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Magee T, Peters C, Jacobsen SM, Nees D, Dunford B, Ford AI, Vassar M. Inequities in the treatment of opioid use disorder: A scoping review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209082. [PMID: 37271346 DOI: 10.1016/j.josat.2023.209082] [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: 08/11/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Given the lack of access to evidenced-based OUD treatment and the corresponding overdose crisis, researchers must evaluate and report health care inequities involving the treatment of OUD. Additionally, clinicians should be aware of these inequities in the treatment of patients. METHODS We carried out a scoping review of the literature regarding health inequities in treatment for OUD in July 2022. The study team retrieved articles published between 2016 and 2021 from MEDLINE and Ovid Embase. After authors received training, screening and data extraction were performed in masked, duplicate fashion. The team screened a total of 3673 titles and abstracts, followed by 172 articles for full-text review. The inequities that we examined were race/ethnicity, sex or gender, income, under-resourced/rural, occupational status, education level, and LGBTQ+. We used Stata 17.0 (StataCorp, LLC, College Station, TX) to summarize data and statistics of the studies within our sample. RESULTS A total of 44 studies evaluating inequities in OUD treatment met inclusion criteria. The most common inequity that studies examined was race/ethnicity (34/44 [77.27 %] studies), followed by under-resourced/rural (19/44 [43.18 %] studies), and sex or gender (18/44 [40.91 %] studies). LGBTQ+ (0/44 [0.0 %] studies) was not reported in the included studies. Our results indicate that many historically marginalized populations experience inequities related to access and outcomes in OUD treatment. The included studies in our scoping review occasionally demonstrated inconsistent findings. CONCLUSIONS Gaps exist within the literature on health inequities in treatment for OUD. The most examined inequities were race/ethnicity, under-resourced/rural and sex or gender, while studies did not examine LGBTQ+ status. Future research should aim to advance and supplement literature investigating health inequities in OUD treatment to ensure inclusive, patient-centered care.
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Affiliation(s)
- Trevor Magee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States.
| | - Caleb Peters
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Samuel M Jacobsen
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Danya Nees
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Bryan Dunford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
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Curtis M, Wilkinson AL, Dietze P, Stewart AC, Kinner SA, Winter RJ, Aitken C, Walker SJ, Cossar RD, Butler T, Stoové M. Is use of opioid agonist treatment associated with broader primary healthcare use among men with recent injecting drug use histories following release from prison? A prospective cohort study. Harm Reduct J 2023; 20:42. [PMID: 36978089 PMCID: PMC10044112 DOI: 10.1186/s12954-023-00773-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND A precipitous decline in health status among people recently released from prison is common. In Victoria, Australia, opioid agonist treatment (OAT) in the community involves frequent contact with primary care, potentially facilitating broader use of primary healthcare services. Among a cohort of men who injected drugs regularly pre-imprisonment, we estimated differences in rates of primary healthcare use and medication dispensation between people who did and did not receive OAT post-release. METHODS Data came from the Prison and Transition Health Cohort Study. Three-month post-release follow-up interviews were linked with primary care and medication dispensation records. Generalised linear models were fit with one exposure (OAT: none/partial/complete) for 13 outcomes relating to primary healthcare use, pathology testing, and medication dispensation, adjusted for other covariates. Coefficients were reported as adjusted incidence rate ratios (AIRR). RESULTS Analyses included 255 participants. Compared to no OAT use, both partial and complete OAT use were associated with increased rates of standard (AIRR: 3.02, 95%CI: 1.88-4.86; AIRR: 3.66, 95%CI: 2.57-5.23), extended (AIRR: 2.56, 95%CI: 1.41-4.67; AIRR: 2.55, 95%CI: 1.60-4.07) and mental health-related (AIRR: 2.71, 95%CI: 1.42-5.20; AIRR: 2.27, 95%CI: 1.33-3.87) general practitioner (GP) consultations, total medication (AIRR: 1.88, 95%CI: 1.19-2.98; AIRR: 2.40, 95%CI: 1.71-3.37), benzodiazepine (AIRR: 4.99, 95%CI: 2.81-8.85; AIRR: 8.30, 95%CI: 5.28-13.04) and gabapentinoid (AIRR: 6.78, 95%CI: 3.34-13.77; AIRR: 4.34, 95%CI: 2.37-7.94) dispensations, respectively. Partial OAT use was also associated with increased after-hours GP consultations (AIRR: 4.61, 95%CI: 2.24-9.48) and complete OAT use? with increased pathology utilisation (e.g. haematological, chemical, microbiological or immunological tissue/sample testing; AIRR: 2.30, 95%CI: 1.52-3.48). CONCLUSION We observed higher rates of primary healthcare use and medication dispensation among people who reported partial and complete OAT use post-release. Findings suggest that access to OAT post-release may have a collateral benefit in supporting broader health service utilisation, underscoring the importance of retention in OAT after release from prison.
