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Gryczynski J, Mitchell SG, Whitter M, Fuller D, Mitchell MM, Edelman EJ, Schwartz RP. A trial of implementation facilitation to increase timely admission to methadone treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209375. [PMID: 38642889 PMCID: PMC11197887 DOI: 10.1016/j.josat.2024.209375] [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: 11/11/2023] [Revised: 02/27/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND During the ongoing opioid epidemic, some Opioid Treatment Programs (OTPs) are unable to admit program applicants in a timely fashion. Interim methadone (IM) treatment (without routine counseling) is an effective approach to overcome this challenge when counseling capacity is inadequate to permit admissions within 14 days of request. It requires both federal and state approval and has been rarely utilized since its incorporation into the federal OTP regulations in 1993. METHODS We evaluated the impact of Implementation Facilitation (IF) on OTPs providing timely admission to methadone treatment (i.e., within 14 days of request), adopting IM, and changing admissions procedures. IF included data collection on admission processes and an external facilitator who engaged OTP leadership, Local Champions through site visits, remote academic detailing, and feedback. Local Champions and State Opioid Treatment Authorities (SOTAs) participated in learning collaboratives. Using a modified stepped wedge design, six OTPs in four US states on the east and west coasts were randomly assigned to one of two clusters that staggered the timing of IF receipt. Study Phases included: Pre-Implementation, IF, and Sustainability. OTPs submitted data on treatment requests and admissions for 28 months (N = 3108 requests for treatment). RESULTS Although none of the OTPs adopted IM, all six developed policies and procedures to enable its use. Some OTPs streamlined admissions processes prior to study launch and during the IF intervention. OTPs reduced admission delays over time, although there was substantial site heterogeneity. The IF Phase for the early cluster coincided with the onset of COVID-19, complicating the study. Rates of timely admission within 14 days of request were 56.2 % (Pre-Implementation), 55.8 % (IF), and 78.8 % (Sustainability). Compared to the Pre-Implementation Phase, the odds of timely admission were not significantly different during the IF Phase but significantly higher during the Sustainability Phase (OR = 2.35 [95 % CI = 1.34, 4.12]; p = 0.003). CONCLUSIONS Committing to study participation and IF activities may have prompted some OTPs to change practices that improved timely admission. Attributing changes to IF should be done with caution considering study limitations. Data collection for the study spanned the COVID-19 pandemic, which complicates interpretation. TRIAL REGISTRATION Clinicaltrials.gov registration # NCT04188977.
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Affiliation(s)
- J Gryczynski
- Friends Research Institute, Inc., Baltimore, MD, United States of America.
| | - S G Mitchell
- Friends Research Institute, Inc., Baltimore, MD, United States of America
| | - M Whitter
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., United States of America
| | - D Fuller
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., United States of America
| | - M M Mitchell
- MMM was with FRI at time of the study, United States of America
| | - E J Edelman
- Yale Schools of Medicine and Public Health, New Haven, CT, United States of America
| | - R P Schwartz
- Friends Research Institute, Inc., Baltimore, MD, United States of America
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Becker TD, Eschliman EL, Thakrar AP, Yang LH. A conceptual framework for how structural changes in emerging acute substance use service models can reduce stigma of medications for opioid use disorder. Front Psychiatry 2023; 14:1184951. [PMID: 37829763 PMCID: PMC10565357 DOI: 10.3389/fpsyt.2023.1184951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Stigma toward people taking medication for opioid use disorder (MOUD) is prevalent, harmful to the health and well-being of this population, and impedes MOUD treatment resource provision, help-seeking, and engagement in care. In recent years, clinicians have implemented new models of MOUD-based treatment in parts of the United States that integrate buprenorphine initiation into emergency departments and other acute general medical settings, with post-discharge linkage to office-based treatment. These service models increase access to MOUD and they have potential to mitigate stigma toward opioid use and MOUD. However, the empirical literature connecting these emerging service delivery models to stigma outcomes remains underdeveloped. This paper aims to bridge the stigma and health service literatures via a conceptual model delineating how elements of emerging MOUD service models can reduce stigma and increase behavior in pursuit of life goals. Specifically, we outline how new approaches to three key processes can counter structural, public, and self-stigma for this population: (1) community outreach with peer-to-peer influence, (2) clinical evaluation and induction of MOUD in acute care settings, and (3) transition to outpatient maintenance care and early recovery. Emerging service models that target these three processes can, in turn, foster patient empowerment and pursuit of life goals. There is great potential to increase the well-being of people who use opioids by reducing stigma against MOUD via these structural changes.
