title: Effects of nurse-delivered home visits combined with telephone calls on medication adherence and quality of life in HIV-infected heroin users in Hunan of China. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial Improved Quality of Life for Opioid-Dependent Patients Receiving Buprenorphine Treatment in HIV Clinics A randomized trial of effectiveness and cost-effectiveness of observed versus unobserved administration of buprenorphine-naloxone for heroin dependence. Staff attitudes and retention of patients in methadone maintenance programs. Pre-treatment characteristics, program philosophy and level of ancillary services as predictors of methadone maintenance treatment outcome. The Sickness Impact Profile: Development and Final Revision of a Health Status Measure Effects of a randomized contingency management intervention on opiate abstinence and retention in methadone maintenance treatment in China. Buprenorphine versus methadone in the treatment of opioid dependence: self-reports, urinalysis, and addiction severity index. Sublingual Buprenorphine and Methadone Maintenance Treatment: A Three-Year Follow-Up of Quality of Life Assessment The effectiveness of methadone maintenance treatment: an overview.
abstract: AIMS AND OBJECTIVES This study aim ed to examine the effects of nurse-delivered home visits combined with telephone intervention on medication adherence , and quality of life in HIV-infected heroin users . BACKGROUND Drug use is consistently reported as a risk factor for medication non-adherence in HIV-infected people . DESIGN An experimental , pretests and post-tests , design was used : baseline and at eight months . METHODS A sample of 116 participants was recruited from three antiretroviral treatment sites , and 98 participants completed the study . They were r and omly assigned to two groups : 58 in the experimental group and 58 in the control group . The experimental group received nurse-delivered home visits combined with telephone intervention over eight months , while the control group only received routine care . The question naire of Community Programs for Clinical Research on AIDS ( CPCRA ) Antiretroviral Medication Self-Report was used to assess levels of adherence , while quality of life and depression were evaluated using Chinese versions of World Health Organization Quality of Life Instrument-Abbreviated version ( WHOQOL-BREF ) and Self-rating Depression Scale , respectively . Data were obtained at baseline and eight months . RESULTS At the end of eight months , participants in the experimental group were more likely to report taking 100 % of pills ( Fisher 's exact = 14.3 , p = 0.0001 ) and taking pills on time ( Fisher 's exact = 18.64 , p = 0.0001 ) than those in the control group . There were significant effects of intervention in physical ( F = 10.47 , p = 0.002 ) , psychological ( F = 9.41 , p = 0.003 ) , social ( F = 4.09 , p = 0.046 ) and environmental ( F = 4.80 , p = 0.031 ) domains of WHOQOL and depression ( F = 5.58 , p = 0.02 ) . CONCLUSIONS Home visits and telephone calls are effective in promoting adherence to antiretroviral treatment and in improving the participants ' quality of life and depressive symptoms  in HIV-infected heroin users . RELEVANCE TO CLINICAL PRACTICE It is important for nurses to recognise the issues of non-adherence to antiretroviral treatment in heroin users . Besides st and ard care , nurses should consider conducting home visits and telephone calls to ensure better health outcome of antiretroviral treatment in this population BACKGROUND The partial opiate-receptor agonist buprenorphine has been suggested for treatment of heroin dependence , but there are few long-term and placebo-controlled studies of its effectiveness . We aim ed to assess the 1-year efficacy of buprenorphine in combination with intensive psychosocial therapy for treatment of heroin dependence . METHODS 40 individuals aged older than 20 years , who met DSM-IV criteria for opiate dependence for at least 1 year , but did not fulfil Swedish legal criteria for methadone maintenance treatment were r and omly allocated either to daily buprenorphine ( fixed dose 16 mg sublingually for 12 months ; supervised daily administration for a least 6 months , possible take-home doses thereafter ) or a tapered 6 day regimen of buprenorphine , thereafter followed by placebo . All patients participated in cognitive-behavioural group therapy to prevent relapse , received weekly individual counselling sessions , and su bmi tted thrice weekly supervised urine sample s for analysis to detect illicit drug use . Our primary endpoint was 1-year retention in treatment and analysis was by intention to treat . FINDINGS 1-year retention in treatment was 75 % and 0 % in the buprenorphine and placebo groups , respectively ( p=0.0001 ; risk ratio 58.7 [ 95 % CI 7.4 - 467.4 ] ) . Urine screens were about 75 % negative for illicit opiates , central stimulants , cannabinoids , and benzodiazepines in the patients remaining in treatment . INTERPRETATION The combination of buprenorphine and intensive psychosocial treatment is safe and highly efficacious , and should be added to the treatment options available for individuals who are dependent on heroin Background : Opioid dependence and HIV infection are associated with poor health-related quality of life ( HRQOL ) .  