1
|
Heidari O, Shah H, Bhagwat A, Ahmad NJ, Whaley S, Sherman SG, Morris M, Saloner B. Changes in opioid treatment programs and harm reduction provider services during the COVID-19 pandemic: Findings from 10 states. Psychol Serv 2024; 21:658-664. [PMID: 37824245 PMCID: PMC11009379 DOI: 10.1037/ser0000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Harm reduction and opioid treatment programs (OTPs) modified service delivery based on rapid changes to state and federal regulations during the COVID-19 pandemic. There is little evidence on how these regulations changed the delivery of medication for opioid use disorder and harm reduction services and whether certain regulations should be made permanent. This study explores how harm reduction OTPs across the United States leveraged changes in regulations and responded to impacts of COVID-19 to continue providing services and perspectives on future legislation that regulates their practice and practice sites. The COVID Harm Reduction and Treatment programs Survey study administered a survey that included closed-ended and free-response questions to 22 sites between August 2020 and January 2021. Program demographics and responses to survey items pertaining to site and service modifications were tabulated and proportions reported. A qualitative descriptive method was used to analyze free-response questions. All (100%) surveyed providers reported the need to modify their services. The majority (68%) reported an increase or no change in client volume; 68% reported increases in naloxone services and 77% reported increases in syringe services programs. Qualitative themes included (a) flexibility in reaching clients due to regulatory changes, (b) benefits and drawbacks of telehealth, and (c) increased vulnerabilities of their clients during the pandemic. Despite difficulties during the COVID-19 pandemic, harm reduction and OTP sites found that regulatory changes provided flexibility in service delivery and that they were better able to serve their clients. Future policies should bolster these sites to continue to provide low-barrier and high-quality services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Omeid Heidari
- University of Washington, School of Nursing, Department of Child, Family, and Population Health
| | - Hridika Shah
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Atharva Bhagwat
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - N. Jia Ahmad
- Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital and Brigham and Women’s Hospital
| | - Sara Whaley
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins University, Bloomberg School of Public Health
| | - Miles Morris
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| | - Brendan Saloner
- Department of Health, Policy, and Management, Johns Hopkins University, Bloomberg School of Public Health
| |
Collapse
|
2
|
Gullahorn B, Kuo I, Robinson AM, Bailey J, Loken J, Taggart T. Identifying facilitators and barriers to the uptake of medication for opioid use disorder in Washington, DC: A community-engaged concept mapping approach. PLoS One 2024; 19:e0306931. [PMID: 39028730 PMCID: PMC11259286 DOI: 10.1371/journal.pone.0306931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/25/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Opioid overdose is a major public health challenge. We aimed to understand facilitators and barriers to engagement in medication for opioid use disorder (MOUD) among persons with OUD in Washington, DC. METHODS We used a cross-sectional mixed-methods concept mapping approach to explore MOUD engagement between 2021-2022. Community members at-large generated 70 unique statements in response to the focus prompt: "What makes medication for opioid use disorder like buprenorphine (also known as Suboxone or Subutex) difficult to start or keep using?" Persons with OUD (n = 23) and service providers (n = 34) sorted and rated these statements by theme and importance. Data were analyzed with multidimensional scaling and hierarchical cluster analysis, producing thematic cluster maps. Results were validated by our community advisory board. RESULTS Seven themes emerged in response to the focus prompt: availability and accessibility; hopelessness and fear; unmet basic needs; characteristics of treatment programs; understanding and awareness of treatment; personal motivations, attitudes, and beliefs; and easier to use drugs. "Availability and accessibility," "hopelessness and fear," and "basic needs not being met" were the top three identified barriers to MOUD among consumers and providers; however, the order of these priorities differed between consumers and providers. There was a notable lack of communication and programming to address misconceptions about MOUD's efficacy, side effects, and cost. Stigma underscored many of the statements, showcasing its continued presence in clinical and social spaces. CONCLUSIONS This study distinguishes itself from other research on MOUD delivery and barriers by centering on community members and their lived experiences. Findings emphasize the need to expand access to treatment, dismantle stigma associated with substance use and MOUD, and address underlying circumstances that contribute to the profound sense of hopelessness and fear among persons with OUD-all of which will require collective action from consumers, providers, and the public.
Collapse
Affiliation(s)
- Britta Gullahorn
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public of Health, Washington, DC, United States of America
| | - Irene Kuo
- Department of Epidemiology, George Washington University Milken Institute School of Public of Health, Washington, DC, United States of America
| | - Artius M. Robinson
- Family and Medical Counseling Services, Inc., Washington, DC, United States of America
| | | | - Jennifer Loken
- Whitman-Walker Health, Washington, DC, United States of America
| | - Tamara Taggart
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public of Health, Washington, DC, United States of America
- Whitman-Walker Health, Washington, DC, United States of America
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| |
Collapse
|
3
|
Nakamoto CH, Huskamp HA, Donohue JM, Barnett ML, Gordon AJ, Mehrotra A. Medicare Payment for Opioid Treatment Programs. JAMA HEALTH FORUM 2024; 5:e241907. [PMID: 39028654 PMCID: PMC11259898 DOI: 10.1001/jamahealthforum.2024.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/19/2024] [Indexed: 07/21/2024] Open
Abstract
Importance Medicare began paying for medications for opioid use disorder (MOUD) at opioid treatment programs (OTPs) that dispense methadone and other MOUD in January 2020. There has been little research describing the response to this payment change and whether it resulted in more patients receiving MOUD or just a shift in who pays for this care. Objective To describe how many and which Medicare beneficiaries receive care from OTPs and how this compares to those receiving MOUD in other settings. Design, Setting, and Participants This cross-sectional study included all patients receiving MOUD care identified in 2019-2022 100% US Medicare Parts B and D claims. Patients receiving care in an OTP who were dually insured with Medicare and Medicaid in the 2019-2020 Transformed Medicaid Statistical Information System were also included. Exposure Receiving MOUD care in an OTP. Main Outcomes and Measures Comparisons of 2022 beneficiaries treated in OTPs vs other non-OTP settings in 2022. Results The share of Medicare beneficiaries treated by OTPs rose steadily from 4 per 10 000 (14 160 beneficiaries) in January 2020 to 7 per 10 000 (25 596 beneficiaries) in August 2020, then plateaued through December 2022; of 38 870 patients (23% ≥66 years; 35% female) treated at an OTP in 2022, 96% received methadone. Patients in OTPs, compared to those receiving MOUD in other settings, were more likely be 65 years and younger (65% vs 62%; P < .001), less likely to be White (72% vs 82%; P < .001), and more likely to be an urban resident (86% vs 74%; P < .001). When Medicare OTP coverage began, there was no associated drop in the number of dually insured patients with Medicaid with an OTP claim. Of the 1854 OTPs, 1115 (60%) billed Medicare in 2022, with the share billing Medicare ranging from 13% to 100% across states. Conclusions and Relevance This study showed that since the initiation of Medicare OTP coverage in 2020, there has been a rapid increase in the number of Medicare beneficiaries with claims for OTP services for MOUD, and most OTPs have begun billing Medicare. Patients in OTPs were more likely to be urban residents and members of racial or ethnic minority groups than the patients receiving other forms of MOUD.
Collapse
Affiliation(s)
- Carter H. Nakamoto
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Julie M. Donohue
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
- VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Tilhou AS, Burns M, Chachlani P, Chen Y, Dague L. How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders? SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:473-485. [PMID: 38494728 PMCID: PMC11179974 DOI: 10.1177/29767342241236028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown. METHODS Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share"). RESULTS The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only. CONCLUSIONS Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
Collapse
Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University Medical Center, Boston, MA, USA
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA
| | - Ying Chen
- Department of Risk and Insurance, Wisconsin School of Business, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura Dague
- The Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
| |
Collapse
|
5
|
Weiner SG, Burgess A, Singh H, Miller EN, Murphy C, Chehregosha E, Clear B. Patient experiences with telehealth treatment for opioid use disorder in Alabama. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209451. [PMID: 38960146 DOI: 10.1016/j.josat.2024.209451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/18/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Telehealth-only provision of buprenorphine for the treatment of opioid use disorder (OUD) was first made possible during the COVID-19 pandemic. However, Alabama instituted a law in July 2022 that mandated an annual in-person visit in order to receive this treatment. In July 2023, our usually telehealth-only group established a temporary clinic in Birmingham to meet this requirement. METHODS The study administered a survey instrument to patients at the time of clinic check-in. RESULTS 158 of 160 (98.8 %) patients completed the survey. Mean distance traveled was 86.4 (standard deviation (SD) 53.7) miles; time required for travel was mean 1.6 (SD 1.0) hours. Twenty-five patients (15.8 %) reported needing to find childcare to attend the visit and 40 patients (25.3 %) reported missing work to attend. Patients disagreed (median 2 on 1-5 Likert scale, interquartile range (IQR) <1-3>) that it is important to see their provider in-person, that seeing their provider in-person improves care or improves their ability to succeed in treatment, and that they have other OUD treatment resources in their community. Patients strongly agreed (median 5, IQR <5-5>) that OUD can be treated by telehealth without the need for an in-person visit. CONCLUSIONS An annual in-person visits requirement to receive telehealth OUD services imposed a significant burden on patients, was not desired by patients, and may be associated with harm.
Collapse
Affiliation(s)
- Scott G Weiner
- Bicycle Health, Inc., Boston, MA, United States of America; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
| | - Amelia Burgess
- Bicycle Health, Inc., Boston, MA, United States of America
| | - Herman Singh
- Bicycle Health, Inc., Boston, MA, United States of America
| | - Emily N Miller
- Bicycle Health, Inc., Boston, MA, United States of America
| | - Colleen Murphy
- Bicycle Health, Inc., Boston, MA, United States of America
| | | | - Brian Clear
- Bicycle Health, Inc., Boston, MA, United States of America
| |
Collapse
|
6
|
Maxwell JF, Feldman SS, Li L. Patient Retention in a Substance Use Disorder Telemedicine Clinic. South Med J 2024; 117:374-378. [PMID: 38959966 DOI: 10.14423/smj.0000000000001709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVES Although research has continued to show that substance use disorders (SUDs) can be treated effectively with evidence-based treatment, there continues to be gaps in access, and utilization remains low. Alternative SUD treatment methods, including telemedicine, are increasingly being explored to reach patients where traditional in-person treatment approaches are inaccessible. This cross-sectional study aimed to explore SUD treatment retention, specifically comparing telemedicine-delivered opioid use disorder (OUD) treatment with a traditional in-person treatment delivery approach. METHODS Patients at Cahaba Medical Care, an FQHC in Birmingham, AL with a diagnosis of OUD and undergoing buprenorphine/naloxone or buprenorphine treatment were categorized into two groups: treatment and control. The dependent variable, retention to SUD treatment, was assessed at four different time periods over 12 months to determine patient SUD consultation appointment attendance. Multiple linear regression was used to examine the relationship between SUD treatment retention and delivery mode. Correlations were obtained to assess associations between frequency of urine drug screens performed and SUD treatment retention. RESULTS As the number of the urine drug screens patients received increased by 1, the number of SUD treatment program consultations patients attended increased by 0.69 (P < 0.001). There was no significant difference in SUD treatment retention between traditional in-person and telemedicine delivered approaches, however. CONCLUSIONS The findings of this study suggest that a telemedicine-delivered treatment program equals retention effectiveness when compared with in-person delivery. This suggests that leveraging telemedicine to treat patients with SUD could be an effective alternative for those unable to access treatment or who are less likely to attend or complete traditional in-person treatment sessions.
Collapse
Affiliation(s)
| | - Sue S Feldman
- From the Department of Health Services Administration
| | - Li Li
- the Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham
| |
Collapse
|
7
|
Couch JV, Whitcomb M, Buchheit BM, Dorr DA, Malinoski DJ, Korthuis PT, Ono SS, Levander XA. Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis. Harm Reduct J 2024; 21:125. [PMID: 38937779 PMCID: PMC11210005 DOI: 10.1186/s12954-024-01043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma. METHODS In this qualitative study, we interviewed patients with OUD at a single urban academic medical center consisting of multiple primary care and addiction clinics in Oregon, USA. Participants were eligible if they had (1) at least one virtual visit for OUD between March 2020 and December 2021, and (2) a prescription for buprenorphine not exclusively used for chronic pain. We conducted phone interviews between October and December 2022, then recorded, transcribed, dual-coded, and analyzed using reflexive thematic analysis. RESULTS The mean age of participants (n = 30) was 40.5 years (range 20-63); 14 were women, 15 were men, and two were transgender, non-binary, or gender-diverse. Participants were 77% white, and 33% had experienced homelessness in the prior six months. We identified four themes regarding how telehealth for OUD treatment shaped patient perceptions of and experiences with stigma at the individual (1), public (2-3), and structural levels (4): (1) Telehealth offers wanted space and improved control over treatment setting; (2) Public stigma and privacy concerns can impact both telehealth and in-person encounters, depending on clinical and personal circumstances; (3) The social distance of telehealth could mitigate or exacerbate perceptions of clinician stigma, depending on both patient and clinician expectations; (4) The increased flexibility of telehealth translated to perceptions of increased clinician trust and respect. CONCLUSIONS The forms of stigma experienced by individuals with OUD are complex and multifaceted, as are the ways in which those experiences interact with telehealth-based care. The mixed results of this study support policies allowing for a more individualized, patient-centered approach to care delivery that allows patients a choice over how they receive OUD treatment services.
