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Poster 2016
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Title
Author
P1
Factors associated with risk of transition to injecting among men using opioids
through non-injecting routes: a multi-site study from North India
P2
The effect of e-cigarette on the smoking behavior of adolescents
P3
Psychoactive substance use and treatment needs among undergraduates in a
Nigerian university
P4
Psychometric Properties of Alcohol Smoking and Substance involvement
screening test (Assist V3.0) among University students
P5
Satisfaction with Like in Opiate Substitution Treatment
P6
Testosterone suppression in opiate substitution treatment
P7
Study of Critical Period to Intervene Smoking Behavior among adolescents
P8
Comparison of characteristics of tramadol-dependent patients to heroindependent patients
P9
Relationship of ADHD symptoms with severity dissociative experiences in a
sample of inpatients with alcohol use disorder
P10
Direct or detailed questions which should be asked in large population survey
for tobacco use/tobacco dependence assessment
P11
Community based study of tobacco use characteristic in women
P12
Patterns and psychosocial consequences of cannabis use in treatment
nonseekers in a community setting in Delhi, India
P13
Calcium/Calmodulin-dependent Protein Kinase IV Gene Polymorphisms in
Korean Alcohol-dependent Patients
P14
Relationship between trait emotional intelligence and tobacco use among
school going students
P15
A Randomized trial of probuphine implants in adults stabilized on sublingual
buprenorphine
P16
A need for a Standardized Addiction Medicine Curriculum: an Expert
Consultation
P17
From Pre-contemplation to Action during Acute hospitalization for patients with
infectious complications of injection drug addiction: recognizing and
responding to a devastating epidemic
AMBEKAR, Atul
New Delhi India
[email protected]
BAEK, Young-Kyung
Incheon, Korea
[email protected]
BELLO, Abidemi Olubunmi
Ilishan Nigeria
[email protected]
BELLO, Abidemi Olubunmi
Ilishan Nigeria
[email protected]
CERNOVSKY, Zack
London ON
[email protected]
CERNOVSKY, Zack
London ON
[email protected]
DOO, Jeong-Hun
Incheon Korea
[email protected]
EL MAGD, Samir
Cairo, Egypt
[email protected]
EVREN, Cuneyt
Istanbul Turkey
[email protected]
JENA, Pratap Kumar
Bhubaneswar, India
[email protected]
JHANJEE, Sonali
New Delhi India
[email protected]
JHANJEE, Sonali
New Delhi India
[email protected]
JUNG, Woo-Young
Pusan, Korea
[email protected]
KHAN, Luqman Munawar
Punjab Pakistan
[email protected]
KIM, Sonnie
Princeton NJ
[email protected]
KLIMAS, Jan
Vancouver BC
[email protected]
KOIVU, Sharon
London ON
[email protected]
1
P18
Street Level Workers at Risk Community Response
P19
Clinical characteristics of alcohol related criminals in Korea
P20
P21
Increasing access to medical detox services for First Nations and Inuit: a novel
collaboration between Onen’to:kon Healing Lodge, Health Canada and Hopital
Saint-Luc du CHUM
The role of family in patient retention: a residential addiction treatment context
P22
Diabetes and Substance Use Disorder: Is there any association?
P23
Application of GIS for understanding Epidemiology of Substance Use in India
P24
Differences in care and needs in the opioid dependent population in Northern
vs Southern Ontario
P25
First year outcomes in dually diagnosed patients receiving injectable
Naltrexone at discharge from private residential treatment
P26
Implementation of a Standardized Clinical Screening Battery for an Inpatient
and Outpatient Concurrent Disorders Program: Initial Findings
P27
Non-opioid protocol for outpatient opioid detoxification and transition to agonist
treatment
P28
Adherence among opioid dependent patients treated with buprenorphine in a
length of treatment study
P29
Patient characteristics among opioid dependent buprenorphine treated
patients in a length of treatment study
P30
CIWA-Ar protocol versus scheduled benzodiazepine during alcohol
detoxification, a retrospective study
2
KOIVU, Sharon
London ON
[email protected]
LEE, Kye-Seong
Incheon Korea
[email protected]
MARSAN, Stephanie
Montreal QC
[email protected]
McPHERSON, Carson
Vancouver Island, BC
[email protected]
MEHTA, Gaurav
Newmarket ON
[email protected]
MISHRA, Ashwani Kumar
Delhi India
[email protected]
MORIN, Kristen
Sudbury ON
[email protected]
MORSE, Siobhan
Brentwood TN
[email protected]
RAYMOND, Holly
Hamilton ON
[email protected]
RUDOLF, Vania
Seattle WA
[email protected]
ZAH, Vladimir
Mississauga ON
[email protected]
ZAH, Vladimir
Mississauga ON
[email protected]
ZEEUWS, Dieter
Brussels, Belgium
[email protected]
POSTERS
P1: Factors associated with risk of transition to injecting among men using opioids through non-injecting
routes: A multi-site study from North India
Author(s): Atul Ambekar, Tuleshwar Singh, Ashwani Mishra, Ravindra Rao, Alok Agrawal
National Drug Dependence Treatment Centre, Dept. of Psychiatry, All India Institute of Medical Sciences, Ansari
Nagar, New Delhi – 110029, India
Email [email protected]
Introduction
People Who Inject Drugs (PWID), mostly begin drug-use with non-injecting drugs. Factors associated with transition
to injecting from non-injecting route are poorly studied.
Objective
To analyse the factors associated with self-report of likelihood to start injecting drugs among non-injecting opioid
users.
Methodology
Cross section study. IRB clearance obtained. After informed consent we interviewed people (n=752 males) who use
non-injecting opioids (oral/smoking), with a semi-structured questionnaire. Sample recruited in non-biased purposive
manner from various cities in north India. Data collected on socio-demographic, drug-use practices and likelihood to
start injecting. To the question “are you likely to start injecting?”, factors associated with the response ‘yes’, were
analysed.
Results
Mean age 31.2 years (SD 9.1). Rates of opioid use were: 34% - heroin chasing; 42% - oral pharmaceutical opioids;
25% - oral opium. About 49% had PWID as peers; 40% had seen someone inject, and 35% received offer to inject
drugs. Ninety-two (12%) reported ‘yes’ to question whether it was likely that they could start injecting. Following
factors were significantly associated with this self-reported likelihood (pearson’s chi-square; p<0.05): “knowing an
IDU personally”, “witnessing an act of injection”, “history of having received an offer to inject”, and beliefs that
injections “act faster” and “are cheaper.”
Conclusion
Many non-injecting opioid users are at risk of switching to injecting route and get exposed to injecting. Unfortunately
interventions that may enable them to make informed choices do not reach this group. Apart from addictiontreatment, Harm-reduction messages must reach this group too, to prevent the risk of transition.
Learning Objectives:
1. Understanding that non-injecting opioid users are at risk of switch to injecting route of drug intake and there
may be certain factors associated with this risk
2. Scope of Harm reduction services need to be expanded to include not just people who inject drugs, but
those who use drugs through oral / smoking routes too.
3
P2: The effect of e-cigarette on the smoking behavior of adolescents.
Author(s): Youn-Kyung Baek, Sung-Me Jo, Na-rae Lee, Jin- Hee kim, Do-hui Kim, Su-Hyun Jo, Kye-Seong Lee
M.D., Young-Hoon Chon M.D.
Incheon Chamsarang Hospital, Wonchang-ro 240beon-gil 9, Seo-gu, Incheon, Korea. 22783
Email: [email protected]
The study was conducted to find the effect of e-cigarette on the smoking behavior of adolescents. Out of total 1410 in
7 middle and high school students reported self-administered questionnaire developed to evaluate smoking and ecigarette status.
144(10.2%) students reported smoking experience of past year and 73(5.2%) students had e-cigarette experiences.