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Affiliation(s)
- Timothy D. Becker
- Department of Psychiatry, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, United States
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Evan L. Eschliman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ashish P. Thakrar
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, United States
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Sigmon SC, Peck KR, Batchelder SR, Badger GJ, Heil SH, Higgins ST. Technology-Assisted Buprenorphine Treatment in Rural and Nonrural Settings: Two Randomized Clinical Trials. JAMA Netw Open 2023; 6:e2331910. [PMID: 37755833 PMCID: PMC10534272 DOI: 10.1001/jamanetworkopen.2023.31910] [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: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 09/28/2023] Open
Abstract
Importance Expansion of opioid use disorder treatment is needed, particularly in rural communities. Objective To evaluate technology-assisted buprenorphine (TAB) efficacy (1) over a longer period than previously examined, (2) with the addition of overdose education, and (3) among individuals residing in rural communities. Design, Setting, and Participants Two parallel, 24-week randomized clinical trials were conducted at the University of Vermont between February 1, 2018, and June 30, 2022. Participants were adults with untreated opioid use disorder from nonrural (trial 1) or rural (trial 2) communities. These trials are part of a programmatic effort to develop TAB protocols to improve treatment availability in underserved areas. Interventions Within each trial, 50 participants were randomized to TAB or control conditions. Participants in the TAB group completed bimonthly visits to ingest medication and receive take-home doses via a computerized device. They received nightly calls via an interactive voice response (IVR) system, IVR-generated random call-backs, and iPad-delivered HIV, hepatitis C virus (HCV), and overdose education. Control participants received community resource guides and assistance with contacting resources. All participants received harm reduction supplies and completed monthly assessments. Main Outcomes and Measures The primary outcome was biochemically verified illicit opioid abstinence across monthly assessments. Secondary outcomes included self-reported opioid use in both groups and abstinence at bimonthly and random call-back visits, treatment adherence, satisfaction, and changes in HIV, HCV, and overdose knowledge among TAB participants. Results Fifty individuals (mean [SD] age, 40.6 [13.1] years; 28 [56.0%] male) participated in trial 1, and 50 (mean [SD] age, 40.3 [10.8] years; 30 [60.0%] male) participated in trial 2. Participants in the TAB group achieved significantly greater illicit opioid abstinence vs controls at all time points in both trial 1 (85.3% [128 of 150]; 95% CI, 70.7%-93.3%; vs 24.0% [36 of 150]; 95% CI, 13.6%-38.8%) and trial 2 (88.0% [132 of 150]; 95% CI, 72.1%-95.4%; vs 21.3% [32 of 150]; 95% CI, 11.4%-36.5%). High abstinence rates were also observed at TAB participants' bimonthly dosing visits (83.0% [95% CI, 67.0%-92.0%] for trial 1 and 88.0% [95% CI, 71.0%-95.0%] for trial 2). Treatment adherence was favorable and similar between trials (with rates of approximately 99% for buprenorphine administration, 93% for daily IVR calls, and 92% for random call-backs), and 183 of 187 urine samples (97.9%) tested negative for illicit opioids at random call-backs. iPad-delivered education was associated with significant and sustained increases in HIV, HCV, and overdose knowledge. Conclusions and Relevance In these randomized clinical trials of TAB treatment, demonstration of efficacy was extended to a longer duration than previously examined and to patients residing in rural communities. Trial Registration ClinicalTrials.gov Identifier: NCT03420313.