Buprenorphine/naloxone ( bup/nx ) provided in HIV care setting s may improve HRQOL . Methods : We surveyed 289 HIV-infected opioid-dependent persons treated with clinic-based bup/nx about HRQOL  using the Short Form Health Survey ( SF-12 ) administered at baseline , 3 , 6 , 9 , and 12 months . We used normalized SF-12 scores , which correspond to a mean HRQOL of 50 for the general US population ( SD 10 , possible range 0 - 100 ) . We compared mean normalized mental and physical composite and component scores in quarters 1 , 2 , 3 , and 4 with baseline scores using generalized estimating equation models . We assessed the effect of clinic-based bup/nx prescription on HRQOL composite scores using mixed effects regression with site as r and om effect and time as repeated effect . Results : Baseline normalized SF-12 scores were lower than the general US population for all HRQOL domains . Average composite mental HRQOL improved from 38.3 ( SE 12.5 ) to 43.4 ( SE 13.2 ) [ β 1.13 ( 95 % CI : 0.72 to 1.54 ) ] and composite physical HRQOL remained unchanged [ β 0.21 ( 95 % CI : −0.16 to 0.57 ) ] over 12 months follow-up . Continued bup/nx treatment across all 4 quarters was associated with improvements in both physical [ β 2.38 ( 95 % CI : 0.63 to 4.12 ) ] and mental [ β 2.51 ( 95 % CI : 0.42 to 4.60 ) ] HRQOL after adjusting for other contributors to HRQOL . Conclusions : Clinic-based bup/nx maintenance therapy is potentially effective in ameliorating some of the adverse effects of opioid dependence on HRQOL for HIV-infected population AIMS To compare the effectiveness and cost-effectiveness of unobserved versus observed dosing of patients seeking treatment of heroin dependence . DESIGN R and omized controlled trial and cost-effectiveness analysis . Setting Specialist out-patient drug treatment centres in Australia . PARTICIPANTS Heroin users seeking maintenance treatment . INTERVENTION Participants were allocated r and omly to observed or unobserved dosing for 3 months . All subjects received buprenorphine-naloxone and weekly clinical review s. MEASUREMENTS Primary end-points were retention in treatment and heroin use at 3 months . Costs of treatment were measured ( in Australian dollars , AU$ ) and cost-effectiveness compared . Secondary outcomes included quality of life , psychological symptoms and use of non-opioid drugs . FINDINGS A total of 119 subjects were r and omized and analysed . At 3 months , 33/58 ( 57 % ) r and omized to unobserved treatment , and 37/61 ( 61 % ) observed were retained ( log-rank chi2 = 0.04 , df = 1 , P = 0.84 ) . On an intention-to-treat analysis , reductions in days of heroin use in the preceding month , from baseline to 3 months , did not differ significantly ; 18.5 days ( 95 % CI : 21.8 - 15.3 ) and 22.0 days ( 95 % CI : 24.3 - 19.7 ) , respectively ( Mann-Whitney U = 807.5 , P = 0.13 ) . The mean cost for the unobserved group was AU$1,663 ( 95 % CI 1308 - 2017 ) per treatment episode , significantly less than the mean cost for the observed group at AU$2,138 ( 95 % CI 1713 - 2562 ) . CONCLUSIONS Retention and heroin use was not significantly different between observed and unobserved dosing groups . Attendance for observed dosing was not associated with worse retention . Treatment with close clinical monitoring , but no observation of dosing , was significantly cheaper and therefore significantly more cost-effective A study was made of the effect of staff commitment to abstinence-oriented policies on retention of  patients in methadone maintenance . Staff working in six public methadone programs in Sydney , Australia , were surveyed in 1989 and 1992 using the  Abstinence Orientation Scale . The association of the clinics ' median Abstinence Orientation scores with the time in treatment of a r and om sample of their 1988 - 1989 admissions was summarised using Cox regression . Patients ' risk of discharge increased by a factor of three with every one unit increase in the clinics ' median Abstinence Orientation scores , ( RR 3.4 , 95 % CI 2.3 - 5.0 ) . Abstinence-oriented policies were shown to disadvantage ex-prisoners Predictors of methadone maintenance treatment outcome have not been extensively studied as they relate to variations in program philosophy , nor have such predictors received much examination among recently treated , older cohorts of opioid addicts for whom drug use patterns have changed . Predictors of outcome were examined at 18 months post-treatment entry for 353 admissions to methadone maintenance who received r and om assignment to one of three counseling conditions : ( 1 ) medication only , ( 2 ) st and ard counseling and ( 3 ) enhanced services ; and one of two contingency conditions : ( 1 ) no contingencies , and ( 2 ) contingency contracting in a six-cell 3 x 2 design . Subjects in contingency contracting conditions were placed on contingency contracts for positive urine toxicology results and ultimately discharged for unremitting drug use . All subjects completed the Addiction Severity Index ( ASI ) and provided weekly urine specimens . Predictors of urinalysis results and treatment retention were determined using bivariate and multivariate techniques . Interactions between subject characteristics by experimental condition assignment were also examined as predictors . Higher rates of total positive urine specimens were predicted by younger age , greater pre-treatment frequency of smoking cocaine , lower ASI psychiatric composite scores , and higher ASI legal composite scores . Higher rates of opiate positive specimens were predicted by younger age , lower pre-treatment frequency of alcohol intoxication , higher ASI legal and lower ASI employment and psychiatric composite scores , and assignment to medication only/no contingencies condition . Higher rates of cocaine positives were predicted by younger age , black race , lower ASI psychiatric composite score , greater pre-treatment frequency of intravenous and smoked cocaine use , less pre-treatment frequency of marijuana use , and lower methadone dose level . Assignment to enhanced/contingency contracting predicted lower rates of cocaine positives . Treatment retention was predicted by older age , non-black race , lower ASI legal composite score , higher methadone dose level and assignment to non-contingent conditions . While subject variables over which treatment providers have little control were , thus , related to outcome , type of treatment provided and methadone dose also influenced outcome The final development of the Sickness Impact Profile ( SIP ) , a behaviorally based measure of health status , is presented . A large field trial on a r and om sample of prepaid group practice enrollees and smaller trials on sample s of patients with hyperthyroidism , rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses . Test-retest reliability ( r = 0.92 ) and internal consistency ( r = 0.94 ) were high . Convergent and discriminant validity was evaluated using the multitrait – multi method technique . Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores . The relationship between the SIP and criterion measures were moderate to high and in the direction hypotheszed . A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis . The final SIP contains 136 items in 12 categories . Overall , category , and dimension scores may be calculated AIMS Methadone maintenance treatment has been made available in China in response to the rapid spread of human immunodeficiency virus ( HIV ) , but high rates of dropout and relapse are problematic . The aim of this study was to apply and test if a contingency management ( or motivational incentives ) intervention can improve treatment retention and reduce drug use . DESIGN R and om assignment to usual care with ( n = 160 ) or without ( n = 159 ) incentives during a 12-week trial . Incentives participants earned draws for a chance to win prizes on two separate tracks targeting opiate-negative urine sample or consecutive attendance ; the number of draws increased with continuous abstinence or attendance . SETTING Community-based methadone maintenance clinics in Shanghai and Kunming . PARTICIPANTS The sample was 23.8 % female , mean age was 38 , mean years of drug use was 9.4 and 57.8 % had injected drugs in the past 30 days . MEASUREMENTS Treatment retention and negative drug urine . FINDINGS Relative to the treatment-as-usual ( control ) group , better retention was observed among the incentive group in Kunming ( 75 % versus 44 % ) , but no difference was found in Shanghai ( 90 % versus 86 % ) . Su bmi ssion of negative urine sample s was more common among the incentive group than the usual care ( 74 % versus 68 % in Shanghai , 27 % versus 18 % in Kunming ) , as was the longest duration of sustained abstinence ( 7.7 weeks versus 6.5 in Shanghai , 2.5 versus 1.6 in Kunming ) . The average total prize amount was 371 Yuan ( or $ 55 ) per participant ( 527 for Shanghai versus 216 in Kunming ) . CONCLUSIONS Contingency management improves treatment retention and drug abstinence in methadone maintenance treatment clinics in China , although there can be considerable site differences in