Malmö University Publications
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  • 1.
    Andersson, Lisa
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Håkansson, Anders
    Lund University.
    Berge, Jonas
    Lund University.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Changes in opioid-related deaths following increased access to opioid substitution treatment2021In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 16, no 1, article id 15Article in journal (Refereed)
    Abstract [en]

    Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing opioid-related deaths represent an important area of study. In Skane County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related deaths. Methods Detailed data on opioid-related deaths in Skane during the 2 years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skane and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related deaths in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skane and the rest of Sweden before and after the intervention. Results There was no significant difference in the number of deaths in Skane between the data collection periods (RR: 1.18 95% CI:0.89-1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12-6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51-1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug deaths in Skane compared to the rest of Sweden following the onset of the reform (0.90, 0.84-0,97, p= 0.004). Conclusions Opioid-related deaths, as assessed using forensic data, has not changed significantly in Skane following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased overdose deaths. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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  • 2.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Liahaugen Flensburg, Olivia
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Capusan, Andrea Johansson
    Department of Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Patient perspectives on depot buprenorphine treatment for opioid addiction: a qualitative interview study2022In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 17, no 1, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recently developed buprenorphine depot injections have the potential to reduce risk for diversion and misuse, and to increase adherence with fewer visits for supervised intake. However, it is unclear how patients perceive this new form of medication. The purpose of this study was to explore patients' experiences of depot injections and their reasons for continuing, discontinuing, or declining depot injection treatment.

    METHODS: We conducted semi-structured qualitative interviews with 32 people, 14 of whom had ongoing depot injection treatment, 11 who had discontinued depot-injections and switched to other medication and seven who had declined treatment with depot formulations. Interviews were transcribed, coded, and analysed using NVivo, based on this overall stratification into three participant groups.

    RESULTS: The main categories relate to the effects and side effects of the depot formulation, social and practical factors, psychological benefits and disadvantages, and interactions with treatment staff. Social and practical factors were of importance for choosing depot formulations, such as increased freedom and their making it easier to combine treatment with work and family life, as well as psychological advantages including "feeling normal". Initial withdrawal symptoms that resolved themselves after a number of injections were reported by most participants. Reliable information and patient-staff relationships characterized by trust helped patients to cope with these initial problems. Those who discontinued treatment often did so near the beginning of the treatment, reporting withdrawal symptoms and insufficient effects as the main reasons. Coercion and insufficient information contributed to a negative pharmaceutical atmosphere at one of the clinics, which may have adversely influenced perceptions of depot formulations and decreased willingness to accept and continue treatment.

    CONCLUSIONS: Buprenorphine depot injections may have social, practical, and psychological benefits compared to other formulations. However, depot injections are not perceived as an attractive option by all patients. Trust, consistent and adequate information, and awareness of the implications of the pharmaceutical atmosphere should be considered when introducing new medications.

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  • 3.
    Richert, Torkel
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Anderberg, Mats
    Dahlberg, Mikael
    Mental health problems among young people in substance abuse treatment in Sweden2020In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 15, no 1, article id 43Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Young people with substance use problems face a high risk of co-occurring mental health problems, something that may involve a more difficult life situation, social problems as well as worse treatment outcomes. The aim of this study is to analyse self-reported mental health problems among young people receiving outpatient treatment for substance use problems in Sweden. We explore what types of mental health problems are more or less predominant, and whether there are significant differences between boys and girls. In addition, we analyse how various mental health problems covary with indicators of substance abuse severity.

    METHODS: The study is based on structured interviews with 1970 young people enrolled at outpatient clinics in 11 Swedish cities. The data was analysed through frequency- and averages-calculations, Chi-square tests and multivariate logistic regression analyses.

    RESULTS: Self-reported mental health problems were common among the young people in the study. A relatively large percentage of the total group (34-54%) reported problems such as concentration difficulties, sleeping difficulties, anxiety and depression. At the same time, many of the young people did not report any symptoms and only a small group, about 20%, reported diagnosed mental health disorders. The results show substantial gender differences, with girls reporting significantly higher levels of mental health problems. Multivariate logistic regression analyses demonstrated significant associations between severity of drug use problems and anxiety, concentration difficulties, aggression, hallucinations and mental stress caused by experiences of trauma.

    CONCLUSIONS: Treatment needs are diverse within this group of young people who use drugs. Since girls report higher levels of all mental health problems, and a larger burden of psychosocial risk factors than boys, they are likely to require more comprehensive treatment interventions. The link between more severe drug problems and mental health problems points to the importance of exploring this relationship in treatment. A multidisciplinary approach, in which co-occurring problems can be addressed simultaneously, may be the best treatment form for many young people with drug problems.

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