, and homelessness. Mortality rate was 23%.Conclusions: BUP-XR with a flexible dosing schedule and a nonstandard default dose of 300 mgs resulted in robust retention, provided effective treatment of OUD, and reduced health care utilization for these complex patients with high mortality risk. However, due to the lack of statistical significance generalization of these findings is limited.

Methadone "callbacks" within a veterans affairs opioid treatment program: Detecting methadone misuse.

BACKGROUND AND OBJECTIVES: A "callback" requires patients to bring in take-home methadone doses for inspection. An opioid treatment program (OTP) quality-improvement project examined random versus "for-cause" callbacks. METHOD: Eighty-two random callbacks and 60 for-cause callbacks were conducted among patients enrolled in an OTP (N = 183). RESULTS: Among patients with more take home doses, 6% of random callbacks versus 44% of for-cause callbacks were failed. Among patients with fewer take home doses, 36% of for-cause callbacks were failed. DISCUSSION AND CONCLUSIONS: For-cause callbacks are more useful than random ones. SCIENTIFIC SIGNIFICANCE: For-cause callbacks based on clinical judgment detect methadone misuse. (Am J Addict 2017;26:50-52).

Dissolution of a harm reduction track for opiate agonist treatment: longitudinal impact on treatment retention, substance use and service utilization.

BACKGROUND: There is great need to sustain harm reduction programmes for opiate-dependent persons, given variable retention of opioid agonist treatment (OAT) enrolees. Resource challenges may lead some health organizations to discontinue such programmes, though just as programmatic evaluation may determine efficacy and cost-effectiveness so to does it aid in examining impacts of programme dissolution. METHODS: This retrospective evaluation investigated impacts of the dissolution of a 'Minimal Services' (MS) harm reduction programme for substance-abusing OAT clientele at an urban U.S. Veterans Affairs Medical Centre. Targeted clinical data concerning treatment retention, substance use and service utilization was abstracted from medical records of MS-assignees (N=32) and a matched comparison group of standard OAT enrolees. Chart reviewers gathered data for a two-year period encompassing baseline, transitional, and dissolution study phases. RESULTS: Relative to matched-controls, MS-assignees exhibited: (1) disproportionately poor treatment retention over the two-year period; (2) high and temporally stable rates of documented substance use across study phases, and (3) increased utilization of resource-laden VAMC services after MS dissolution. CONCLUSION: Collective results suggest MS programme dissolution was associated with adverse conditions for assignees and the larger treatment setting, and reinforce the need for pragmatic, humane treatment policies to facilitate retention of opiate-dependent persons.

Taking charge: a pilot curriculum of self-defense and personal safety training for female veterans with PTSD because of military sexual trauma.

The authors describe an overview of the pilot project Taking Charge, a 36-hour comprehensive behavioral intervention involving psychoeducation, personal safety, and self-defense training for 12 female veterans with posttraumatic stress disorder (PTSD) from military sexual trauma. Self-defense training can incorporate the benefits of repeated exposure while teaching proactive cognitive and behavioral responses to the feared stimuli, and thus facilitate emotional and physical rescripting of and mastery over the trauma. Results up to 6 months follow-up indicate significant reductions in behavioral avoidance, PTSD hyperarousal, and depression, with significant increases in interpersonal, activity, and self-defense self-efficacy. The authors propose that this therapeutic self-defense curriculum provides an enhanced exposure therapy paradigm that may be a potent therapeutic tool in the treatment of PTSD.

Prostitution in Vancouver: violence and the colonization of First Nations women.

We interviewed 100 women prostituting in Vancouver, Canada. We found an extremely high prevalence of lifetime violence and post-traumatic stress disorder (PTSD). Fifty-two percent of our interviewees were women from Canada's First Nations, a significant overrepresentation in prostitution compared with their representation in Vancouver generally (1.7-7%). Eighty-two percent reported a history of childhood sexual abuse, by an average of four perpetrators. Seventy-two percent reported childhood physical abuse, 90% had been physically assaulted in prostitution, 78% had been raped in prostitution. Seventy-two percent met DSM-IV criteria for PTSD. Ninety-five percent said that they wanted to leave prostitution. Eighty-six percent reported current or past homelessness with housing as one of their most urgent needs. Eighty-two percent expressed a need for treatment for drug or alcohol addictions. Findings are discussed in terms of the legacy of colonialism, the intrinsically traumatizing nature of prostitution and prostitution's violations of basic human rights.

Making a case for personal safety: perceptions of vulnerability and desire for self-defense training among female veterans.

We assessed perceptions of vulnerability and the desire for personal safety/self-defense (PS/SD) training among 67 female veterans receiving outpatient mental health treatment, primarily for post-traumatic stress disorder (PTSD) from sexual and/or physical trauma. Consistent with the literature on the impact of such training on nonclinical populations and on individuals with visual impairments, the results of this study indicate that traumatized female veterans believe that PS/SD training would be an effective and powerful addition to more traditional treatments for PTSD. Study participants indicated they believe such training would positively affect their sense of personal safety; promote increased competence in thwarting future assaults; improve their self-esteem, confidence, and assertiveness; and reduce avoidant and agoraphobic behaviors. These pilot results support the development of an adjunct intervention to augment current PTSD treatments for women veterans with histories of sexual and physical trauma.