Canadian family physician Medecin de famille canadien · 2017
Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: Retrospective study.
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Mamakwa Solomon, Kahan Meldon, Kanate Dinah, Kirlew Mike, Folk David, Cirone Sharon, Rea Sara, Parsons Pierre, Edwards Craig, Gordon Janet, Main Fiona, Kelly Len
Аннотация
OBJECTIVE: To evaluate established opioid addiction treatment programs that use traditional healing in combination with buprenorphine-naloxone maintenance treatment in 6 First Nations communities in the Sioux Lookout region of northwestern Ontario.
DESIGN: Retrospective cohort study.
SETTING: Six First Nations communities in northwestern Ontario.
PARTICIPANTS: A total of 526 First Nations participants in opioid-dependence treatment programs.
INTERVENTION: Buprenorphine-naloxone substitution therapy and First Nations healing programming.
MAIN OUTCOME MEASURES: Retention rates and urine drug screening (UDS) results.
RESULTS: Treatment retention rates at 6, 12, and 18 months were 84%, 78%, and 72%, respectively. We estimate that the rate at 24 months will also be more than 70%. The UDS programming varied and was implemented in only 1 community. Initially urine testing was voluntary and it then became mandatory. Screening with either method found the proportion of urine samples with negative results for illicit opioids ranged between 84% and 95%.
CONCLUSION: The program's treatment retention rates and negative UDS results were higher than those reported for most methadone and buprenorphine-naloxone programs, despite a patient population where severe posttraumatic stress disorder is endemic, and despite the programs' lack of resources and addiction expertise. Community-based programs like these overcome the initial challenge of cultural competence. First Nations communities in other provinces should establish their own buprenorphinenaloxone programs, using local primary care physicians as prescribers. Sustainable core funding is needed for programming, long-term aftercare, and trauma recovery for such initiatives.
DESIGN: Retrospective cohort study.
SETTING: Six First Nations communities in northwestern Ontario.
PARTICIPANTS: A total of 526 First Nations participants in opioid-dependence treatment programs.
INTERVENTION: Buprenorphine-naloxone substitution therapy and First Nations healing programming.
MAIN OUTCOME MEASURES: Retention rates and urine drug screening (UDS) results.
RESULTS: Treatment retention rates at 6, 12, and 18 months were 84%, 78%, and 72%, respectively. We estimate that the rate at 24 months will also be more than 70%. The UDS programming varied and was implemented in only 1 community. Initially urine testing was voluntary and it then became mandatory. Screening with either method found the proportion of urine samples with negative results for illicit opioids ranged between 84% and 95%.
CONCLUSION: The program's treatment retention rates and negative UDS results were higher than those reported for most methadone and buprenorphine-naloxone programs, despite a patient population where severe posttraumatic stress disorder is endemic, and despite the programs' lack of resources and addiction expertise. Community-based programs like these overcome the initial challenge of cultural competence. First Nations communities in other provinces should establish their own buprenorphinenaloxone programs, using local primary care physicians as prescribers. Sustainable core funding is needed for programming, long-term aftercare, and trauma recovery for such initiatives.
Предметные рубрики MeSH
AdultBenzodiazepinesBuprenorphineCocaineCommunity Health ServicesCounselingDrug Therapy, CombinationFemaleHumansIndians, North AmericanMaleMiddle AgedMorphineNaloxoneNarcotic AntagonistsOntarioOpiate Substitution TreatmentOpioid-Related DisordersOxycodoneProgram EvaluationRetrospective StudiesRural Health ServicesSubstance Abuse DetectionSuicideYoung AdultDrug Monitoring