Collapse
Affiliation(s)
- Jessica V Couch
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Mackenzie Whitcomb
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Bradley M Buchheit
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David A Dorr
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Darren J Malinoski
- Office of Digital Health, Oregon Health & Science University, Portland, OR, USA
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - P Todd Korthuis
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Ximena A Levander
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA.
| |
Collapse
|
8
|
Arwady MA, Delphin-Rittmon M, Volkow ND. Major Gaps in the Cascade of Care for Opioid Use Disorder: Implications for Clinical Practice. JAMA 2024:2820545. [PMID: 38935607 DOI: 10.1001/jama.2024.11977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
This Viewpoint examines a recent report that used data from the 2022 National Survey on Drug Use and Health to estimate the opioid cascade of care, a framework to characterize the adult US populations who needed and received opioid use disorder (OUD) treatment, as well as discusses ways in which clinicians can close gaps in care.
Collapse
Affiliation(s)
- M Allison Arwady
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Miriam Delphin-Rittmon
- Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
9
|
Rishworth A, King B, Holmes LM. Digital geographies of care: Telehealth landscapes of addiction treatment during the COVID-19 pandemic. Health Place 2024; 89:103296. [PMID: 38917673 DOI: 10.1016/j.healthplace.2024.103296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 03/23/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
The COVID-19 pandemic has created new digital health care landscapes for the management of substance use and misuse. While telehealth was prohibited for addiction treatment prior to the pandemic, the severity of COVID-19 precipitated telehealth expansion for the delivery of individual and group-based treatment. Research has highlighted benefits and challenges of telehealth; however, little is known about the impacts of telehealth on the quality, use, and effectiveness of treatment. Fewer studies examine how these emerging digital geographies of care transform the spaces and landscapes of substance misuse. This article examines how telehealth affects landscapes of opioid use disorder care in Pennsylvania, West Virginia, and Kentucky during the COVID-19 pandemic. Our findings reveal that while telehealth extends access to treatment for opioid use disorder (OUD), it also creates new care inequities within and between providers and clientele that can undermine effective care and recovery.
Collapse
Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, Mississauga, Ontario, Canada.
| | - Brian King
- Department of Geography, The Pennsylvania State University, State College, University Park, PA, United States.
| | - Louisa M Holmes
- Department of Geography, The Pennsylvania State University, State College, University Park, PA, United States.
| |
Collapse
|
10
|
Nateghi Haredasht F, Fouladvand S, Tate S, Chan MM, Yeow JJL, Griffiths K, Lopez I, Bertz JW, Miner AS, Hernandez-Boussard T, Chen CYA, Deng H, Humphreys K, Lembke A, Vance LA, Chen JH. Predictability of buprenorphine-naloxone treatment retention: A multi-site analysis combining electronic health records and machine learning. Addiction 2024. [PMID: 38923168 DOI: 10.1111/add.16587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND AIMS Opioid use disorder (OUD) and opioid dependence lead to significant morbidity and mortality, yet treatment retention, crucial for the effectiveness of medications like buprenorphine-naloxone, remains unpredictable. Our objective was to determine the predictability of 6-month retention in buprenorphine-naloxone treatment using electronic health record (EHR) data from diverse clinical settings and to identify key predictors. DESIGN This retrospective observational study developed and validated machine learning-based clinical risk prediction models using EHR data. SETTING AND CASES Data were sourced from Stanford University's healthcare system and Holmusk's NeuroBlu database, reflecting a wide range of healthcare settings. The study analyzed 1800 Stanford and 7957 NeuroBlu treatment encounters from 2008 to 2023 and from 2003 to 2023, respectively. MEASUREMENTS Predict continuous prescription of buprenorphine-naloxone for at least 6 months, without a gap of more than 30 days. The performance of machine learning prediction models was assessed by area under receiver operating characteristic (ROC-AUC) analysis as well as precision, recall and calibration. To further validate our approach's clinical applicability, we conducted two secondary analyses: a time-to-event analysis on a single site to estimate the duration of buprenorphine-naloxone treatment continuity evaluated by the C-index and a comparative evaluation against predictions made by three human clinical experts. FINDINGS Attrition rates at 6 months were 58% (NeuroBlu) and 61% (Stanford). Prediction models trained and internally validated on NeuroBlu data achieved ROC-AUCs up to 75.8 (95% confidence interval [CI] = 73.6-78.0). Addiction medicine specialists' predictions show a ROC-AUC of 67.8 (95% CI = 50.4-85.2). Time-to-event analysis on Stanford data indicated a median treatment retention time of 65 days, with random survival forest model achieving an average C-index of 65.9. The top predictor of treatment retention identified included the diagnosis of opioid dependence. CONCLUSIONS US patients with opioid use disorder or opioid dependence treated with buprenorphine-naloxone prescriptions appear to have a high (∼60%) treatment attrition by 6 months. Machine learning models trained on diverse electronic health record datasets appear to be able to predict treatment continuity with accuracy comparable to that of clinical experts.
Collapse
Affiliation(s)
- Fateme Nateghi Haredasht
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
- Division of Hospital Medicine, Stanford University, Stanford, California, USA
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Sajjad Fouladvand
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
- Division of Hospital Medicine, Stanford University, Stanford, California, USA
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Steven Tate
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Min Min Chan
- Holmusk Technologies, Inc., Singapore, Singapore
- Holmusk Technologies, Inc., New York, New York, USA
| | - Joannas Jie Lin Yeow
- Holmusk Technologies, Inc., Singapore, Singapore
- Holmusk Technologies, Inc., New York, New York, USA
| | - Kira Griffiths
- Holmusk Technologies, Inc., Singapore, Singapore
- Holmusk Technologies, Inc., New York, New York, USA
| | - Ivan Lopez
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
- Division of Hospital Medicine, Stanford University, Stanford, California, USA
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Jeremiah W Bertz
- Center for the Clinical Trials Network, National Institute on Drug Abuse, North Bethesda, Maryland, USA
| | - Adam S Miner
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Tina Hernandez-Boussard
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
- Division of Hospital Medicine, Stanford University, Stanford, California, USA
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| | - Chwen-Yuen Angie Chen
- Division of Primary Care and Population Health, Department of Medicine Stanford University School of Medicine, Stanford, California, USA
| | - Huiqiong Deng
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - L Alexander Vance
- Holmusk Technologies, Inc., Singapore, Singapore
- Holmusk Technologies, Inc., New York, New York, USA
| | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
- Division of Hospital Medicine, Stanford University, Stanford, California, USA
- Clinical Excellence Research Center, Stanford University, Stanford, California, USA
| |
Collapse
|
11
|
Jalali A. Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies. Expert Rev Pharmacoecon Outcomes Res 2024; 24:599-611. [PMID: 38696161 DOI: 10.1080/14737167.2024.2350561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis. AREAS COVERED In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field. EXPERT OPINION Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies.
Collapse
Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Division of Comparative Effectiveness & Outcomes Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| |
Collapse
|
12
|
Floyd AS, Silcox J, Strickler G, Nong T, Blough M, Bolivar D, Rabin M, Bratberg J, Irwin AN, Hartung DM, Hansen RN, Bohler R, Green TC. Policies, adaptations, and ongoing challenges to naloxone, buprenorphine and nonprescription syringe access across four-states: Findings from an environmental scan and key informant interviews. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100243. [PMID: 38948428 PMCID: PMC11214408 DOI: 10.1016/j.dadr.2024.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 07/02/2024]
Abstract
Background As the US opioid-involved morbidity and mortality increase, uptake and implementation of evidence-based interventions remain key policy responses. Respond to Prevent was a multi-component, randomized trial implemented in four states and two large pharmacy chains with the aim of improving the pharmacy's capacity to provide naloxone, dispense buprenorphine, and sell nonprescription syringes (NPS). We sought to provide context and assess how policies and organizational practices affect communities and pharmacies across the study states. Methods Using a multi-method approach we: 1) conducted an environmental scan of published literature and online materials spanning January 2015 to June 2021, 2) created timelines of key events pertaining to those policies and practices and 3) conducted semi-structured interviews with stakeholders (key informants) at the state and local levels (N=36) to provide further context for the policies and practices we discovered. Results Key informants discussed state policies, pharmacy policies and local practices that facilitated access to naloxone, buprenorphine and NPSs. Interviewees from all states spoke about the impact of naloxone standing orders, active partnerships with community-based harm reduction organizations, and some federal and state policies like Medicaid coverage for naloxone and buprenorphine, and buprenorphine telehealth permissions as key facilitators. They also discussed patient stigma, access in rural settings, and high cost of medications as barriers. Conclusion Findings underscore the important role harm reduction-related policies play in boosting and institutionalizing interventions in communities and pharmacies while also identifying structural barriers where more focused state and local attention is needed.
Collapse
Affiliation(s)
- Anthony S. Floyd
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
| | - Joseph Silcox
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Gail Strickler
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Thuong Nong
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Malcolm Blough
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Derek Bolivar
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Megan Rabin
- Northeastern University, Bouve College of Health Sciences, Boston, MA, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | | | | | - Ryan N. Hansen
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Robert Bohler
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
- Jiann-Ping Hsu College of Public Health at Georgia Southern University, Statesboro, GA, USA
| | - Traci C. Green
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
- Departments of Emergency Medicine and Epidemiology, Brown Schools of Medicine and Public Health, Providence, RI, USA
| |
Collapse
|
13
|
Coules CL, Novotny CB, McDonough ME, Kopak AM. Levels of engagement among office-based opioid treatment (OBOT) patients with concurrent methamphetamine use. Am J Addict 2024. [PMID: 38711245 DOI: 10.1111/ajad.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Recent increases in methamphetamine use among people seeking treatment for opioid use disorder (OUD) has created significant demand for effective approaches to support this clinical population. This study assessed the extent to which office-based opioid treatment (OBOT) patients, who were diagnosed with methamphetamine use disorder (MUD), engaged with providers. METHODS A retrospective analysis was conducted of adult patients (n = 470) seeking treatment for OUD who attended at least one visit between March 2020 and March 2023 at a rural regional OBOT provider. Approximately one quarter (28.7%) of patients were diagnosed with MUD in addition to receiving an OUD diagnosis. Bivariate methods and multivariate negative binomial regression models were estimated to examine the associations between clinical measures and the numbers of office visits, peer visits, and telehealth visits. RESULTS Regression results indicated patients who met criteria for MUD in addition to OUD attended a higher rate of peer visits (incidence rate ratio [IRR] = 2.63, p = .036) when compared to patients who did not meet criteria for MUD. In contrast, patients with MUD and OUD diagnoses displayed significantly lower (IRR = 0.68, p < .001) engagement rates through fewer office visits relative to those who did not meet MUD criteria. DISCUSSION AND CONCLUSIONS Patients seeking treatment for OUD who meet criteria for MUD are more likely to engage through peer support specialists rather than office visits. SCIENTIFIC SIGNIFICANCE This study demonstrates the ways patients who meet criteria for OUD and MUD engage with providers to receive treatment.