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Affiliation(s)
- Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Kelly R. Peck
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Sydney R. Batchelder
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
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Welsh JW, Yarbrough CR, Sitar SI, Mataczynski MJ, Peralta AM, Kan M, Crawford ND, Conrad TA, Kee C, Young HN. Demographic and socioeconomic correlates to buprenorphine access in pharmacies. J Am Pharm Assoc (2003) 2023; 63:751-759. [PMID: 36658013 PMCID: PMC11332381 DOI: 10.1016/j.japh.2022.12.015] [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: 05/17/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Research has focused on buprenorphine prescribing with limited attention to the role of pharmacy access to buprenorphine for opioid use disorder. OBJECTIVE This study examines demographic and socioeconomic correlates to buprenorphine access in Georgia pharmacies. METHODS A 5-question (12 potential subqueries) telephone administered survey was used to investigate access and stocking patterns of specific dosages and formulations of buprenorphine in Georgia pharmacies (n = 119). Descriptive statistics characterized physician and pharmacy demographics and buprenorphine stocking practices. Correlations between various factors including buprenorphine stocking practices, geographic, and sociodemographic characteristics were identified using nonlinear regression models. RESULTS The majority of pharmacies stocked the most commonly prescribed 8/2 mg dosage strength of buprenorphine/naloxone films and tablets (69.0% and 63.0%, respectively). Other strengths were less likely to be readily available. Pharmacies in Suburban Census tracts were 77.0% more likely to stock any type of buprenorphine monotherapy [odds ratio (OR) = 1.77, t = 2.37, P < 0.05] and 58.1% more likely to stock the 8 mg buprenorphine monotherapy formulation [OR = 1.58, t = 2.15, P < 0.05] than Urban tracts. Pharmacies in areas with above-average non-White populations were 29.6% more likely to stock a monotherapy product [OR = 1.30, t = 2.16, P < 0.05], and those in areas with above-average poverty rates were more likely to stock the 8 mg/2 mg buprenorphine/naloxone tablets [OR = 1.04, t = 2.02, P < 0.05]. There were no additional differences across the sample in formulation or dosage strengths. Pharmacists who endorsed challenges dispensing buprenorphine (23.3%) cited issues around insurance coverage, payment difficulty, prior authorization issues, and low stock of specific formulations. CONCLUSIONS Results suggest that low availability of certain dosages or formulations of buprenorphine in local pharmacies could obstruct access for patients. Future research should address barriers to supplying buprenorphine and collaborative measures between pharmacists and prescribers to improve access.
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Affiliation(s)
- Justine W. Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory Addiction Center, Atlanta, GA
| | | | - Siara I. Sitar
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory Addiction Center, Atlanta, GA
| | - Maggie J. Mataczynski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | | | - Mary Kan
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | | | - Henry N. Young
- Department Head, Director of Pharmaceutical Health Services, Outcomes, and Policy, College of Pharmacy, University of Georgia, Athens, GA
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Williams AR, Mauro CM, Feng T, Wilson A, Cruz A, Olfson M, Crystal S, Samples H, Chiodo L. Non-prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder. J Subst Abuse Treat 2022; 139:108770. [PMID: 35337715 PMCID: PMC9187606 DOI: 10.1016/j.jsat.2022.108770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/01/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non-prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. METHODS The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015-2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding. Outcomes included hazards of treatment discontinuation and rates of opioid use. RESULTS Compared to patients testing negative for buprenorphine at intake, those testing positive (59.6%) had lower hazards of treatment discontinuation (HR = 0.52, 95% CI: 0.44, 0.60, p < 0.01). Results were little changed following adjustment for baseline opioid use and other patient characteristics (aHR: 0.60, 95% CI: 0.51, 0.70, p < 0.01). Risk of discontinuation did not significantly differ between patients by buprenorphine source: prescribed v. NPB (reference) at admission (HR = 1.15, 95% CI: 0.90, 1.46). Opioid use was lower in the buprenorphine positive group at admission (25.0% vs. 53.1%, p < 0.0001) and throughout early months of treatment but converged after 7 months for those remaining in care (17.1% vs. 16.5%, p = 0.89). CONCLUSION NPB preceding treatment intake was associated with decreased hazards of treatment discontinuation and lower opioid use. These findings suggest use of NPB may be a marker of treatment readiness and that buprenorphine testing at intake may have predictive value for clinical assessments regarding risk of early treatment discontinuation.
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Affiliation(s)
- Arthur Robin Williams
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America.
