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Introduction: Opioid agonist treatment (OAT) is an effective treatment for opioid dependence syndrome in adults. However, studies on effectiveness of OAT in adolescents are limited; existing studies show varying retention rates. The present study aimed to assess OAT retention rates in adolescent patients with opioid dependence syndrome registered in a community drug treatment clinic in Delhi, India, and to analyse factors associated with retention at 1 year. Methods: Retrospective cohort study. All adolescents (n = 130) aged 10–19 years, started on OAT from January 2020 to July 2022 were included. Baseline and follow‐up data was extracted from online record system maintained at the clinic. OAT retention rates at different timepoints were assessed. Multivariable logistic regression was used to discern factors associated with one‐year retention. Results: The participants' mean age was 16.9 (SD 1.4) years. Mean age of starting opioids was 14.9 (SD 2.2) years; 29.5% (n = 38) injected opioids. The 6‐, 12‐, 18‐ and 24‐month retention rate on OAT was 64.4%, 45.6%, 38.7% and 29% respectively. The retention rates with buprenorphine and methadone were comparable. Multivariate logistic regression showed retention for less than 12 months to be significantly associated with younger age of starting heroin, involvement in illegal activities, absenteeism from school and substance use in family. Discussion and Conclusions: The 12‐month retention rates on OAT in adolescents is comparable to retention rates in adults. Various factors associated with early age of onset of opioid use are also associated with lower retention rates on OAT. [ABSTRACT FROM AUTHOR]

Maternal cardiac arrest (MCA) requires a multidisciplinary team well versed in the cascade of steps involved during resuscitation. Historically, maternal outcomes were poor, primarily because cardiac arrest management in pregnant women was neither optimum nor standardized. However, current evidence has shown better maternal survival given the young age and reversible causes of death. There are specific interventions such as manual left uterine displacement (MLUD) for relief of aortocaval compression that, if not performed, may undermine the success of resuscitation. The team should simultaneously explore the etiology of MCA, which could be a combination of pregnancy-related causes and comorbid conditions. Resuscitative Hysterotomy or Resuscitative Uterine Interventions (RUI) should be considered if there is no return of spontaneous circulation following 4–5 min of cardiopulmonary resuscitation. Teamwork is critical to success in the high-stakes environment of MCA. This consensus statement was prepared by the experts after reviewing evidence-based literature on maternal resuscitation during MCA.