Among 73 students who reported e-cigarette experience, 68 students(3.2%) also smoke and only 5 students reported
exclusive e-cigarette use. The mean amount of smoking per day was 5.66±5.0 cigarettes. Even though 60(56%)
students reported they smoke e-cigarette below 10 puffs at a time, but 31(29%) students smoke more than 20 puffs
and 18(16.2%) students said e-cigarette is hard to stop puff. 64(44.4%) smoker students had begun to use ecigarette to quit smoking. Most of students(94.1%) have used e-cigarette to quit smoking but 88% of respondents
thought e-cigarette does not helpful to quit smoking. Among the students who use e-cigarette to quit smoking,
40(44.4%) students smoke again, 16(17.8%) students using both, merely 2(2.2%) students smoke e-cigarette only.
Interestingly, 6(6.7%) students answered quit both of them though, rate of quit smoking of whom did not experience
e-cigarette was much higher as 17(31.5%) smoker students had quit smoking.
One of two smoke students has tried e-cigarette at least once, and the purpose of use e-cigarette was to quit
smoking. But e-cigarette does not helpful to quit smoking rather e-cigarette has higher risk of abuse and seems to
enhance nicotine dependence of smoking.
Learning Objectives:
1. We will learn about the behavior of young people use electronic cigarettes.
2. We will learn about the effects of using electronic cigarettes to youth smoking behavior
4
P3: Psychoactive substance use and treatment needs among undergraduates in a Nigerian University
Auhtor(s): Abidemi Bello, Peter Onifade, Increase Adeosun, Taiwo Williams, Elizabeth Okonkwo, Olugbenga Ajayi,
Sotunsa John and Olusegun Baiyewu
Babcock University Teaching Hospital, Ilishan, Ogun State, Nigeria
Email [email protected]
Objectives: Use of psychoactive substances among adolescents and young adults is a universal problem and
contributes enormous health burden. Many studies have determined the prevalence rate of psychoactive substances
among university students but there is paucity of data on the degree of involvement in substance use and
corresponding treatment needs of the students. This study aimed to determine prevalence rate of substance use and
treatment needs of the students in a Nigerian university.
Methodology: This was a cross-sectional survey of substance use in students of a Nigerian university. The World
Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test was used in November 2013 to
determine the substance use prevalence, the risk levels of substance use and the corresponding treatment needs
among 5938 undergraduates. The study was approved by the university’s research ethics committee.
Results: The mean age of the participants was 19 years (sd=2). The commonly ever-used substances were alcohol
(32.5%), Tobacco products (3.8%), Amphetamine or other stimulant (2.9%), Opioids (2.5%) and Marijuana (1.8%);
while the commonly used substances in the past three months were alcohol (11.4%), Opioids (1.4%), Marijuana
(1.2%) and Tobacco products (1.1%). None of students who participated used any drug at high risk level which
required referral for intensive treatment, but 188 (3.2%) used at least one substance at moderate risk level.
Conclusions: At least 188 (3%) students needed secondary intervention against substance use. Those who were at
moderate risk of multiple substances might need more than brief intervention.
Learning Objectives
1. To determine the prevalence rate of psychoactive substance use and the degree of involvement among University
undergraduates.
2. To determine the treatment needs of the students involved in psychoactive substances in a Nigerian university.
5
P4: Psychometric Properties of Alcohol Smoking and Substance Involvement Screening Test (Assist V3.0)
Among University Students
Author(s) Name : Dr. Abidemi Olubunmi Bello, Onifade Peter, Abiodun Olumide, Sotunsa John, Ladipo Oluwakemi
and Adesanya Ocheze
Babcock University Teaching Hospital, Ilishan, Ogun State, Nigeria
Email [email protected]
Objectives: This study aimed to determine the reliability of the self-report instrument and its validity against urine drug test
(UDT).
Methodology: This study of diagnostic accuracy was conducted among students of Babcock University, Nigeria, in 2013. The
study was approved by the university’s research ethics committee. Each student had urine drug test in addition to an interview
with the use of Alcohol Smoking and Substance Involvement Screening Test (ASSIST) on the same day. The laboratory officers
and the interviewers were blind to the results of each other.
Results: The 2797 participants were mostly 18-20 years (61.2%) and females (65.1%), Urine of 0.1% tested positive to cannabis
and Methamphetamine, 0.4% to Opiates. The three-month self-report gave the prevalence rates of Amphetamine Type
Stimulants, Opioids, Diazepam, Cannabis and cocaine at 1.2%, 2.6%, 1.4%, 1.0%, and 0.3% respectively. Against the urine drug
test, ASSIST had low sensitivity and high specificity. Its diagnostic accuracy was greater than 95%. Eleven domains of ASSIST
had internal correlation coefficients of greater than 0.7.
Conclusions: The ASSIST version 3 has acceptable psychometric properties and is valid for use among university students.
Because it is able to detect students who had not used drug recently enough to be picked by UDT and because it is able to
determine level of risk and treatment needs of the students, it is recommended as an essential part of drug use screen program
in the university. It is also recommended that UDT, or better still, hair drug analysis be done alongside ASSIST administration.
Learning Objectives
1. To determine the psychometric properties of Alcohol Smoking and Substance Involvement Screening Test (Assist V3.0)
among University undergraduates.
2. To determine the reliability of the self-report and its validity against urine drug test.
6
P5: Satisfaction with Life in Opiate Substitution Treatment
Author(s): Gamal Sadek, Zack Cernovsky, Paul Istasy, Yves Bureau, Simon Chiu.
Professor of Psychiatry, Western University, London ON; 98 Greenbrier Crescent, London, ON N6J 3X9
Email: [email protected]
Objective. Opiate substitution treatment aims at restoring an adequate satisfaction in life. We evaluated to what
extent chronic pain and concurrent substance abuse interfere with this goal.
Method. Sixty patients (mean age 37.9, SD=9.3; 32 males, 28 females) underwent urine tests for cocaine,
benzodiazepines, oxycodone, and for other opiates, and completed Pavot’s Temporal Satisfaction With Life Scale
(TSWLS). This scale consists of 15 items of which 5 assess the satisfaction with one’s past, 5 with the present, and
another 5 with the future. The patients also completed 3 items from the Brief Pain Inventory (scales from 0 = no pain
to 10 = extreme pain) to assess their average level of pain, the worst pain, and the least pain.
Results. Only 4 patients (6.7 %) rated their worst pain at zero, i.e., as absent. The average pain in this sample was
4.2 (SD=2.7), the worst pain 6.3 (SD=3.2), and the least pain was 2.6 (SD=2.3). Our patients’ average satisfaction
score (59.8, SD=19.6) was significantly lower than in Pavot’s normative sample of 294 adults (70.8, SD=14.8, t=4.1,
df=72.8, p<.001). A significant inverse correlation (r=.31, p=.008) was found between the total satisfaction score and
the sum of all pain ratings. The satisfaction score was not significantly related to concurrent substance abuse
(p>.05).
Conclusions. Pain is prevalent among our patients and its management remains an important clinical issue.
Reference. Pavot W, Diener E, Suh E The temporal satisfaction with life scale. Journal of Personality Assessment,
1998, 70(2), 340-354.
Learning Objectives:
1. Chronic pain is prevalent among patients in opiate substitution treatment
2 The pain interferes with the satisfaction in life of patients in opiate substitution treatment.
7
P6: Testosterone suppression in opiate substitution treatment
Author(s): Simon Chiu, Gurpreet Sidhu, Heinz Mayr, Zack Cernovsky, Katrina Warren, Yves Bureau
Professor of Psychiatry, Western University, London ON; 98 Greenbrier Crescent, London, ON N6J 3X9
Email: [email protected]
Objective. Suboxone is theoretically less likely to suppress testosterone than methadone in opioid dependent
patients. We examined related hormonal measures and their clinical correlates.
Method. We compared laboratory measures of total testosterone, free testosterone, LH, FSH, and prolactin of 33
male methadone maintenance patients (mean age = 38.6 years, SD=10.0) with those of 31 male suboxone patients
(mean age=40.7 years, SD=11.3) in opiate substitution treatment. The two groups did not significantly differ in age,
height, and weight (t-tests, p>.05, 1-tailed).