| | - Christine M Mauro
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St., New York, NY 10032, United States of America
| | - Tianshu Feng
- Research Foundation for Mental Hygiene, 1051 Riverside Dr., New York, NY 10032, United States of America
| | - Amanda Wilson
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America; North-Star Care, Inc., 4810 Point Fosdick Dr. Suite #92, Gig Harbor, WA 98335, United States of America
| | - Angelo Cruz
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America
| | - Hillary Samples
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America
| | - Lisa Chiodo
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America; North-Star Care, Inc., 4810 Point Fosdick Dr. Suite #92, Gig Harbor, WA 98335, United States of America; University of Massachusetts Amherst, School of Nursing, 651 N Pleasant St, Amherst, MA 01003, United States of America
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Bonifonte A, Garcia E. Improving geographic access to methadone clinics. J Subst Abuse Treat 2022; 141:108836. [PMID: 35870438 DOI: 10.1016/j.jsat.2022.108836] [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: 08/19/2021] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Opioid misuse is a nationwide public health crisis. Methadone treatment is proven to be highly successful in preventing opioid use disorder, reducing the use of illicit drugs, and preventing overdoses. Clients acquire methadone daily from clinics, making geographic access crucial for the initiation of and adherence to treatment. METHODS This work estimates unsatisfied methadone demand due to lack of geographic access at a census tract level and models the problem of identifying optimal locations to open new methadone clinics. The objective function of the model is a weighted combination of providing access to individuals with unmet methadone demand and improving the travel time of individuals currently attending a clinic. Data on existing methadone clinics and statewide methadone demand is acquired from Substance Abuse and Mental Health Services Administration (SAMHSA) surveys from 2019. Unsatisfied demand is estimated through a linear regression model after aggregating the population, heroin use, and satisfied methadone demand at the state level. RESULTS Nationwide, we find 18.2 % of the United States population does not have geographic access to a methadone clinic and estimate 77,973 individuals in these areas would attend a clinic if geographic access barriers were removed (95 % CI: 67,413-88,532). In a case study of six Midwestern states, we find that geography significantly contributes to the value of opening additional clinics and we see large differences in expected gains between states sharing similar characteristics such as population and satisfied methadone demand. The number of additional clients served by opening one new clinic ranges from 180 to 804 across these six states, representing between 8.4 % and 16.2 % of state unmet demand. Between 1.2 % and 14.1 % of existing clients were reassigned with a single newly opened clinic, with a one-way average travel distance improvement between 6.3 and 11.9 miles / person / day for these clients. CONCLUSIONS The results demonstrate the large unserved methadone demand in the United States, the significant improvement in methadone access for new and existing clients that can be achieved by opening new clinics, and the important role state-specific geography plays in these decisions.
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Affiliation(s)
- Anthony Bonifonte
- Data Analytics Department, Denison University, Granville, OH, United States of America.
| | - Erin Garcia
- Department of Industrial and Systems Engineering, Auburn University, Auburn, AL, United States of America.
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Peck KR, Moxley-Kelly N, Badger GJ, Sigmon SC. Posttraumatic stress disorder in individuals seeking treatment for opioid use disorder in Vermont. Prev Med 2021; 152:106817. [PMID: 34599919 PMCID: PMC8641000 DOI: 10.1016/j.ypmed.2021.106817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) and opioid use disorder (OUD) may be associated with poor outcomes in rural areas where access to mental health services and opioid agonist treatment (OAT) is limited. This study examined the characteristics associated with a history of PTSD among a sample of individuals seeking buprenorphine treatment for OUD in Vermont, the second-most rural state in the US. Participants were 89 adults with OUD who participated in one of two ongoing randomized clinical trials examining the efficacy of an interim buprenorphine dosing protocol for reducing illicit opioid use during waitlist delays to OAT. Thirty-one percent of participants reported a history of PTSD. Those who did (PTSD+; n = 28) and did not (PTSD-; n = 61) report a history of PTSD were similar on sociodemographic and drug use characteristics. However, the PTSD+ group was less likely to have received prior OUD treatment compared to the PTSD- group (p = .02) despite being more likely to have a primary care physician (p = .009) and medical insurance (p = .002). PTSD+ individuals also reported greater mental health service utilization, more severe psychiatric, medical and drug use consequences, and greater pain severity and interference vs. PTSD- individuals (ps < 0.05). These findings indicate that a history of PTSD is prevalent and associated with worse outcomes among individuals seeking treatment for OUD in Vermont. Dissemination of screening measures and targeted interventions may help address the psychiatric and medical needs of rural individuals with OUD and a history of PTSD.
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Affiliation(s)
- Kelly R Peck
- The Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
| | | | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
| | - Stacey C Sigmon
- The Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
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Challenges and opportunities during the COVID-19 pandemic: Treating patients for substance use disorders during the perinatal period. Prev Med 2021; 152:106742. [PMID: 34302836 PMCID: PMC8389664 DOI: 10.1016/j.ypmed.2021.106742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/05/2021] [Accepted: 07/18/2021] [Indexed: 11/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic exacerbated the opioid use disorder epidemic and accelerated alcohol and other substance use disorders. Sudden health care service delivery changes during the COVID-19 pandemic created both challenges and opportunities for all patients with substance use disorders including the use of virtual or telemedicine visits, medication access issues and ensuring access to naloxone when supplies cannot be handed out. Unique challenges for pregnant and post-partum patients with substance use disorders includes some evidence of reduced access to medication to treat opioid use disorders and changes in delivery protocols that isolate birthing people from supports. Opportunities for all patients with substance use disorders include virtual platforms presenting positive opportunities for treatment. They are time efficient, eliminate transportation barriers, and potentially reduce childcare barriers. For pregnant and post-partum patients with substance use disorders, hybrid models of telemedicine and in-person visits reduced no-show visit rates and increased flexibility in medication dosing regimens. Thus, there is a unique opportunity to study the success of different virtual care models given the variety of implemented strategies. The COVID-19 pandemic provides an unprecedented opportunity to dramatically transform standard care approaches to help optimize care for all patients, including pregnant and post-partum people.
