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brief intervention for substance use

ASSIST

ASSIST

CAN BE COMPLETED AS PART OF A ROUTINE CONSULTATION

CAN BE COMPLETED AS PART OF A ROUTINE CONSULTATION.

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assist on ice thai version

ASSIST

ASSIST

CAN BE USED IN A RANGE OF COMMUNITY SETTINGS.

can be used in a range of community settings.

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assist lite

ASSIST

ASSIST

AND ASSIST-LITE CAN BE COMPLETED ON A COMPUTER TABLET.

and ASSIST-Lite can be completed on a computer tablet.

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assist with substance

LEARN HOW

LEARN HOW

THE ASSIST-LITE CAN BE COMPLETED IN THE EMERGENCY DEPARTMENT

the ASSIST-Lite can be completed in the Emergency Department

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assist on ice screening tool

WATCH ASSIST

WATCH ASSIST

WITH SUBSTANCE AND LEARN HOW NURSES CAN MAKE A DIFFERENCE.

with Substance and learn how Nurses can make a difference.

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ice portal

ENQUIRE ABOUT

ENQUIRE ABOUT

FACE-TO-FACE ASSIST WORKSHOPS.

face-to-face ASSIST workshops.

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ASSIST DIGITAL SCREENING TOOLS

The ASSIST and the ASSIST-Lite are available in electronic format. The eASSIST and the eASSIST-Lite are web based versions that can be used on a personal computer.The ASSIST Checkup and ASSIST Checkup Lite are downloadable apps for completion on any smartphone or tablet.

The eASSIST is an electronic version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

The ASSIST was developed for the World Health Organisation (WHO), by an international group of specialists, as a tool that is easy to use to detect substance use and related problems. The ASSIST is an eight-item questionnaire and takes approximately 5-10 minutes to complete. The ASSIST helps identify the risks associated with substance use.

The eASSIST provides feedback on any risks and can help you explore options for addressing those risks.

LAUNCH eASSIST

ASSIST Checkup

Assist checkup & Assist checkup lite android apps Assist checkup & Assist checkup lite ios apps

The ASSIST Checkup is a free downloadable app so you can complete the ASSIST on your mobile device. You will receive instant feedback and tips on how to cutback or stop your substance use including information on where to seek help. The ASSIST Checkup is confidential and you can complete it every three months to track your progress.

The ASSIST Checkup is suitable for most iPhones and an android version is currently being developed.

Assist checkup & Assist checkup lite android apps Assist checkup & Assist checkup lite ios apps

ASSIST Checkup Lite

Assist checkup & Assist checkup lite android apps Assist checkup & Assist checkup lite ios apps

Find ASSIST Resources

Assist Potal- assist drug screening tool & drug and alcohol testing Resources & Tools

Resources & Tools

Need to download ASSIST resources or tools?

Download a full range of ASSIST and ASSIST-Lite tools and resources.

EXPLORE ALL RESOURCES
ASSIST Checkup apps and ASSIST-Lite apps Instructional videos

Instructional videos

Like to see the ASSIST and ASSIST-Lite in action?

The instructional videos demonstrate how to administer the ASSIST and ASSIST-Lite in a range of settings.

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The ASSIST screening test version 3.0 by Ho2 Who Assist Fact Sheet Bibliography

Bibliography

Looking for research evidence for the ASSIST and where it has been used?

Find a list of over 400 articles on the ASSIST and ASSIST-Lite.

DOWNLOAD BIBLIOGRAPHY

ASSIST eLEARNING

Register to complete the ASSIST eLearning package. You can also join the ASSIST Community to connect with experts and network with other members. Once registered, you can keep up to date with the latest news and conference presentations.

ASSIST NOTICEBOARD


SOCIAL MEDIA UPDATES


Comments Box SVG iconsUsed for the like, share, comment, and reaction icons

NEWS ARTICLE SPOTLIGHT!

New heroin treatment option yielding positive results among patients at Melbourne injecting rooms (ABC).

