Last session for me today at @APSAD40 on prescription opioids, treatment, and prescription drug monitoring programs. First up - a mini-symposium with @PPrathivadi , @LouisaPicco and @Sarah_Haines_ .. lets see if I can pull out a few key findings 1/
2/ First up @PPrathivadi talking about GPs use of PDMP, benefits for informing prescribing but challenges with reluctance to use technology - also check out this super commentary with @Sarah_Haines_ in the @AusJPrimHealth on evaluation considerations publish.csiro.au/py/PY20296
3/ Next is @LouisaPicco talking about implementation of prescription monitoring with #pharmacists. Alerts seem to really drive responses (over other clinical risk factors).. are automatic alerts replacing clinical judgement? Conclusion: PDMP should not replace clinical decisions
4/ @Sarah_Haines_ raises issue of stigma and other potential negative impacts of PDMPs on the consumer - powerful quotes from consumers. This is a critical implementation issue to address to avoid unintended consequences
5/ Fantastic presentation by @Ria_Hopkins at #apsad40 unpacking some of the challenges consumers are having accessing #opioids for chronic pain - around one in three reported difficulties accessing opioids for pain. Involuntary cessation is a huge concern.
6/ @DanWinter_AU (University of Sydney) presented on driving on Opioid Agonist Treatment .. around 3 in 10 drive, but that is higher in regional areas. Need for a careful balance with safety without unduly targeting those on treatment
7/ Isabella Natale (@BarwonHealth) why do 20% of people in OAT decline naloxone? Barriers include assuming it wont 'happen to me', facilitators include the opportunity to save friends lives (empowerment)
8/ Last but not least, Dr Martyn Lloyd (@AlfredHealth) case studies of injectable buprenorphine during inpatient admissions - conclusions supporting that long acting #buprenorphine has some key advantages, especially during a pandemic!
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At the #CPDD22 mini-symposium on #gabapentin talks about considerable research highlighting potential for SUD treatment but also high rates of identification in overdose. Prescribing continues to increase yet diversion appears to trend down after regulatory changes 1/
2/ anecdotal reports of #gabapentin enhancing opioid effects and reducing withdrawal. Motivation for use is a mix of non-medical use with other substances and therapeutic motivations e.g. to self manage pain/withdrawal
3/ increases in gapabentin increase in a linear manner compared with low/stable pregabalin prescribing (interesting this is reversed in Australia) - it is commonly being prescribed off label for substance use treatment
Really important study being presented by Staci Gruber at #CPDD22 which longitudinally assesses a whole range of functioning in cannabis naive ppl before and following use of medical cannabis (now 3 years of follow up funded) 1/
2/ most interested in use for pain, detailed info collected on cannabinoid use..including developing the cannacount metric to measure cannabinoid use
Most are using CBD dominant products, which include a range of other minor cannabinoids including CBG and CBC
David Ledgerwood talks about a pharmacist delivered contingency management in people with HIV who smoke - and of course I am super excited to see #pharmacists deliver these interventions #cpdd22 1/
2/ can pharmacists be trained to deliver contingency management for smoking cessation?
3/ yes! Of course they can. Pharmacists do really well in terms of delivering contingency management, especially discussing smoking and praising efforts and being generally skilful in smoking cessation
"Won't giving people #naloxone increase their drug use?" I get this question almost every time I deliver training to healthcare professionals. Superstar student @WaiChungTse1 led this systematic review to examine this common concern 1/ (FREE to download) authors.elsevier.com/c/1e5JG_LkIBSl…
2/ So what did we do? We looked for studies where substance use and overdose was measured before and after naloxone provision. We found no evidence that take-home naloxone leads to increased substance use or overdose. 1 study found reduced ED attendances following naloxone supply
3/ So if you are providing naloxone, or thinking about it, this might be reassuring. If you train pharmacists, doctors, first responders etc and they have concern.. please feel free to share this work with them! @PSA_National@RACGP@ijdrugpolicy authors.elsevier.com/c/1e5JG_LkIBSl…
Last afternoon of #APSAD40! It is a joy to chair this session on #overdose - lots of key learnings and great work in the prevention space. Here are a couple of highlights from the session 1/
2/ Louisa Durrant (NUM at Melaleuca, @qldhealthnews) spoke about lessons learned supplying take-home naloxone in the opioid treatment program in QLD. Despite many having experienced an overdose, few had access to naloxone before the pilot, and consumers valued being offered THN.
3/ Dr Eleanor Black presented on the ONE study, a pilot study looking at ED delivery of #naloxone - a key opportunity to offer naloxone to people at risk of overdose. Most (not all) staff through they should offer #naloxone, with common misconception of naloxone increased OD risk
What's new in take-home #naloxone in Australia? 1/ Ange Matheson from @NSWHealth explains the NSW model which allows a whole range of workers and non-medical services across the NSW (e.g. those working NGOs without pharmacists or doctors on staff) to supply naloxone #APSAD40
2/ Tegan Nuckey from Queensland (QuIHN) talks about their #naloxone program, adapted from the WA model.. now funded until 2023 (but no recurrent funding). Hopefully a national program will be funded by then! No cost, script, no ID - addressing key barriers.
3/ Robin Greaves (Tasmania) presented on the Tasmanian gov program where poisons regulations were changed to allow supply by NPS workers as part of their pilot. With limited funding, the pilot focused on people who use heroin, now ongoing funding provides FREE naloxone from NSPs