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Characterizing the Clinical use of a Novel Video-assisted Dosing Protocol With Secure Medication Dispensers to Reduce Barriers to Opioid Treatment. J Addict Med 2021; 16:310-316. [PMID: 34282084 DOI: 10.1097/adm.0000000000000895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Distance and travel costs to opioid treatment programs (OTPs), especially in rural communities, are barriers to treatment for opioid use disorder. Retention rates at 12 months in our OTP are 55% (range 53%-61%). We piloted a novel treatment platform utilizing a video directly observed therapy (VDOT) smartphone app and a secure medication dispenser to support adherence with take-home doses of methadone or buprenorphine while enabling patients to maintain prosocial activities, reduce time and cost of travel, and increase retention. METHODS Participants (n = 58) were adults in a Vermont OTP. Inclusion criteria included travel hardship, access to Wi-Fi or cellular network, and having an iPhone 4S or Android 4.0 or greater. Patients received a dispenser, VDOT app, clinic dispensed medication, counseling, and urine drug testing. Chart reviews assessed VDOT compliance, engagement in prosocial activities, travel costs and time savings, and treatment disposition/retention. Project-associated costs were examined. RESULTS Of the 15,831 expected videos, 15,581 (98.4%) were received and only 10 (0.063%) showed signs of medication noncompliance with 1 (0.0064%) showing an overt attempt at diversion. About 93% of participants engaged in prosocial activities, travel time and costs were reduced 86%, median cost saved $72 weekly, median travel time saved 5.5 hours weekly and 98% of participants were in treatment 12 months later. CONCLUSIONS VDOT participants using dispensers showed high levels of medication ingestion integrity, had favorable clinical stability, and lower travel time and costs. These findings suggest that using VDOT with dispensers may hold promise as an innovative platform for supporting medication adherence.
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Peck KR, Ochalek TA, Streck JM, Badger GJ, Sigmon SC. Impact of Current Pain Status on Low-Barrier Buprenorphine Treatment Response Among Patients with Opioid Use Disorder. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:1205-1212. [PMID: 33585885 PMCID: PMC8139817 DOI: 10.1093/pm/pnab058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/07/2020] [Accepted: 02/10/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Chronic non-cancer pain (CNCP) is prevalent among individuals with opioid use disorder (OUD). However, the impact of CNCP on buprenorphine treatment outcomes is largely unknown. In this secondary analysis, we examined treatment outcomes among individuals with and without CNCP who received a low-barrier buprenorphine maintenance regimen during waitlist delays to more comprehensive opioid treatment. METHODS Participants were 28 adults with OUD who received 12 weeks of buprenorphine treatment involving bimonthly clinic visits, computerized medication dispensing, and phone-based monitoring. At intake and monthly follow-up assessments, participants completed the Brief Pain Inventory, Beck Anxiety Inventory, Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI), Addiction Severity Index, and staff-observed urinalysis. RESULTS Participants with CNCP (n = 10) achieved comparable rates of illicit opioid abstinence as those without CNCP (n = 18) at weeks 4 (90% vs 94%), 8 (80% vs 83%), and 12 (70% vs 67%) (P = 0.99). Study retention was also similar, with 90% and 83% of participants with and without CNCP completing the 12-week study, respectively (P = 0.99). Furthermore, individuals with CNCP demonstrated significant improvements on the BDI-II and Global Severity Index subscale of the BSI (P < 0.05). However, those with CNCP reported more severe medical problems and smaller reductions in legal problems relative to those without CNCP (P = 0.03). CONCLUSIONS Despite research suggesting that chronic pain may influence OUD treatment outcomes, participants with and without CNCP achieved similar rates of treatment retention and significant reductions in illicit opioid use and psychiatric symptomatology during low-barrier buprenorphine treatment.