Recently, there was an article posted on the ABC regarding a trial of long-acting injectable buprenorphine in a clinic in Richmond, Victoria, as part of a push to improve outcomes for medication-assisted treatment of opioid dependence.

The article is written with reference to a 34-year old female ('Summer') who has struggled with opioid dependence for the past 6 years. The article focuses on some of the benefits of the injectable buprenorphine treatment, compared to regular oral methadone or buprenorphine treatments that are typically available.

In addition, the article also makes reference to recent study in the US in which long-acting buprenorphine injections were trialed. In the double blind, placebo-controlled trial, published in Lancet, 2019, by Haight et al., a total of 489 participants were randomized into 3 groups (2x treatment and 1 placebo). All groups received an injection every 28 days. Both treatment groups received the long-acting (subcutaneous) injectable buprenorphine, on different volume schedules (6 injections of 300mg vs. 2 injections of 300mg, and 4 subsequent injections of 100mg); whereas the control group received a volume matched ATRIGEL placebo injection. All groups also received individual drug counselling. All participants were asked to provide weekly urine samples (20 samples in total), and complete a self-reported illicit opioid use measure (20 assessments in total). The main study effects under investigation were the percentage of participants abstinent from illicit opioid use (based on negative urine samples and self-reported inabstinence); and overall treatment success (defined by individuals achieving over 80% abstinence across the 20 weeks of treatment).

In the Haight et al. (2019) trial, the rate of abstinence among both treatment groups was significantly higher, around 42% (41.3 and 42.7 respectively) compared with 5% in the control. In terms of treatment success, 29% of participants in group 1 and 28% in group 2 achieved over 80% abstinence, significantly higher compared with 2% of participants in the control. Overall, while preliminary, these results demonstrate that evidence for buprenorphine injections, when combined with effective counselling, is compelling. One of the primary implications of the trial is that subcutaneous injection of buprenorphine appears to have an advantage over transmucosal (under-the-tongue) administration in that it prevents the return of potential same-day craving and withdrawal features that are common with current treatment. Also, given the treatment is administered by a GP or health professional, adherence to treatment protocol is retained, and discontinuation of treatment for illicit use is limited. Finally, the authors also point out that the risks of diversion, misuse and harm to children are also reduced.

Returning to the ABC article for a moment, the results from the trial in Melbourne appear to be following a similar trend. The article suggests that, of the 41 patients using the injecting room in the Richmond clinic, there was a dramatic reduction (~60%) in the number of patients returning to use the room. Anecdotally, some patients who were attending the clinic every 2-3 days stopped visiting altogether after commencing the treatment.

One of the reasons why the new buprenorphine treatment might be preferable compared to methadone, can be found in its action. According to the National Guidelines for Medication-Assisted Treatment of Opioid Dependence (2014):
"Buprenorphine is a partial mu opioid agonist. It binds to the mu opioid receptors in the brain and activates them, but not to the same degree as full agonists. The consequence of this is that there is a ceiling effect, with the effect of buprenorphine reaching a maximum level that is not increased further even with increasing doses of buprenorphine. Like antagonists, partial agonists occupy receptors and prevent further activation by a full agonist." (p.3)

The implication is that the risk of overdose during induction with subcutaneous buprenorphine injection is lower than for methadone. For example, the risk of overdose during methadone induction is high, and has been associated with toxicity and death. Moreover, inadequate initial dosing of methadone can lead to withdrawal. However, until recently, one of the main criticisms of buprenorphine treatment is that it can also precipitate withdrawal due to a higher affinity and lower intrinsic activity than full agonists. As such, buprenorphine displaces agonists from opioid receptors and, in the short term, may not produce sufficient agonist effects to compensate for the displaced opioid, producing withdrawal as the buprenorphine reaches its peak effects. Results from these trials so far appear to show that the long-acting nature of these buprenorphine injections mitigates this risk.