Collapse
Affiliation(s)
- Courtney L Coules
- The Mountain Area Health Education Center (MAHEC), Asheville, North Carolina, USA
| | - Clara B Novotny
- The Mountain Area Health Education Center (MAHEC), Asheville, North Carolina, USA
| | - Margaret E McDonough
- The Mountain Area Health Education Center (MAHEC), Asheville, North Carolina, USA
| | - Albert M Kopak
- The Mountain Area Health Education Center (MAHEC), Asheville, North Carolina, USA
| |
Collapse
|
14
|
Chatterjee A, Baker T, Rudorf M, Walt G, Stotz C, Martin A, Kinnard EN, McAlearney AS, Bosak J, Medley B, Pinkhover A, Taylor JL, Samet JH, Lunze K. Mobile treatment for opioid use disorder: Implementation of community-based, same-day medication access interventions. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209272. [PMID: 38128649 PMCID: PMC10947870 DOI: 10.1016/j.josat.2023.209272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/20/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Medications for Opioid Use Disorder (MOUD) are lifesaving, but <20 % of individuals in the US who could benefit receive them. As part of the NIH-supported HEALing Communities Study (HCS), coalitions in several communities in Massachusetts and Ohio implemented mobile MOUD programs to overcome barriers to MOUD receipt. We defined mobile MOUD programs as units that provide same-day access to MOUD at remote sites. We aimed to (1) document the design and organizational structure of mobile programs providing same-day or next-day MOUD, and (2) explore the barriers and facilitators to implementation as well as the successes and challenges of ongoing operation. METHODS Program staff from five programs in two states (n = 11) participated in semi-structured interviews. Two authors conducted thematic analysis of the transcripts based on the domains of the social-ecological model and the semi-structured interview guide. RESULTS Mobile MOUD units sought to improve immediate access to MOUD ("Our answer is pretty much always, 'Yes, we'll get you started right here, right now,'"), advance equity ("making sure that we have staff who speak other languages, who are on the unit and have some resources that are in different languages,"), and decrease opioid overdose deaths. Salient program characteristics included diverse staff, including staff with lived experience of substance use ("She just had that personal knowledge of where we should be going"). Mobile units offered harm reduction services, broad medical services (in particular, wound care), and connection to transportation programs and incorporated consistency in service provision and telemedicine access. Implementation facilitators included trusting relationships with partner organizations (particularly pharmacies and correctional facilities), nuanced understanding of local politics, advertising, protocol flexibility, and on-unit prescriber hours. Barriers included unclear licensing requirements, staffing shortages and competing priorities for staff, funding challenges due to inconsistency in grant funding and low reimbursement ("It's not really possible that billing in and of itself is going to be able to sustain it"), and community stigma toward addiction services generally. CONCLUSIONS Despite organizational, community, and policy barriers, participants described mobile MOUD units as an innovative way to expand access to life-saving medications, promote equity in MOUD treatment, and overcome stigma.
Collapse
Affiliation(s)
- Avik Chatterjee
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America.
| | - Trevor Baker
- Boston Medical Center, Boston, MA, United States of America
| | - Maria Rudorf
- Boston Medical Center, Boston, MA, United States of America
| | - Galya Walt
- Boston Medical Center, Boston, MA, United States of America
| | - Caroline Stotz
- Boston Medical Center, Boston, MA, United States of America
| | - Anna Martin
- Boston Medical Center, Boston, MA, United States of America
| | | | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Julie Bosak
- Boston Medical Center, Boston, MA, United States of America
| | - Bethany Medley
- Columbia University School of Social Work, New York, NY, United States of America
| | - Allyson Pinkhover
- Brockton Neighborhood Health Center, Brockton, MA, United States of America; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jessica L Taylor
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Jeffrey H Samet
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Karsten Lunze
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| |
Collapse
|
15
|
Rajagopal S, Westra J, Raji MA, Wilkes D, Kuo YF. Access to Medications for Opioid Use Disorder During COVID-19: Retrospective Study of Commercially Insured Patients from 2019-2022. Am J Prev Med 2024; 66:635-644. [PMID: 37979624 PMCID: PMC11128187 DOI: 10.1016/j.amepre.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION This study assesses disparities in medications for opioid use disorder in adults with opioid use disorder and examines the associations between state-level COVID-19 lockdown and telehealth policies and medications for opioid use disorder utilization rates during the COVID-19 pandemic. METHODS This retrospective cohort study of 396,872 adults with opioid use disorder analyzed monthly medications for opioid use disorder utilization rates between January 2019 and June 2022 using data from Clinformatics Data Mart Database. Primary outcome measure was monthly medications for opioid use disorder utilization rates. Variables of interest were patients' demographics and state-level characteristics (telehealth policies for controlled substance prescribing, COVID-19 lockdown policy, and registered buprenorphine providers/100,000). In multivariable analyses, time trend was grouped into four time periods: before COVID-19, early COVID-19, early vaccine, and Omicron-related COVID-19 surge and thereafter. RESULTS Medications for opioid use disorder rates increased from a 1.2% change in slope monthly on a log scale to 2% monthly from February 2021 to October 2021, after which the utilization rate increased to a lesser degree. Women had 28% lower odds of receiving medications for opioid use disorder than men; Hispanic, Black, and Asian patients had 40%, 34%, and 32% lower odds of receiving medications for opioid use disorder than White patients, respectively. These sex and racial disparities persisted throughout the pandemic. Regional medications for opioid use disorder rate differences, mediated by buprenorphine providers/100,000 state population, decreased during the pandemic. States with telehealth policies for controlled substance prescribing had greater percentages of patients on medications for opioid use disorder (11.7%) than states without such policies (10.4%). CONCLUSIONS Monthly medications for opioid use disorder rates increased during the pandemic, with higher rates in men, White individuals, and residents of the Northeast region. States with policies permitting telehealth prescribing of controlled substances also had higher medications for opioid use disorder rates, supporting a future expansion of medications for opioid use disorder-related telehealth to improve access to care.
Collapse
Affiliation(s)
- Shilpa Rajagopal
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Jordan Westra
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A Raji
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center On Aging, University of Texas Medical Branch, Galveston, Texas
| | - Denise Wilkes
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas; Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center On Aging, University of Texas Medical Branch, Galveston, Texas.
| |
Collapse
|
16
|
McLean K, Murphy J, Kruis N. "I think we're getting better but we're still not there": Provider-based stigma and perceived barriers to care for people who use opioids (PWUO). JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209270. [PMID: 38103831 DOI: 10.1016/j.josat.2023.209270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/18/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Despite significant efforts to improve access to medications for opioid use disorder (MOUD), uptake remains low relative to the scope of the problem in the United States. A growing body of quantitative and qualitative research has documented consistent barriers to MOUD treatment access and retention, at the level of individuals, institutions, and society at large. Stigma - surrounding both people who use opioids (PWUO) and treatment using MOUD - is among the most-cited barriers by patients and providers alike, yet few studies have examined provider-based stigma specifically, or considered its interaction with other impediments to OUD care. METHODS This paper employs a qualitative approach to the analysis of provider-based stigma among professionals involved in the treatment or supervision of individuals with OUD. We conducted and analyzed interviews with 19 professionals as part of a larger mixed methods study on stigma among substance use treatment providers and court personnel in Pennsylvania. Beyond capturing providers' perceptions of PWUO and MOUD, the authors asked participants to describe barriers to recovery, and the effective delivery of care within this population. RESULTS Interviewees enumerated multiple entrenched barriers that sometimes operated at different levels, such as criminal-legal involvement, which weakened PWUO's social networks and employment prospects, while undermining providers' attempts at continuity of care; moreover, participants cited the "War on Drugs" as an overarching impediment to effective substance use treatment, not least for its role in perpetuating stigma against PWUO. CONCLUSIONS Interestingly, while an overwhelming majority of participants named stigma as a barrier to treatment at every level, most also articulated stigmatizing beliefs around PWUO. Namely, providers evoked one element of stigma - blameworthiness - in their contention that many PWUO are inadequately motivated to recover. In addition to adding further complexity to MOUD barriers research, this study troubles the notion that professional training and education on the disease model of addiction serve to eradicate stigma.
Collapse
Affiliation(s)
- Katherine McLean
- Penn State Greater Allegheny, 4000 University Dr., McKeesport, PA 15131, United States of America.
| | - Jennifer Murphy
- Penn State Berks, 1801 Broadcasting Rd, Reading, PA 19610, United States of America.
| | - Nathan Kruis
- Penn State Altoona, 3000 Ivyside Park, Altoona, PA 16601, United States of America.
| |
Collapse
|
17
|
Qian G, Humphreys K, Goldhaber-Fiebert JD, Brandeau ML. Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis. Drug Alcohol Depend 2024; 256:111112. [PMID: 38335797 PMCID: PMC10940194 DOI: 10.1016/j.drugalcdep.2024.111112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/12/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
AIM To assess the effectiveness and cost-effectiveness of buprenorphine and methadone treatment in the U.S. if exemptions expanding coverage for substance use disorder services via telehealth and allowing opioid treatment programs to supply a greater number of take-home doses of medications for opioid use disorder (OUD) continue (Notice of Proposed Rule Making, NPRM). DESIGN SETTING AND PARTICIPANTS Model-based analysis of buprenorphine and methadone treatment for a cohort of 100,000 individuals with OUD, varying treatment retention and overdose risk among individuals receiving and not receiving methadone treatment compared to the status quo (no NPRM). INTERVENTION Buprenorphine and methadone treatment under NPRM. MEASUREMENTS Fatal and nonfatal overdoses and deaths over five years, discounted lifetime per person QALYs and costs. FINDINGS For buprenorphine treatment under the status quo, 1.21 QALYs are gained at a cost of $19,200/QALY gained compared to no treatment; with 20% higher treatment retention, 1.28 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment, and the strategy dominates the status quo. For methadone treatment under the status quo, 1.11 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment. In all scenarios, methadone provision cost less than $20,000/QALY gained compared to no treatment, and less than $50,000/QALY gained compared to status quo methadone treatment. CONCLUSIONS Buprenorphine and methadone OUD treatment under NPRM are likely to be effective and cost-effective. Increases in overdose risk with take-home methadone would reduce health benefits. Clinical and technological strategies could mitigate this risk.
Collapse
Affiliation(s)
- Gary Qian
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
| | - Keith Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| |
Collapse
|
18
|
Shelke S, Veerubhotla K, Lee Y, Lee CH. Telehealth of cardiac devices for CVD treatment. Biotechnol Bioeng 2024; 121:823-834. [PMID: 38151894 DOI: 10.1002/bit.28637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
This review covers currently available cardiac implantable electronic devices (CIEDs) as well as updated progress in real-time monitoring techniques for CIEDs. A variety of implantable and wearable devices that can diagnose and monitor patients with cardiovascular diseases are summarized, and various working mechanisms and principles of monitoring techniques for Telehealth and mHealth are discussed. In addition, future research directions are presented based on the rapidly evolving research landscape including Artificial Intelligence (AI).
Collapse
Affiliation(s)
- Sushil Shelke
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Krishna Veerubhotla
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Yugyung Lee
- Division of Computer Science, School of Science and Engineering, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Chi H Lee
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| |
Collapse
|
19
|
Burke B, Miller E, Clear B, Weiner SG. A qualitative study to determine perspectives of clinicians providing telehealth opioid use disorder treatment. Drug Alcohol Depend 2024; 256:111118. [PMID: 38367534 DOI: 10.1016/j.drugalcdep.2024.111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Telehealth-only medication for opioid use disorder (teleMOUD) treatment with buprenorphine was first made possible in the United States during the COVID-19 Public Health Emergency. As a result, several large provider groups now treat opioid use disorder (OUD) patients in nearly every state using telehealth. This study evaluates the perceptions and experiences of providers working almost exclusively in a teleMOUD program. METHODS Qualitative interviews were conducted with 18 providers (physicians, physician assistants and nurse practitioners) using a semi-structured interview guide. Interviews were recorded, transcribed and reviewed. After reviewing the transcripts, a codebook was developed, interviews were coded, and coded excerpts were analyzed for key themes. RESULTS Inductive codes were used to organize provider responses and included patient-level codes, provider-level codes, and telehealth environment codes. For providers, there are benefits of a flexible and less stressful working environment, which contribute to a higher quality of life. Providers also expressed mixed feelings regarding professional identity and focusing specifically on OUD, differences in relationships with colleagues, and challenges related to policy changes and ambiguities. For patients, providers perceived greater access, less stigma, more convenience, and a unique provider-patient relationship compared to in-person treatment. These themes affect providers and patients on multiple levels of the social-ecological model. CONCLUSIONS Multiple themes emerged in this study. This work is amongst the first to describe perspectives of providers working in the nascent teleMOUD setting, and can inform initiatives to improve provider wellness, provider retention, and quality of care for patients treated in the setting.
