The official journal of
EUROPAD - European Opiate Addiction Treatment Association
WFTOD - World Federation for the Treatment of Opioid Dependence
Editor: Icro Maremmani, MD - Pisa, Italy, EU
Associate Editors:
Thomas Clausen, MD - Oslo, Norway
Pier Paolo Pani, MD - Cagliari, Italy, EU
Marta Torrens, MD - Barcelona, Spain, EU
Statistical Editor:
Mario Miccoli, PhD - Pisa, Italy, EU

HARCP Archives

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Heroin Addiction and Related Clinical Problems: 2021, 23, N1 (pages: 47 - 55)

A Shared Medical Appointment (Sma) Model for U.S. Veterans Treated with Buprenorphine in an Outpatient Setting: an Appraisal of Mortality, Risk, and Protective Factors

Phelan J.E.

Summary: Background: Those addicted to heroin and other opioids have high rates of mortality and comorbidity. Based on several studies in the literature between 0.4% and 2% crude all cause morality rates (CMR) (per 100 patients per year) have been reported for patients in buprenorphine treatment. Data on U.S. Veteran populations is lacking, however. This paper details a buprenorphine shared medical appointment (SMA) treatment model for U.S. Veterans in an outpatient setting and highlights appraisals of demographics, mortality, depression, risk factors and protective factors. Methods: A cohort of 30 U.S. Veterans enrolled in a substance disorders outpatient clinic at a Veterans Health Administration ambulatory care center, were prescribed maintenance doses of buprenorphine (no higher than 16 mg) and participated in SMAs for at least 5 years. A review of secondary patient data, and review of results from other metrics used, were conducted between the years of 2010 and 2014. Results: A records review of Veterans who attended SMAs revealed a 4.4% mortality rate over a 5-year period (CMR = 0.7%). Deaths were mainly somatic in nature and not from overdose. Mortality rates were typically equal to, or better than community samples. Other appraisals indicated that Veterans who were active in SMAs showed marked improvements in drug cessation, decreases in depression, decreases of risk factors, and increases in protective factors, over a 5-year treatment span. Conclusion: Based on current patterns and assumptions, opioid addicts are at greater risk for mortality, depression and other morbidities without treatment. Shared medical appointment model is one way to help decrease Veteran's use, risk and to increase protective factors.


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