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Affiliation(s)
- Michael Curtis
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Monash Addition Research Centre, Monash University, Melbourne, VIC, Australia.
| | - Anna L Wilkinson
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul Dietze
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Ashleigh C Stewart
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stuart A Kinner
- School of Population Health, Curtin University, Perth, WA, Australia
- Justice Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia
| | - Rebecca J Winter
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Campbell Aitken
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shelley J Walker
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Reece D Cossar
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark Stoové
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Majer JM, Bobak TJ, Jason LA. Psychiatric severity and stress among recovery home residents utilizing medication assisted treatment: a moderated mediation analysis of homophily. ADVANCES IN DUAL DIAGNOSIS 2021. [DOI: 10.1108/add-07-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to examine the relationship between psychiatric severity and stress among persons utilizing medication assisted treatment (MAT), and there is a need to identify resources that promote resilience against these risk factors. Although recovery homes might complement pharmacological interventions for persons using MAT, a lack of homophily (e.g. similar experiences) among residents could produce stress and increase psychiatric severity. The purpose of this paper is to examine stress and psychiatric severity in relation to recovery outcomes, and whether homophily moderated these relationships.
Design/methodology/approach
A cross-sectional analysis was conducted among recovery home residents who were recruited from the USA, including those using (n = 40) and not using (n = 132) MAT. Participants’ levels of psychiatric severity, stress, abstinence self-efficacy and quality of life were assessed in addition to whether residents using MAT were living with at least one other resident who used MAT. Moderated mediation analyses were conducted to examine whether homophily among residents using MAT would moderate the mediating effects of stress on the relationships between psychiatric severity and recovery outcomes (abstinence-self efficacy, quality of life).
Findings
Mediating effects were observed but they were significant only through homophily. Although stress increased the negative effects of psychiatric severity among residents using MAT, significantly lesser effects were observed among those living with residents using MAT.
Practical implications
Although psychiatric (problem) severity and stress threaten recovery for persons with substance use disorders, little is known how they impact recovery among those living in community-based settings such as recovery homes. In addition, there is a need to identify community resources that would complement MAT protocols, as patients who use MAT face unique stressors related to their sense of shared interests and experiences (i.e. homophily) when developing social bonds with others in recovery.
Social implications
This study suggests the social networks within recovery homes reduce the effects of psychiatric severity and stress, and that these effects are lessened for residents who use MAT when they live with others who also use MAT.
Originality/value
Little is known about recovery home residents who use MAT and have high psychiatric severity. Findings suggest homophily among persons using MAT living in recovery homes who have high psychiatric severity can promote resilience.