Collapse
Affiliation(s)
| | | | | | - Scott G Weiner
- Bicycle Health, Boston, MA, USA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
20
|
Emezue CN, Karnik NS, Sabri B, Anakwe A, Bishop-Royse JC, Dan-Irabor D, Froilan AP, Dunlap A, Li Q, Julion W. Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01936-y. [PMID: 38366279 DOI: 10.1007/s40615-024-01936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Recent data show high school students from racial and ethnic minority (REM) backgrounds in the United States confront a twofold challenge, marked by the highest rates of firearm-related homicides since 1994 and increased youth substance use. The pandemic increased online and telehealth usage opportunities for at-risk REM youth. Therefore, this study investigated (1) the frequency and prevalence of co-occurring youth violence and substance use among REM adolescents, (2) racial/ethnic, age, and natal sex (as gender data was not collected) differences in patterns and trends in co-occurring youth violence and substance use among REM adolescents, and (3) the relationship between these syndemic issues and REM adolescent mental telehealth use during the pandemic. METHODS Data was sourced from a nationally representative sample of U.S. 9th-12th students (n = 3241) who completed the CDC's 2021 Adolescent and Behavioral Experiences Survey (ABES). Using univariate (frequency distribution), bivariate (Pearson's chi-squared test), and multivariate logistic regression models, we examined seven violence victimization outcomes, four violence perpetration outcomes, two family violence outcomes, and six substance use outcomes and their associations with telehealth use for mental health (dependent variable) among REM adolescents. RESULTS This sample was primarily female (50.7%), Black or African American (48.3%), Hispanic or Latinx (20.6%), and identified as straight or heterosexual (69.5%). The study found significant sex-based differences in violence perpetration/victimization, substance use, and telehealth use for mental health. In general, mental telehealth use was significantly associated with substance use among REM adolescents (cigarette smoking, vaping, alcohol, marijuana, prescription meds, and illicit drug use) (p-value = .001). Mental telehealth use was also significantly associated with all peer and family violence outcomes (p < 0.001). Controlling for covariates, gun carrying was associated with 4.8 times higher odds of using mental telehealth. Students in a physical fight or carrying a weapon (gun, knife, or club) on school property had 2.45 times and 8.09 times the odds of utilizing mental telehealth. Bullied students were 2.5 times more likely to use mental telehealth (p-value < 0.05). Illicit drug use (cocaine, heroin, methamphetamines, and ecstasy) was associated with a higher likelihood of mental telehealth use (AOR = 1.3, p-value = .05). CONCLUSION Our results suggest crucial insights for shaping violence and substance use prevention strategies, with implications for the future of online and telehealth behavioral services. Mental telehealth help-seeking emerges as a crucial avenue for supporting adolescents affected by violence and substance use, especially when they face obstacles to accessing traditional services. It can work in tandem with in-person services to address these challenges.
Collapse
Affiliation(s)
- Chuka N Emezue
- Department of Women, Children, and Family Nursing, College of Nursing, Rush University Medical Center, Chicago, USA.
| | - Niranjan S Karnik
- Department of Psychiatry, Institute for Juvenile Research (IJR), University of Illinois Chicago, Chicago, USA
| | - Bushra Sabri
- Johns Hopkins University, School of Nursing, Baltimore, USA
| | - Adaobi Anakwe
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Dale Dan-Irabor
- School of Humanities and Social Sciences, University of Missouri Kansas City - Volker Campus, Kansas City, USA
| | - Andrew Paul Froilan
- Faculty Practice and Department of Women, Children, and Family Nursing, Rush University Medical Center, Chicago, USA
| | - Aaron Dunlap
- Department of Women, Children, and Family Nursing, College of Nursing, Rush University Medical Center, Chicago, USA
| | - Qing Li
- University of Mississippi Medical Center, School of Nursing, Jackson, USA
| | - Wrenetha Julion
- Department of Women, Children, and Family Nursing, College of Nursing, Rush University Medical Center, Chicago, USA
| |
Collapse
|
21
|
Stopka TJ, Babineau DC, Gibson EB, Knott CE, Cheng DM, Villani J, Wai JM, Blevins D, David JL, Goddard-Eckrich DA, Lofwall MR, Massatti R, DeFiore-Hyrmer J, Lyons MS, Fanucchi LC, Harris DR, Talbert J, Hammerslag L, Oller D, Balise RR, Feaster DJ, Soares W, Zarkin GA, Glasgow L, Oga E, McCarthy J, D’Costa L, Chahine R, Gomori S, Dalvi N, Shrestha S, Garner C, Shadwick A, Salsberry P, Konstan MW, Freisthler B, Winhusen J, El-Bassel N, Samet JH, Walsh SL. Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing: A Prespecified Secondary Analysis of the HCS Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240132. [PMID: 38386322 PMCID: PMC10884876 DOI: 10.1001/jamanetworkopen.2024.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
Importance Buprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined. Objective To determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing. Design, Setting, and Participants This prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list-controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022. Intervention Waiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity. Main Outcomes and Measures The rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed. Results A total of 8 166 963 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 0.97; 95% CI, 0.86-1.10). Conclusions and Relevance In this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder. Trial Registration ClinicalTrials.gov Identifier: NCT04111939.
Collapse
Affiliation(s)
- Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Erin B. Gibson
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Charles E. Knott
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Debbie M. Cheng
- Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Jonathan M. Wai
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Derek Blevins
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - James L. David
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Dawn A. Goddard-Eckrich
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Michelle R. Lofwall
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Richard Massatti
- Ohio Department of Mental Health and Addiction Services, Columbus
| | | | | | - Laura C. Fanucchi
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | | | | | - Lindsey Hammerslag
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Devin Oller
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Raymond R. Balise
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - William Soares
- UMass Chan Medical School–Baystate, Springfield, Massachusetts
| | - Gary A. Zarkin
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - LaShawn Glasgow
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Emmanuel Oga
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - John McCarthy
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Lauren D’Costa
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Rouba Chahine
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Steve Gomori
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Netrali Dalvi
- Office of Prescription Monitoring and Drug Control, Massachusetts Department of Public Health, Boston
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Aimee Shadwick
- RecoveryOhio, Office of Ohio Governor Mike DeWine, Columbus
| | - Pamela Salsberry
- Health Behavior and Health Promotion, Ohio State University, Columbus
| | | | | | - John Winhusen
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nabila El-Bassel
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Jeffrey H. Samet
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Sharon L. Walsh
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| |
Collapse
|
22
|
Xu JJ, Seamans MJ, Friedman JR. Drug overdose mortality rates by educational attainment and sex for adults aged 25-64 in the United States before and during the COVID-19 pandemic, 2015-2021. Drug Alcohol Depend 2024; 255:111014. [PMID: 38142465 DOI: 10.1016/j.drugalcdep.2023.111014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/01/2023] [Accepted: 10/24/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Dramatic increases in U.S. drug overdose deaths involving synthetic opioids, especially fentanyl, beginning around 2014 have driven a marked progression in overall drug overdose deaths in the U.S., which sharply rose to unprecedented levels amid the COVID-19 pandemic. Disparities in drug overdose deaths by educational attainment (EA) during the fentanyl era of the drug overdose epidemic and its intersection with the COVID-19 pandemic have not been widely scrutinized. METHODS Utilizing restricted-use mortality data from the National Vital Statistics System and population estimates from the American Community Survey, we estimated annual national age-adjusted mortality rates (AAMRs) from drug overdoses jointly stratified by EA and sex for adults aged 25-64 from 2015 to 2021. State-level AAMRs in 2015 and 2021 were also estimated to examine the geographic variation in the cumulative evolution of EA-related disparities over the course of the analysis period. RESULTS Nationally, AAMRs rose fastest among persons with at most a high school-level education, whereas little to no change was observed for bachelor's degree holders, widening pre-existing disparities. During the analysis period, the difference in national AAMRs between persons with at most a high school-level education and bachelor's degree holders increased from less than 8-fold (2015) to approximately 13-fold (2021). The national widening of EA-related disparities accelerated amid the COVID-19 pandemic, and they widened in nearly every state. Among non-bachelor's degree holders, national AAMRs increased markedly faster for males. CONCLUSIONS The widening disparities in drug overdose deaths by EA are a likely indicator of a rapidly increasing socioeconomic divide in drug overdose mortality more broadly. Policy strategies should address upstream socioeconomic drivers of drug use and overdose, particularly among males.
Collapse
Affiliation(s)
- Jay J Xu
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Marissa J Seamans
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Joseph R Friedman
- Center for Social Medicine and Humanities, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| |
Collapse
|
23
|
Alessio-Bilowus D, Luby AO, Cooley S, Evilsizer S, Seese E, Bicket M, Waljee JF. Perioperative Opioid-Related Harms: Opportunities to Minimize Risk. Semin Plast Surg 2024; 38:61-68. [PMID: 38495063 PMCID: PMC10942841 DOI: 10.1055/s-0043-1778043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Although substantial attention has been given to opioid prescribing in the United States, opioid-related mortality continues to climb due to the rising incidence and prevalence of opioid use disorder. Perioperative care has an important role in the consideration of opioid prescribing and the care of individuals at risk for poor postoperative pain- and opioid-related outcomes. Opioids are effective for acute pain management and commonly prescribed for postoperative pain. However, failure to align prescribing with patient need can result in overprescribing and exacerbate the flow of unused opioids into communities. Conversely, underprescribing can result in the undertreatment of pain, complicating recovery and impairing well-being after surgery. Optimizing pain management can be particularly challenging for individuals who are previously exposed to opioids or have critical risk factors, including opioid use disorder. In this review, we will explore the role of perioperative care in the broader context of the opioid epidemic in the United States, and provide considerations for a multidisciplinary, comprehensive approach to perioperative pain management and optimal opioid stewardship.
Collapse
Affiliation(s)
- Dominic Alessio-Bilowus
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Alexandra O. Luby
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Mark Bicket
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
- Division of Pain Research, Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
| | - Jennifer F. Waljee
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
24
|
Newton H, Miller-Rosales C, Crawford M, Cai A, Brunette M, Meara E. Availability of Medication for Opioid Use Disorder Among Accountable Care Organizations: Evidence From a National Survey. Psychiatr Serv 2024; 75:182-185. [PMID: 37614155 PMCID: PMC10895446 DOI: 10.1176/appi.ps.20230087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE This report aimed to assess how accountable care organizations (ACOs) addressed ongoing opioid use disorder treatment needs over time. METHODS Responses from the 2018 (N=308 organizations) and 2022 (N=276) National Survey of Accountable Care Organizations (response rate=55% in both years) were used to examine changes in availability of medication for opioid use disorder (MOUD) among ACOs with Medicare and Medicaid contracts. RESULTS The percentage of respondents offering at least one MOUD grew from 39% in 2018 to 52% in 2022 (p<0.01). MOUDs were more likely to be available in 2022 among ACOs with (vs. without) in-network substance use treatment facilities (80% vs. 33%, p<0.001). The percentage of 2022 respondents who reported offering MOUD was similar in states with high versus low opioid overdose mortality rates. CONCLUSIONS Despite growing availability of MOUD among ACOs, nearly half reported not offering any MOUD in 2022, and the availability of MOUD did not increase with treatment need.
Collapse
Affiliation(s)
- Helen Newton
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (Newton); Department of Health Care Policy, Harvard Medical School, Boston (Miller-Rosales); Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (Crawford); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Cai, Meara); Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Brunette)
| | - Chris Miller-Rosales
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (Newton); Department of Health Care Policy, Harvard Medical School, Boston (Miller-Rosales); Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (Crawford); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Cai, Meara); Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Brunette)
| | - Maia Crawford
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (Newton); Department of Health Care Policy, Harvard Medical School, Boston (Miller-Rosales); Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (Crawford); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Cai, Meara); Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Brunette)
| | - Arno Cai
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (Newton); Department of Health Care Policy, Harvard Medical School, Boston (Miller-Rosales); Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (Crawford); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Cai, Meara); Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Brunette)
| | - Mary Brunette
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (Newton); Department of Health Care Policy, Harvard Medical School, Boston (Miller-Rosales); Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (Crawford); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Cai, Meara); Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Brunette)
| | - Ellen Meara
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (Newton); Department of Health Care Policy, Harvard Medical School, Boston (Miller-Rosales); Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire (Crawford); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Cai, Meara); Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Brunette)
| |
Collapse
|
25
|
White SA, McCourt AD, Tormohlen KN, Yu J, Eisenberg MD, McGinty EE. Navigating addiction treatment during COVID-19: policy insights from state health leaders. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae007. [PMID: 38344412 PMCID: PMC10853880 DOI: 10.1093/haschl/qxae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 04/12/2024]
Abstract
To mitigate pandemic-related disruptions to addiction treatment, US federal and state governments made significant changes to policies regulating treatment delivery. State health agencies played a key role in implementing these policies, giving agency leaders a distinct vantage point on the feasibility and implications of post-pandemic policy sustainment. We interviewed 46 state health agency and other leaders responsible for implementing COVID-19 addiction treatment policies across 8 states with the highest COVID-19 death rate in their census region. Semi-structured interviews were conducted from April through October 2022. Transcripts were analyzed using summative content analysis to characterize policies that interviewees perceived would, if sustained, benefit addiction treatment delivery long-term. State policies were then characterized through legal database queries, internet searches, and analysis of existing policy databases. State leaders viewed multiple pandemic-era policies as useful for expanding addiction treatment access post-pandemic, including relaxing restrictions for telehealth, particularly for buprenorphine induction and audio-only treatment; take-home methadone allowances; mobile methadone clinics; and out-of-state licensing flexibilities. All states adopted at least 1 of these policies during the pandemic. Future research should evaluate these policies outside of the acute COVID-19 pandemic context.
