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Publications (8 of 8) Show all publications
Monwell, B. & Gerdner, A. (2019). Opioid maintenance treatment: trajectories in and out of treatment. Nordic Journal of Psychiatry
Open this publication in new window or tab >>Opioid maintenance treatment: trajectories in and out of treatment
2019 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725Article in journal (Refereed) Epub ahead of print
Abstract [en]

Problem: Although efficacy studies of opioid maintenance treatment (OMT) have shown evidence of treatment benefits, there is still need for studies on its effectiveness in natural clinical processes. This study investigates the development in health, substance use and social conditions of those who applied for OMT, including those denied access or discharged.

Method: First, persons assessed for admittance in 2005–2011 (n = 127) were categorized into four trajectory groups based on whether they were admitted or denied (n = 19), discharged (n = 31), readmitted (n = 21) or had been undergoing OMT without interruption (n = 56). Second, 99 of these, the analytical sample, were interviewed at follow-up using (a) the Addiction Severity Index (ASI) for seven problem-areas and housing, and (b) self-rated change in 11 problem areas. The ASI was compared to baseline interviews after 55 months (mean). Third, outcomes within groups was studied in relation to alternative interventions.

Results: Within the analytical sample, those denied OMT showed no improvements at group level, those discharged had some improvements, more if readmitted than if not and those with uninterrupted OMT showed the most comprehensive improvements. Those outside OMT, denied and discharged, had considerable mortality risks related to ongoing drug use, especially in lack of well-planned alternative interventions.

Conclusion: Improvements strongly relate to access to OMT. This study underscores that access to OMT improves the situation in all areas investigated and decreases the risk for drug-related death. It underscores the importance of two major risk situations, i.e. being denied OMT and being discharged.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Opioid maintenance treatment, drop-outs, treatment outcome, treatment process
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-42623 (URN)10.1080/08039488.2018.1539120 (DOI)30636473 (PubMedID)2-s2.0-85060035376 (Scopus ID)
Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-02-01
Monwell, B., Bülow, P. & Johnson, B. (2018). The pros and cons of supervised urine tests in opioid replacement therapy: A study of patients' experiences. Heroin Addiction and Related Clinical Problems, 20(6), 5-15
Open this publication in new window or tab >>The pros and cons of supervised urine tests in opioid replacement therapy: A study of patients' experiences
2018 (English)In: Heroin Addiction and Related Clinical Problems, ISSN 1592-1638, Vol. 20, no 6, p. 5-15Article in journal (Refereed) Published
Abstract [en]

Background and aim: In opioid maintenance treatment (OMT), drug testing is performed continuously to ensure that patients are taking their prescribed medication, and to detect whether they have taken other, non-prescribed, substances. Typically, supervised urine testing is conducted, and in Sweden such testing is often a treatment precondition. This study investigates OMT patients’ experiences of and views on supervised urine testing.

Methods: Structured interviews were conducted with 90 Swedish OMT patients. During the interview, patients were asked to say what they thought about the supervised urine tests required. The answers were then analysed through content analysis.

Results: Three main themes with sub-themes were found in the patients’ statements. 1) The consequences of the test results (sub-themes: external control can provide assurance; proven drug intake may have negative consequences for patients; proven drug abstinence can yield advantages for patients), 2) The testing procedures (sub-themes: supervised urine testing is humiliating and causes harm; how you are treated is important; clinical culture and attitudes differ; stress, pressure and anxiety – tests can be difficult to perform), and 3) The structure of the testing (sub-themes: structure is needed in life; inflexible testing schemes can interfere with treatment goals; gathering people with similar problems can be counterproductive).

Conclusions: Most interviewees found the testing functional as support or as proxy control in case of personal loss of control. However, supervised urine testing also constitutes a severe invasion of privacy. Less demeaning testing methods need to be developed and implemented.