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Sharp A, Carlson M, Howell V, Moore K, Schuman-Olivier Z. Letting the sun shine on patient voices: Perspectives about medications for opioid use disorder in Florida. J Subst Abuse Treat 2021; 123:108247. [PMID: 33612190 PMCID: PMC8128038 DOI: 10.1016/j.jsat.2020.108247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/13/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
The 2017 declaration of the opioid overdose epidemic as a public health emergency in the United States enhanced a national focus on effective and sustainable treatments for opioid use disorder (OUD), including multiple options utilizing medication. Despite clinical studies demonstrating efficacy, numerous reports suggest that medication for opioid use disorder (MOUD) has been underutilized, leaving many questions about specific barriers and facilitators. This study examines factors impacting attitudes and perspectives related to MOUD that influence its utilization and acceptance in a state where support for harm reduction and treatment policy has been limited. With consideration for the contextual cultural factors of this region, we conducted twelve individual interviews with people seeking treatment for OUD at a detoxification facility in Tampa, Florida. This study called attention to the perspectives of patients regarding their unique self-identified needs and beliefs around MOUD as it relates to their addiction treatment. We evaluated the perspectives collected in the interviews (N = 12) based on three main themes: 1) positive perceptions of MOUD; 2) negative perceptions of MOUD; and 3) overall perceptions of treatment and recovery. Findings suggest that participants' varying levels of positive and negative perspectives about MOUD are informed by nuances in their social networks and varying levels of exposure or education. For example, participants held more negative opinions of MOUD than positive, accounting mostly for a view that it serves as a direct substitute for illicit opioids rather than a sustainable or supportive solution addressing the underlying causes of addiction. These opinions may be largely dependent on geographic location that dictates policy, practice, funding, and, in turn, cultural acceptance of MOUD. The findings in this qualitative study may help to inform future education efforts, initiatives addressing patient-level concerns, and provide decision-makers with meaningful information to tailor programmatic policy and procedures specific to local area social inputs and resource exposure.
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Affiliation(s)
- Amanda Sharp
- University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States.
| | - Melissa Carlson
- University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States
| | - Veronica Howell
- University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States
| | - Kathleen Moore
- University of South Florida, Department of Mental Health Law and Policy, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States
| | - Zev Schuman-Olivier
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St, Boston, MA 02115, United States
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Hallgren KA, Witwer E, West I, Baldwin LM, Donovan D, Stuvek B, Keppel GA, Mollis B, Stephens KA. Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network. J Subst Abuse Treat 2020; 110:18-27. [PMID: 31952624 PMCID: PMC7255441 DOI: 10.1016/j.jsat.2019.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Most people with alcohol or opioid use disorders (AUD or OUD) are not diagnosed or treated for these conditions in primary care. This study takes a critical step toward quantifying service gaps and directing improvement efforts for AUD and OUD by using electronic health record (EHR) data from diverse primary care organizations to quantify the extent to which AUD and OUD are underdiagnosed and undertreated in primary care practices. METHODS We extracted and integrated diagnosis, medication, and behavioral health visit data from the EHRs of 21 primary care clinics within four independent healthcare organizations representing community health centers and rural hospital-associated clinics in the Pacific Northwest United States. Rates of documented AUD and OUD diagnoses, pharmacological treatments, and behavioral health visits were evaluated over a two-year period (2015-2016). RESULTS Out of 47,502 adult primary care patients, 1476 (3.1%) had documented AUD; of these, 115 (7.8%) had orders for AUD medications and 271 (18.4%) had at least one documented visit with a non-physician behavioral health specialist. Only 402 (0.8%) patients had documented OUD, and of these, 107 (26.6%) received OUD medications and 119 (29.6%) had at least one documented visit with a non-physician behavioral health specialist. Rates of AUD diagnosis and AUD and OUD medications were higher in clinics that had co-located non-physician behavioral health specialists. CONCLUSIONS AUD and OUD are underdiagnosed and undertreated within a sample of independent primary care organizations serving mostly rural patients. Primary care organizations likely need service models, technologies, and workforces, including non-physician behavioral health specialists, to improve capacities to diagnose and treat AUD and OUD.
