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Klimas, Jan
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Klimas, Jan
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Klimas, Jan
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- PublicationPsychosocial interventions for problem alcohol use in illicit drug users (Protocol)(John Wiley & Sons, 2011-08-10)
; ; ; ; ; ; ; ; This is the protocol for a review and there is no abstract. The objectives are as follows:To determine the effectiveness of psychosocial interventions targeting problem alcohol use versus other treatments in illicit drug users.330 - PublicationGenetic pre-determinants of concurrent alcohol and opioid dependence: a critical review(OA Publishing London, 2013-11)
; ; ; ; ; ; ; Concurrent alcohol dependence poses a significant burden to health and wellbeing of people with established opioid dependence. Although previous research indicates that both genetic and environmental risk factors contribute to the development of drug or alcohol dependence, the role of genetic determinants in development of concurrent alcohol and opioid dependence has not been scrutinised. To search for genetic pre-determinants of concurrent alcohol and opioid dependence, electronic literature searches were completed using MEDLINE (PubMed) and EBSCO (Academic Search Complete) databases. Reference lists of included studies were also searched. In this discussion paper, we provide an overview of the genes (n=33) which are associated with the opioid, serotonergic, dopaminergic, GABA-ergic, cannabinoid, and metabolic systems for each dependency (i.e., alcohol or opioid) separately. The current evidence base is inconclusive regarding an exclusively genetic pre-determinant of concurrent alcohol and opioid dependence. Further search strategies and original research are needed to determine the genetic basis for concurrent alcohol and opioid dependency.297 - PublicationThe management of problem alcohol use among drug users in primary care : exploring patients’ experience of screening and treatment(2012-03-09)
; ; ; ; ; ; ; Problem alcohol use is common among drug using patients who attend GPs in Ireland (35%) and other European countries. It is associated with adverse health outcomes including physical, psychological and social implications. These include various forms of liver disease exacerbated by the high prevalence of Hepatitis C among IDUs (62-81% in Ireland), fatal/non-fatal opiate overdose, mood anxiety, personality disorders, poor emotional health and wellbeing, early cessation of drug treatment, poor treatment outcomes and an increase in anti-social behaviour. Evidence has demonstrated the role of primary care in screening and treatment for problem alcohol use and the importance of a stepped approach to alcohol treatment. This study examined patients’ experience of being screened and treated for problem alcohol use, the barriers and enablers to addressing these issues and their views on how these therapeutic interventions can be improved.169 - PublicationTime to confront iatrogenic opioid addictionCanada has been grappling for decades in a largely ineffective attempt to keep heroin out of our borders. Now the unsafe prescribing of opioids has organized crime groups turning their attention to customers whose addiction started in the doctor's office. Physicians are going to have to face the tough conversations that involve two of the hardest words in a doctor's vocabulary: enough and no.
118 - PublicationWhat are the training needs of early career professionals in addiction medicine? A BEME scoping review protocol(BEME, 2018-06-19)
; ; ; ; ; Background: Substance use disorders (SUD) represent a significant social and economic burden globally. Accurate diagnosis and treatment by early career professionals in addiction medicine (ECPAM) fails, in part, due to a lack of training programs targeting this career stage. Prior research has highlighted the need to assess the specific training needs of early career professionals working in this area. Aim: To conduct a scoping review of the literature on the self-reported training needs of ECPAM worldwide. Methods: Medical and education databases will be searched for studies reporting perceived training needs of early career professionals (having completed their training within a five year period at the time of assessment) in addiction medicine. Retrieved citations will be screened and full text articles reviewed for eligibility by two independent reviewers. A third reviewer will arbitrate where there was disagreement. Two reviewers will independently extract data from included studies and conduct a quality appraisal assessment. Importance: Overall, the evidence on the training needs from this review will inform efforts to optimise ECPAM education internationally. Training needs assessment of early career professionals working in the field of addiction medicine is a priority.171 - PublicationPsychosocial Interventions for Alcohol use among problem drug users (PINTA) : protocol for a feasibility study in primary care(JMIR, 2013-08)