Objective To assess the implementation of a mobile dispensing service to improve opioid users' access to methadone maintenance therapy. Methods In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service. Findings The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9- month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients' adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites. Conclusion It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic. Distribution mobile de methadone a Delhi, en Inde: etude de la mise en oeuvre Objectif Analyser la mise en oeuvre d'un service de distribution mobile destine a ameliorer l'acces des consommateurs d'opiaces au traitement de maintien a la methadone. Methodes En mars 2019, nous avons commence la distribution mobile de methadone dans une agglomeration urbaine defavorisee a Delhi, en Inde. Le medecin restait au centre communautaire de prise en charge de la toxicomanie pour assurer les services cliniques, tandis que l'infirmiere circulait dans une ambulance reconvertie pour fournir de la methadone. Nous avons demande aux patients d'identifier les responsables au sein de la communaute, afin de les inclure dans le processus de sensibilisation et de determiner quand et ou organiser la distribution. Nous avons mene un examen retrospectif des dossiers regroupant les donnees du programme, recoltees lors de la prestation des services cliniques. Enfin, nous avons compare le nombre de patients enregistres pour le traitement a la methadone, leur maintien et leur adhesion au traitement sur des periodes de 12 mois, avant et apres la mise en oeuvre de la distribution mobile. Resultats Le nombre de patients inscrits a la clinique en vue de recevoir un traitement est passe de 167 durant l'annee precedant la mise en oeuvre a 671 l'annee suivante. Un pourcentage nettement plus eleve de patients ont maintenu leur traitement 3, 6 et 9 mois apres l'avoir entame; le taux de maintien apres 9 mois etait de 19% (32/167 patients) avant la mise en oeuvre, et de 45% (44/97 patients) apres celle-ci. Aucune difference notable n'a ete constatee entre les deux periodes au niveau de l'adhesion des patients au traitement. Plusieurs defis se sont presentes: proposer des heures de distribution qui conviennent aux patients exercant un emploi, et apaiser les inquietudes de la communaute locale installee a proximite des lieux de distribution. Conclusion Il est possible de distribuer de la methadone par l'intermediaire d'une equipe mobile dans un environnement urbain, et les taux de maintien du traitement sont meilleurs que ceux observes dans une clinique fixe. Distribucion movil de metadona en Delhi (India): investigacion sobre su implementacion Objetivo Evaluar la implementacion de un servicio de distribucion movil para mejorar el acceso de los usuarios de opioides a la terapia de mantenimiento con metadona. Metodos En marzo de 2019, iniciamos la distribucion movil de metadona en una localidad urbana desfavorecida de Delhi (India). El medico solo estaba disponible en la clinica principal de tratamiento de medicamentos de la comunidad para los servicios clinicos, mientras que la enfermera dispensaba la metadona desde una ambulancia transformada. Involucramos a los pacientes en la identificacion de los lideres de la comunidad para la sensibilizacion y en la decision del lugar y los horarios de distribucion. Realizamos una revision retrospectiva de los datos del programa recogidos durante la prestacion de los servicios clinicos. Se comparo el numero de pacientes registrados para la terapia con metadona y su retencion y adherencia al tratamiento en periodos de 12 meses antes y despues de la implementacion del servicio movil. Resultados El numero de pacientes registrados para recibir tratamiento en la clinica aumento de 167 en el ano anterior a la implementacion a 671 en el ano posterior. Una proporcion significativamente mayor de pacientes siguio con el tratamiento a los 3, 6 y 9 meses de su inscripcion; las tasas de retencion a los 9 meses fueron del 19% (32/167 pacientes) y del 45% (44/97 pacientes) en el ano anterior y posterior a la implantacion, respectivamente. No hubo diferencias significativas en el cumplimiento terapeutico de los pacientes entre los dos periodos. Los desafios incluyeron la provision de un horario de distribucion adecuado para los pacientes con empleo y las preocupaciones de la comunidad local cercana a los lugares de distribucion. Conclusion Es factible la distribucion de metadona por un equipo movil en un entorno urbano, con mejores tasas de retencion en el tratamiento en comparacion con la distribucion a traves de una clinica fija., Introduction Although opioids are the second most commonly used group of illicit drugs worldwide, they cause the most harm to the health of users. Opioids account for 66% of the [...]

Background: People with Substance Use Disorder have higher adverse outcomes associated with COVID-19 infection that can be reduced with COVID-19 vaccines. Various factors influence the acceptability of COVID-19 vaccines. We assessed COVID-19 vaccine-related knowledge, attitude, and beliefs in patients on Opioid Agonist Treatment (OAT) from a community clinic in an urban impoverished area in Delhi, India. Methods: Cross-sectional design. We interviewed 200 adult males using a structured questionnaire. Results: The participants' mean age was 27.4 (SD 6.8) years; majority (68%, n = 136) had less than 10 years of schooling. While family members of 77% (n = 154) of the participants were vaccinated for COVID-19, only 32% (n = 64) of the participants had been vaccinated with at least a single dose. 43% (n = 86) felt they are ineligible for vaccine due to their addiction or their ongoing addiction treatment (46.5%, n = 93). Though the majority (78.5%, n = 157) were willing to get vaccinated, they had not done so due to concerns, such as fear of vaccine-related adverse-effects (35%). Conclusions: COVID-19 vaccination rates in individuals with opioid dependence are much lower compared to the general population. There are several misconceptions related to COVID-19 vaccinations in this population that needs to be addressed to achieve universal vaccination against COVID-19 infection. [ABSTRACT FROM AUTHOR]