Results. Our methadone patients did not significantly differ (t-tests, ns, 1-tailed) from their suboxone counterparts in
their laboratory mean values of any of the 5 hormonal measures. All average hormonal values for these two groups
of patients were within the normal reference range, except for below normal levels of free testosterone (122.6 pmol,
SD=100.5 for those on methadone and 163.2 pmol, SD=145.7 for those on suboxone). Longer duration of opiate use
was significantly associated with lower total testosterone (r =-.41, p< .05, 1-tailed) in our methadone patients, but not
in suboxone patients (r =-.03, p= .445, 1-tailed). No significant correlations were noted of the duration of opiate use
to the other hormonal measures (p>.05, 1-tailed).
Conclusions. Group averages of hormonal values were within normal both in methadone and suboxone patients,
except for free testosterone which was below normal in both groups. Longer duration of opiate use was significantly
associated with lower total testosterone in methadone patients, but not in suboxone patients.
Learning Objectives:
1. Average levels of total testosterone, free testosterone, LH, FSH, and prolactin are not significantly different in
methadone versus suboxone patients, but average level of free testosterone is below normal in both groups.
2. Longer duration of opiate use in methadone patients is associated with lower total testosterone.
8
P7: Study of Critical Period to Intervene Smoking Behavior among Adolescents
Author(s): Jeong-Hun Doo, Chong-Nak Son, Kye-Seong Lee M.D., Young-Hoon Chon M.D.
Incheon Chamsarang Hospital Wonchang-ro 240beon-gil 9, Seo-gu, Incheon, Korea. 22783
Email [email protected]
The purpose of this study was to investigate the critical period to intervene smoking behavior among adolescents.
2285 data of adolescent in middle and high school were analyzed. The study results show that the first period of
smoking among adolescents is second grade of middle school on average. The adolescents whose parents are
smokers are more likely to show smoking behaviors. The adolescents whose friends are smokers are more likely to
start smoking by the time of second grade of middle school. So more active interventions are needed such as the
education about the risk of smoking or the intervention program.
Learning Objectives:
1. I want to know first period of smoking among adolescents
2. I want to explain the variable that they start smoking
9
P8: Comparison of characteristics of tramadol-dependent patients to heroin-dependent patients
Author(s): Samir Fouad Abou El Magd, MD, Momtaz Mohamed Abd El Wahab M.D , Reham Abdelmaksoud
Abuismail, Christine. Grella M.D , Dalia Ahmed Enaba M.D .
63 Abdel Aziz Al Saad – Manial Cairo Egypt
Email: [email protected]
Objective: To evaluate the clinical characteristics of patients with current tramadol dependence disorder compared
to heroin dependence disorder, examine association between sociodemographic variables and dependence disorder
of each substance, identify the risk factors correlated to dependence disorder of each substance and correlate the
quality of life to severity of dependence of each substance in addition to other characteristics.
Method: A cross sectional observational study including 100 treatment seeking patients with either tramadol or
heroin as a primary substance of dependence. Psychometric assessment included: Psychiatric assessment using
MINI, Addiction severity index (ASI), assessment of Quality of life using WHO QoL BREF, motives of initial and
continued substance use and history of traumatic life events.
Results: Tramadol patients had lower educational level, more manual work, initiated any substance at older age, had
less previous treatment trials (including inpatient admission), more seizures, more childhood trauma and less number
of lifetime trauma. Heroin patients are more likely to initiate substance use at younger age, have longer history of
addiction treatment, more legal complications, lifetime trauma and worse environmental quality of life. Psychiatric
disorders are almost comparable between tramadol and heroin. Among tramadol patients, pleasure seeking was the
strongest motive category for drug initiation, while heroin stated pain avoidance as the strongest motive for drug
initiation.
Conclusion: Heroin patients are worse in most of the aspects of medical, psychiatric, social and legal domains.
Tramadol are more likely to suffer from seizures.
References :
Babalonis, S., Lofwall, M. R., Nuzzo, P. A., Siegel, A. J., & Walsh, S. L. (2013). Abuse liability and reinforcing efficacy
of oral tramadol in humans. Drug and Alcohol Dependence, 129(1), 116-124.
Hser, Y. I., Evans, E., Grella, C., Ling, W., & Anglin, D. (2015). Long-term course of opioid addiction. Harvard review
of psychiatry, 23(2), 76-89.
Learning Objectives:
1. Tramadol is a substance of abuse works on opioid and monoaminergic pathway.
2. Clinical profile of Tramadol-dependent patients is different from that of heroin.
10
P9: Relationship of ADHD symptoms with severity dissociative experiences in a sample of inpatients with
alcohol use disorder
Author(s): Cuneyt Evren1, Gokhan Umut2, Bilge Evren3
1 Assoc. Prof., 2 M.D., Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM),
Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
3 M.D., Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
Email: [email protected]
Aim: The aim of the present study was to evaluate relationship of ADHD symptoms with severity of dissociative
experiences, while controlling the effects of anxiety, depression and childhood traumas in a sample of inpatients with
alcohol use disorder (AUD).
Materials and Methods: Participants included 190 inpatients with AUD. Participants were evaluated with the StateTrait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), the Adult ADHD Self-Report Scale (ASRS), and
Dissociative Experiences Scale (DES).
Results: The ratio of those who receive 10 points or less from DES was 26.8%, those who receive points between
11 and 30 was 45.3% and those who receive more than 30 points was 27.9%. The latter group considered as a
group with high risk of dissociative disorder. This group had higher scores from anxiety, depression, childhood
trauma and ADHD scores than the other groups. Age, education, marital status and employment did not differ
between the groups. ASRS total score and inattentive (IN) subscale scores were moderately correlated with DES
score (r=0.552 and r=0.547 respectively), whereas hyperactive/impulsive (HI) subscale was mildly correlated with
DES score (r=0.430). Severity of ADHD (particularly HI dimension) predicted the severity of dissociative symptoms
even after controlling the state anxiety, depressive symptoms and childhood trauma.
Conclusion: These findings suggest that the severity of ADHD symptoms, particularly IN dimension, may be related
with the severity of dissociative experiences, together with the depression and physical abuse among inpatients with
AUD.
Learning Objectives:
1. Severity of ADHD symptoms, particularly inattentive dimension, is related with the severity of dissociative
experiences
2. Severity of depressive symptoms and childhood physical abuse has important effect on this relationship
11
P10: Direct or Detailed Question - which should be asked in large population survey for tobacco
use / tobacco dependence assessment?
Author(s) Name: Pratap Kumar Jena, Sagarika Das
KIIT School of Public Health, KIMS, Campus, KIIT University, Patia, Bhubaneswar, India-751024
Email [email protected]
Introduction: Global adult tobacco survey (GATS) asks both direct (Do you currently smoke/chew
tobacco?) and product wise detailed (How many of the following products do you currently smoke/chew,
each day/week?) questions to assess overall burden of tobacco use and intensity of specific tobacco
product use (dependence) respectively. Comparison of these estimates could assess validity of selfreported responses for tobacco (dependence) assessment.
Objective: To compare the tobacco use estimates from direct and detailed questions asked in GATSIndia survey.
Methods: Estimates from detailed question on smoking (B06 & B10) and chewing (C06 & C10) tobacco
were compared with estimates from direct questions on smoking (B01) and chewing (C01). Daily use is
here considered as proxy indicator for tobacco dependence.
Results: Overall tobacco use, smoking and chewing tobacco use estimates were lower by 1.7%(13.32
million), 0.6%(4.97 million) and 1.2%(9.3 million) respectively in the estimates from detailed question than
the direct question (Table-1). Smoking dependence and chewing dependence were lower by 0.4% and
0.8% in estimates from detailed question than direct one.