Collapse
Affiliation(s)
- Sarah A White
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Alexander D McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Kayla N Tormohlen
- Division of Health Policy and Economics, Weill Cornell Medicine, New York, NY 10065, United States
| | - Jiani Yu
- Division of Health Policy and Economics, Weill Cornell Medicine, New York, NY 10065, United States
| | - Matthew D Eisenberg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Emma E McGinty
- Division of Health Policy and Economics, Weill Cornell Medicine, New York, NY 10065, United States
| |
Collapse
|
26
|
Liu P, Korthuis PT, Buchheit BM. Novel Therapeutic and Program-Based Approaches to Opioid Use Disorders. Annu Rev Med 2024; 75:83-97. [PMID: 37827194 DOI: 10.1146/annurev-med-050522-033924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Opioid use disorder continues to drive overdose deaths in many countries, including the United States. Illicit fentanyl and its analogues have emerged as key contributors to the complications and mortality associated with opioid use disorder. Medications for opioid use disorder treatment, such as methadone and buprenorphine, are safe and substantially reduce opioid use, infectious complications, and mortality risk, but remain underutilized. Polysubstance use and emerging substances such as xylazine and designer benzodiazepines create additional treatment challenges. Recent clinical and policy innovations in treatment delivery, including telemedicine, bridge clinics, and expanded models for accessing methadone have the potential to increase access to life-saving care for people living with opioid use disorder.
Collapse
Affiliation(s)
- Patricia Liu
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
| | - P Todd Korthuis
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Bradley M Buchheit
- Section of Addiction, Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA;
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
27
|
Wyte-Lake T, Cohen DJ, Williams S, Casey D, Chan M, Frank B, Levander XA, Stein D, White KK, Bailey SR. Patients' and Clinicians' Experiences with In-person, Video, and Phone Modalities for Opioid Use Disorder Treatment: A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-023-08586-6. [PMID: 38228990 DOI: 10.1007/s11606-023-08586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) is a chronic condition that requires regular visits and care continuity. Telehealth implementation has created multiple visit modalities for OUD care. There is limited knowledge of patients' and clinicians' perceptions and experiences related to multi-modality care and when different modalities might be best employed. OBJECTIVE To identify patients' and clinicians' experiences with multiple visit modalities for OUD treatment in primary care. DESIGN Comparative case study, using video- and telephone-based semi-structured interviews. PARTICIPANTS Patients being treated for OUD (n = 19) and clinicians who provided OUD care (n = 15) from two primary care clinics within the same healthcare system. APPROACH Using an inductive approach, interviews were analyzed to identify patients' and clinicians' experiences with receiving/delivering OUD care via different visit modalities. Clinicians' and patients' experiences were compared using a group analytical process. KEY RESULTS Patients and clinicians valued having multiple modalities available for care, with flexibility identified as a key benefit. Patients highlighted the decreased burden of travel and less social anxiety with telehealth visits. Similarly, clinicians reported that telehealth decreased medical intrusion into the lives of patients stable in recovery. Patients and clinicians saw the value of in-person visits when establishing care and for patients needing additional support. In-person visits allowed the ability to conduct urine drug testing, and to foster relationships and trust building, which were more difficult, but not impossible via a telehealth visit. Patients preferred telephone over video visits, as these were more private and more convenient. Clinicians identified benefits of video, including being able to both hear and see the patient, but often deferred to patient preference. CONCLUSIONS Considerations for utilization of visit modalities for OUD care were identified based on patients' needs and preferences, which often changed over the course of treatment. Continued research is needed determine how visit modalities impact patient outcomes.
Collapse
Affiliation(s)
- Tamar Wyte-Lake
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Shannon Williams
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David Casey
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Matt Chan
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brian Frank
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ximena A Levander
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Dan Stein
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Katie Kirkman White
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
28
|
Lopez I, Fouladvand S, Kollins S, Chen CYA, Bertz J, Hernandez-Boussard T, Lembke A, Humphreys K, Miner AS, Chen JH. Predicting premature discontinuation of medication for opioid use disorder from electronic medical records. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1067-1076. [PMID: 38222349 PMCID: PMC10785878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Medications such as buprenorphine-naloxone are among the most effective treatments for opioid use disorder, but limited retention in treatment limits long-term outcomes. In this study, we assess the feasibility of a machine learning model to predict retention vs. attrition in medication for opioid use disorder (MOUD) treatment using electronic medical record data including concepts extracted from clinical notes. A logistic regression classifier was trained on 374 MOUD treatments with 68% resulting in potential attrition. On a held-out test set of 157 events, the full model achieved an area under the receiver operating characteristic curve (AUROC) of 0.77 (95% CI: 0.64-0.90) and AUROC of 0.74 (95% CI: 0.62-0.87) with a limited model using only structured EMR data. Risk prediction for opioid MOUD retention vs. attrition is feasible given electronic medical record data, even without necessarily incorporating concepts extracted from clinical notes.
Collapse
Affiliation(s)
- Ivan Lopez
- Department of Medicine, Biomedical Informatics Research, Stanford Medicine, Stanford University, CA
| | - Sajjad Fouladvand
- Department of Medicine, Biomedical Informatics Research, Stanford Medicine, Stanford University, CA
| | | | | | - Jeremiah Bertz
- Center for the Clinical Trials Network, National Institute on Drug Abuse, MD
| | - Tina Hernandez-Boussard
- Department of Medicine, Biomedical Informatics Research, Stanford Medicine, Stanford University, CA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford University, CA
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford University, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Adam S Miner
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford University, CA
| | - Jonathan H Chen
- Department of Medicine, Biomedical Informatics Research, Stanford Medicine, Stanford University, CA
| |
Collapse
|
29
|
Tormohlen KN, Eisenberg MD, Fingerhood MI, Yu J, McCourt AD, Stuart EA, Rutkow L, Quintero L, White SA, McGinty EE. Trends in Opioid Use Disorder Outpatient Treatment and Telehealth Utilization Before and During the COVID-19 Pandemic. Psychiatr Serv 2024; 75:72-75. [PMID: 37461819 PMCID: PMC11034749 DOI: 10.1176/appi.ps.20230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
OBJECTIVE The authors examined trends in opioid use disorder treatment and in-person and telehealth modalities before and after COVID-19 pandemic onset among patients who had received treatment prepandemic. METHODS The sample included 13,113 adults with commercial insurance or Medicare Advantage and receiving opioid use disorder treatment between March 2018 and February 2019. Trends in opioid use disorder outpatient treatment, treatment with medications for opioid use disorder (MOUD), and in-person and telehealth modalities were examined 1 year before pandemic onset and 2 years after (March 2019-February 2022). RESULTS From March 2019 to February 2022, the proportion of patients with opioid use disorder outpatient and MOUD visits declined by 2.8 and 0.3 percentage points, respectively. Prepandemic, 98.6% of outpatient visits were in person; after pandemic onset, at least 34.9% of patients received outpatient care via telehealth. CONCLUSIONS Disruptions in opioid use disorder outpatient and MOUD treatments were marginal during the pandemic, possibly because of increased telehealth utilization.
Collapse
Affiliation(s)
- Kayla N Tormohlen
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Matthew D Eisenberg
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Michael I Fingerhood
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Jiani Yu
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Alexander D McCourt
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Elizabeth A Stuart
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Lainie Rutkow
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Luis Quintero
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Sarah A White
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Emma E McGinty
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| |
Collapse
|
30
|
Burke B, Clear B, Rollston RL, Miller EN, Weiner SG. An Assessment of the One-Month Effectiveness of Telehealth Treatment for Opioid Use Disorder Using the Brief Addiction Monitor. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:16-23. [PMID: 38258856 DOI: 10.1177/29767342231212790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Telehealth treatment with medication for opioid use disorder (teleMOUD) was made possible with regulations following the COVID-19 pandemic that permitted prescribing buprenorphine without an in-person visit. This study evaluates the self-reported outcomes of patients treated by teleMOUD using the Brief Addiction Monitor (BAM), a 17-question tool that assesses drug use, cravings, physical and psychological health, and psychosocial factors to produce 3 subset scores: substance use, risk factors, and protective factors. METHODS Patients treated by a teleMOUD provider group operating in >30 states were asked to complete an app-based version of BAM at enrollment and at 1 month. Patients who completed both assessments between June 2022 and March 2023 were included. RESULTS A total of 2556 patients completed an enrollment BAM and 1447 completed both assessments. Mean number of days from baseline BAM to follow-up was 26.7 days. Changes were significantly different across most questions. The substance use subscale decreased from mean 2.6 to 0.8 (P < .001), the risk factors subscale decreased from mean 10.3 to 7.5 (P < .001), and the protective factors subscale increased from mean 14.3 to 15.0. (P < .001). Substance use and risk factor subscale changes were significant across all sex and age groups, while protective factors subscale did not improve for those <25 and >54 years. Patient reports of at least 1 day of illegal use or misuse decreased, including marijuana (28.1% vs 9.0%), cocaine/crack (3.9% vs 2.6%), and opioids (49.8% vs 10.5%). CONCLUSIONS Among patients treated by teleMOUD who completed assessments at enrollment and 1 month, there was improvement in drug use, risk factor, and protective factor scores.
Collapse
Affiliation(s)
| | | | - Rebekah L Rollston
- Bicycle Health, Boston, MA, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Scott G Weiner
- Bicycle Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
31
|
Nguyen B, Zhao C, Bailly E, Chi W. Telehealth Initiation of Buprenorphine for Opioid Use Disorder: Patient Characteristics and Outcomes. J Gen Intern Med 2024; 39:95-102. [PMID: 37670069 PMCID: PMC10817870 DOI: 10.1007/s11606-023-08383-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic exacerbated access barriers for patients with opioid use disorder. Telehealth presents an opportunity to improve access, treatment quality, and patient outcomes. OBJECTIVE To determine patient characteristics associated with initiating buprenorphine treatment via telehealth and to examine how telehealth initiation is associated with access, treatment quality, and health outcomes. DESIGN AND PARTICIPANTS This cross-sectional study used deidentified insurance claims to identify opioid use disorder adult patients initiating buprenorphine treatment between March 1, 2020, and November 30, 2021. Multivariable logistic regression assessed determinants of telehealth initiation. Propensity score matching addressed observed differences between in-person and telehealth initiators. MAIN MEASURES Treatment quality outcomes included initiation within 14 days of diagnosis, engagement (at least 2 opioid use disorder-related visits), and any buprenorphine refill during the study period. Health outcomes included opioid overdose and opioid use disorder-related emergency department and inpatient visits. KEY RESULTS We identified 23,565 adult buprenorphine initiators, including 3314 (14.1%) patients using telehealth. Younger patients (OR 0.91 to 0.77), females (OR 1.18), South (OR 1.63) and Midwest (OR 1.27) regions, rural area (OR 1.12), and higher-income (OR 1.16) neighborhood residents were more likely to use telehealth. Telehealth patients were more likely than in-person patients (54.5% vs. 48.4%; adjusted odds ratio (AOR), 1.29; 95% CI, 1.19-1.40) to stay engaged with opioid use disorder treatment, and more likely to refill buprenorphine during the study period (83.6% vs. 79.0%, AOR 1.37; 95% CI, 1.23-1.52). Telehealth initiation of buprenorphine was associated with 36% lower overdose rate than in-person initiation (adjusted incidence rate ratio 0.64; 95% CI, 0.45-0.94). The two groups evidenced no significant differences in opioid use disorder-related ED visit and hospitalization. CONCLUSIONS Our findings suggest that telehealth-initiated buprenorphine treatment is associated with reduced opioid overdose rate and improved patient engagement. Our findings strengthen the case for extending telehealth exemptions and prescribing flexibilities for treatment.
Collapse
Affiliation(s)
| | | | | | - Winnie Chi
- Elevance Health Inc, Wilmington, DE, USA.
| |
Collapse
|
32
|
Marshall SA, Siebenmorgen LE, Youngen K, Borders T, Zaller N. Primary Care Providers' Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic. J Prim Care Community Health 2024; 15:21501319241246359. [PMID: 38600789 PMCID: PMC11008087 DOI: 10.1177/21501319241246359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic. METHODS Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis. RESULTS The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education. CONCLUSION This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth's value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.