Various factors limit the acceptability of methadone as an opioid agonist treatment (OAT), in which case, buprenorphine becomes the preferred alternative. The classical approach is to gradually taper methadone to a low dose and buprenorphine is initiated after some opioid-free period, which generally takes weeks. A novel approach known as ’microdosing’ or the ’Bernese method’ might serve as a valuable alternative. We describe two cases where the patients were successfully transitioned from methadone to buprenorphine using this method. [ABSTRACT FROM AUTHOR]

Background: Naltrexone is a Food and Drug Administration (FDA)-approved anti-craving agent for the long-term treatment of alcohol dependence syndrome (ADS). However, it may not be equally effective in all patients. This study aims to assess naltrexone treatment response over four weeks in a national-level tertiary care setting. Methods: Male patients with ADS (n = 100) who were initiated on naltrexone were included in the study. The clinical data, including the drinking pattern and craving, were recorded at baseline. At the end of the one-month follow-up, the drinking status and compliance with naltrexone were recorded. Findings: At the end of one month, more than half of the patients (n = 53) were retained in the study. All the treatment-retained patients (n = 53) reported naltrexone consumption for more than 24 days in the last month. Those who retained in the study reported significantly less craving among 72% of patients, while an almost 50% reduction in alcohol use was observed. Conclusion: This study adds to the evidence of outcomes with naltrexone in terms of reduced craving and alcohol use. [ABSTRACT FROM AUTHOR]

Background. Untreated co-occurring substance use and substance use disorders (SUDs) in patients with medical conditions may be associated with unfavourable medical outcomes. Understanding the prevalence of substance use and SUDs among patients admitted to hospital for medical illness may help in developing appropriate strategies to manage SUDs in this population and improve the outcomes of medical illness. We assessed the prevalence of substance use and SUDs among patients admitted for medical illnesses and the association between substance use and medical illness. Methods. This cross-sectional study was done in an inpatient setting in a multidisciplinary teaching medical institution in India. Using systematic sampling, adult patients admitted in various departments for at least 24 hours were interviewed using standard instruments by psychiatrists trained in the study methodology. Results. Two hundred and ninety patients participated. Their mean (SD) age was 42.2 (15.6) years. One hundred and nine participants (37.6%) reported lifetime use of any psychoactive substance, with tobacco being the most common substance used (91, 31.4%), followed by alcohol (69, 23.8%) and cannabis (12, 4.1%). Lifetime alcohol use was significantly associated with diseases of the circulatory system. Lifetime use of any substance or of alcohol, and current use of any substance or tobacco were significantly associated with injuries, poisoning and other consequences of external causes. Conclusions. A large proportion of patients hospitalized for medical illness reported the use of psychoactive substances or had SUDs. The use of some of these substances was also associated with injuries as well as diseases of the circulatory system. [ABSTRACT FROM AUTHOR]

Background: About one-fourth of individuals who are dependent on opioids use opioids through injecting route. Most of such individuals start using opioids through noninjecting route much earlier before they transition to injecting opioids. It is important to identify important factors that delineate individuals who inject opioids from those who use opioids through other routes, which was the objective of the present study. Methods: This was a cross-sectional study design. Four hundred treatment-naïve opioid users with opioid dependence were selected using a snowballing sampling technique. The drug use details, family relations, social and occupational functioning, and peer network history were assessed using a self-developed questionnaire and the use of structured instruments such as the Leeds Dependence Questionnaire Scale, High-Risk Behavior Scale, and Functional Status Questionnaire Scale. Comorbid psychiatric symptoms were assessed using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Ask Suicide-Screening Questions was used for assessing different domains of suicidality. Results: The mean age of the participants was 26 (standard deviation = 6) years. One-third (n = 136) of these were injecting opioid users (injecting drug users [IDUs]) and the remaining were taking opioids through other routes (non-IDUs). In multivariate analysis, IDUs (as compared to non-IDUs) had higher rates of family history of opioid use (odds ratio [OR] =3.53, 95% confidence interval: 1.17–8.69), incarceration history (OR = 2.16, 1.78–3.11), lower employment (OR = 0.53, 0.31–0.84), more people with <5 years of education (OR = 4.31, 2.60–12.73), lower age of starting opioid use (OR = 0.44, 0.26–0.69), more concurrent sedative use (OR = 5.60, 4.34–7), more self-harm attempts history (OR = 1.88, 1.16–3.2), larger peer groups (OR = 1.89, 1.11–2.63), and greater involvement in selling illegal drugs (OR = 1.81, 1.49–3.67). Conclusions: Various factors are significantly associated with using opioids through injecting route in individuals with opioid dependence. These factors can help identify individuals with opioid dependence who are likely to transition to injecting opioids. [ABSTRACT FROM AUTHOR]

