This trial is evaluating whether Case management will improve 1 primary outcome in patients with Opioid Abuse. Measurement will happen over the course of 90 days from treatment initiation.
This trial requires 120 total participants across 2 different treatment groups
This trial involves 2 different treatments. Case Management is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are not being studied for commercial purposes.
Opioid abuse is an addiction to opioids, and can be severe, especially with a strong family history of addiction to opioids. The onset of prescription opioid abuse typically begins between adolescence and adulthood. Approximately three-quarters of all US adults ages 12 and older have used prescription opioids over their lifetimes.
Opioid use may result in symptoms of opioid withdrawal during the first few months taking the medication, such as nausea, insomnia, agitation, tremors, sweating and feelings of hunger but the person may not have difficulty keeping the symptoms under control and often stops taking the drug. Problems with an opioid tolerance and withdrawal is commonly present in people who abuse opioid medication.\n
Several factors (age of first-time abuse, age during first addiction, gender, first-time abuse method, duration of last addiction) are related to the choice of treatments for opioid abuse. Opioid abuse is increasingly being treated medically with buprenorphine. However, many patients do not adhere to treatment regimens and continue to abuse opioids. Methadone maintenance treatment has shown success in reducing illicit opioid use while maintaining the use of methadone as an effective treatment. Treatment of opioid abuse by methadone maintenance has been shown to improve medical conditions and reduce the frequency of injection and other drug use by patients.
The current drug treatment environment, which provides a wide array of pharmaceuticals for many chronic conditions, has enabled heroin and opiate abusers to take the first steps toward detoxification. Over the last decade, an opioid medication-assisted treatment program aimed at reducing heroin use was established in New York City. This program increased participation by both male and female heroin users and resulted in a significant reduction of heroin use. In this program, male opioid abusers have become more stable and adherent to participating in treatment. Over time, they have begun to taper their use and eventually ceased opioid usage entirely.
Opioid-mediated mental and physical dependence are challenging if not impossible to eliminate. However, dependence can be ameliorated or cured with proper treatment of opioid abuse.
The estimated number of patients addicted to opioids in the United States exceeds the estimated number of heroin addicts. Both numbers are, however, probably underreported. In the United States, 3 million people per year are addicted to opioids. About 1-3% of these addicts inject opioid medication each year. Most heroin is injected, but about half of the opioid addicts who use prescription pain medication misuse the pills instead.
Findings from a recent study demonstrates that a genetic contribution to opioid abuse is present in at least some families but not all. Identifying genetic factors underlying a patient's susceptibility to opioid abuse is valuable in identifying individuals who are candidates for treatment early in their use of opioids.
Case management interventions were mainly used in conjunction with any other treatments. The use of a case manager did not result in statistically appreciable improvement in patient outcome. Further research on the effectiveness of any treatment alone for SUD can help clarify the role of case management and should address the appropriateness and duration of treatment.
Therapeutic case management is a promising strategy for addressing comorbid substance use disorder and mental health disorders. Additional research is needed to increase reliability, generalizability, and treatment fidelity to support recovery of patients with both substance use disorders and concurrent mental health disorders.
An improved quality of life is associated with improved medication adherence by opioid abusing participants in an intensive case management program. Improved quality of life is likely to be a surrogate for improved cessation rates. Additional interventions are necessary to reduce opioid use among those prescribed opioids for pain management.
The number of emergency departments visits, hospitalizations, and arrests for nonmedical opioid use increased substantially over this 11-yr period. This may be due to changes in prescription opioids or to a change in the prescribing patterns for opioids. Although the proportion of patients with SCI is small, the findings from this study could be used to inform efforts to reduce opioid prescribing for SCI patients.
The most common side effects reported were physical problems (dizziness, headache, and low grade fever), social problems (excessive crying, anger, irritability, fatigue, and irritability), emotional and behavioral problems (depression, anxiety, and loneliness), and sleep disturbances (insomnia and difficulty in falling asleep or staying asleep). In addition, some patients experienced gastrointestinal problems (nausea, diarrhea, and discomfort with eating), and a few patients reported other issues.