Regardless, the Lancet trial, and the anecdotal evidence from the Richmond clinic both show early promise in the success of long-acting buprenorphine as part of medication assisted treatment of opioid dependence. One key thing to remember with the Haight et al. paper is that treatment also included drug counselling. In order for interventions (such as these) to be successful, there must be integration with other psychosocial aspects. The ABC article touches on the wider implications of medication-assisted treatment, though not explicitly, by highlighting the positive outcomes of the treatment for 'Summer', such as living independently in a nice apartment, and reviving her passion for hand-crafting furniture.

Helping individuals reduce and eventually abstain from problematic substance use represents an important role for primary health clinicians; but also those working in community and corrections setting as well.

For more information about buprenorphine in long-acting injectable formulation, visit the Australian Drug Foundation:
https://adf.org.au/drug-facts/…

For more information about opioids in general, visit the ASSIST Portal:
https://assistportal.com.au/resources/ under 'drug information' tab, where you can find downloadable drug information cards.

The opioid drug information card can be downloaded here: https://assistportal.com.au/download/…

You can read the Haight et al. 2019 paper here:
https://doi.org/10.1016/S0140-6736(18)32259-1

You can read the article via the ABC here:
https://abc.net.au/news/2021-06-15/…
... See MoreSee Less

NEWS ARTICLE SPOTLIGHT!

New heroin treatment option yielding positive results among patients at Melbourne injecting rooms (ABC).

Recently, there was an article posted on the ABC regarding a trial of long-acting injectable buprenorphine in a clinic in Richmond, Victoria, as part of a push to improve outcomes for medication-assisted treatment of opioid dependence.

The article is written with reference to a 34-year old female (Summer) who has struggled with opioid dependence for the past 6 years. The article focuses on some of the benefits of the injectable buprenorphine treatment, compared to regular oral methadone or buprenorphine treatments that are typically available. 

In addition, the article also makes reference to recent study in the US in which long-acting buprenorphine injections were trialed. In the double blind, placebo-controlled trial, published in Lancet, 2019, by Haight et al., a total of 489 participants were randomized into 3 groups (2x treatment and 1 placebo). All groups received an injection every 28 days. Both treatment groups received the long-acting (subcutaneous) injectable buprenorphine, on different volume schedules (6 injections of 300mg vs. 2 injections of 300mg, and 4 subsequent injections of 100mg); whereas the control group received a volume matched ATRIGEL placebo injection. All groups also received individual drug counselling. All participants were asked to provide weekly urine samples (20 samples in total), and complete a self-reported illicit opioid use measure (20 assessments in total). The main study effects under investigation were the percentage of participants abstinent from illicit opioid use (based on negative urine samples and self-reported inabstinence); and overall treatment success (defined by individuals achieving over 80% abstinence across the 20 weeks of treatment). 

In the Haight et al. (2019) trial, the rate of abstinence among both treatment groups was significantly higher, around 42% (41.3 and 42.7 respectively) compared with 5% in the control. In terms of treatment success, 29% of participants in group 1 and 28% in group 2 achieved  over 80% abstinence, significantly higher compared with 2% of participants in the control. Overall, while preliminary, these results demonstrate that evidence for buprenorphine injections, when combined with effective counselling, is compelling. One of the primary implications of the trial is that subcutaneous injection of buprenorphine appears to have an advantage over transmucosal (under-the-tongue) administration in that it prevents the return of potential same-day craving and withdrawal features that are common with current treatment. Also, given the treatment is administered by a GP or health professional, adherence to treatment protocol is retained, and discontinuation of treatment for illicit use is limited. Finally, the authors also point out that the risks of diversion, misuse and harm to children are also reduced.

Returning to the ABC article for a moment, the results from the trial in Melbourne appear to be following a similar trend. The article suggests that, of the 41 patients using the injecting room in the Richmond clinic, there was a dramatic reduction (~60%) in the number of patients returning to use the room. Anecdotally, some patients who were attending the clinic every 2-3 days stopped visiting altogether after commencing the treatment.