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Affiliation(s)
- Kevin A Hallgren
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States.
| | - Elizabeth Witwer
- University of Washington, Department of Family Medicine, United States
| | - Imara West
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States
| | - Laura-Mae Baldwin
- University of Washington, Department of Family Medicine, United States
| | - Dennis Donovan
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States; University of Washington, Alcohol and Drug Abuse Institute, United States
| | - Brenda Stuvek
- University of Washington, Alcohol and Drug Abuse Institute, United States
| | - Gina A Keppel
- University of Washington, Department of Family Medicine, United States
| | - Brenda Mollis
- University of Washington, Department of Family Medicine, United States
| | - Kari A Stephens
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States; University of Washington, Department of Biomedical Informatics and Medical Education, United States
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Abraham AJ, Andrews CM, Harris SJ, Friedmann PD. Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA. Neurotherapeutics 2020; 17:55-69. [PMID: 31907876 PMCID: PMC7007488 DOI: 10.1007/s13311-019-00814-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.
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Affiliation(s)
- Amanda J. Abraham
- School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA 30602 USA
| | - Christina M. Andrews
- College of Social Work, University of South Carolina, 1512 Pendleton St., Room 309, Columbia, SC 29208 USA
| | - Samantha J. Harris
- School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA 30602 USA
| | - Peter D. Friedmann
- University of Massachusetts Medical School Baystate, 280 Chestnut St., Springfield, MA 01199 USA
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Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model. J Am Board Fam Med 2019; 32:724-731. [PMID: 31506368 PMCID: PMC6754209 DOI: 10.3122/jabfm.2019.05.190012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Medication-assisted treatment (MAT) for opioid use disorder (OUD) is underused in primary care. Little is known about patient demographics associated with MAT initiation, particularly among models with an interdisciplinary approach, including behavioral health integration. We hypothesize few disparities in MAT initiation by patient characteristics after implementing this model for OUD. METHODS Electronic health record data were used to identify adults with ≥1 primary care visit in 1 of 2 study clinics in a Pacific Northwest academic health system between September 1, 2015 and August 31, 2017 (n = 23,372). Rates of documented OUD diagnosis were calculated. Multivariate logistic regression estimated odds ratios of MAT initiation, defined as ≥1 electronic health record order for buprenorphine or naltrexone, by patient covariates. RESULTS Seven percent of the study sample had an OUD diagnosis. Of those patients, 32% had ≥1 MAT order. Patients with documented psychiatric diagnoses or tobacco use had higher odds of initiating MAT (odds ratio [OR] = 1.62, P = .0003; OR = 2.46, P < .0001, respectively). Uninsured, Medicaid, and Medicare patients had lower odds than those commercially insured (OR = 0.53, 0.38, and 0.31, respectively; P < .0001). Patients who were older, of a race/ethnicity other than non-Hispanic white, had documented diabetes, and had documented asthma or chronic obstructive pulmonary disease showed lower odds of initiation. DISCUSSION MAT initiation varied by patient characteristics, including disparities by insurance coverage and race/ethnicity. The addition of behavioral health did not eliminate disparities in care, but higher odds of initiation among those with a documented psychiatric diagnosis may suggest this model reaches some vulnerable populations. Additional research is needed to further examine these findings.
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Treating chronic pain and opioid misuse disorder among underserved populations in Colorado. J Am Assoc Nurse Pract 2019; 31:766-772. [PMID: 31169790 DOI: 10.1097/jxx.0000000000000238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The increased use of prescription opioids has resulted in widespread misuse. As a result, more than 40,000 Americans lost their lives to opiate overdose in 2016 alone. These data have led to a national movement focused on appropriate opioid prescribing practices. The Centers for Disease Control and Prevention (CDC) developed its Guidelines for Prescribing Opioids for Chronic Pain (2017), a template for pain management and substance assessment in primary care. These CDC guidelines aim to prevent misuse/deaths and early identification of substance use disorders. Although the guidelines are appropriate for initiation of opioid therapy, they are not sufficient to manage patients who have already developed misuse disorders. Other modalities such as medication-assisted treatment (MAT) have been described as beneficial for patients with high risk for or who have an opioid misuse disorder. This article builds on the CDC's 2017 advisory document by applying it in praxis: first, non-opioid medication therapy options and nonmedication therapy options are explored; next, a case study is presented of an integrated primary care-managed patient who presented with both chronic pain and established opioid use disorder. Although the CDC guidelines were not followed in the patient's initial prescription opioid treatment regimen, those guidelines were used as a starting point for follow-up treatment, helping both to assess the patient's risk for opioid misuse disorder and to determine that MAT was an appropriate method of treatment.