Collapse
Affiliation(s)
| | | | | | | | - Nickolas Zaller
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
33
|
Monico LB, Eastlick M, Michero D, Pielsticker P, Glasner S. Feasibility and acceptability of a novel digital therapeutic combining behavioral and pharmacological treatment for opioid use disorder. Digit Health 2024; 10:20552076241258400. [PMID: 38812851 PMCID: PMC11135073 DOI: 10.1177/20552076241258400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Objective Despite the worsening of the opioid epidemic, access to quality treatment for opioid use disorder (OUD) including buprenorphine remains a challenge. With the onset of the COVID-19 public health emergency, temporary regulatory changes and expanded reimbursement for telehealth services allowed for the rapid expansion of remote treatment for OUD and increased access to buprenorphine, but limited research exists to support this revolutionary shift in care delivery. This study evaluates the feasibility and acceptability of a novel digital therapeutic intervention for OUD combining buprenorphine and behavioral therapy. Methods Adults (n = 27) with OUD received treatment with daily sublingual buprenorphine and psychosocial treatment delivered digitally via a smartphone app over 12 weeks. Participants were evaluated monthly for continued opioid use, medication adherence, anxiety and depression indicators, abstinence self-efficacy, craving, and overall well-being, as well as a one-time measure of treatment acceptability. Results Participants reported increased opioid abstinence days from baseline (M = 8.2, SD = 8.6) to 12 weeks per 30 days (M = 24.9, SD = 10.1), t(20) = -6.5, p < .000, with strong medication adherence across study waves (96.2%). Anxiety and depression indicators, and opioid craving significantly decreased, and abstinence self-efficacy and overall well-being significantly increased following the intervention. Participants also demonstrated high rates of treatment engagement. Conclusions As current public health emergency regulatory changes are reviewed for permanency, this feasibility and acceptability study of a novel digital therapeutic intervention for OUD including buprenorphine adds to the growing evidence that supports maintaining telehealth access for quality OUD treatment.
Collapse
Affiliation(s)
| | - Megan Eastlick
- Department of Clinical Affairs, Pelago, New York, NY, USA
| | - Darcy Michero
- Department of Clinical Affairs, Pelago, New York, NY, USA
| | | | | |
Collapse
|
34
|
Lance Tippit T, O'Connell MA, Costantino RC, Scott-Richardson M, Peters S, Pakieser J, Tilley LC, Highland KB. Racialized and beneficiary inequities in medication to treat opioid use disorder receipt within the US Military Health System. Drug Alcohol Depend 2023; 253:111025. [PMID: 38006670 DOI: 10.1016/j.drugalcdep.2023.111025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) can be critical to managing opioid use disorder (OUD). It is unknown the extent to which US Military Health System (MHS) patients diagnosed with OUD receive MOUD. METHODS Healthcare records of MHS-enrolled active duty and retired service members (N = 13,334) with a new (index) OUD diagnosis were included between 2018 and 2021, without 90-day pre-index MOUD receipt were included. Elastic net logistic and Cox regressions evaluated care- and system-level factors associated with 1-year MOUD receipt (primary outcome) and time-to-receipt. RESULTS Only 9% of patients received MOUD 1-year post-index; only 4% received MOUD within 14 days. Black patients (OR for receipt 0.38, 95% CI 0.30-0.49), Latinx patients (OR for receipt 0.44, 95% CI 0.33-0.59), and patients whose race and ethnicity was Other (OR for receipt 0.52, 95%CI 0.35, 0.77) experienced lower MOUD access (all p < 0.001). Retirees were more likely to receive MOUD relative to active duty service members (OR for receipt 1.81, 95%CI 1.52, 2.16, p <0.001). CONCLUSIONS Institutional racism in MOUD prescribing, combined with the overall low rates of MOUD receipt after OUD diagnosis, highlight the need for evidence-based, multifaceted, and multilevel approaches to OUD care in the Military Health System. Without clear Defense Health Agency policy, including the designation of responsible entities, transparent and ongoing evaluation and responsiveness using standardized methodology, and resourced programming and public health campaigns, MOUD rates will likely remain poor and inequitable.
Collapse
Affiliation(s)
- T Lance Tippit
- School of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Megan A O'Connell
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Enterprise Intelligence & Data Solutions Program Management Office Data Innovation Branch, Defense Health Management Systems, USA; Henry M. Jackson Foundation, Inc., 11300 Rockville Pike Suite 709, Rockville, MD 20852, USA
| | - Ryan C Costantino
- Enterprise Intelligence & Data Solutions Program Management Office Data Innovation Branch, Defense Health Management Systems, USA; Department of Military & Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | | | - Sidney Peters
- Department of Emergency Medicine, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA
| | - Jennifer Pakieser
- Department of Emergency Medicine, University of California, Davis School of Medicine, 4150 V Street, PSSB Suite 2100, Sacramento, CA 95817, USA
| | - Laura C Tilley
- Department of Military & Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Krista B Highland
- Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| |
Collapse
|
35
|
Perry A, Wheeler-Martin K, Hasin DS, Terlizzi K, Mannes ZL, Jent V, Townsend TN, Pamplin JR, Crystal S, Martins SS, Cerdá M, Krawczyk N. Utilization and disparities in medication treatment for opioid use disorder among patients with comorbid opioid use disorder and chronic pain during the COVID-19 pandemic. Drug Alcohol Depend 2023; 253:111023. [PMID: 37984034 PMCID: PMC10841620 DOI: 10.1016/j.drugalcdep.2023.111023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The COVID-19 pandemic's impact on utilization of medications for opioid use disorder (MOUD) among patients with opioid use disorder (OUD) and chronic pain is unclear. METHODS We analyzed New York State (NYS) Medicaid claims from pre-pandemic (August 2019-February 2020) and pandemic (March 2020-December 2020) periods for beneficiaries with and without chronic pain. We calculated monthly proportions of patients with OUD diagnoses in 6-month-lookback windows utilizing MOUD and proportions of treatment-naïve patients initiating MOUD. We used interrupted time series to assess changes in MOUD utilization and initiation rates by medication type and by race/ethnicity. RESULTS Among 20,785 patients with OUD and chronic pain, 49.3% utilized MOUD (versus 60.3% without chronic pain). The pandemic did not affect utilization in either group but briefly disrupted initiation among patients with chronic pain (β=-0.009; 95% CI [-0.015, -0.002]). Overall MOUD utilization was not affected by the pandemic for any race/ethnicity but opioid treatment program (OTP) utilization was briefly disrupted for non-Hispanic Black individuals (β=-0.007 [-0.013, -0.001]). The pandemic disrupted overall MOUD initiation in non-Hispanic Black (β=-0.007 [-0.012, -0.002]) and Hispanic individuals (β=-0.010 [-0.019, -0.001]). CONCLUSIONS Adults with chronic pain who were enrolled in NYS Medicaid before the COVID-19 pandemic had lower MOUD utilization than those without chronic pain. MOUD initiation was briefly disrupted, with disparities especially in racial/ethnic minority groups. Flexible MOUD policy initiatives may have maintained overall treatment utilization, but disparities in initiation and care continuity remain for patients with chronic pain, and particularly for racial/ethnic minoritized subgroups.
Collapse
Affiliation(s)
- Allison Perry
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.
| | - Katherine Wheeler-Martin
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Kelly Terlizzi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Zachary L Mannes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Victoria Jent
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Tarlise N Townsend
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - John R Pamplin
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Stephen Crystal
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
36
|
Brandeau ML. Responding to the US opioid crisis: leveraging analytics to support decision making. Health Care Manag Sci 2023; 26:599-603. [PMID: 37804456 DOI: 10.1007/s10729-023-09657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
The US is experiencing a severe opioid epidemic with more than 80,000 opioid overdose deaths occurring in 2022. Beyond the tragic loss of life, opioid use disorder (OUD) has emerged as a major contributor to morbidity, lost productivity, mounting criminal justice system costs, and significant social disruption. This Current Opinion article highlights opportunities for analytics in supporting policy making for effective response to this crisis. We describe modeling opportunities in the following areas: understanding the opioid epidemic (e.g., the prevalence and incidence of OUD in different geographic regions, demographics of individuals with OUD, rates of overdose and overdose death, patterns of drug use and associated disease outbreaks, and access to and use of treatment for OUD); assessing policies for preventing and treating OUD, including mitigation of social conditions that increase the risk of OUD; and evaluating potential regulatory and criminal justice system reforms.
Collapse
Affiliation(s)
- Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
| |
Collapse
|
37
|
Mannes ZL, Wheeler-Martin K, Terlizzi K, Hasin DS, Perry A, Pamplin JR, Crystal S, Cerdá M, Martins SS. Risks of opioid overdose among New York State Medicaid recipients with chronic pain before and during the COVID-19 pandemic. Prev Med 2023; 177:107789. [PMID: 38016582 PMCID: PMC10842754 DOI: 10.1016/j.ypmed.2023.107789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/27/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The COVID-19 pandemic contributed to healthcare disruptions for patients with chronic pain. Following initial disruptions, national policies were enacted to expand access to long-term opioid therapy (LTOT) for chronic pain and opioid use disorder (OUD) treatment services, which may have modified risk of opioid overdose. We examined associations between LTOT and/or OUD with fatal and non-fatal opioid overdoses, and whether the pandemic moderated overdose risk in these groups. METHODS We analyzed New York State Medicaid claims data (3/1/2019-12/31/20) of patients with chronic pain (N = 236,391). We used generalized estimating equations models to assess associations between LTOT and/or OUD (neither LTOT or OUD [ref], LTOT only, OUD only, and LTOT and OUD) and the pandemic (03/2020-12/2020) with opioid overdose. RESULTS The pandemic did not significantly (ns) affect opioid overdose among patients with LTOT and/or OUD. While patients with LTOT (vs. no LTOT) had a slight increase in opioid overdose during the pandemic (pre-pandemic: aOR:1.65, 95% CI:1.05, 2.57; pandemic: aOR:2.43, CI:1.75,3.37, ns), patients with OUD had a slightly attenuated odds of overdose during the pandemic (pre-pandemic: aOR:5.65, CI:4.73, 6.75; pandemic: aOR:5.16, CI:4.33, 6.14, ns). Patients with both LTOT and OUD also experienced a slightly reduced odds of opioid overdose during the pandemic (pre-pandemic: aOR:5.82, CI:3.58, 9.44; pandemic: aOR:3.70, CI:2.11, 6.50, ns). CONCLUSIONS Findings demonstrated no significant effect of the pandemic on opioid overdose among people with chronic pain and LTOT and/or OUD, suggesting pandemic policies expanding access to chronic pain and OUD treatment services may have mitigated the risk of opioid overdose.
Collapse
Affiliation(s)
- Zachary L Mannes
- Department of Emergency Medicine, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA
| | - Katherine Wheeler-Martin
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - Kelly Terlizzi
- Department of Population Health, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016, USA
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Allison Perry
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - John R Pamplin
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA
| | - Stephen Crystal
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, School of Public Health, Rutgers University, 683 Hoes Ln W, Piscataway, NJ 08854, USA; School of Social Work, Rutgers University, 120 Albany St, New Brunswick, NJ 08901, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA.
| |
Collapse
|
38
|
Chen L, Sethi S, Poland C, Frank C, Tengelitsch E, Goldstick J, Sussman JB, Bohnert ASB, Lin L(A. Prescriptions for Buprenorphine in Michigan Following an Education Intervention. JAMA Netw Open 2023; 6:e2349103. [PMID: 38127344 PMCID: PMC10739087 DOI: 10.1001/jamanetworkopen.2023.49103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Buprenorphine is an underused treatment for opioid use disorder (OUD) that can be prescribed in general medical settings. Founded in 2017, the Michigan Opioid Collaborative (MOC) is an outreach and educational program that aims to address clinician and community barriers to buprenorphine access; however, the association between the MOC and buprenorphine treatment is unknown. Objective To evaluate the association between MOC service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine. Design, Setting, and Participants This cohort study exploited staggered implementation of MOC services across all Michigan counties. Difference-in-difference analyses were conducted by applying linear fixed-effects regression across all counties to estimate the overall association of MOC engagement with outcomes and linear regression for each MOC-engaged county separately to infer county-specific results using data from May 2015 to August 2020. Analyses were conducted from September 2021 to November 2023. Exposures MOC engagement. Main Outcomes and Measures County-level monthly numbers of buprenorphine prescribers and patients receiving buprenorphine (per 100 000 population). Results Among 83 total counties, 57 counties (68.7%) in Michigan were engaged by MOC by 2020, with 3 (3.6%) initiating engagement in 2017, 19 (22.9%) in 2018, 27 (32.5%) in 2019, and 8 (9.6%) in 2020. Michigan is made up of 83 counties with a total population size of 9 990 000. A total of 5 070 000 (50.8%) were female, 1 410 000 (14.1%) were African American or Black, 530 000 (5.3%) were Hispanic or Latino, and 7 470 000 (74.7%) were non-Hispanic White. The mean (SD) value of median age across counties was 44.8 (6.4). The monthly increases in buprenorphine prescriber numbers in the preengagement (including all time points for nonengaged counties) and postengagement periods were 0.07 and 0.39 per 100 000 population, respectively, with the absolute difference being 0.33 (95% CI, 0.12-0.53) prescribers per 100 000 population (P = .002). The numbers of patients receiving buprenorphine increased by an average of 0.6 and 7.15 per 100 000 population per month in preengagement and postengagement periods, respectively, indicating an estimated additional 6.56 (95% CI, 2.09-11.02) patients receiving buprenorphine per 100 000 population (P = .004) monthly increase after engagement compared with before. Conclusions and Relevance In this cohort study measuring buprenorphine prescriptions in Michigan over time, counties' engagement in OUD-focused outreach and clinician education services delivered by a multidisciplinary team was associated with a temporal increase in buprenorphine prescribers and patients receiving buprenorphine.
