CPDD 72nd Annual Meeting • Scottsdale, Arizona - The College on ...

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EMPLOYMENT-BASED REINFORCEMENT OF ORAL
NALTREXONE COMPLIANCE WITHIN UNEMPLOYED
INJECTION DRUG USERS.
Kelly E Dunn, A DeFulio, J Everly, W Donlin, A Umbricht, M Fingerhood, G
Bigelow, K Silverman; Johns Hopkins University School of Medicine,
Baltimore, MD
Aims: Naltrexone is an opiate antagonist that effectively prevents relapse to opioid
use, however rates of compliance are notoriously poor. Reinforcement of naltrexone
administration via an employment-based intervention may increase rates
of compliance with oral naltrexone.
Methods: Recently-detoxified participants were randomly assigned to a
Naltrexone Contingency (NC; n=35) or Work Only (WO; n=32) group for a 6month
period. Participants attended the workplace daily, received access to computer
training and educational programs, and could earn up to $6,000 in hourly
wages and productivity pay. Urine samples were collected thrice weekly and tested
for evidence of opiates and cocaine. Naltrexone urinalysis testing was conducted
monthly. Participants in the NC group were required to ingest oral naltrexone
thrice weekly to gain entry into the workplace while WO participants
received a take-home prescription and could work independently of naltrexone
compliance. Outcome measures are naltrexone, opiate and cocaine urinalysis
results.
Results: At intake, participants were on average 45 years old, 61% male, 85%
African-American and had injected heroin and cocaine for 18 and 13 years,
respectively. Data show access to the workplace successfully reinforced compliance
with naltrexone. Mean percent naltrexone-positive urine samples were 83%
and 34% in the NC and WO groups, respectively. Mean opiate-positive samples
were also lower among NC versus WO participants (18% and 31%, respectively);
however no effect was observed on cocaine use (41% vs. 39%, respectively).
Conclusions: This study provides evidence that an employment-based behavioral
treatment can successfully reinforce compliance with naltrexone and help
prevent relapse to opioid abuse. <strong>The</strong> ability to reinforce compliance of a medication
that has a notoriously poor adherence rate in the context of a workplace
environment has important implications for dissemination and use with other
low-compliance medications.
Financial Support: NIDA R01-DA019386 and T32-DA007209
167
INTERNALIZATION OF COMPLIMENTARY SEXUAL
STEREOTYPES AS A CORRELATE OF RISKY SEXUAL
ATTITUDES AMONG AFRICAN-AMERICAN FEMALES.
Jamieson L Duvall, C Oser, J Mooney, J Havens, M Staton-Tindall, C Leukefeld;
Behavioral Science, University of Kentucky, Lexington, KY
Aims: Although standard forms of prejudice and racial discrimination are known
to affect physical and mental health in African Americans (e.g., Landrine &
Klonoff, 1996), no research has examined the influence of complimentary racial
stereotypes on such outcomes. This study examines the relationship between
African American women’s internalization of complimentary sexual stereotypes
(CSS) and their attitudes regarding the acceptability of engaging in risky sexual
behaviors.
Methods: Data were gathered from 206 African American women (both drug
users and non-drug users) as part of the Black Women in the Study of Epidemics
project (B-WISE). A series of multivariate regression models were used to examine
associations between women’s internalization of CSS and various sex-related
attitudes.
Results: <strong>The</strong> majority of participants were single (89%) and heterosexual (76%)
with a mean age of 35 years. Although no significant relationships were found
between CSS and measures of drug use, greater internalization of CSS was significantly
associated with African American women’s beliefs that having sex without
protection would strengthen their relationship (B = .37, SE = .19, p = .05),
that they could use drugs and always make healthy choices about protection (B
= .62, SE = .27, p = .02), and that they knew their partner was safe from HIV
by the way he looked (B = .34, SE = .16, p = .03). Marginally significant associations
were found for women’s beliefs regarding their own levels of HIV risk (B
= .41, SE = .22, p = .06) and their willingness to have sex in exchange for
money/drugs (B = .29, SE = .19, p = .13).
Conclusions: <strong>The</strong>se results suggest that in addition to distress brought about by
the experience of more straightforward types of prejudice and discrimination, the
internalization CSS by African American women can lead to increased health
risk, particularly in relation to infection with HIV or other sexually transmitted
diseases.
Financial Support: This research was supported by the NIDA (R01-
DA022967; K01-DA021309).
<strong>CPDD</strong> <strong>72nd</strong> <strong>Annual</strong> <strong>Meeting</strong> <strong>•</strong> <strong>Scottsdale</strong>, <strong>Arizona</strong>
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166
RELATIONSHIPS BETWEEN SUBSTANCE USE AND
NEUROPSYCHOLOGICAL FUNCTIONING AMONG DRUG
USERS IN NOVOSIBIRSK, RUSSIA.