Conclusion: In absence of respondent refusal, detailed question should yield the same estimate as in
direct question. Consistent lower estimates from detailed question than the direct one in GATS-India data
regarding tobacco use or tobacco dependence, suggests, poor internal validity. Estimates form detailed
question may be closer to truth and it should be used for more précised and conservative estimates from
large population surveys on tobacco use. Further study using biomarker to validate this is recommended.
Learning Objectives:
1. Apprise the audience about the community assessment of tobacco use and tobacco dependence
2. Apprise the audience about methods for to check internal validity is large population surveys.
12
P11: Community based study of tobacco use characteristics in women
Author(s): Dr. Sonali Jhanjee, Rakesh Lal, Ashwani Mishra, Deepak Yadav
National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India
E-mail: [email protected]; [email protected]
Background: India has a huge problem of smokeless tobacco use in disadvantaged women and it is important to
study tobacco use characteristics in this population so that urgent measures can be taken to address this issue.
Methodology: The sample of 100 women tobacco users was recruited from an urban resettlement colony in Delhi.
A prior available sampling frame was utilized and the sample was selected through systematic random sampling.
Results: A total of 100 female tobacco users with a mean age of 43 ± 13 years were recruited. Majority of them
were married (78%), illiterate (62%), housewives (68%) and 58% came from nuclear families. Most females were
smokeless tobacco users and pan with tobacco (92.6%) was the commonest form of use. Common reason for
initiation of tobacco use was as a cure for dental problems. Nearly half of women had never previously attempted to
quit tobacco use and the mean number of quit attempts among those who tried to quit was very low (1.3 ±0.7).
Nearly 40% reported cancer as one the major harms of tobacco use. However awareness of other harms was very
low. Most women perceived self-help alone (57%) and advice and guidance only (52%) as adequate interventions to
quit tobacco use.
Conclusions: There is a need to educate about harms of continued tobacco use and knowledge regarding
availability of treatment should be provided. Myths regarding use of smokeless tobacco for treatment of dental
problems needs to be specifically addressed.
Learning Objectives:
1. Gender specific tobacco use characteristics need to be explored in different regions of the world.
2. It is important to address myths which perpetuate tobacco use in different cultures.
13
P12: Patterns and psychosocial consequences of cannabis use in treatment nonseekers in a community
setting in Delhi, India
Author(s): Dr. Sonali Jhanjee, Igam Bagra, Priyanka Yadav, Tuleshwar Manhar
National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India.
Email: [email protected]; [email protected]
Introduction
Subjects using cannabis do not usually seek treatment and identifying people who experience acute or chronic
problems with use of cannabis is important as it’s use is associated with known harmful consequences
Objective : To find patterns of use and psychosocial consequences of cannabis use in a community setting.
Methodology : A purposive sample of 30 male cannabis users residing in a urban resettlement colony were
recruited. Subjects more than 18 years with current cannabis use and not dependent on any drug except cannabis
and nicotine were included. Subjects were assessed cross-sectionally using Cannabis Use Disorders Identification
Test (CUDIT), Marijuana Problem scale, Severity of dependence scale.
Results
Mean age(S.D) of the sample was 28±10 yrs. Half the users were unmarried, 40% were illiterate, 30% were
unemployed and rest were either unskilled(33%) or semiskilled labourers(37%). A mixture of tobacco and cannabis
was smoked together in a bidi. Mean age(S.D) of initiation of tobacco and cannabis use was 14±3 yrs and 17±3 yrs
respectively. 80% of users smoked ganja as their preferred form of cannabis and 70% users smoked ≤ 10 bidis
containing cannabis per day. The mean(S.D) scores of CUDIT and SDS were I8±4.5 and 18± 9.6 indicating definitely
the presence a cannabis use disorder. Family problems, withdrawal, financial difficulties, memory loss and lowered
self-esteem were the most common associated problems.
Conclusions
The above study indicates the presence of cannabis dependence and associated psychosocial problems in these
subjects with a definite need for defining preventive and treatment interventions.
Learning Objectives:
1. Screening of treatment non-seeking for problematic cannabis use disorder is important.
2. Studying their severity of use and psychosocial consequences may help define preventative
interventions
14
P13: Calcium/Calmodulin-dependent Protein Kinase IV Gene Polymorphisms in Korean Alcohol-dependent
Patients
Author(s): Woo-Young, Jung, MD,PhD.1, Sung-Gon, Kim, MD, PhD.1, Seongho Min, MD, PhD.2
1 Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan-Si, Republic of Korea, 2 Head &
Professor Wonju Mental Health Center Department of Psychiatry Yonsei University Wonju College of Medicine,
Republic of Korea
Email: [email protected]
Objectives: The purpose of this study is to compare the frequency of Calcium/calmodulin-dependent protein kinase
IV (CAMKIV) genotypes and alleles between AD and normal control subjects in Korean.
Methodology: The present study include 281 alcohol dependence patients and 139 normal control group. CAMKIV
gene SNPs known to show a significant separation ratio in Asian was searched in SNP database and previous
studies related with CAMKIV gene. Among these SNPs, 5 SNPs (rs25917, rs3797740, rs3733995, rs10491334, rs
117590959) was selected for the present study. PCR and RELP technique was used to analyze genotype of CAMKIV
gene SNPs.
Results: Major TT genotype and T allele frequency of rs 25917 in AD patients was significantly higher than that of
normal control. Major CC genotype and C allele frequency of rs 117590959 in AD patients was significantly higher
than that of normal control. Major genotypes of rs25917 and rs11790959 showed a significantly higher odds ratio
related with AD than minor genotypes in logistic regression adjusted by gender. In secondary analysis, major
genotypes and allele frequency of rs 3797740 and rs 25917 was significantly higher than normal control in men AD
patients. Contrast with men AD patients, major genotype and allele frequency of rs 117590959 was significantly
higher than normal control in women AD patients.
Conclusions: The results of the present study suggest that CAMKIV may be a candidate AD gene, although further
research to determine the precise relationship between CAMKIV and AD and the function of each SNP should be
performed.
Learning Objectives:
1. Calcium/calmodulin-dependent protein kinase IV
2. Gene polymorphism in Korean alcohol dependent patients
15
P14: Relationship between Trait Emotional Intelligence and Tobacco Use among school going students
Luqman Munawar Khan
House no. 275,Askari 2 , Gujranwala Cantt ,Punjab , Pakistan.
Email [email protected]
Emotional intelligence(EI) is the ability to use emotional information to guide thinking & behavior. Trait Emotional
Intelligence (TEI) refers to an individual's self-perception of their emotional abilities. Previous studies have shown a
negative relation between trait emotional intelligence with tobacco use in school going students thus suggesting that
improvement in EI of students through awareness campaigns & curricular reforms may play an important part in
decreased tobacco use.
OBJECTIVE
To determine the relationship between Trait Emotional Intelligence & tobacco use in school students between 13-18
years of age.
Methodology
After permission from school authorities 2043 private school students between 13-18 years of age who were
attending the school for the past one year were included in the study. Trait Emotional Intelligence Questionnaire
Short Form comprising of 30 short statements was used to calculate the Trait Emotional Intelligence of students.
Questionnaire used by International Evaluation Consortium of California Tobacco Control and Education Program
administered by Gallop Organization and University of California, was used in this study to assess the response on
tobacco use.
Results
Out of 2043 students,1640 students completed the questionnaires. Students TEI scores & their response on tobacco
use was entered in SPSS(version 21.0)Descriptive statistics were calculated. There was a negative correlation(0.761) between TEI score & Tobacco use & the result was statistically significant (p=0.003).
CONCLUSION
Study showed a strong negative correlation between TEI score & Tobacco use. Conclusive results could be obtained
if the study is done at a large scale in multiple setups & over different time periods.
Learning Objectives:
1.Trait Emotional Intelligence score of school going students between 13-18 years of age.