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Affiliation(s)
- Kelly R Peck
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Departments of Psychiatry, Burlington, Vermont, USA
- Psychological Science, Burlington, Vermont, USA
| | - Taylor A Ochalek
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Psychological Science, Burlington, Vermont, USA
| | - Joanna M Streck
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Psychological Science, Burlington, Vermont, USA
| | - Gary J Badger
- Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Departments of Psychiatry, Burlington, Vermont, USA
- Psychological Science, Burlington, Vermont, USA
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Peck KR, Ochalek TA, Badger GJ, Sigmon SC. Effects of Interim Buprenorphine Treatment for opioid use disorder among emerging adults. Drug Alcohol Depend 2020; 208:107879. [PMID: 31991327 PMCID: PMC7108757 DOI: 10.1016/j.drugalcdep.2020.107879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Although opioid maintenance is a first-line approach for treating opioid use disorder (OUD), suboptimal treatment outcomes have been reported among emerging adults (EAs; 18-25 years of age). In this secondary analysis, we compared treatment outcomes between EAs and older adults (OAs; ≥ 26 years of age) receiving low-barrier, technology-assisted Interim Buprenorphine Treatment (IBT) during waitlist delays to comprehensive opioid maintenance treatment. METHOD Participants were 35 individuals with OUD who received IBT consisting of 12-weeks of buprenorphine maintenance with bi-monthly clinic visits and technology-assisted monitoring. At monthly follow-up assessments, participants completed staff-observed urinalysis, the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), and Addiction Severity Index (ASI). RESULTS At study intake, EAs (n = 10) reported greater past-year intravenous drug use and greater employment, legal, and psychiatric severity (p's < .05) compared to OAs (n = 25). Despite these initial differences, there were no significant differences in the percentages of urine specimens testing negative for illicit opioids between EA and OA participants at Study Week 4 (90 % vs. 88 %, p = .99), Week 8 (80 % vs. 76 %, p = .99) or Week 12 (60 % vs. 68 %, p = .71). Relative to their older peers, EAs also demonstrated significantly greater improvements on the BAI, BDI-II, and ASI Employment and Legal subscales (p's < .05). CONCLUSIONS Despite presenting with greater past-year intravenous drug use and psychosocial severity relative to OAs, EAs responded favorably to the IBT intervention.
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Affiliation(s)
- Kelly R Peck
- Vermont Center on Behavior and Health, University of Vermont, 1 S. Prospect Street, Burlington, VT 05401, United States.
| | - Taylor A Ochalek
- Vermont Center on Behavior and Health, University of Vermont, 1 S. Prospect Street, Burlington, VT 05401, United States
| | - Gary J Badger
- University of Vermont, Department of Biostatistics, 27 Hills Building, 105 Carrigan Drive, Burlington, VT 05405, United States
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, 1 S. Prospect Street, Burlington, VT 05401, United States
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Champagne-Langabeer T, Swank MW, Langabeer JR. Routes of non-traditional entry into buprenorphine treatment programs. Subst Abuse Treat Prev Policy 2020; 15:6. [PMID: 31959194 PMCID: PMC6972002 DOI: 10.1186/s13011-020-0252-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/09/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Excessive prescribing, increased potency of opioids, and increased availability of illicit heroin and synthetic analogs such as fentanyl has resulted in an increase of overdose fatalities. Medications for opioid use disorder (MOUD) significantly reduces the risk of overdose when compared with no treatment. Although the use of buprenorphine as an agonist treatment for opioid use disorder (OUD) is growing significantly, barriers remain which can prevent or delay treatment. In this study we examine non-traditional routes which could facilitate entry into buprenorphine treatment programs. METHODS Relevant, original research publications addressing entry into buprenorphine treatment published during the years 1989-2019 were identified through PubMed, PsychInfo, PsychArticles, and Medline databases. We operationalized key terms based on three non-traditional paths: persons that entered treatment via the criminal justice system, following emergencies, and through community outreach. RESULTS Of 462 screened articles, twenty studies met the inclusion criteria for full review. Most studies were from the last several years, and most (65%) were from the Northeastern region of the United States. Twelve (60%) were studies suggesting that the criminal justice system could be a potentially viable entry route, both pre-release or post-incarceration. The emergency department was also found to be a cost-effective and viable route for screening and identifying individuals with OUD and linking them to buprenorphine treatment. Fewer studies have documented community outreach initiatives involving buprenorphine. Most studies were small sample size (mean = < 200) and 40% were randomized trials. CONCLUSIONS Despite research suggesting that increasing the number of Drug Addiction Treatment Act (DATA) waived physicians who prescribe buprenorphine would help with the opioid treatment gap, little research has been conducted on routes to increase utilization of treatment. In this study, we found evidence that engaging individuals through criminal justice, emergency departments, and community outreach can serve as non-traditional treatment entry points for certain populations. Alternative routes could engage a greater number of people to initiate MOUD treatment.
