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Can we predict recovery trajectories from initial assessment information and early engagement in those enrolled in opioid replacement therapy for the first time?

A 2019/2020 Summer Studentship research project

Better understanding of current drug presentations, aspects of initial presentation and response to treatment will assist CORS in choosing specific elements of treatment to enable a faster response for those likely to be early responders; as well as early identification of those at risk of non-response or dropping out so great attention can be given to enhancing engagement.

Student: Cassian Duthie
Supervisors: Jenny Jordan, Dr Katharine Shaw, Dr Carmen Lowe, Mike Donaldson, Tony Harley, Pam Dimond
Sponsor: Canterbury Medical Research Foundation

Introduction

It is well established that many of those referred for opioid substitution treatment (OST) also have complex psychiatric presentations with marked psychosocial and socioeconomic disadvantage (1). Previous studies of engagement have examined patient predictors, service issues and aspects related to the fit of patient and service e.g. misalignment of goals (2). OST is a harm reduction strategy aiming to stabilise drug use in those dependent on opiates. There are very well-established benefits for the individual (3), whanau and society (e.g. reduced crime, increased work capacity). Many seeking OST are desperate for help but continue to struggle to with motivation to change and to stop illicit drug use. Engagement with OST is essential for benefits to occur and dropping out or being removed from the programme has significant negative consequences.

Aim

To determine whether initial assessment data and early engagement with the service predicts treatment trajectories in those enrolled for the first time in OST

Method

This study is an audit of routine clinical data collected at CORS. A full clinical assessment is collected at entry to the service, including a substance use disorder history, other psychiatric diagnosis, routine bloods and a urine drug toxicology screen, and impact of substance use disorder on psychosocial functioning.
New referrals from November 2017 – October 2018 (there are up to 120 referrals per year) to CORS for establishment on OST will be included in the audit. This will allow examination of recovery trajectories over 12 months.

Initial assessment data extracted from Healthlinks will be SUD and psychiatric diagnoses mood anxiety, trauma, other diagnoses), the ADOM (substance use and psychosocial functioning) results of the baseline ECG, and physical examination findings. Urine toxicology data will be extracted from ÉCLAIR. CORS prescribing data regarding type of opioid replacement chose (Suboxone or Methadone). Treatment progress will be rated according to percentage of missed appointments, missed doses, continued use of non-prescribed substances, response to treatment based on change on standardized measures (ADOM). The Global Clinical Impression scale will be rated by a clinical based on progress reviews over the first 6 months, at 12 months and / or on last contact with the service. Biostatistician advice will be sought regarding differentiating recovery trajectories based on characteristics of the data but the likely method is group-based trajectory modelling using SPSS and R.

Student researcher’s component of the study

With supervisor guidance, the student will conduct the audit, extract file information from computerized clinical databases and file notes, enter data in excel, analyse data using descriptive and modelling statistics. In addition to the summer studentship requirements of the written report and presentation, the student do an oral presentation of findings to the CORS team. The student will offered authorship on any publications arising from the project.

References

  1. Pikovsky M, Peacock A, Larney S, Larance B, Conroy E, Nelson E, et al. Alcohol use disorder and associated physical health complications and treatment amongst individuals with and without opioid dependence: A case-control study. Drug & Alcohol Dependence. 2018;188:304-10.
  2. Bojko MJ, Mazhnaya A, Marcus R, Makarenko I, Islam Z, Filippovych S, et al. The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment. J Subst Abuse Treat. 2016;66:37-47.
  3. Peles E, Schreiber S, Sason A, Adelson M. Similarities and changes between 15- and 24-year survival and retention rates of patients in a large medical-affiliated methadone maintenance treatment (MMT) center. Drug & Alcohol Dependence. 2018;185:112-9.

Student Prerequisites

Medical, psychology, or other health sciences student

How to apply

Email jenny.jordan@otago.ac.nz