2.Relationship between Trait Emotional Intelligence & Tobacco Use
16
P 15: A Randomized Trial of Probuphine® Implants in Adults Stabilized on Sublingual Buprenorphine
Author(s): Richard N. Rosenthal, Michelle Lofwall, Sonnie Kim, PharmD, Katherine Beebe, Frank Vocci
47 Hulfish Street, Princeton, NJ 08542
Email: [email protected]
Background: Long-acting buprenorphine implants (BI) were noninferior to daily sublingual buprenorphine 12–16 mg
(SL BPN) in opioid-dependent treatment-naïve users.
Purpose/Hypothesis: This was a randomized, double-blind, noninferiority study in opioid-dependent adult
outpatients clinically stabilized for ≥3 months on ≤8 mg SL BPN who were randomized 1:1 to daily SL BPN tablets
plus 4 placebo implants or daily SL placebo tablets plus four 80-mg long-lasting BI.
Procedures/Data/Observations: Urine was tested at 6 scheduled monthly and 4 random visits. The primary efficacy
variable was responder rate (subjects without evidence of illicit opioid use in >4 of 6 study months). Safety was
assessed throughout the study. Responder rates were greater for long-acting BI (96.4%; 84/89) relative to SL BPN
(87.6%; 81/84); the 2-sided 95% confidence interval (0.009, 0.167) of the proportion difference was above the
predefined noninferiority margin (P<0.001 for noninferiority; p=0.034 for superiority). Of subjects receiving SL BPN,
28.1% (25/89) showed evidence of illicit opioid use compared with 14.3% (12/84) receiving BI. Study completion
rates were similar (94.4% SL BPN; 93.3% BI). Of subjects receiving SL BPN, 10.1% had ≥1 severe treatmentemergent adverse event vs 3.4% receiving BI (p>0.05).
Conclusion: BI maintained treatment efficacy in clinically stable opioid-dependent adults. BI may provide superior
relapse prevention relative to SL BPN in this population.
Learning Objectives:
1. Buprenorphine implants maintained treatment efficacy relative to sublingual buprenorphine in a clinically stable
population
2. Buprenorphine implants may provide superior relapse prevention relative to sublingual buprenorphine in this
population
17
P16: A need for a Standardised Addiction Medicine Curriculum: An Expert Consultation
Klimas, J., McNeil, R., Ahamad, K., Mead, A., Rieb, L., Cullen, W., Wood, E., Small, W.
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 – 1081 Burrard
Street, Vancouver, British Columbia, Canada, V6Z 1Y6
Email [email protected]
Objectives: The high prevalence of substance use disorders and associated comorbidities warrant innovative
educational activities to scale up the use of novel treatments for substance use disorder and increase the health
system’s capacity to deal with it. Although the large evidence-base upon which to base clinical practice keeps
growing, most health systems have not invested in standardised training of healthcare providers in addiction
medicine. As a result, addiction related care is often lacking, or not based on evidence or best practices. We
undertook a study to assess the international expert views on the need for a standardised addiction medicine
curriculum for physicians.
Methods: We interviewed experts who were also members of the International Society of Addiction Medicine (ISAM).
Initially, we invited all of the international ISAM experts (N=35, http://isamweb.org/membership). Of those invited, 13
experts from 12 different countries took part in the interviews (37% response rate), conducted over Skype, email or
in-person - at the conference. We content-analysed the interview transcripts, using constant comparison
methodology.
Results: We identified recommendations related to the standardised addiction medicine curriculum at three
educational levels: (i) undergraduate (ii) postgraduate and (iii) continued medical education (CME). The experts
described broad ideas, such as basic knowledge / skills of addiction to be obtained at undergraduate level, or
knowledge of addiction treatment to be acquired at graduate level, as well as specific pointers, e.g., need to target
curriculum for each country and medical specialty. Furthermore, there were recommendations for improvement of the
education internationally, including standardisation of addiction curriculum at the national, regional, and international
levels.
Conclusion: The views of international experts appear to support a standardised addiction medicine curriculum.
However, significant differences exist between the extent of integration and the perceived need to unify the
curriculum at under- vs. post-graduate level. While it is unclear whether a curriculum needs to be officially
standardized across international boundaries, a common set of evidence-based principles would obviously have
value given various areas of concern (e.g. detention camps in South East Asia, the methadone situation in Russia,
etc.).
Learning Objectives:
1. Describe how addiction related care is often lacking, or not based on evidence or best practices
2. Understand the methodology of the project
3. List the main themes from the qualitative interviews
18
P17: From Precontemplation to Action during Acute Hospitalization for Patients with Infectious
Complications of Injection Drug Addiction: Recognizing and Responding to a Devastating Epidemic
Author(s): Dr. Sharon Koivu
849 Dufferin Avenue, London ON N5W 3J7
Email: [email protected]
As prescription opioids have increased we have seen death rates increase. 1/8 of young adult deaths have been
linked to prescription opioids. However this rate only refers to overdose. The actual toll is far greater.
There has also been a substantial rise in morbidity and mortality from complication of injection opioid use, particularly
endocarditis. To date these illnesses and deaths have been largely overlooked. This increases marginalization and
results in an inadequate medical response.
For many, the inpatient experience and complications such as withdrawal provide an intolerable environment
unconducive to recovery.
By prioritizing the problem and developing a hospital-community collaborative we have been able to work with many
patients through their stage of change during hospitalization.
Adapting the META:PHI Care Pathway, we are focusing on withdrawal management at the time of patient admission
to hospital. Patients are therefore able to accept necessary medical treatment and consider addiction recovery.
Numerous patients, often admitted precontemplative have been able to move to action initiating buprenorphinenaloxone therapy during their hospitalization with sustainable community support and follow-up at the Rapid Access
Addiction medicine Clinic. This is resulting in improved outcomes.
We will share the results of our data, highlighting the impact of infectious complications of injection drug use. We will
discuss the benefits of our hospital-community collaborative and consider the work we are doing to address this
epidemic and the societal changes that must occur in order prevent further travesty.
Learning Objectives:
1) Examine the impact of infectious complications of injection opioid addiction.
2) Examine a Hospital-Community Collaborative aimed at assisting patient’s transition from precontemplation
to action while hospitalized in acute care.
19
P18: Street Level Workers at Risk Community Response
Author(s): Dr. Sharon Koivu
849 Dufferin Avenue, London ON N5W 3J7
Email: [email protected]
Street Level Workers are at risk. They are at risk of death and morbidity. This can result from direct violence, or
complication of poverty, homelessness and addiction. The Pickton Murders illustrated all too well the consequences
of marginalization of the vulnerable population. In recognition of this tragedy communities are called to respond.
This presentation will describe the collective community plan that is being developed in London, Ontario.
Grounded in London’s Homeless Prevention System, the Community Plan regarding Street Level Women at Risk is
aimed at supporting housing stability, sustainable exit strategies, and long term health, well-being and community
belonging for women involved in survival sex work. The Model is framed in a service collaboration providing rapid
response, housing with intensive in-home support, and a system of supports focussed on long term community
integration and belonging.
Learning Objectives:
1. Explore social determinants of health including addiction that contribute to street work
2. Consider a community strategy with a housing first approach as a means to recovery
20
P19: Clinical characteristics of alcohol related criminals in Korea
Author(s): Kye-Seong Lee M.D., Young-Hoon Chon M.D.
Incheon Chamsarang Hospital Wonchang-ro 240beon-gil 9, Seo-gu, Incheon, Korea. 22783
Email : [email protected]
Objectives
This study was to survey the level of alcohol use disorder(AUD) and characteristics of alcohol problems among
criminals
Method
Of 5150 Questionnaire distributed at 11 probation office and 18 prison, 875 probationer and 3504 prisoner was
reported self-administered questionnaire consist of general characteristics, history of crime, Alcohol Use Disorder
Identification Test(AUDIT), Short Inventory of Problems(SIPS), Readiness to Change Questionnaire(RTCQ), Life
Style Criminality Screening Form(LCSF).
Results
566(64.7%) probationers and 1486(42.4%) prisoners reported their crime was alcohol-related. The proportion of AUD
was higher in alcohol-related criminals as 38% compared 24% of alcohol-unrelated criminals. Among alcohol-related
criminals almost 46.2% of prisoners and 37.2% of probationers suffer from alcohol-related impulse control problems.