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Affiliation(s)
| | - Michael W Swank
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA
| | - James R Langabeer
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.
- McGovern Medical School, University of Texas Health Science Center, 7000 Fannin Street, Suite 600, Houston, TX, 77030, USA.
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13
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Henningfield JE, Ashworth JB, Gerlach KK, Simone B, Schnoll SH. The nexus of opioids, pain, and addiction: Challenges and solutions. Prev Med 2019; 128:105852. [PMID: 31634511 DOI: 10.1016/j.ypmed.2019.105852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022]
Abstract
Pain and addiction are complex disorders with many commonalities. Beneficial outcomes for both disorders can be achieved through similar principles such as individualized medication selection and dosing, comprehensive multi-modal therapies, and judicious modification of treatment as indicated by the patient's status. This is implicit in the term "medication assisted treatment" (MAT) for opioid use disorders (OUD), and is equally important in pain management; however, for many OUD and pain patients, medication is central to the treatment plan and should neither be denied nor withdrawn if critical to patient well-being. Most patients prescribed opioids for pain do not develop OUD, and most people with OUD do not develop it as a result of appropriately prescribed opioids. Nonetheless, concerns about undertreatment of pain in the late 20th century likely contributed to inappropriate prescribing of opioids. This, coupled with a shortfall in OUD treatment capacity and the unfettered flood of inexpensive heroin and fentanyl, behavioral economics and other factors facilitated the 21st century opioid epidemic. Presently, injudicious reductions in opioid prescriptions for pain are contributing to increased suffering and suicides by pain patients as well as worsening disparities in pain management for ethnic minority and low-income people. Many of these people are turning to illicit opioids, and no evidence shows that the reduction in opioid prescriptions is reducing OUD or overdose deaths. Comprehensive, science-based policies that increase access to addiction treatment for all in need and better serve people with pain are vital to addressing both pain and addiction.
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Affiliation(s)
- Jack E Henningfield
- Pinney Associates, United States of America; The Johns Hopkins University School of Medicine, United States of America.
| | - Judy B Ashworth
- Pinney Associates, United States of America; Harm Reduction Therapeutics, United States of America
| | | | - Bernie Simone
- Pinney Associates, United States of America; Harm Reduction Therapeutics, United States of America
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“They're making it so hard for people to get help:” Motivations for non-prescribed buprenorphine use in a time of treatment expansion. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:118-124. [DOI: 10.1016/j.drugpo.2019.06.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 01/22/2023]
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Stuart Bradley E, Liss D, Pepper Carreiro S, Brush DE, Babu K. Potential uses of naltrexone in emergency department patients with opioid use disorder. Clin Toxicol (Phila) 2019; 57:753-759. [PMID: 30831039 PMCID: PMC6908461 DOI: 10.1080/15563650.2019.1583342] [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: 07/19/2018] [Revised: 01/21/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
Introduction: Despite widespread recognition of the opioid crisis, opioid overdose remains a common reason for Emergency Department (ED) utilization. Treatment for these patients after stabilization often involves the provision of information for outpatient treatment options. Ideally, an ED visit for overdose would present an opportunity to start treatment for opioid use disorder (OUD) immediately. Although widely recognized as effective, opioid agonist therapy with methadone and buprenorphine commonly referred to as "medication-assisted therapy" but more correctly as "medication for addiction treatment" (MAT), can be difficult to access even for motivated individuals due to shortages of prescribers and treatment programs. Moreover, opioid agonist therapy may not be appropriate for all patients, as many patients who present after overdose are not opioid dependent. More treatment options are required to successfully match patients with diverse needs to an optimal treatment plan in order to avoid relapse. Naltrexone, a long-acting opioid antagonist, available orally and as a monthly extended-release intramuscular injection, may represent another treatment option. Methods: We conducted a literature search of MEDLINE and PubMed. We aimed to capture references related to naltrexone and is use as MAT for OUD, as well as manuscripts that discussed naltrexone in comparison toother agents used for MAT, opioid detoxification, and naltrexone metabolism. Our initial search logic returned a total of 618 articles. Following individual evaluation for relevance, we selected 65 for in-depthreview. Manuscripts meeting criteria were examined for citations meriting further review, leading to the addition of 30 manuscripts Conclusions: Here, we review the pharmacology of naltrexone as it relates to OUD, its history of use, and highlight recent studies and new approaches for use of the drug as MAT including its potential initiation after ED visit for opioid overdose.
