Projects

Current opioid agonist treatment (OAT) requires daily supervised intake of medication, posing considerable demands on both patients and staff. In a multicenter study involving seven clinics in Sweden, we investigate using multiple scientific methods how new prolonged-release formulations of buprenorphine impact every-day life for patients with opioid use disorder. Replacing daily visits with a monthly injection is expected to profoundly impact daily life but it is yet unclear which patients are most likely to benefit when contact with health care decreases. Could these medications facilitate rehabilitation to employment when contact with health care becomes less frequent or to the contrary, will the loss of structure provided by daily visits lead to more frequent relapse and substance related complication? In what way will access to care, overall health care consumption and health care costs change in OAT.

Harmful alcohol use and AUD is underdiagnosed and only a fraction of those in need are offered treatment interventions. A biological marker for high alcohol consumption, phosphatidylethanol (PEth), has been available for several years and would facilitate the detection of alcohol-related problems. However, its use in primary care is limited and varies greatly between health centers. Using register-based and prospective observational studies, we investigate PEth use in primary care in general and more specifically for patients with psychiatric comorbidities. Our hypothesis is that increased PEth use is linked to increased diagnosis and treatment of AUD for patients with comorbidities. We use qualitative interviews to investigate attitudes and perceptions of PEth sampling among physicians and patients in primary care to identify potential barriers and opportunities for a broader implementation. This research has been funded by the Systembolagets Alkoholforskningsråd.

In a larger study at CSAN, we are using register-based and experimental methods to follow a unique cohort of objectively verified severe maltreatment in childhood, namely former patients at BUP Elefanten in Linköping. Based on this cohort and national registers, I have been able to show that children exposed to maltreatment have a more than threefold increased risk of addiction later in life, compared to their unexposed siblings. In an ongoing study, we investigate how intelligence, as a hereditary risk factor, affects the risk of addiction development.

In collaboration with the National Board of Institutional Care, we will also have the opportunity to investigate how relevant factors such as childhood maltreatment and cognitive ability affect outcomes for compulsory care for addiction and hopefully tailor treatment interventions to address specific risks.

Photo credit Elva Etienne