Over 60 % of alcohol-related crime are at least their second conviction. Almost 6 times more prisoner report their first
age of drinking was before 15. The rate of prisoners who arrested before age of 20 was more than double(35.1% vs
16.6%) moreover arrest before age 15 was more than 7 times(5.9% vs 0.8%). And more than double of prisoners
report experience of domestic violence. Though over 60% of subjects report they are at contemplation or
actionphase, but treatment experience rate was less than 4%.
Conclusions
The scope of alcohol-related crime in Korea is huge and repetitive. Majority of criminals suffer from AUD and impulse
control problems. Alcohol problem set out in younger age and brewing from family Because of denial, it seems only
small portion of criminals had treatment experience.
Reference
1)Raistrick D., Heather N., Godfrey C. Review of the Effectiveness of Treatment for Alcohol Problems. London:
National Treatment Agency for Substance Misuse. 2006.
2) Lee KS. The Relationship of Alcohol and Crime in Korea. J Korean Med Sci 2013;28:1-3.
Learning Objectives:
1. Be aware of relationship between alcohol use and crime.
2. Identify the clinical characteristics alcohol problem among criminals
21
P20: Increasing access to medical detox services for First Nations and Inuit: A novel collaboration
between Onen’to:kon Healing Lodge, Health Canada and Hôpital Saint-Luc du CHUM
Dr. Stéphanie Marsan
Email [email protected]
Addiction is a serious health issue affecting individuals, families, communities, and all of society. Despite the burden
posed by addiction, accessing services and compassionate help can be difficult. For First Nations and Inuit
communities, access to addiction treatment can be even more challenging.
In order to improve access to addiction medicine services, a novel collaboration was established between
Onen’to:kon Healing Lodge, Health Canada and the Hôpital Saint-Luc du CHUM. A memorandum of understanding
between the three parties describes how they will share services, resources and expertise to help treat First Nations
and Inuit patients.
At the core of the collaboration is an integrated care process, with clearly established transitions between care
settings. Patients are evaluated by the CHUM’s Service de médecine des toxicomanies and rapidly admitted to its
21-bed inpatient unit to undergo detox. Once stabilized, a patient is transferred to Onen’to:kon Healing Lodge to
complete a 6-week, First Nations-run, treatment program that incorporates traditional First Nations healing practices
and one-on-one therapy. After completing the 6-week long program, patients return to their community and are seen
in follow-up at the CHUM as necessary.
Since starting the program in 2015, 12 patients, from Kahnawake and Kanesatake, were referred to the CHUM for
their opioid addiction. All were stabilized on opioid replacement therapy, Methadone or Suboxone, and all continue
to be followed at the outpatient clinic after completing the 6-week therapeutic program at Onen’to:kon Healing Lodge.
Given the initial success, all three parties are exploring how to build on this collaboration to increase access to opioid
replacement therapy for First Nations and Inuit patients residing in remote areas of northern Quebec.
Learning Objectives:
Upon reviewing this poster, participants will be able:
1. To describe the program that has been implemented.
2. To understand the importance of coordinated transitions in care for addiction treatment services in First Nations
and Inuit populations.
3. To be aware of the challenges facing First Nations and Inuit communities accessing addiction treatment services.
22
P21: The Role of Family in Patient Retention: A Residential Addiction Treatment Context
Author(s) Name : Carson McPherson
107 Yon Place
Email. [email protected]
Objective: This study aims to examine the relationship between the addicted individual and their ability to complete
treatment in a residential addiction centre when the individual’s family members or significant others participate in the
therapeutic process, contrasted with those who have no family participation.
Methods: Data was analyzed from 274 patients enrolled in a residential addiction treatment program. These
patients were divided into two groups, one having had family participation during treatment and the other having no
family participation. These groups were analyzed for successful program completion across various characteristics.
Results: Outcome analysis reported a 9.62% increased program completion rate for those with a family member or
significant other involved in a seven-day family program. Further, individuals referred to treatment from a
professional source coupled with familial participation reported a 95.18% program completion rate.
Conclusion: This study provides a promising awareness of the positive relationship between the patient and family
as well as the value provided by primary healthcare and workplace professionals to those recovering from addiction.
Learning Objectives:
1.
2.
Understanding the role of family involvement as it relates to completion of residential addiction treatment.
Provide an overview of the retention rates across a variety of biopsychosocial factors when family and or
concerned significant others engage in the treatment process.
23
P22: Diabetes and Substance Use Disorder, is there any association?
Author(s) :Dr Gaurav Mehta MBBS DCP PgDip(Psych) PgDip(Diabetes) MAcadMEd FRCPC FAPA CISAM
Southlake Regional Health Centre, Department of Psychiatry,5th Floor, West Building 596 Davis Drive, Newmarket,
Ontario, L3Y 2P9
Email: [email protected]
Rajavashisth et al 2012 showed that Cannabis use was independently linked with a decreased prevalence of
Diabetes Mellitus by conducting a cross sectional study. There are theories and explanations such as
immunomodulatory effects on oxidative stress and inflammation pathways to suggest that cannabis have inverse co
relation with diabetes outcome.
We tried to compare prevalence of substance use disorder in diabetic population attending a tertiary care centre in
the diabetic mental health clinic and compared with non-diabetic population attending the mental health outpatients
department ,sample size of 50 each, from 2015-2016 .The study involved retrospective study of notes , co-founders
were accounted for.
Ethical approval was taken and all necessary protocols were followed. This study is going to reveal the association
between diabetes and substance use disorder.
References
1
Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and
Nutrition Examination Survey (NHANES) III.
Rajavashisth TB, Shaheen M, Norris KC, Pan D, Sinha SK, Ortega J, Friedman TC, - BMJ Open - January
1, 2012;
2
Tobacco, alcohol, and illicit drug use in adolescents with diabetes mellitus.
Martínez-Aguayo A, Araneda JC, Fernandez D, Gleisner A, Perez V, Codner E, - Pediatr Diabetes - October
1, 2007; 8 (5); 265-71
Learning Objectives:
1
2
To understand if there is an association between diabetes and substance use disorder.
To identify if diabetic patients are at increased risk of substance abuse.
24
P23: Application of GIS for understanding Epidemiology of Substance Use in India
Author(s) Name : Ashwani Kumar Mishra, Yatan Pal Singh Balhara, Swati Kedia Gupta, Sudhir K Khandelwal
National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi-110029, INDIA
Email [email protected]
Objectives
The Drug Abuse Monitoring System (DAMS) provides preliminary epidemiological information on substance use
among treatment seeking population at various de addiction health services. This utilizes the cross sectional
assessment and data is summarized using descriptive epidemiology. However, usage of enhanced visualization
methodology like Geographical Information system (GIS) is seldom used for understanding the typology of substance
use, in developing country like India. GIS is potentially suited to convert the flat based cross sectional data to ‘Geospatial’ points, both at country and regional level. With these views in mind the present study attempts to display the
epidemiology of substance use through GIS methodology.
Methodology
The study uses the DAMS data collected from 2007 onward, and thereby use DIVA-GIS platform for conversion of
various socio demographic attributes (age, education, marital status, living arrangement, employment), and different
substances (tobacco, alcohol, cannabis, opium, volatile solvents, inhalants, sedatives/hypnotics, injecting drug use),
to ‘Geospatial’ points. The five different thematic maps were drawn, e.g., country, regions of north; central and
western; south; and eastern and north eastern for the period of data collection (2006-2015).
Results
There were substantial difference in the pattern and prevalence of substance use across regions. Although, alcohol
and tobacco were the most common substance of abuse, marked increasing trend was also observed for cannabis
and inhalants.
Conclusions
The GIS based information provides evidence for varying typology of substance use at country and regional level for
India.