Collapse
Affiliation(s)
- Liying Chen
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Sheba Sethi
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Cara Poland
- Department of Obstetrics, Gynecology and Reproductive Health, Michigan State University, East Lansing
| | - Christopher Frank
- Department of Family Medicine, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Jason Goldstick
- Injury Prevention Center, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor
| | - Jeremy B. Sussman
- Division of General Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Amy S. B. Bohnert
- Department of Anesthesiology, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Lewei (Allison) Lin
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| |
Collapse
|
39
|
Lira MC, Jimes C, Coffey MJ. Retention in Telehealth Treatment for Opioid Use Disorder Among Rural Populations: A Retrospective Cohort Study. Telemed J E Health 2023; 29:1890-1896. [PMID: 37184856 PMCID: PMC10714254 DOI: 10.1089/tmj.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction: There are limited studies to date on telemedicine treatment outcomes for opioid use disorder (OUD) among rural populations. Methods: This was a retrospective cohort study of rural adults enrolled in telemedicine OUD treatment. Study outcomes were percent retained in care and adherence to buprenorphine assessed by urine drug screens at 1, 3, and 6 months. Results: From April 1, 2020, through January 31, 2022, 1,816 rural patients across 14 states attended an initial telemedicine visit and received a clinical diagnosis of OUD. Participants had the following characteristics: mean age 37.7 years (±8.6); 52.4% female; and 66.7% Medicaid. At 1, 3, and 6 months, 74.8%, 61.5%, and 52.3% of participants were retained in care, and 69.0%, 56.0%, and 49.2% of participants were adherent, respectively. Conclusions: Telemedicine is an effective approach for treating OUD in rural populations, with retention comparable to in-person treatment.
Collapse
Affiliation(s)
| | - Cynthia Jimes
- Workit Labs, Workit Health, Ann Arbor, Michigan, USA
| | - M. Justin Coffey
- Workit Labs, Workit Health, Ann Arbor, Michigan, USA
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| |
Collapse
|
40
|
Locke T, Salisbury-Afshar E, Coyle DT. Treatment Updates for Pain Management and Opioid Use Disorder. Med Clin North Am 2023; 107:1035-1046. [PMID: 37806723 DOI: 10.1016/j.mcna.2023.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The medical community has proposed several clinical recommendations to promote patient safety and health amid the opioid overdose public health crisis. For a frontline practicing physician, distilling the evidence and implementing the latest guidelines may prove challenging. This article aims to highlight pertinent updates and clinical care pearls as they relate to primary care management of chronic pain and opioid use disorder.
Collapse
Affiliation(s)
- Thomas Locke
- University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA.
| | - Elizabeth Salisbury-Afshar
- University of Wisconsin School of Medicine and Public Health, 610 North Whitney Way, Suite 200, Madison, WI 53705, USA
| | - David Tyler Coyle
- University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA
| |
Collapse
|
41
|
Agniel D, Cantor J, Golan OK, Yu H, Andraka-Christou B, Simon KI, Stein BD, Taylor EA. How are state telehealth policies associated with services offered by substance use disorder treatment facilities? Evidence from 2019 to 2022. Drug Alcohol Depend 2023; 252:110959. [PMID: 37734281 PMCID: PMC10731590 DOI: 10.1016/j.drugalcdep.2023.110959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The COVID-19 pandemic led several states to adopt policies permitting the delivery of substance use disorder treatment (SUDT) by telehealth. We assess the impact of state-level telehealth policies in 2020 that specifically permitted audio or audiovisual forms of telehealth offerings among SUDT facilities. PROCEDURE Cross-sectional analysis of secondary data from between 2019 and 2022. Pre-pandemic, federal law permitted states to allow audiovisual telehealth modes for SUDT to a limited extent. 2020 laws permitted states to allow audio-only modes for the first time and strengthened ability to offer audiovisual modes. We compared national SUDT facility self-reported telehealth offerings in 2020 and beyond to 2019, in states that in 2020 had policies permitting audiovisual and audio only, compared to other states. MAIN FINDINGS Among outpatient SUDT facilities (n = 5227) present in all four years of our data, the proportion offering telehealth increased from 18% (n = 921) in 2019-26% in 2020, 60% in 2021, and 79% in 2022. We estimate an audiovisual and audio only policy in 2020 was associated with an increase in telehealth offering rates in 2022 of +16.5% points (pp) (95% CI [+10.4,+22.6]) compared to the rates in states with no such listed policy. There was little evidence of an influence on telehealth offering in 2020 (-2.9 pp, CI [-9.0,+3.2]) and 2021 (+0.6 pp, CI [-5.5,+6.7]). CONCLUSIONS The enactment of state-level telehealth policies that allow audio and audiovisual modalities may have increased SUDT facilities' likelihood of offering telehealth services two years after enactment.
Collapse
Affiliation(s)
| | | | | | - Hao Yu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | | | | | | |
Collapse
|
42
|
Rollston R, Burke B, Weiner SG, Gallogly W, Brandon AD, Carter R, Clear B. Evaluation of urine drug screen falsification of results among patients with opioid use disorder receiving treatment in a telehealth model of care. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209151. [PMID: 37652209 DOI: 10.1016/j.josat.2023.209151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/22/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION As telehealth models for treatment of opioid use disorder (OUD) are expanding, the field does not know the reliability of urine drug screening (UDS) in this setting. The objective of this study is to determine the rate of falsification of UDS testing among patients with OUD in active treatment with buprenorphine via a telehealth provider. METHODS This is a prospective cohort study of 899 randomly selected eligible patients, of which 392 participated in the final cohort that the study team used for analysis. The study mailed patients a UDS cup and asked them to return the sample by mail. After the UDS sample was received, a buccal swab was mailed, and the study asked patients to schedule a virtual meeting in which consent was sought and an observed buccal swab was obtained. We evaluated urine for evidence of falsification, and used buccal swabs to genetically match individuals to urine samples. RESULTS After exclusion criteria, 395 (52.3 %) of 755 patients who received a UDS kit returned it for analysis prior to knowledge of the study. Of that, 392 samples had sufficient quantity for testing. We determined 383 (97.7 %) to be human urine containing buprenorphine without indication of exogenous buprenorphine addition and with evidence of compliance. A total of 374 patients received a buccal swab kit and 139 (37.2 %) attended the consent/observed buccal swab session. One hundred and thirty-two patients consented and completed the swab under video observation, and 120 successfully sent the swab back to the external laboratory. Of the 120 buccal swabs received, 109 (90.8 %) were a genetic match, 10 (8.3 %) were indeterminate, and 1 (0.8 %) was a genetic mismatch. CONCLUSIONS This study of patients treated by a telehealth OUD provider demonstrated a low rate of urine test falsification.
Collapse
Affiliation(s)
| | - Barbara Burke
- Bicycle Health, Inc., Boston, MA, United States of America
| | - Scott G Weiner
- Bicycle Health, Inc., Boston, MA, United States of America; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
| | | | | | - Robyn Carter
- Bicycle Health, Inc., Boston, MA, United States of America
| | - Brian Clear
- Bicycle Health, Inc., Boston, MA, United States of America
| |
Collapse
|
43
|
Kannarkat JT, Kannarkat JT, Torous J. Rebalancing Controlled Substance Regulations in Telemedicine. JAMA HEALTH FORUM 2023; 4:e233251. [PMID: 37862032 DOI: 10.1001/jamahealthforum.2023.3251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
This Viewpoint elucidates major components of the proposed rules about controlled substance prescribing in telehealth, highlights evolving considerations with the US Drug Enforcement Agency’s approach, and offers potential improvements before finalization of the rules.
Collapse
Affiliation(s)
- Jacob T Kannarkat
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - John Torous
- Department of Psychiatry at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
44
|
Hammerslag LR, Mack A, Chandler RK, Fanucchi LC, Feaster DJ, LaRochelle MR, Lofwall MR, Nau M, Villani J, Walsh SL, Westgate PM, Slavova S, Talbert JC. Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees. JAMA Netw Open 2023; 6:e2336914. [PMID: 37851446 PMCID: PMC10585416 DOI: 10.1001/jamanetworkopen.2023.36914] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/22/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Early COVID-19 mitigation strategies placed an additional burden on individuals seeking care for opioid use disorder (OUD). Telemedicine provided a way to initiate and maintain transmucosal buprenorphine treatment of OUD. Objective To examine associations between transmucosal buprenorphine OUD treatment modality (telemedicine vs traditional) during the COVID-19 public health emergency and the health outcomes of treatment retention and opioid-related nonfatal overdose. Design, Setting, and Participants This retrospective cohort study was conducted using Medicaid claims and enrollment data from November 1, 2019, to December 31, 2020, for individuals aged 18 to 64 years from Kentucky and Ohio. Data were collected and analyzed in June 2022, with data updated during revision in August 2023. Exposures The primary exposure of interest was the modality of the transmucosal buprenorphine OUD treatment initiation. Relevant patient demographic and comorbidity characteristics were included in regression models. Main Outcomes and Measures There were 2 main outcomes of interest: retention in treatment after initiation and opioid-related nonfatal overdose after initiation. For outcomes measured after initiation, a 90-day follow-up period was used. The main analysis used a new-user study design; transmucosal buprenorphine OUD treatment initiation was defined as initiation after more than a 60-day gap in buprenorphine treatment. In addition, uptake of telemedicine for buprenorphine was examined, overall and within patients initiating treatment, across quarters in 2020. Results This study included 41 266 individuals in Kentucky (21 269 women [51.5%]; mean [SD] age, 37.9 [9.0] years) and 50 648 individuals in Ohio (26 425 women [52.2%]; mean [SD] age, 37.1 [9.3] years) who received buprenorphine in 2020, with 18 250 and 24 741 people initiating buprenorphine in Kentucky and Ohio, respectively. Telemedicine buprenorphine initiations increased sharply at the beginning of 2020. Compared with nontelemedicine initiation, telemedicine initiation was associated with better odds of 90-day retention with buprenorphine in both states (Kentucky: adjusted odds ratio, 1.13 [95% CI, 1.01-1.27]; Ohio: adjusted odds ratio, 1.19 [95% CI, 1.06-1.32]) in a regression analysis adjusting for patient demographic and comorbidity characteristics. Telemedicine initiation was not associated with opioid-related nonfatal overdose (Kentucky: adjusted odds ratio, 0.89 [95% CI, 0.56-1.40]; Ohio: adjusted odds ratio, 1.08 [95% CI, 0.83-1.41]). Conclusions and Relevance In this cohort study of Medicaid enrollees receiving buprenorphine for OUD, telemedicine buprenorphine initiation was associated with retention in treatment early during the COVID-19 pandemic. These findings add to the literature demonstrating positive outcomes associated with the use of telemedicine for treatment of OUD.
Collapse
Affiliation(s)
- Lindsey R. Hammerslag
- Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington
| | - Aimee Mack
- Division of Health Sciences, The Ohio State University Wexner Medical Center, Columbus
| | - Redonna K. Chandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Laura C. Fanucchi
- Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Marc R. LaRochelle
- Clinical Addiction Research & Education Unit, Boston University School of Medicine, Boston, Massachusetts
| | - Michelle R. Lofwall
- Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington
| | - Michael Nau
- Division of Health Sciences, The Ohio State University Wexner Medical Center, Columbus
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Sharon L. Walsh
- Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington
| | - Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
| | - Jeffery C. Talbert
- Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington
| |
Collapse
|
45
|
Marks SJ, Davoodi NM, Felton R, Rothberg A, Goldberg EM. The Effect of COVID-19 on Dual-Eligible Beneficiaries: A Scoping Review. J Am Med Dir Assoc 2023; 24:1565-1572. [PMID: 37696498 PMCID: PMC10576100 DOI: 10.1016/j.jamda.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To examine the impact of COVID-19 on clinical health outcomes and health-related social needs among Medicaid-Medicare dual-eligible beneficiaries. DESIGN Scoping review. SETTING AND PARTICIPANTS Dual eligibles during COVID-19. METHODS We performed a comprehensive scoping review including observational studies, clinical trials, and original empirical research studies of PubMed and CINAHL. We generated a list of terms related to programs that both serve dual eligibles and address our desired outcomes. With the assistance of a medical librarian, we identified relevant abstracts published during COVID-19 meeting our inclusion criteria. We performed full-text reviews of relevant abstracts and selected the final studies. We extracted the study population, design, and major findings, then conducted thematic analysis. RESULTS 1100 articles were identified, with 439 deemed relevant. On full text-review, 15 articles met inclusion criteria representing more than 86 million Medicare beneficiaries. No studies were specific only to dual eligibles. Topic areas included in this review include COVID-19 case counts (2 articles), mortality (8 articles), hospitalizations (7 articles), food insecurity (1 article), self-reported mental health (1 article), and social connectedness (2 articles). Dual eligibles had disparate COVID-19-related outcomes from Medicare-only enrollees in 12 of 15 studies. Studies show higher mortality for dual eligibles overall, but this was not true for dual eligibles in nursing homes and assisted living communities. Dual eligibles were more likely to experience food insecurity. More favorably, dual eligibles reported greater social connectedness. CONCLUSIONS AND IMPLICATIONS Dual eligibles had different outcomes from Medicare-only recipients in multiple health outcomes and health-related social needs during COVID-19, but studies are limited, particularly in terms of health-related social needs. Future work focusing on outcomes only among dual-eligible beneficiaries, integrated care programs, and fiscal alignment between Medicare and Medicaid plans may help stakeholders address health needs specific to dual eligibles.