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Kinsky S, Houck PR, Mayes K, Loveland D, Daley D, Schuster JM. A comparison of adherence, outcomes, and costs among opioid use disorder Medicaid patients treated with buprenorphine and methadone: A view from the payer perspective. J Subst Abuse Treat 2019; 104:15-21. [PMID: 31370980 DOI: 10.1016/j.jsat.2019.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/24/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
Medication-assisted treatment (MAT) with methadone or buprenorphine has been shown to be more effective at reducing the use of illicit opioids, the risk of drug-related overdose, and overall healthcare costs, on average, compared to abstinence-based addiction treatments for individuals with an opioid use disorder (OUD). Individuals who are adherent to MAT are more likely to experience positive outcomes. We used physical and behavioral Medicaid claims data of individuals newly treated with methadone (n = 212) and buprenorphine (n = 972) to examine the overall predictors of adherence, differences in adherence to each medication, the relationship between adherence and ED nonfatal drug-related overdose, and differences in total cost of care between the two medications. We found that older individuals and women had significantly lower risk of non-adherence. At six months, only 3.6% of individuals who were adherent to either treatment experienced a nonfatal drug-related overdose in the ED, compared to 13.2% of individuals who were non-adherent. We found no significant difference between methadone and buprenorphine on nonfatal drug-related overdose. Non-adherence to methadone was associated with a significant increase in total cost of care. Implications for how these results could be used to improve the overall impact of MAT are discussed.
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Affiliation(s)
- Suzanne Kinsky
- UPMC Center for High-Value Health Care, US Steel Tower, 600 Grant Street, 40th Floor, Pittsburgh, PA 15219, USA.
| | - Patricia R Houck
- UPMC Health Plan, Department of Health Economics, , US Steel Tower, 600 Grant Street, 21st Floor, Pittsburgh, PA 15219, USA.
| | - Kristin Mayes
- UPMC Center for High-Value Health Care, US Steel Tower, 600 Grant Street, 40th Floor, Pittsburgh, PA 15219, USA.
| | - David Loveland
- Community Care Behavioral Health, 339 Sixth Avenue, Suite 1300, Pittsburgh, PA 15222, USA.
| | - Dennis Daley
- UPMC Health Plan, US Steel Tower, 600 Grant Street, Pittsburgh, PA 15219, USA.
| | - James M Schuster
- UPMC Insurance Services Division, US Steel Tower, 600 Grant Street, 55th Floor, Pittsburgh, PA 15219, USA.
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Bunn TL, Quesinberry D, Jennings T, Kizewski A, Jackson H, McKee S, Eustice S. Timely linkage of individuals to substance use disorder treatment: development, implementation, and evaluation of FindHelpNowKY.org. BMC Public Health 2019; 19:177. [PMID: 30744608 PMCID: PMC6371481 DOI: 10.1186/s12889-019-6499-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Substance use disorders (SUD) have steadily increased over the last two decades. Seeking SUD treatment involves searching SUD treatment facility types (inpatient, outpatient and intensive outpatient, residential and family residential, and detoxification facilities) that offer specialized SUD treatment depending on individual needs and preferences. Referrals to SUD treatment require innovative strategies that rapidly link individuals to SUD treatment when they are at the critical stage of readiness. The aim of this study was to develop, implement, and evaluate a user-friendly SUD treatment facility opening availability website called FindHelpNowKY.org. The objectives of the study were to 1) recruit SUD treatment facility and partner participation; 2) develop platform, content, and analytics for the FindHelpNowKY.org website intervention with an information repository; 3) assess barriers and facilitators to implementation; and 4) evaluate the development and implementation of FindHelpNowKY.org. Methods Website development stakeholders were identified and the website concept was developed. The logic model for FindHelpNowKY.org outlined resources, activities, and outputs as well as the associated short-term, medium-term, and long-term objectives, along with a website evaluation plan. Website usability and focus group testing was conducted. Information repository resource documents were compiled and categorized. An inventory of Kentucky-based SUD treatment facilities was compiled using various state and federal resources. Results Development/implementation barriers were addressed, facilitators were identified, and the website was implemented; 83% of SUD treatment facilities were indexed on the website, and average website user time was 7 min. From February to October 2018, there were 29,000 visitors, and 30,000 unique searches. The most common website query was a friend or family member seeking long-term residential or outpatient treatment facilities accepting Medicaid or Medicare. Conclusions FindHelpNowKY.org has the potential to fill a critical need for timely access to available SUD treatment in the state. The website may be a valuable resource for health professionals that can enhance clinical workflow and reduce staff time conducting phone and website searches for available SUD treatment. The website is a promising tool for assessing current SUD treatment capacity vs. SUD treatment need. The FindHelpNow model can be used by other states to increase timely access to SUD treatment.