Place, publisher, year, edition, pages
Associazione per l'Utilizzo delle Conoscenze Neuroscientifiche a fini Sociali (AU-CNS), 2018
Keywords
drug testing, supervised urine testing, opioid maintenance treatment, user perspective, methadone, buprenorphine
National Category
Substance Abuse
Identifiers
urn:nbn:se:hj:diva-37850 (URN)000452530100001 ()
Available from: 2018-11-01 Created: 2017-11-09 Last updated: 2018-12-20Bibliographically approved
Monwell, B. & Gerdner, A. (2017). Opiates versus other opioids – are these relevant as diagnostic categorizations?. Heroin Addiction and Related Clinical Problems, 19(6), 39-48
Open this publication in new window or tab >>Opiates versus other opioids – are these relevant as diagnostic categorizations?
2017 (English)In: Heroin Addiction and Related Clinical Problems, ISSN 1592-1638, Vol. 19, no 6, p. 39-48Article in journal (Refereed) Published
Abstract [en]

Background:

For more than three decades, the international diagnostic systems have used the term ‘opioids’, including opiates, yet research publications continue to use an older terminology. In 2010, new Codes of Statutes for “opiate replacement therapy” (ORT) was brought into effect in Sweden, stating that only those “dependent on opiates” – explicitly described as heroin, morphine or opium – were eligible. Those addicted to other opioids were then denied access. This study examines the relevance of the distinction of opiates vs. other opioids. Are there differences in the severity of opioid dependence or concerning other substance-related diagnoses?

Methods:

Ninety-nine individuals participated: 1) the opiate group (n = 69), and 2) the other opioids group (n=30). Structured interviews covered the ICD-10 criteria of nine different types of addictive substances. For opioids, questions were asked separately in relation to opiates versus other opioids.

Results:

The two groups fulfilled the criteria for opioid dependence to the same extent, with most participants meeting all six criteria, so indicating a severe opioid dependence problem. Both opiates and other opioids had contributed to their development of opioid dependence, and both groups, to the same high degree, showed comorbidity affecting other dependence conditions.

Conclusions:

This study reveals that the two categories of opioids used contribute to the development of opioid dependence and that the term ‘opioids’ can be suitably used to convey a unitary concept in diagnostic terms. There was no support for treating the two groups differently. The study calls for more stringent use of terminology in accordance with the international diagnostic systems.

Place, publisher, year, edition, pages
Associazione per l'Utilizzo delle Conoscenze Neuroscientifiche a fini Sociali, 2017
Keywords
Maintenance treatment; Buprenorphine; opioid; opiate; dependence; diagnosis; nosology
National Category
Substance Abuse Pharmacology and Toxicology
Identifiers
urn:nbn:se:hj:diva-37848 (URN)000416893800005 ()2-s2.0-85035240103 (Scopus ID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-02-05Bibliographically approved
Monwell, B. & Gerdner, A. (2017). Type of opioid dependence: Are there differences in background and severity of problems? . Heroin Addiction and Related Clinical Problems
Open this publication in new window or tab >>Type of opioid dependence: Are there differences in background and severity of problems?
2017 (English)In: Heroin Addiction and Related Clinical Problems, ISSN 1592-1638Article in journal (Refereed) In press
National Category
Substance Abuse Psychiatry Social Work
Identifiers
urn:nbn:se:hj:diva-37841 (URN)
Projects
LARO-projektetDiagnosinstrument
Available from: 2017-11-08 Created: 2017-11-08 Last updated: 2017-11-09
Monwell, B., Blix, O., Gerdner, A. & Bülow, P. (2016). Drug list as a cognitive support to provide detailed information on a patient's drug use: A comparison of two methods within the assessment of drug misuse and dependence. Substance Use & Misuse, 51(11), 1470-1476
Open this publication in new window or tab >>Drug list as a cognitive support to provide detailed information on a patient's drug use: A comparison of two methods within the assessment of drug misuse and dependence
2016 (English)In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 51, no 11, p. 1470-1476Article in journal (Refereed) Published
Abstract [en]

Background: It is important to identify the type of drugs a patient has used, especially when polydrug misuse has increased and new drugs and patterns of misuse are quickly spread. Objectives: In order to acquire sufficient information about drug use, an effective and simple form of mapping is needed.

Methods: Persons actualized for Opioid Substitution Treatment (n = 135) were interviewed about their drug-history in a two-stage model. First, they were asked to write down the drugs misused, and dot those injected with a felt pen. Second, they were asked to do the same on a drug list provided as a cognitive support. For a subsample of 50 persons, the drug list included four fictive drugs to evaluate possible over-reporting.