Learning Objectives:
1. Understanding the Epidemiology of Substance Use, through Drug Abuse Monitoring System
2. Conversion of Cross Sectional Data to Geo-Spatial Points through GIS Methodology
25
P 24: Differences in care and needs in the opioid dependent population in Northern vs Southern Ontario
Kristen Morin
Email [email protected]
Objective: Opioid-dependence is a major health issue in Ontario, Canada; and as of 2015, there are over 42,000
people enrolled in opioid-agonist therapy (OAT). OAT is the standard of care for opioid dependence; but, there is a
recognized need for access to supportive programming to address concurrent health issues, including mental health.
Approximately half of patients enrolled in OAT have a co-occurring mental health related diagnosis. Recently, our
group demonstrated that patients in the Northern Region of the province had better OAT treatment outcomes as
compared to patients in Southern regions. The goal of this study is to characterize differences in OAT in Northern
Ontario and Southern Ontario with respect to patient demographics, psychiatric diagnosis, co-morbidities and health
system usage.
Methodology: Data from a cohort of patients who had engaged with the mental health system and were in Methadone
Maintenance Treatment and/or Buprenorphine Maintenance treatment (MMT/BMT) retrieved from the Institute of
Clinical and Evaluative Sciences (ICES) database was used. Based on Ontario Health Insurance Plan billing codes
from 2008 to 2014, the cohort was stratified into northern and southern Ontario and by model of care for mental
health treatment. Data were analyzed descriptively and groups were compared.
Results: There is a higher proportion of patients receiving MH services who are in MMT/BMT in the North (p <.001),
but a higher proportion of claims for MMT/BMT in southern Ontario. The MMT cohort in Northern Ontario is younger
with a higher proportion of females than the MMT cohort in Southern Ontario (p-value <.001). A higher proportion of
people with acute mental illnesses are being treated in specialist care in both jurisdictions, but a higher proportion of
drug addiction is being treated in primary care settings in the north. The rates of HIV in northern Ontario are higher
compared to Southern Ontario (p<.001). Resource use for non-mental health issues, emergency department visits
and hospitalizations are higher in the north compared to the south for patients in MMT/BMT (p <.001).
Conclusion: These findings suggest that there is a difference in mental health and addiction needs and service use in
northern and southern regions of the province. There is a higher proportion of MMT/BMT patients in northern Ontario,
but there is a higher number of service provision in southern Ontario. There are also gender and age differences
between north and south cohorts; differences in care provision; differences in co-morbidities; and differences in
number of hospitalizations and emergency department visits. We encourage policy makers and planners to consider
these differences to facilitate greater change in mental health and addiction outcomes in Ontario.
Learning Objectives:
1. After this presentation participants will understand the current state Medication assisted Therapy for opioid
dependence in Northern Ontario
2. After this presentation, participants will appreciate the barriers and enablers to service coordination for opiate
dependence in Northern Ontario
26
P 25: First Year Outcomes in Dually Diagnosed Patients Receiving Injectable Naltrexone at Discharge from
Private Residential Treatment
Author(s): Siobhan A. Morse, MHSA, CRC, CAI, MAC, Brioan Bride, MSW, PhD
5409 Maryland Way #320, Brentwood, TN 37027, USA
Email [email protected]
The objective of this study was to examine the impact of injectable naltrexone on the post-discharge outcomes of
individuals who received private, residential treatment for co-occurring substance use and mental health disorders.
Participants completed a baseline instrument at intake and again at 30 days, 6-months, and 12-months post
discharge that included items from the following measures: ASI Lite, Treatment Service Review, WHO Quality of Life
Questionnaire, Beck Depression Inventory, Beck Anxiety Inventory, and DSM Criteria for Substance Use Disorder. In
addition to 25-30 days of integrated, residential treatment for co-occurring SUD and mental health disorder,
participants received an injection of naltrexone within 72 hours prior to discharge, and a prescription for 11 months of
injectable naltrexone at discharge. Participants reported a reduction in substance use, particularly opiates, as well as
improvement in a variety of psychosocial outcomes.
Learning Objectives:
1. Evaluate the effectiveness of injectable naltrexone following private residential treatment compared to
patients not receiving injectable naltrexone
2. Evaluate patient compliance with injectable naltrexone following private residential treatment.
27
P 26: Implementation of a Standardized Clinical Screening Battery for an Inpatient and Outpatient Concurrent
Disorders Program: Initial Findings
Author(s): Holly Raymond, Michael Amlung, Prabjhot Saini, Jodi Younger, Iris Balodis, and James MacKillop
Peter Boris Centre for Addictions Research. 100 West 5th Street; Hamilton ON L8N 3K7 Canada
Email: [email protected]
Background and Objective: Epidemiological studies consistently reveal high rates of comorbidity between addictive
disorders and other psychiatric disorders (i.e., concurrent disorders, CD). Given the substantial heterogeneity in CD,
comprehensive screening of symptom profiles is critical for focused and efficient treatment. The objective of this
study was to implement a standardized clinical screening battery to aid diagnosis and treatment of individuals with
CD.
Methodology: Inpatient and outpatient clients in the CD program at St. Joseph’s Healthcare Hamilton completed a
computerized questionnaire battery during an intake assessment. The battery comprised validated measures of
substance use (e.g., alcohol, drugs, tobacco) and a range of psychiatric disorders (e.g., depression, bipolar disorder,
psychosis, borderline personality, etc.). Each client’s responses are automatically scored to generate a one-page
clinician report summarizing substance use and mental health status.
Results: We will present findings from an initial cohort of clients from the inpatient and outpatient CD clinics. At
present, data are available for 101 outpatients. Preliminary analyses indicated significant correlations between
elevated drug use severity and higher scores on each of the psychiatric scales examined, including symptoms of
depression, bipolar disorder, psychosis, PTSD, and borderline personality. Multiple regression analyses indicated
that depression and bipolar disorder scales accounted for unique variance in drug use severity.
Conclusions: These preliminary results may offer useful strategies for other mental health programs that seek to
address CD. In addition, this approach represents a bench-to-bedside partnership between academic researchers
and treatment providers that is consistent with a growing emphasis on translational research in psychiatry.
Learning Objectives:
1. Increase understanding of the scope and challenges associated with treatment for individuals with concurrent
disorders
2. Learn about the implementation of a standardized electronic screening battery for concurrent disorders and initial
empirical findings from this project
28
P27: Non-opioid Protocol for Outpatient Opioid Detoxification and Transition to Antagonist Treatment
Author(s): Vania Rudolf MD, MPHFASAM, James Walsh, MD, Paul Gianutsos, MD, MPH, Kaitlan Baston, MD ,
Gregory Rudolf, MD
Swedish Medical Center Addiction Recovery Service, Seattle, WA
Email [email protected]
Background: Successful transition from active opioid use to intramuscular extended release naltrexone (XR-NTX)
depends upon effective management of opioid withdrawal symptoms. Effective therapies to facilitate induction onto
antagonist treatment are greatly needed.
Objective: Using a case series design, the study examines a novel non-opioid and non-benzodiazepine approach
used to transition patients from active opioid addiction to outpatient XR-NTX treatment.
Methods: Twenty opioid dependent individuals were offered a 7-10 day outpatient XR-NTX induction procedure
which consisted of detoxification, home-based initiation of low dose oral naltrexone (NTX), and an in-office XR-NTX
injection. Protocol medications included scheduled tizanidine, gabapentin and hydroxyzine. Treatment was
supervised by daily telephone and scheduled office visits as well as in home sober support to monitor the process.
Primary outcomes measured completion of outpatient detoxification and successful XR-NTX induction. Secondary
outcomes were length of detoxification, length of NTX and XR-NTX initiation, opioid and other drug use measured by
urine drug screen (UDS), adverse events, and engagement in chemical dependency treatment.