; ; ; ; ; Background: Alcohol use is an important issue among problem drug users. Although screening and brief intervention are effective in reducing problem alcohol use in primary care, no research has examined this issue among problem drug users. Objectives: To determine if a complex intervention, incorporating screening and brief intervention for problem alcohol use among problem drug users, is feasible and acceptable in practice and effective in reducing the proportion of patients with problem alcohol use. Methods: PINTA is a pilot feasibility study of a complex intervention comprising screening and brief intervention for problem alcohol use among problem drug users with cluster randomisation at the level of general practice, integrated qualitative process evaluation, and involving general practices in two socioeconomically deprived regions. Participants: Practices (N=16) will be eligible to participate if they are registered to prescribe methadone and/or at least 10 patients of the practice are currently receiving addiction-treatment. Patient inclusion criteria are: aged 18 or over and receiving addiction treatment / care (e.g.methadone) or known to be a problem drug user. Interventions: A complex intervention, supporting screening and brief intervention for problem alcohol use among problem drug users (experimental group) compared to an 'assessment only' control group. A delayed intervention being available to 'control' practices after follow up. Outcome: Primary outcomes are feasibility and acceptability of the intervention to patients andprofessionals. Secondary outcome is the effectiveness of the intervention on care process (documented rates of screening and brief intervention) and outcome (proportion of patients with problem alcohol use at the follow up). Randomisation: Stratified random sampling of general practices based on level of training in providing addiction-related care and geographical area. Blinding: Single-blinded; GPs and practice staff, researchers and trainers will not be blinded, but patients and remote randomisers will. Discussion: This is the first study to examine feasibility and acceptability of primary care based complex intervention to enhance alcohol screening and brief intervention among problem drug users. Results will inform future research among this high-risk population and guide policy and service development locally and internationally.253 - PublicationTraining needs, access to and contextual factors of addiction education in Europe: Towards a research agenda(2020-08-28)
; Drug and alcohol addiction cause a significant social and economic burden globally. Adequate diagnosis and treatment by general practitioners fails, in part due to a lack of knowledge and accredited training in addiction medicine. In Ireland, the training of general practitioners in identifying and treating addiction is lacking. Internationally, a number of initiatives to address this challenge have emerged. This study improves addiction education for doctors and allied health professionals and responds directly to the European Research Agency’s priorities “Excellent Science, Health, Demographic Change and Wellbeing”, specifically “improve ability to monitor health and to prevent, detect, treat and manage disease”. To build on these initiatives, the goal of this project is to establish the feasibility and acceptability of training primary care practitioners in addiction medicine, and, in particular, how international models of addiction medicine training might inform the future development of general practice education in Ireland. Specifically, the ongoing study seeks to increase incorporation of new understandings about addictive disorders from multiple disciplines into undergraduate and postgraduate medical curricula. The three years of the project have yielded an array of scientific outputs, including a dozen peer-reviewed studies describing the project’s impacts. These publications indicate that addiction medicine education provides a range of benefits to the clinicians and the greater community, including increased knowledge of identification and treatment of substance use disorders as well as increased professional competency in addiction medicine. Studies were independently peer-reviewed and published in top scientific periodicals, including the Academic Medicine, and Journal of Substance Abuse Treatment.37 - PublicationBetter Addiction Medicine Education for Doctors and Allied Health Professions: A ToolkitThe report disseminates the outcomes and deliverables of a research project entitled: Better Addiction Medicine Education for Doctors and Allied Health Professions.
185 - PublicationPrescription opioids, opioid use disorder, and overdose crisis in Canada: Current dilemmas and remaining questionsIn Canada, a rise in opioid use disorder (OUD) and overdose has been linked to opioid prescriptions in a number of contexts. At the same time, relatively few patients prescribed opioids reportedly develop OUD. This combination of findings suggests a pressing need for research on specific avenues through which medically prescribed opioids influence OUD and overdose in Canada. In this commentary, we therefore discuss a few of the potential processes that might allow for medically prescribed opioids to indirectly influence rising overdose rates, and the processes that might account for inconsistencies between large correlational research and studies of OUD incidence in opioid prescribed patients.
233Scopus© Citations 1 - PublicationAlcohol screening and brief intervention among drug users in primary care : a discussion paper(Springer, 2012-06-01)
; ; ; ; ; ; ; Background problem alcohol use is common among problem drug users (PDU) and associated with adverse health outcomes. Primary care has an important role in the overall stepped approach to alcohol treatment, especially screening and brief intervention (SBI). Aim To discuss three themes that emerged from an exploration of the literature on SBI for problem alcohol use in drug users attending primary care. Methods material for this discussion paper was gathered from three biomedical databases (PubMed, PsycINFO and Cochrane library), conference proceedings and online resources of professional organisations or national health agencies. Themes discussed in this paper are: (a) the potential of primary care for delivery of alcohol SBIs to PDUs, (b) screening methods and (c) application of brief interventions to PDUs. Although SBI improves health outcomes associated with problem alcohol use in the general population, further research is needed among high-risk patient groups, especially PDUs.336Scopus© Citations 11