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Affiliation(s)
- Terry Lee Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA. .,Department of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, 111 Washington Ave, Lexington, KY, 40536, USA.
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Tyler Jennings
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Amber Kizewski
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Heather Jackson
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Sarah McKee
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Sarah Eustice
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
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Burton BN, Labastide AS, Meineke MN, Schmidt UH, Gabriel RA. Cardiorespiratory morbidity and mortality of opioid overdose during admission to safety-net hospitals. J Clin Anesth 2018; 54:66-71. [PMID: 30408618 DOI: 10.1016/j.jclinane.2018.10.036] [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: 08/27/2018] [Revised: 10/11/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE Safety-net hospitals disproportionately care for high-risk patients. Prior work has shown safety-net hospitals to have inferior postoperative outcomes with higher cost and worse patient ratings. We aim to examine the association of hospital safety-net burden with morbidity and mortality in patients with opioid overdose hospital admission. DESIGN Retrospective cross-sectional analysis using the National Inpatient Sample registry from 2010 to 2014. SETTING Multi-institutional. PATIENTS We included 547, 399 patients admitted to a United States hospital with an International Classification of Disease, Ninth Revision, code of opioid overdose. To study the association of hospital safety-net burden on mortality and morbidity, we calculated hospital safety-net burden defined as the percent of Medicaid or uninsured among all admitted patients. Hospitals were categorized into one of three categories: low burden hospitals, medium burden hospitals, and high burden hospitals (i.e., safety-net hospitals). We performed a mixed effects multivariable logistic regression analysis to assess the association of hospital safety-net burden with short-term inpatient outcomes. INTERVENTION None. MEASUREMENTS The primary outcomes were inpatient mortality and morbidity. MAIN RESULTS Compared to MBHs and LBHs, HBHs had a greater proportion of minority patients (i.e., Black, Hispanic, and Native American) and patients with median household income in the lowest quartile (p < 0.001). Among prescription opioid overdose admissions, the odds of inpatient mortality and pulmonary and cardiac morbidity were also not significantly higher between HBHs versus LBHs (p > 0.05). CONCLUSIONS Safety-net hospital disproportionately care for vulnerable populations, however the odds of poor outcomes were no different in opioid overdose. Safety-net hospitals should have equal access to the funding and resources that allows them to deliver the same standard of care as their counterparts.
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Affiliation(s)
- Brittany N Burton
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Angele S Labastide
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Minhthy N Meineke
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Ulrich H Schmidt
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA.
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Glass JE, Williams EC. The Future of Research on Alcohol Health Disparities: A Health Services Research Perspective. J Stud Alcohol Drugs 2018; 79:322-324. [PMID: 29553364 PMCID: PMC6019777 DOI: 10.15288/jsad.2018.79.322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101,
| | - Emily C. Williams
- Denver–Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Services Research & Development, Seattle, Washington,Department of Health Services, University of Washington, Seattle, Washington
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