RESUMEN
INTRODUCTION: People with substance use disorder (SUD) face challenges like stigma and discrimination, impacting their healthcare experiences. AIM: This study aims to: (i) assess physicians' clinical practices and stigma toward SUD patients among healthcare personnel and (ii) explore the relationship among stigma, psychological well-being, and burnout. METHODS: A survey covering sociodemographic data, physicians' clinical practices, stigmatizing attitudes, psychological well-being, and burnout was completed by 1,796 employees of the Veneto's Local Health Units (Italy). RESULTS: Healthcare professionals reported increased stigma towards SUDs (p-values<0.05). Stigma consistently correlated with variables such as sex, profession, department, and levels of burnout (p-values<0.05). Notably, high burnout levels were associated with increased stigma. Staff in addiction departments displayed lower stigma levels compared to other departments. No significant differences were found in physicians' clinical practices. CONCLUSIONS: Targeted training for healthcare professionals is crucial to reduce stigma, enhance attitudes toward SUDs, and broaden overall knowledge of the condition.
Asunto(s)
Actitud del Personal de Salud , Agotamiento Profesional , Personal de Salud , Estigma Social , Trastornos Relacionados con Sustancias , Humanos , Italia , Masculino , Femenino , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Persona de Mediana Edad , Personal de Salud/psicología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Encuestas y Cuestionarios , Médicos/psicologíaRESUMEN
This study aims to determine prevalence and frequency of use of novel psychoactive substances (NPS) and to identify the factors associated with NPS use in an Italian sample of patients diagnosed with substance use disorder (SUD). Prevalence and correlates of NPS knowledge and use were assessed in 185 patients with SUD in three addiction services (Padova, Belluno, Feltre) in the Veneto region with an ad-hoc designed survey. Two thirds of the samples reported knowing NPS and one third reported using them. NPS were considered by them less dangerous than "regular" substances of abuse (t = 6.06 mean 0.78, p < 0.001). Factors associated with NPS use were youth (OR = 4.81; p < 0.001), studentship (OR = 4.99; p = 0.004), subsequent mental disorders diagnosis (OR = 2.49; p = 0.027), suicide attempt history (OR = 11.67; p < 0.001), home detention (OR = 2.30; p = 0.040), residential care (OR = 5.66; p = 0.002), and polysubstance abuse (t = 8.99 mean 2.65 p < 0.001). NPS use in patients with SUD is highly prevalent, particularly in the youngest age group, and associated with psychiatric comorbidity and worse prognosis. It is crucial to systematically assess NPS use and inform addiction service users with SUD of the toxic and potentially lethal side effects. Mental healthcare professionals working in addiction services should receive education and training. Cohort and longitudinal studies are needed.
Asunto(s)
Psicotrópicos , Trastornos Relacionados con Sustancias , Adolescente , Comorbilidad , Humanos , Italia/epidemiología , Prevalencia , Psicotrópicos/uso terapéutico , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
Abuse and misuse of pharmacological therapies represent major challenges in the healthcare system, particularly in patients receiving long-acting opioid drugs for the treatment of heroin or opioid addiction. The partial mu-opioid receptor agonist buprenorphine is used to treat opioid dependence, but diversion and misuse may occur. The sublingual combination formulation of buprenorphine and the opioid receptor antagonist naloxone (buprenorphine/naxolone) is associated with a reduced abuse potential, and has been shown to have promising efficacy for the treatment of opioid dependence. This observational study assessed the safety and efficacy of sublingual buprenorphine/naloxone combination therapy in patients with opioid dependence after therapeutic switch from buprenorphine monotherapy. A total of 94 patients being treated with buprenorphine monotherapy (average dose 8 mg/day; mean duration of therapy 840 days) were switched to buprenorphine/naloxone combination therapy. Patients were asked to rate their level of satisfaction with buprenorphine/naloxone combination treatment with respect to the management of withdrawal symptoms, and urinary toxicology tests were carried out before and 14 days after switching to combination therapy. Within 3 months, 75/94 patients (80%) previously treated with buprenorphine monotherapy had switched to sublingual buprenorphine/naloxone combination treatment (average dose buprenorphine 8 mg). Among patients receiving combination treatment for >3 months, 83% were receiving medication either weekly or fortnightly, based on the results of toxicological testing. A reduction in positive urinary toxicology tests was observed in patients within two weeks after being switched to combination treatment (before switch: 28, 9 and 2 positive tests for heroin, cocaine and heroin + cocaine, respectively vs 11, 3 and 1 after switch) and a total of 64 patients of the 75 who switched to combination therapy (85%) were satisfied with the management of withdrawal symptoms during buprenorphine/naloxone treatment. Few adverse events were reported and no patients dropped out of treatment. This study shows that switching from buprenorphine monotherapy to sublingual buprenorphine/naloxone combination therapy is effective and well tolerated, and associated with good control of withdrawal symptoms in the majority of patients. In addition, combination therapy reduced illicit drug use (based on negative urinary toxicology texts) and allowed the time between clinic visits to be increased.