Collapse
Affiliation(s)
- Sarah J Marks
- Department of Health Behavior and Policy and MSTP Program, Virginia Commonwealth University, Richmond, VA, USA.
| | - Natalie M Davoodi
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | | | | | - Elizabeth M Goldberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA
| |
Collapse
|
46
|
Feder KA, Patel EU, Buresh M, Kirk GD, Mehta SH, Genberg BL. Trends in self-reported non-fatal overdose and patterns of substance use before and during the COVID-19 pandemic in a prospective cohort of adults who have injected drugs - Baltimore, Maryland, 2014-2022. Drug Alcohol Depend 2023; 251:110954. [PMID: 37716287 PMCID: PMC10538370 DOI: 10.1016/j.drugalcdep.2023.110954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/25/2023] [Accepted: 08/26/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Overdose deaths increased during the COVID-19 pandemic in the United States. Less is known about drug use behavior changes during the same time period. We examined differences in non-fatal overdose and drug use behaviors before and after the start of the COVID-19 pandemic in a community-recruited cohort of adults who have injected drugs. METHODS 721 participants attended 7401 visits between Jan 2014 and Mar 2022. Outcomes (non-fatal overdose, drug route of administration, type of drugs used) were assessed via self-report in the last six months. We compared pre-pandemic (Jan 2014-Mar 2020) to inter-pandemic (Dec 2020-Mar 2022) prevalence of each outcome using Cohcrane-Maentel-Haeszel odds ratios (CMH-OR). We then estimated probabilities for transitioning between specific behaviors from participants' last pre-pandemic visit to their first inter-pandemic visit. RESULTS Comparing pre-pandemic visits to inter-pandemic visits, the prevalence of non-fatal overdose did not change (CMH-OR 1.06, 95% CI 0.75-1.50); the prevalence of injection (CMH-OR 0.13, 95% CI 0.1-0.17) and non-injection (CMH-OR 0.51, 95% CI 0.42-0.61) drug use declined. More than a third (35.7%) of persons using both injection and non-injection drugs pre-pandemic transitioned to exclusive non-injection use during the pandemic. By contrast, few (4.0%) persons using non-injection drugs exclusively pre-pandemic transitioned to injecting during the pandemic. CONCLUSION Among adults who have injected drugs, the start of the COVID-19 pandemic was associated with a reduced drug use prevalence and transitions from injection to non-injection use. Average overdose prevalence was unchanged, but these behavior changes may have helped mitigate overdose harm.
Collapse
Affiliation(s)
- Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, USA.
| | - Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Megan Buresh
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| |
Collapse
|
47
|
McDonald R, Bech AB, Clausen T. Flexible delivery of opioid agonist treatment during COVID-19 in Norway: qualitative and quantitative findings from an online survey of provider experiences. BMC Health Serv Res 2023; 23:965. [PMID: 37679751 PMCID: PMC10485985 DOI: 10.1186/s12913-023-09959-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND For patients receiving daily opioid agonist treatment (OAT) for opioid dependence, several countries relaxed treatment guidelines at the beginning of the COVID-19 pandemic. This involved longer take-home intervals for methadone and buprenorphine doses as well as a reduction in supervised dosing and drug screening. To date, little is known about the medium or long-term experience of OAT deregulation. Therefore, we conducted a survey to explore how OAT providers perceived greater flexibility in OAT service delivery at the end of the second year of the pandemic. METHODS Nationwide cross-sectional study of twenty-three OAT units in 19 publicly funded hospital trusts in Norway. OAT units were sent a 29-item online questionnaire comprising closed-format and open-ended questions on treatment provider experiences and changes in OAT service delivery during the past 12 months (January to December 2021). RESULTS Twenty-three (of whom female: 14; 60.8%) managers or lead physicians of OAT units completed the questionnaire reporting that, in 2021, most OAT units (91.3%, n = 21) still practiced some adjusted approaches as established in the beginning of the pandemic. The most common adaptions were special protocols for COVID-19 cases (95.7%, n = 22), increased use of telephone- (91.3%, n = 21) and video consultations (87.0%, n = 20), and longer take-home intervals for OAT medications (52.2%, n = 12). The use of depot buprenorphine also increased substantially during the pandemic. According to the OAT providers, most patients handled flexible treatment provision well. In individual cases, patients' substance use was identified as key factor necessitating a reintroduction of supervised dosing and drug screening. Collaboration with general practitioners and municipal health and social services was generally perceived as crucial for successful treatment delivery. CONCLUSIONS Overall, the Norwegian OAT system proved resilient in the second year of the COVID-19 pandemic, as its healthcare workforce embraced innovation in technology (telemedicine) and drug development (depot buprenorphine). According to our nationally representative sample of OAT providers, most patients were compliant with longer take-home doses of methadone and buprenorphine. Our findings suggest that telemedicine can be useful as adjunct to face-to-face treatment and provide greater flexibility for patients.
Collapse
Affiliation(s)
- Rebecca McDonald
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, Oslo, 0318, Norway.
| | - Anne Berit Bech
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, Oslo, 0318, Norway
- Faculty of Social and Health Sciences, Inland University of Applied Sciences, P.O. Box 400 Vestad, Elverum, 2418, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, P.O. Box 1171, Blindern, Oslo, 0318, Norway
| |
Collapse
|
48
|
Jones CM, Han B, Baldwin GT, Einstein EB, Compton WM. Use of Medication for Opioid Use Disorder Among Adults With Past-Year Opioid Use Disorder in the US, 2021. JAMA Netw Open 2023; 6:e2327488. [PMID: 37548979 PMCID: PMC10407686 DOI: 10.1001/jamanetworkopen.2023.27488] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
This cross-sectional study uses data from the 2021 National Survey on Drug Use and Health to estimate the receipt of medication for opioid use disorder among US adults with past-year opioid use disorder.
Collapse
Affiliation(s)
- Christopher M. Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Grant T. Baldwin
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily B. Einstein
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
49
|
Chen A, Ayub MH, Mishuris RG, Rodriguez JA, Gwynn K, Lo MC, Noronha C, Henry TL, Jones D, Lee WW, Varma M, Cuevas E, Onumah C, Gupta R, Goodson J, Lu AD, Syed Q, Suen LW, Heiman E, Salhi BA, Khoong EC, Schmidt S. Telehealth Policy, Practice, and Education: a Position Statement of the Society of General Internal Medicine. J Gen Intern Med 2023; 38:2613-2620. [PMID: 37095331 PMCID: PMC10124932 DOI: 10.1007/s11606-023-08190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary waivers and flexibilities tied to the public health emergency. Early studies demonstrate significant potential to advance the quintuple aim (patient experience, health outcomes, cost, clinician well-being, and equity). Supported well, telemedicine can particularly improve patient satisfaction, health outcomes, and equity. Implemented poorly, telemedicine can facilitate unsafe care, worsen disparities, and waste resources. Without further action from lawmakers and agencies, payment will end for many telemedicine services currently used by millions of Americans at the end of 2024. Policymakers, health systems, clinicians, and educators must decide how to support, implement, and sustain telemedicine, and long-term studies and clinical practice guidelines are emerging to provide direction. In this position statement, we use clinical vignettes to review relevant literature and highlight where key actions are needed. These include areas where telemedicine must be expanded (e.g., to support chronic disease management) and where guidelines are needed (e.g., to prevent inequitable offering of telemedicine services and prevent unsafe or low-value care). We provide policy, clinical practice, and education recommendations for telemedicine on behalf of the Society of General Internal Medicine. Policy recommendations include ending geographic and site restrictions, expanding the definition of telemedicine to include audio-only services, establishing appropriate telemedicine service codes, and expanding broadband access to all Americans. Clinical practice recommendations include ensuring appropriate telemedicine use (for limited acute care situations or in conjunction with in-person services to extend longitudinal care relationships), that the choice of modality be done through patient-clinician shared decision-making, and that health systems design telemedicine services through community partnerships to ensure equitable implementation. Education recommendations include developing telemedicine-specific educational strategies for trainees that align with accreditation body competencies and providing educators with protected time and faculty development resources.
Collapse
Affiliation(s)
- Anders Chen
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Box 356421, Seattle, WA, 98195, USA.
| | - Mariam H Ayub
- Division of General Internal Medicine, MedStar Georgetown University Hospital, Georgetown University Medical Center, Washington, DC, USA
| | - Rebecca G Mishuris
- Digital, Mass General Brigham, Somerville, MA, USA
- Division of General Internal Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Jorge A Rodriguez
- Division of General Internal Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Kendrick Gwynn
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Margaret C Lo
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Malcom Randall VAMC, Gainesville, FL, USA
| | - Craig Noronha
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Tracey L Henry
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle Jones
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Wei Wei Lee
- Section of General Internal Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Malvika Varma
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- New England VA GRECC, Boston VA Medical Center, Boston, MA, USA
| | - Elizabeth Cuevas
- Division of Academic Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Chavon Onumah
- Division or General Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Reena Gupta
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John Goodson
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy D Lu
- Division of General Internal Medicine, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Quratulain Syed
- Birmingham-Atlanta VA GRECC, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Leslie W Suen
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erica Heiman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bisan A Salhi
- Department of Emergency Medicine, Drexel University College of Medicine, Reading, PA, USA
| | - Elaine C Khoong
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stacie Schmidt
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
50
|
Lowenstein M, Abrams MP, Crowe M, Shimamoto K, Mazzella S, Botcheos D, Bertocchi J, Westfahl S, Chertok J, Garcia KP, Truchil R, Holliday-Davis M, Aronowitz S. "Come try it out. Get your foot in the door:" Exploring patient perspectives on low-barrier treatment for opioid use disorder. Drug Alcohol Depend 2023; 248:109915. [PMID: 37207615 PMCID: PMC10330675 DOI: 10.1016/j.drugalcdep.2023.109915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/15/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE Low-barrier treatment is an emerging strategy for opioid use disorder (OUD) care that prioritizes access to evidence-based medication while minimizing requirements that may limit treatment access in more traditional delivery models, particularly for marginalized patients. Our objective was to explore patient perspectives about low-barrier approaches, with a focus on understanding barriers to and facilitators of engagement from the patient point of view. METHODS We conducted semi-structured interviews with patients accessing buprenorphine treatment from a multi-site, low-barrier mobile treatment program in Philadelphia, PA from July-December 2021. We analyzed interview data using thematic content analysis and identified key themes. RESULTS The 36 participants were 58% male, 64% Black, 28% White, and 31% Latinx. 89% were enrolled in Medicaid, and 47% were unstably housed. Our analysis revealed three main facilitators of treatment in the low-barrier model. These included 1) program structure that met participant needs, such as flexibility, rapid medication access and robust case management services; 2) harm reduction approach that included acceptance of patient goals other than abstinence and provision of harm reduction services on-site; and 3) strong interpersonal connections with team members, including those with lived experience. Participants contrasted these experiences with other care they had received in the past. Barriers related to lack of structure, limitations of street-based care, and limited support for co-occurring needs, particularly mental health. CONCLUSIONS This study provides key patient perspectives on low-barrier approaches for OUD treatment. Our findings can inform future program design to increase treatment access and engagement for individuals poorly served by traditional delivery models.
Collapse
Affiliation(s)
- Margaret Lowenstein
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
| | - Matthew P Abrams
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Molly Crowe
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Denise Botcheos
- Prevention Point Philadelphia, Philadelphia, PA, United States
| | | | - Shawn Westfahl
- Prevention Point Philadelphia, Philadelphia, PA, United States
| | - Judy Chertok
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Kristine Pamela Garcia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Rachael Truchil
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - M Holliday-Davis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Shoshana Aronowitz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States; University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| |
Collapse
|