• The Administration of Naloxone: Social Care Worker Perspectives and Experiences

      Deacy, J.J.P.; Houghton, F. (Irish Medical Journal, 2019-07)
    • Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland's drug and alcohol services.

      Moran, Lisa; Keenan, Eamon; Elmusharaf, Khalifa (BMC Health Services Research, 2018-11-29)
      The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross- departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.
    • Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland

      Griffin, E.; Corcoran, P.; Cassidy, L.; O'Carroll, A.; Perry, I. J.; Bonner, B. (BMJ Open, 2014-07)
    • Closing the gap between training needs and training provision in addiction medicine

      Arya, Sidharth; Delic, Mirjana; Ruiz, Blanca Iciar Indave; Klimas, Jan; Papanti, Duccio; Stepanov, Anton; Cock, Victoria; Krupchanka, Dzmitry (Royal College of Psychiatrists, 2019-12-02)
    • Cocaine use in Young Adults: Correlation with Early Onset Cannabis, Alcohol and Tobacco Use

      Smyth, BP; Hannigan, A; Cullen, W (Irish Medical Journal, 2016-10)
    • Codeine Usage in Ireland- A Timely Discussion on an Imminent Epidemic

      McDonnell, E; Graduate Entry Medical School, University of Limerick (Irish Medical Journal, 2019-03)
    • Commentary on Zeremski et al. (2016)

      McCombe, Geoff; Henihan, Anne Marie; Leahy, Dorothy; Klimas, Jan; Lambert, John S.; Cullen, Walter (2016)
    • Comparing Canadian and United States opioid agonist therapy policies.

      Priest, Kelsey C; Gorfinkel, Lauren; Klimas, Jan; Jones, Andrea A; Fairbairn, Nadia; McCarty, Dennis (2019-02-11)
      Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)-buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada's regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.
    • Development and process evaluation of an educational intervention for overdose prevention and naloxone distribution by general practice trainees

      Klimas, Jan; Egan, Mairead; Tobin, Helen; Coleman, Neil; Bury, Gerard; Funder:HRA-HSR-2012-14; Funder:ELEVATEPD/2014/6 (2015-11-20)
    • Development and process evaluation of an educational intervention to support primary care of problem alcohol among drug users

      Klimas, Jan; Lally, Kevin; Murphy, Lisa; Crowley, Louise; Anderson, Rolande; Meagher, David; McCombe, Geoff; Smyth, Bobby P.; Bury, Gerard; Cullen, Walter; et al. (Drugs and Alcohol Today, 2014)
    • Feasibility of alcohol screening among patients receiving opioid treatment in primary care

      Henihan, Anne M; McCombe, Geoff; Klimas, Jan; Swan, Davina; Leahy, Dorothy; Anderson, Rolande; Bury, Gerard; Dunne, Colum P; Keenan, Eamon; Lambert, John S; et al. (2016-11-05)
      Abstract Background Identifying and treating problem alcohol use among people who also use illicit drugs is a challenge. Primary care is well placed to address this challenge but there are several barriers which may prevent this occurring. The objective of this study was to determine if a complex intervention designed to support screening and brief intervention for problem alcohol use among people receiving opioid agonist treatment is feasible and acceptable to healthcare providers and their patients in a primary care setting. Methods A randomised, controlled, pre-and-post design measured feasibility and acceptability of alcohol screening based on recruitment and retention rates among patients and practices. Efficacy was measured by screening and brief intervention rates and the proportion of patients with problem alcohol use. Results Of 149 practices that were invited, 19 (12.8 %) agreed to participate. At follow up, 13 (81.3 %) practices with 81 (62.8 %) patients were retained. Alcohol screening rates in the intervention group were higher at follow up than in the control group (53 % versus 26 %) as were brief intervention rates (47 % versus 19 %). Four (18 %) people reduced their problem drinking (measured by AUDIT-C), compared to two (7 %) in the control group. Conclusions Alcohol screening among people receiving opioid agonist treatment in primary care seems feasible. A definitive trial is needed. Such a trial would require over sampling and greater support for participating practices to allow for challenges in recruitment of patients and practices.
    • General practice—A key route for distribution of naloxone in the community

      Klimas, Jan; Tobin, Helen; Egan, Mairead; Tomas, Barry; Bury, Gerard (2016-12)
    • How can we investigate the role of topiramate in the treatment of cocaine use disorder more thoroughly?

      Klimas, Jan; Wood, Evan; Werb, Daniel; St Paul's Hospital; University of British Columbia; Vancouver Canada; Urban Health Research Initiative; BC Centre For Excellence in Hiv/Aids; Vancouver Canada; Urban Health Research Initiative; BC Centre For Excellence in Hiv/Aids; Vancouver Canada (2016)
    • The impact of enrolment in methadone maintenance therapy on initiation of heavy drinking among people who use heroin

      Klimas, Jan; Wood, Evan; Nguyen, Paul; Dong, Huiru; Milloy, Michael John; Kerr, Thomas; Hayashi, Kanna (2016-04-06)
    • Implementation of a regional quality improvement collaborative to improve care of people living with opioid use disorder in a Canadian setting.

