IMPORTANCE: Methadone maintenance is an effective treatment of opioid use disorder, but federal regulations in the US restrict methadone dispensing to opioid treatment programs (OTPs). In Australia, ...Canada, and the UK, patients can obtain methadone maintenance from community pharmacies. OBJECTIVE: To compare driving access to methadone maintenance treatment between OTP and pharmacy dispensing models. DESIGN, SETTING, AND PARTICIPANTS: This descriptive cross-sectional study assessed driving times from census tract mean centers of population to OTPs and pharmacies. Census tracts from the 50 US states and the District of Columbia (based on the 2010 US Census) were included if their population was greater than 0, if their mean center of population (MCP) was within 3 miles of the road network, and if the 1-way driving times from the census tract MCP to both an OTP and a pharmacy were 12 hours or less. Data analyses were performed from November 15, 2019, to April 18, 2020. MAIN OUTCOMES AND MEASURES: The primary outcome was the population-weighted mean driving time from census tract MCPs to OTPs and pharmacies in the US. Census tract MCPs are population-weighted geographic centroids of residents living in each census tract. Driving times were estimated using historical average driving speeds. RESULTS: All 1682 unique locations of OTPs were included, and 69 475 unique pharmacy locations were included after geocoding. A total of 72 443 census tracts were included in the analysis. The mean population-weighted driving time from census tract MCPs was 20.4 minutes (95% CI, 20.3-20.6 minutes) to OTPs and 4.5 minutes (95% CI, 4.4-4.5 minutes) to pharmacies (P < .001). Differences in driving time, distance, and cost between 1-way trips ending at OTPs and pharmacies were largest in micropolitan and noncore counties. CONCLUSIONS AND RELEVANCE: In this study, population-weighted mean driving times from US census tract MCPs were longer to OTPs than to pharmacies.
Digital contact tracing for COVID-19 Kleinman, Robert A; Merkel, Colin
Canadian Medical Association journal (CMAJ),
06/2020, Letnik:
192, Številka:
24
Journal Article
Recenzirano
Odprti dostop
KEY POINTS • App-based contact tracing has the potential to address traditional contact tracing’s limitations of scalability, notification delays, recall errors and contact identification in public ...spaces. • The effectiveness of contact-tracing apps in identifying exposures depends on widespread use of individual apps and the ability of their underlying technologies to identify nearby phones. • Use of contact-tracing apps brings inherent trade-offs between privacy and effectiveness. • Before being released, apps must be field tested in real-world conditions to understand their sensitivity and specificity for identifying exposures. • Integrating app-based and traditional contact tracing may leverage the advantages, and mitigate the limitations, of each approach.
Few studies have characterized methadone-involved overdose deaths in the US since 2014 despite changing patterns of opioid use, the onset of the COVID-19 pandemic, and changes to take-home dose ...guidance in opioid treatment programs (OTPs) in March 2020.
Data on monthly overdose deaths in the US from January 1, 2007 to March 31, 2021 were obtained through CDC WONDER. Interrupted time series models were used to assess for changes in series levels starting in April 2020. Analyses were stratified by involvement of synthetic opioids in overdose deaths.
An increase in methadone-involved overdoses of 105.4 deaths per month (95 % CI: 73.8–137.0) occurred starting in April 2020 compared with prior trends (p < 0.001). Trends in methadone-involved overdose deaths showed a step increase starting in April 2020 both with (54.2 deaths per month; 95 % CI: 39.4–68.9) and without (51.7 deaths per month; 95 % CI: 23.4–78.0) synthetic opioid involvement (p < 0.001 for both). Among overdose deaths without synthetic opioids, the increase in methadone-involved overdose deaths accounted for 26.5 % of the increase between the 12-month periods before and after March 2020. The relative percentage increase in methadone-involved overdose deaths, both with and without synthetic opioid co-involvement, was highest among Hispanic and non-Hispanic Black individuals.
Methadone-involved overdose deaths, both with and without other synthetic opioid co-involvement, increased during the 12-month period after March 2020, compared with prior trends. These results provide a cautionary addition to previous findings of no or limited methadone-related harms after the US regulatory changes during the COVID-19 pandemic.
•Methadone-involved overdose deaths, both with and without other synthetic opioids. increased after March 2020.•Methadone-involved overdose deaths without synthetic opioids had a larger proportional increase than total overdose deaths without synthetic opioids.•Large relative increases in methadone-involved overdose deaths occurred among Hispanic and non-Hispanic Black.
Tobacco use is a leading cause of preventable death in Canada, and it is time for governments to ensure that all people with provincial drug benefits have access to smoking cessation medications. ...Pharmacotherapies are effective for smoking cessation. In a phase-4 randomized controlled trial, people treated with varenicline for 12 weeks had cessation rates of 22% at 24 weeks compared with 9% among those receiving placebo. Meta-analyses have found that combination nicotine replacement therapy, which combines the nicotine patch with a short-acting nicotine formulation, has similar cessation rates to varenicline. Cytisine is a smoking cessation pharmacotherapy with similar effect sizes to varenicline. Bupropion has smaller effect sizes than varenicline but is superior to placebo in helping people stop smoking.
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