magnitude of effects This article reports results for patients who completed the 16-week maintenance phase of a double-blind clinical trial comparing buprenorphine ( N = 43 ; average dose = 9.0 mg/day sublingually ) with methadone ( N = 43 ; average dose = 54 mg/day orally ) in the outpatient treatment of opioid dependence . In addition to pharmacotherapy , treatment during the clinical trial included individual counseling , weekly group therapy , and on-site medical services . Patients in both medication groups showed significant and substantial improvements over time in areas of psychosocial functioning , as assessed by the Addiction Severity Index , rates of urinalysis tests positive for opioids , and self-reports of opioid withdrawal symptoms , illicit opioid use , and cocaine use .  Buprenorphine and methadone produced very similar outcomes on the wide array of outcome measures assessed , and improvements for both groups were large and occurred rapidly after treatment entry . A trend toward continued improvement in opioid-positive urines over time was noted for the buprenorphine but not the methadone group . These results provide further evidence of the efficacy of buprenorphine in the treatment of opioid dependence and provide a characterization of the time course of effects for buprenorphine and methadone . In addition , these results demonstrate the benefits of drug abuse treatment , both for drug and alcohol use and in other areas of psychosocial functioning This study was conducted to compare long-term outcome effects on the quality of life ( QOL ) of oral methadone with sublingual buprenorphine maintenance treatment . The QOL status of opioid-dependent patients was assessed using the German version ( “ Berlin Quality of Life Profile ” ) of the Lancashire Quality of Life Profile . Physical symptoms were measured using the Opiate Withdrawal Scale ( OWS ) . Urine tests were carried out r and omly to detect additional consumption . In the first study period , 53 opioid-dependent subjects were enrolled and 25 could be reached after 3 years . The retention rate was 50 % for methadone and 45 % for buprenorphine ( p = 0.786 ) . Baseline values of the total sample ( completers and noncompleters ) QOL and somatic complaints did not show significant differences between the two treatment groups . QOL characteristics at 6 months of treatment of the buprenorphine completer and noncompleter groups differed significantly regarding job ( p = 0.013 ) , family , and total score of physical symptoms ( p = 0.002 ) , in which the completer group showed the more favorable values . Concerning physical symptoms at 36 months , logistic regression revealed significantly less stomach cramps ( p = 0.037 ) and fatigue and tiredness ( p = 0.034 ) in buprenorphine compared to the methadone . Moreover , the buprenorphine-maintained group showed significantly less additional consumption of benzodiazepines ( p = 0.015 ) compared with methadone participants . It is concluded that opioid addicts improved their QOL and health status when treated with methadone or buprenorphine . In summary , regarding QOL and health status , the present data indicate that buprenorphine is also a useful long-term alternative for maintenance treatment of opioid-dependent patients This paper review s the evidence for the effectiveness of methadone maintenance as used in the treatment of opioid dependence . Findings from r and omized controlled trials and observational studies suggest that methadone maintenance reduces heroin use , crime , injection-related risk behaviours and premature mortality among people dependent on opioids . The research further suggests that two aspects of treatment are important in ensuring this effectiveness . Methadone treatment is more effective when higher doses ( > 50 mg ) are employed and , overall , the evidence suggests that a treatment goal of successful maintenance on methadone rather than total abstinence is appropriate . The importance of ancillary services in treatment outcome is less clear and is the subject of current research and debate
target: Dosage of pharmacologic medication and length of follow-up did not affect changes in domain scores .
  WHOQOL-BREF and ASI domain scoring is a useful tool in measuring overall quality of life and levels of addiction among OST participants .
background: BACKGROUND Opioid substitution treatment ( OST ) can increase quality of life ( WHOQOL-BREF ) and reduce addiction severity index ( ASI ) scores among participants over time .
  OST program participants have noted that improvement in quality of life is one of the most important variables to their reduction in drug use .
  However , there is little systematic underst and ing of WHOQOL-BREF and ASI domain changes among OST participants in low and middle-income countries ( LMIC ) .