Results: Fourteen of the twenty subjects (70%) completed the detoxification and transitioned to XR-NTX. Mean
[range] of detoxification treatment was 6.8 [5-15] days, mean time to home oral NTX was 7 [3-25] days and mean
time to XR-NTX was 10 [4-25] days. No serious adverse events were reported. Treatment engagement (P=.016),
rates of opioid (P < .001), and drug use for more than one substance (P=.002) significantly improved after
detoxification and initiation of XR-NTX compared with baseline. Eight of the fourteen subjects (57%) received a
second XR-NTX.
Conclusions: Outpatient XR-NTX induction via this novel approach was completed by most participants, suggesting
feasibility for withdrawal management and transition to antagonist treatment. Further studies are needed to identify its
place within the spectrum of available therapies.
References:
1. Sigmon SC, Bisaga A, Nunes EV, O’Connor PG, Kosten T, Woody G. Opioid Detoxification and Naltrexone
Induction Strategies: Recommendations for Clinical Practice. Am J Drug Alcohol Abuse 2012 May;38(3):187-99
2. Mannelli P, Wu LT, Peindl KS, Swartz MS, Woody GE. Extended release naltrexone injection is performed in the
majority of opioid dependent patients receiving outpatient induction: a very low dose naltrexone and buprenorphine
open label trial. Drug Alcohol Depend 2014 May
Learning Objectives:
1. Learn about a novel pharmacotherapeutic combination of non-opioid and non-benzodiazepine medications used to
transition patients from active opioid physiologic dependence to antagonist therapy in an outpatient office setting
29
P28: Adherence among opioid dependent patients treated with buprenorphine in a length of treatment study
Author(s) Name: Vladimir Zah1, Nikolay Matveev1, Martina Imro1, Jane Ruby2
1) ZRx Outcomes Research Inc, Toronto, Canada
2) Indivior Inc., Richmond, VA
ZRx Outcomes Research Inc., 3373 Cawthra Rd., Mississauga, ON L5A 2X8, Canada
Email [email protected]
Introduction: A previous study was conducted to identify the optimal minimum length of treatment (LOT) in medically
discontinued opioid dependent patients treated with buprenorphine medication assisted treatment (BMAT) in 6 time
treated cohorts. 12-17 months cohort demonstrated the lowest use of Medicaid resources after treatment.
Objective: To explore the adherence patterns across the six time treated, medically discontinued patient cohort
groups to identify elements for the development of unique patient profiles in successfully treated patients.
Methodology: A retrospective analysis of medication possession ratio (MPR) and proportion of days covered (PDC)
across 6 LOT cohorts was conducted using Truven Health MarketScan Medicaid database from 2007–2014, 1665years old (N=29,062). MPR and PDC values were compared across the following 6 LOT groups (months): 1) 35(N=495), 2) 6-8(N=372), 3) 9-11(N=257), 4) 12-17(N=417), 5) 18-23(N=289), and 6) 24+(N=804).
Results: 3-5 vs. 24+ months LOT cohort comparison demonstrated a mean MPR of 0.948(SD=0.283) vs.
0.728(SD=0.303), and a mean PDC 0.860(SD=0.155) vs. PDC=0.672(SD=0.275), respectively.
Intergroup comparisons of MPR and PDC demonstrated statistically significant differences (p<0.05).
The proportion of patients with a high MPR (>1.1) and PDC (>0.99) significantly decreased as LOT increased. For
LOT 3-5 vs. 24+ months group the percentage of patients with high MPR decreased from 10.7% to 3.5% and the
PDC decreased from 13.7% to 1.7%.
Conclusions: Both MPR and PDC decreased with longer lengths of treatment. Longer length of treatment, already
associated with lower resource use and costs, were also associated with adherence and less indication of abuse and
diversion.
Learning Objectives:
1. Medication Possession Ratio (MPR) as a measure of adherence in successfully treated opioid dependence patient
demonstrated steady decrease in proportion of patients considered potential opioid abusers as length of treatment
increased.
2. Proportion of days covered (PDC) as a more conservative measure of adherence in successfully treated opioid
dependence patient demonstrated steady decrease in proportion of patients considered potential opioid abusers as
length of treatment increased.
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P29: Patient characteristics among opioid dependent buprenorphine treated patients in a length of treatment
study
Author(s) Name: Vladimir Zah1, Nikolay Matveev1, Martina Imro1, Jane Ruby2
1) ZRx Outcomes Research Inc, Toronto, Canada
2) Indivior Inc., Richmond, VA
ZRx Outcomes Research Inc., 3373 Cawthra Rd., Mississauga, ON L5A 2X8, Canada
Email [email protected]
Introduction: Previous studies demonstrated differences in patterns of resource use and cost across the groups of
patients who were medically discontinued after different lengths of treatment (LOT), with buprenorphine medicated
assisted treatment (BMAT).
Objective: The objective of the study was to explore similarities and differences in patient characteristics for patients
medically discontinued across 6 time treated cohort groups particularly the group 12-17months, previously identified
as the optimal minimum LOT.
Methodology: A retrospective analysis of demographic characteristics of opioid dependent patients previously
treated with BMAT and medically discontinued after 3-5, 6-11, 12-17, 18-23, and 24+ months was conducted on the
Truven Health MarketScan Medicaid dataset between 2007- 2014, age of 16-65 years (N=29,062) treated with at
least 2 pharmacy fills of buprenorphine (all formulations) for a minimum 3 months. Medical discontinuation was
defined as either the last dose as lower than the preceding dose or lower than the average daily dose for the entire
treatment period. Mean age, gender, and race were compared across all six LOT groups.
Results: There were no statistically significant differences in the demographic characteristics (age, gender, or race)
of controlled discontinued patients among all six LOT groups (p>0.1 for all intergroup comparisons).
Conclusions: In a group of medically controlled BMAT patients where 12-17 months was previously identified as the
optimal minimum length of treatment, there were no significant differences in general demographic characteristics.
Learning Objectives:
1. Among patients that medically discontinue over different periods of treatment time, there was no statistical age
difference.
2. Among patients that medically discontinue over different periods of treatment time, there was no statistical gender
or race difference.
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P30: CIWA-Ar protocol versus scheduled benzodiazepine during alcohol detoxification, a retrospective study
Author(s): Zeeuws Dieter*, Muiser Susan, Tarsimi Aïcha, Buyl Ronald, Heersema D.J, Matthys Frieda
*University Hospital (UZ Brussel), Psychiatric Department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090
Brussels, Belgium
Email [email protected]
Objective: At the ‘Universitair Ziekenhuis Brussel’ we altered our benzodiazepine substitution for alcohol
detoxification in July 2013. The ‘individually determined fixed-schedule digressive dosing’ protocol was then replaced
by the ‘symptom-triggered dosing with the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised’
(CIWA-Ar). We investigated whether this decreased the total of benzodiazepine administered and if less discharged
patients were still on benzodiazepine substitution.
Methods: For this retrospective cohort study 167 patient records were reviewed in two periods; February 1st 2013 to
June 30th 2013 (scheduled dosing) compared to February 1st, 2014 to June 30th 2014 (CIWA triggered dosing). We
included all patients admitted for alcohol detoxification.
Results: There was a significant difference in the total amount of benzodiazepines used between the scheduled
dosing group (400.18 ± 297.64 mg) and the CIWA triggered dosing group (62.5 ± 86.91 mg). There was also a
significant difference in the number of patients that still needed benzodiazepine substitution at discharge (31.7% vs.
7.1%) and the duration of benzodiazepine substitution (12.80±8.91 days vs. 2.96±3.87 days). Baseline patient
characteristics did not differ.
Conclusions: Introduction of the symptom-triggered protocol with CIWA-Ar led to a decrease in total benzodiazepine
substitution dose and duration. Additionally, fewer patients were discharged while remaining under substitution.
These findings confirm the advantage of symptom-triggered over fixed-schedule dosing for in hospital alcohol
detoxification.
Learning Objectives:
1. In Alcohol detoxification fewer benzodiazepines are needed with the symptom-triggered CIWA-Ar protocol
2. The duration of benzodiazepine substitution is shorter when a symptom-triggered CIWA-Ar protocol is applied in
alcohol detoxification.
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