Eugene Dunne, J Zur, A Melnikov, W Latimer; Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD
Aims: To evaluate relationships between frequent opiate and alcohol use and neuropsychological
test performance among adult drug users in Novosibirsk, Russia
Methods: Participants were 109 active drug users aged 18 to 40 (X = 26.1; SD
= 5.6) and recruited from the Novosibirsk region of Russia with the sample being
100% white and 89% male. <strong>The</strong> assessment included a urine sample collection
to test for recent drug use and neurocognitive test battery comprised of the Trail
Making A and B, Stroop Color Word Test, Shipley Institute of Living Scale
(SILS), and Wisconsin Card Sorting Task (WCST).
Results: Eighty five percent (N=93) reported lifetime heroin injection and 79%
(N=86) reported drinking alcohol in the past month. When compared to infrequent
injectors, frequent injectors exhibited significantly higher rates of deficit
performance on tests of Trails A (Odds Ratio (OR)=2.6; 95% Confidence
Interval (CI), 1.2, 5.8), SILS abstraction scale (OR=2.6; 95% CI, 1.2, 5.8), SILS
conceptual quotient (OR=2.8; 95% CI, 1.2, 6.2), WCST % errors (OR=2.3;
95% CI, 1.1, 5.0), WCST Perseverative Responses (OR=2.7; 95% CI, 1.2, 6.1),
WCST % Perseverative Errors (OR=2.7; 95% CI, 1.2, 6.1), WCST Conceptual
Level Responses (OR=3.8; 95% CI, 1.7, 9.1), WCST % Conceptual Level
Responses (OR=3.6; 95% CI, 1.7, 8.7), and WCST Categories Completed
(OR=3.2; 95% CI, 1.4, 7.2), adjusting for age, education, years of drug use, and
head injury. Compared to infrequent alcohol users, frequent alcohol users exhibited
significantly higher rates of deficit performance on the Stroop test (OR=2.4;
95% CI 1.1, 5.3) and Trails B minus A (OR=2.3; 95% CI 1.0, 5.2), adjusting
for age, education, years of drug use, and head injury.
Conclusions: Neuropsychological deficits associated with heavy alcohol and opiate
use are likely to negatively influence decision-making that may also result in
elevated risk behaviors associated with infectious disease.
Financial Support: Supported by the JH Center for AIDS Research and the
NIDA Epidemiology Training Program 2T32DA007292
168
PHYSICIAN MENTORING TO FACILITATE
BUPRENORPHINE TREATMENT: THE PCSS-
BUPRENORPHINE PROJECT.
James E Egan 1 , L Weiss 1 , A J Saxon 2 , P P Casadonte 3 , J Martin 4 , E McCance-
Katz 5 , J Renner 6 , D A Fiellin 7 ; 1 <strong>The</strong> New York Academy of Medicine, New York,
NY, 2 Addictions Care Line VA Puget Sound Health Care System, Seattle, WA,
3 New York University, New York, NY, 4 BAART Turk Street Clinic, San
Francisco, CA, 5 University of California, San Francisco, San Francisco, CA,
6 Boston University, Boston, MA, 7 Yale University, New Haven, CT
Aims: <strong>The</strong> Physician Clinical Support System-Buprenorphine (PCSS-B) is a
CSAT-funded nationwide system of physician-mentors who provide ongoing
education and support to facilitate and promote office-based buprenorphine
treatment.
Methods: A range of data were collected to assist in the evaluation of the project
including electronic surveys and a web-based system for mentors to enter
descriptions of each participant contact.
Results: <strong>The</strong> PCSS-B provides telephone email and in-person support, a website,
clinical guidances, and a warmline to providers that participate in the program.
<strong>The</strong>re are currently 88 physician-mentors, 5 clinical experts and 4,162 registered
participants in the PCSS-B system. Between July 2005 and July 2009, 67
mentors and 4 clinical experts reported providing mentoring services to 632 participants
in 48 states, DC and Puerto Rico. A total of 1,455 contacts were provided
through email (45%), telephone (34%) and in-person visits (20%).
Support has included both clinical issues (76% of contacts) such as dose management,
induction procedures, and pain issues and logistical issues (18% of contacts)
such as scheduling, payment, availability, paperwork, and medication supply.
<strong>The</strong>re were 72,822 visits to the PCSS-B website with 179,678 pages viewed.
Seven guidances were downloaded more than 1000 times. <strong>The</strong> warmline averaged
more than 100 calls/month.
Conclusions: We conclude that the PCSS-B model provides support for a mentorship
program to assist physicians in the provision of buprenorphine. CSAT
has recently funded the PCSS-Methadone (PCSS-M) to assist with the use of
methadone in opioid treatment programs and its use for chronic pain.
Financial Support: <strong>The</strong> PCSS-B is funded by SAMHSA-CSAT.