Drug Abuse Treatment: The Blending of Research and PracticeA Community Treatment Provider Perspective PRESENTED BY: GREGORY S. BRIGHAM, Ph.D. Washington, DC February 22, 2007
MaryhavenColumbus, Ohio • Central Ohio’s Oldest and Largest Provider of Substance Abuse Treatment • Certified for by both ODADAS & ODMH • Admissions totaling over 7000 annually • Annual revenues of 17 million primary public funds • Joined the NIDA CTN in 2000
Ohio Valley Node • Regional Research and Training Center is University of Cincinnati • Principle Investigator is Dr. Eugene Somoza • 6 core Community Treatment Program (CTP) Sites • COMPASS in Toledo, Ohio • Crossroads Center in Cincinnati, Ohio • JADAC in Louisville, Kentucky • Maryhaven in Columbus, Ohio • Midtown in Indianapolis, Indiana • Prestera in Huntington, West Virginia • http://cinarc.uc.edu/ovn
Community Treatment Program Representative’s Role in the CTN • National Steering Committee • Subcommittees: Research Development, Research Implementation, Dissemination/Adoption • Concept & Protocol Development • Special Interest Groups • CTP – PI for Randomized Clinical Trials • CTP Caucus
What Happens When You Use Opioids? • Acute Effects: Sedation, euphoria, pupil constriction, constipation, itching, and lowered pulse, respiration and blood pressure • Results of Chronic Use: Tolerance, addiction, medical complications • Withdrawal Symptoms: Sweating, gooseflesh, yawning, chills, runny nose, tearing, nausea, vomiting, diarrhea, and muscle and joint aches
Types of Medications Used in Opioid Dependence Treatment death Opiate Full Agonist (e.g., methadone) Effect Partial Agonist (e.g. buprenorphine) Antagonist (e.g. Naloxone) Dose of Opiate
Central Ohio Opioid TX in 2001 • The local OTP has a waiting list of 350 individuals. • Maryhaven admits over 600 opioid dependent individuals to detoxification annually. • Upon completion of detoxification patients are transferred to ongoing treatment. • Detoxification completion rates were about 50% and treatment continuation rates were about 30 %
Opioid Dependence is Lethal • A 33 year long study following 577 heroin addicts admitted to an addiction treatment - nearly half (284) were dead. Leading cause of death (22%) accidental drug overdose or poisoning. Hser, Y., Hoffman, V., Grella, C., Christine, E., & Anglin, D. (2001). A 33-year follow-up of narcotics addicts. Archives of General Psychiatry. 2001; 58(5), 503-508. • Accidental overdose in relapse is of particular concern in moving opioid dependent patients directly from dependence to abstinence. Strang, J., McCambridge, J., Best, D., Beswick, T. Bearn, J., Rees, S., & Gossop, M. (2003). Loss of tolerance and overdose mortality after inpatient opiate detoxification. British Medical Journal. May 2003; 959-960.
NIDA CTN Buprenorphine-Naloxone Detoxification Protocols • Two, open-label, randomized clinical trials, residential & outpatient. • Compared Buprenorphine-Naloxone (n = 77) and Clonidine (n = 36) for 13 day opiate detoxification in residential. • Initiated in 6 Community Treatment Programs. • Outcome: • BUP/NX = 77% (59) Present and Clean on day 13 • Clonidine = 22% (8) Present and Clean on day 13 Ling, W. et al. (2005). A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: Findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction, 100, 1090-1100.
BUP/NX Taper Implemented at Maryhaven June 2003 Brigham, G.S., et al. (In Press) Using buprenorphine short-term taper to facilitate early treatment engagement. Journal of Substance Abuse Treatment.
Retrospective Chart Review Comparison Groups • Prior to BNX implementation, n = 157 • Admitted prior to BNX Implementation between 6/10/03 - 8/24/03 • After BNX implementation but no BNX, n = 227 • Admitted between 8/25/03 - 1/31/04, but did not take BNX • Received BNX, n = 64 • Admitted between 8/25/03 - 1/31/04 and received BNX
Prior To BNX No BNX 100 BNX TX 84 82 % of Patients 80 * * 56 54 60 40 32 31 20 0 Completed Detoxification Continued Early Tx * p = .001 Program Engagement Maryhaven BUP Taper Outcomes
Summary of Opioid Treatment Adoption • Treated over 950 patients with BNX to date • OTP scheduled to start admitting March 07 • Publication in JSAT Pending • Funding application to develop behavioral adjunct to BNX taper awaiting peer review • Adoption presented at numerous State, National, and International Meetings
Summary • Developed proficiencies in conducting clinical trials • Adoption of EBP is underway or planned in all treatment areas • Developed productive bi-directional collaborations within the CTN and in the broader field of addiction researchers • Patient outcomes have improved due to adoption of science based practices • We are off to a good start: Ongoing support is critical!
Acknowledgements • NIDA CTN participation supported by the Ohio Valley Node of the NIDA CTN:The National Institute on Drug Abuse: U10 DA013732-06 • Maryhaven BNX Adoption and Evaluation supported by the: • Ohio Department of Alcoholism and Drug Abuse Services • The Franklin County Alcohol, Drug and Mental Health Services Board • The Columbus Medical Association Foundation