An estimated 6.5 to 13.2 million people with opioid dependence, representing more than half of the world's estimated number, live in Asia. (1) Although most people in Asia who are [...]

Background: Integrating mobile technologies in healthcare (mHealth) is helpful to manage various medical conditions. mHealth applications can bridge the gap in the management of patients with opioid use disorder (OUD). Research evaluating the feasibility of mHealth to address OUD is limited in developing countries. We aimed to assess the digital capacity and interest in mHealth interventions in patients maintained on opioid agonist treatment (OAT). Methods: 150 patients on OAT from a community drug treatment clinic in New Delhi, India, were included. We assessed the participants on their pattern of mobile and Internet use and their willingness to use mHealth technology to access health information and services related to OUD. Results: 88% of participants (n = 132) owned a mobile phone at assessment; 2.7% (n = 4) had never used a mobile phone in their lifetime. 70% (n = 105) participants had Internet access. 80% (n = 120) of participants showed interest in receiving text messages related to the management of OUD. 60% of participants showed a willingness to download and use applications for monitoring their substance use. Conclusions: In India, there is an interest among people on OAT to use mHealth interventions to manage their substance use. This population also has access to mobile phones and the necessary knowledge to install and run applications needed for various mHealth interventions. [ABSTRACT FROM AUTHOR]

Maternal cardiac arrest (MCA) requires a multidisciplinary team well versed in the cascade of steps involved during resuscitation. Historically, maternal outcomes were poor, primarily because cardiac arrest management in pregnant women was neither optimum nor standardized. However, current evidence has shown better maternal survival given the young age and reversible causes of death. There are specific interventions such as manual left uterine displacement (MLUD) for relief of aortocaval compression that, if not performed, may undermine the success of resuscitation. The team should simultaneously explore the etiology of MCA, which could be a combination of pregnancy-related causes and comorbid conditions. Resuscitative Hysterotomy or Resuscitative Uterine Interventions (RUI) should be considered if there is no return of spontaneous circulation following 4–5 min of cardiopulmonary resuscitation. Teamwork is critical to success in the high-stakes environment of MCA. This consensus statement was prepared by the experts after reviewing evidence-based literature on maternal resuscitation during MCA. [ABSTRACT FROM AUTHOR]

Background: Opioid-dependent patients undergoing opioid substitution therapy (OST) consume alcohol in a hazardous pattern which adversely affects their treatment outcome. This study aims to measure alcohol biomarkers to screen for secondary alcohol use in OST patients. Methods: A pilot study was planned to measure alcohol biomarkers (AST, ALT, GGT, and CDT) to assess alcohol use in OST patients from three community clinics. The biomarkers were categorized based on the reported frequency of alcohol use. The association of the biomarkers with the frequency of alcohol consumption was determined using the post hoc (Mann-Whitney) test. Results: Forty-five patients with a mean (SD) age of 37.04 (10.7) years were included in the study. Alcohol intake was reported in daily, weekly, and monthly patterns by 22, 63, and 16% of the patients, respectively. High levels of ALT, GGT, and CDT were measured in patients with daily use of alcohol. Serum CDT levels significantly differentiate daily and weekly use from monthly consumption of alcohol. Conclusions: Alcohol biomarkers significantly predict the pattern of alcohol use among OST patients. These results can be prudent in low-resource community clinics to improve the overall outcomes of OST in India. [ABSTRACT FROM AUTHOR]