      Beamish, Laura; Sagorin, Zach; Stanley, Cole; English, Krista; Garelnabi, Rana; Cousineau, Danielle; Barrios, Rolando; Klimas, Jan (2019-09-14)
    • Incidence of hepatitis C among people who inject drugs in Ireland

      Carew, Anne M; Murphy, Niamh; Long, Jean; Hunter, Kate; Lyons, Suzi; Walsh, Cathal; Thornton, Lelia (2017-01-26)
      Abstract Background Comprehensive information on the incidence and duration of hepatitis C virus (HCV) infection for people who inject drugs (PWID) in Ireland is not available. We created an incidence curve of injecting drug use in Ireland and subsequently estimated incidence of hepatitis C virus (HCV) infection. Methods Anonymised data from the National Drug Treatment Reporting System (NDTRS) were used to identify all people who inject drugs (PWIDs) and who entered drug treatment for the first time between 1991 and 2014. A curve, estimating the incidence of injecting, was created to plot PWIDs by year of commencing injecting. The curve was adjusted for missing data on PWIDs in treatment and for PWIDs who were never treated. An adjustment was made to account for injectors who had never shared injecting equipment. The incidence of HCV infection and chronic infection in PWIDs was estimated by applying published rates. Results Between 1991 and 2014, 14,320 injectors were registered on NDTRS. The majority were young (median age 25 years), male (74%), lived in Dublin (73%) and injected an opiate (e.g. heroin) (94%). The estimated total number of injectors up to the end of 2014 was 16,382. An estimated 12,423 (95% CI 10,799-13,161) were infected with HCV, and 9,317 (95% CI 8,022-9,996) became chronically infected. The estimated annual number of new HCV infections among PWIDs increased steeply from the late 1970s and peaked in 1998. By 2014, almost 30% of injectors were estimated to have been infected for over 20 years. Conclusions This is the first comprehensive national estimate of the incidence of HCV in PWIDs in Ireland and will inform planning and developing appropriate health care services.
    • Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy.

      McEachern, Jasmine; Adye-White, Lauren; Priest, Kelsey C; Moss, Eloise; Gorfinkel, Lauren; Wood, Evan; Cullen, Walter; Klimas, Jan (2019-02-01)
      Opioid agonist therapy (OAT) is a first-line treatment for opioid use disorder (OUD); however, the efficacy and role of urine drug screening (UDS) in OAT has received little research attention. Prior evidence suggests that UDS frequency reflects philosophy and practice context rather than differences in patient characteristics or clinical need. Therefore, we reviewed the literature on the effect of and recommendations for the frequency of UDS on health outcomes for persons with OUD who receive OAT. We searched Medline and EMBASE for articles published from 1995-2017. Search results underwent double, independent review with discrepancies resolved through discussion with a third reviewer, when necessary. Additional articles were identified through snowball searching, hand searching (Google Scholar), and expert consultation. The Cochrane tool was used to assess risk of bias. Of the 60 potentially eligible articles reviewed, only one three-arm randomized open-label trial, comparing weekly and monthly UDS testing with take-home OAT doses, met our inclusion criteria. Our review identified an urgent gap in research evidence underpinning an area of clinical importance and that is routinely reported by patients as an area of concern.
    • Long-term survey of a syringe-dispensing machine needle exchange program: answering public concerns

      Duplessy, Catherine; Reynaud, Emmanuel G (2014-05-22)
      Abstract Background Syringe-dispensing machines (SDM) provide syringes at any time even to hard-to-reach injecting drug users (IDUs). They represent an important harm reduction strategy in large populated urban areas such as Paris. We analyzed the performance of one of the world's largest SDM schemes based in Paris over 12 years to understand its efficiency and its limitations, to answer public and stakeholder concerns and optimize its outputs. Methods Parisian syringe dispensing and exchange machines were monitored as well as their sharp disposals and associated bins over a 12-year period. Moreover, mechanical counting devices were installed on specific syringe-dispensing/exchange machines to record the characteristics of the exchange process. Results Distribution and needle exchange have risen steadily by 202% for the distribution and 2,000% for syringe recovery even without a coin counterpart. However, 2 machines out of 34 generate 50% of the total activity of the scheme. It takes 14 s for an IDU to collect a syringe, while the average user takes 3.76 syringes per session 20 min apart. Interestingly, collection time stops early in the evening (19 h) for the entire night. Conclusions SDMs had an increasing distribution role during daytime as part of the harm reduction strategy in Paris with efficient recycling capacities of used syringes and a limited number of kits collected by IDU. Using counting devices to monitor Syringe Exchange Programs (SEPs) is a very helpful tool to optimize use and answer public and stakeholder concerns.