One of the reasons why the new buprenorphine treatment might be preferable compared to methadone, can be found in its action. According to the National Guidelines for Medication-Assisted Treatment of Opioid Dependence (2014):
Buprenorphine is a partial mu opioid agonist. It binds to the mu opioid receptors in the brain and activates them, but not to the same degree as full agonists. The consequence of this is that there is a ceiling effect, with the effect of buprenorphine reaching a maximum level that is not increased further even with increasing doses of buprenorphine. Like antagonists, partial agonists occupy receptors and prevent further activation by a full agonist. (p.3)

The implication is that the risk of overdose during induction with subcutaneous buprenorphine injection is lower than for methadone. For example, the risk of overdose during methadone induction is high, and has been associated with toxicity and death. Moreover, inadequate initial dosing of methadone can lead to withdrawal. However, until recently, one of the main criticisms of buprenorphine treatment is that it can also precipitate withdrawal due to a higher affinity and lower intrinsic activity than full agonists. As such, buprenorphine displaces agonists from opioid receptors and, in the short term, may not produce sufficient agonist effects to compensate for the displaced opioid, producing withdrawal as the buprenorphine reaches its peak effects. Results from these trials so far appear to show that the long-acting nature of these buprenorphine injections mitigates this risk.

Regardless, the Lancet trial, and the anecdotal evidence from the Richmond clinic both show early promise in the success of long-acting buprenorphine as part of medication assisted treatment of opioid dependence. One key thing to remember with the Haight et al. paper is that treatment also included drug counselling. In order for interventions (such as these) to be successful, there must be integration with other psychosocial aspects. The ABC article touches on the wider implications of medication-assisted treatment, though not explicitly, by highlighting the positive outcomes of the treatment for Summer, such as living independently in a nice apartment, and reviving her passion for hand-crafting furniture. 

Helping individuals reduce and eventually abstain from problematic substance use represents an important role for primary health clinicians; but also those working in community and corrections setting as well. 

For more information about buprenorphine in long-acting injectable formulation, visit the Australian Drug Foundation:
https://adf.org.au/drug-facts/buprenorphine-long-acting-injectable/

For more information about opioids in general, visit the ASSIST Portal:
https://assistportal.com.au/resources/ under drug information tab, where you can find downloadable drug information cards. 

The opioid drug information card can be downloaded here: https://www.assistportal.com.au/download/assist-drug-information-card-heroin-prescription-opioids/?wpdmdl=763&masterkey=60460b7be416e

You can read the Haight et al. 2019 paper here: 
https://doi.org/10.1016/S0140-6736(18)32259-1

You can read the article via the ABC here:
https://www.abc.net.au/news/2021-06-15/new-heroin-treatment-helping-patients-in-melbourne/100197558?utm_campaign=news-article-share-control&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web

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You can also read the National Guidelines for Medication-Assisted Treatment of Opioid Dependence here: www.health.gov.au/sites/default/files/national-guidelines-for-medication-assisted-treatment-of-op...

Interesting insights!

RELATED WORKS

ASSIST Community, eLearning and eASSIST - ASSIST Portal

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Need Help?

Are you concerned about your own or someone else’s alcohol or other drug use? Call the National Alcohol and Other Drug Hotline for free and confidential advice about alcohol and other drugs.

24 hour support line: 1800 250 015

ASSIST PORTAL - ACKNOWLEDGING COUNTRY

Acknowledgement of Country

The ASSIST Program team acknowledges the Traditional Owners of the lands and waters of Australia and the Torres Strait. We respect all Aboriginal and Torres Strait Islander people—their customs and their beliefs. We also pay our respects to Elders past and present, with particular acknowledgement to the Kaurna people, the original custodians of the Adelaide Plains and the land on which the University of Adelaide's campuses at North Terrace, Waite, Thebarton and Roseworthy are built.

Aboriginal and Torres Strait Islander people should be aware that this website may contain images, voices and names of people who have passed away.

ASSIST PORTAL - ACKNOWLEDGING COUNTRY