Results: The use of a drug list did not take longer than the traditional way of using open questions, i.e. about 5–8 minutes. Using a drug list gave a cognitive support resulting in a much higher proportion/number of reported drugs. The majority, 97%, used more than one drug. None of the patients who were given the drug list that included fictive drug names reported having used any of them. The respondents reported 43 additional substances to the 125 given on the list which improve our knowledge of the drug scene.

Conclusions/importance: Using a drug-list was superior to open questions; it does not take more time and provides additional, clinically relevant information than open questions. Using a drug-list also gives improved knowledge of new drugs entering the local drug scene.

Keywords
cognitive support, diagnostic instruments, drug anamnesis, opioid substitution therapy, Substance use disorders
National Category
Substance Abuse
Identifiers
urn:nbn:se:hj:diva-31258 (URN)10.1080/10826084.2016.1186697 (DOI)000382325500008 ()27355832 (PubMedID)2-s2.0-84976385510 (Scopus ID)
Available from: 2016-08-16 Created: 2016-08-16 Last updated: 2018-04-10Bibliographically approved
Monwell, B., Bülow, P. & Gerdner, A. (2016). Type of opioid dependence among patients seeking opioid substitution treatment: Are there differences in background and severity of problems?. Substance Abuse Treatment, Prevention, and Policy, 11(1), 1-8, Article ID 23.
Open this publication in new window or tab >>Type of opioid dependence among patients seeking opioid substitution treatment: Are there differences in background and severity of problems?
2016 (English)In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 11, no 1, p. 1-8, article id 23Article in journal (Refereed) Published
Abstract [en]

Background: The study explores differences and similarities in background and problem severity among those seeking Opioid Substitution Treatment (OST), comparing those who primarily had misused "opiates", e.g. heroin, morphine and opium, with those who primarily had misused other opioids.

Methods: Patients (n=127) assessed for possible admittance in OST are compared based on the Addiction Severity Index. Two groups based on primary type of opioid misused are compared (opiates vs. other opioids).

Results: In the global severity ratings there were no significant differences between the groups other than tautological artefacts concerning heroin. There were few specific differences between the groups. The opiate group more often had Hepatitis C and more often had legal problems related to financing their misuse. Injection of drugs was the main method of administration in both groups, i.e. 90 % for mostly opiates vs. 75 % for mostly other opioids. A great majority in both groups, 96 % vs. 91 %, had misused most other types of drugs. Both groups were found to have severe problems in all areas investigated.

Conclusions: The study demonstrates great similarities in problem severity among those seeking OST, both those who primarily had misused opiates and those who primarily had misused other opioids.

Keywords
Opiates, Opioid Substitution Treatment, Opioid-related disorders, Opioids
National Category
Substance Abuse
Identifiers
urn:nbn:se:hj:diva-31175 (URN)10.1186/s13011-016-0066-1 (DOI)000379329800001 ()27401680 (PubMedID)2-s2.0-84979655919 (Scopus ID)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, Sweden, FUTURUM-342201
Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2017-11-28Bibliographically approved
Monwell, B., Johnson, B. & Gerdner, A. (2015). Opiater eller opioider?: dags att städa bland begreppen. Läkartidningen (43), 1928-1929
Open this publication in new window or tab >>Opiater eller opioider?: dags att städa bland begreppen
2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 43, p. 1928-1929Article in journal (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
Läkartidningen Förlag, 2015
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:hj:diva-37846 (URN)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-01-13Bibliographically approved
Monwell, B., Blix, O., Bülow, P. & Gerdner, A. (2013). Ämneslista som kognitivt stöd gav utförligare uppgifter om droganvändning: Jämförelse av två metoder för utredning av opioidberoende. Läkartidningen, 110(48), 2178-2180
Open this publication in new window or tab >>Ämneslista som kognitivt stöd gav utförligare uppgifter om droganvändning: Jämförelse av två metoder för utredning av opioidberoende
2013 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 48, p. 2178-2180Article in journal (Other academic) Published
Keywords
opioid, missbruk, anamnes
National Category
Social Work Substance Abuse Psychiatry
Identifiers
urn:nbn:se:hj:diva-22637 (URN)
Available from: 2013-12-04 Created: 2013-12-04 Last updated: 2017-12-06Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1749-4727

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