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Affiliation(s)
- Evan Stuart Bradley
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School and Umass Memorial Medical Center, Worcester, MA, USA
| | - David Liss
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephanie Pepper Carreiro
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School and Umass Memorial Medical Center, Worcester, MA, USA
| | - David Eric Brush
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School and Umass Memorial Medical Center, Worcester, MA, USA
| | - Kavita Babu
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School and Umass Memorial Medical Center, Worcester, MA, USA
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Gordon MS, Vocci FJ, Taxman F, Fishman M, Sharma B, Blue TR, O'Grady KE. A randomized controlled trial of buprenorphine for probationers and parolees: Bridging the gap into treatment. Contemp Clin Trials 2019; 79:21-27. [PMID: 30797042 PMCID: PMC6436986 DOI: 10.1016/j.cct.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/07/2019] [Accepted: 02/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Buprenorphine can be effective in a variety of community substance use treatment settings outside of methadone programs, including outpatient programs and medical practices. In these settings, it has been found to be effective in reducing opioid use and retaining patients in treatment. Despite its effectiveness and safety, it is rarely provided to individuals with opioid use disorders in probation and parole settings. METHODS Male and female individuals under probation or parole supervision (N = 320) with histories of opioid use disorder will be enrolled in this randomized controlled trial. Participants will be randomized to one of two study arms: Buprenorphine Bridge Treatment (BBT): Participants will begin buprenorphine using the MedicaSafe dispensing device immediately after an on-site intake at a community supervision office and continue such treatment until they are transitioned to a community program; or Treatment as Usual (TAU): Participants will receive a referral to buprenorphine pharmacotherapy treatment in the community. Treatment outcomes will be: (a) illicit opioid oral saliva drug test results; and (b) treatment adherence (i. entered community based treatment; ii. number of days receiving opioid treatment). RESULTS We describe the background and rationale for the study, its aims, hypotheses, and study design. CONCLUSIONS If shown to increase compliance rates with conditions of probation and parole, buprenorphine treatment co-located at community supervision field offices could have a major impact on delivery of buprenorphine treatment to the criminal justice population. The public health impact of the proposed study would be widespread because this intervention could be implemented throughout areas of the US.
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Affiliation(s)
| | | | - Faye Taxman
- Department of Criminology, Law & Society, George Mason University, Fairfax, VA, USA
| | - Marc Fishman
- Mountain Manor Treatment Center, Baltimore, MD, USA
| | | | - Thomas R Blue
- Department of Criminology, Law & Society, George Mason University, Fairfax, VA, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, MD, USA
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17
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Steinkamp JM, Goldblatt N, Borodovsky JT, LaVertu A, Kronish IM, Marsch LA, Schuman-Olivier Z. Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review. JMIR Ment Health 2019; 6:e12493. [PMID: 30860493 PMCID: PMC6434404 DOI: 10.2196/12493] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. OBJECTIVE The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. METHODS This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. RESULTS The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. CONCLUSIONS Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
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Affiliation(s)
| | - Nathaniel Goldblatt
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States
| | | | - Amy LaVertu
- Tufts University School of Medicine, Boston, MA, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York City, NY, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Zev Schuman-Olivier
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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18
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Williams AR, Nunes EV, Bisaga A, Levin FR, Olfson M. Development of a Cascade of Care for responding to the opioid epidemic. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:1-10. [PMID: 30675818 PMCID: PMC6404749 DOI: 10.1080/00952990.2018.1546862] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 01/13/2023]
Abstract
Amid worsening opioid overdose death rates, the nation continues to face a persistent addiction treatment gap limiting access to quality care for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and extended-release naltrexone) have high quality evidence demonstrating reductions in drug use and overdose events, but most individuals with OUD do not receive them. The development of a unified public health framework, such as a Cascade of Care, could improve system level practice and treatment outcomes. In response to feedback from many stakeholders over the past year, we have expanded upon the OUD treatment cascade, first published in 2017, with additional attention to prevention stages and both individual-level and population-based services to better inform efforts at the state and federal level. The proposed cascade framework has attracted considerable interest from federal agencies including the Centers for Disease Control and Prevention (CDC) and National Institute on Drug Abuse (NIDA) along with policy-makers nationwide. We have reviewed recent literature and evidence-based interventions related to prevention, identification, and treatment of individuals with OUD and modeled updated figures from the 2016 National Survey on Drug Use and Health. Many currently employed interventions (prescriber guidelines, prescription monitoring programs, naloxone rescue) address prevention of OUD or downstream complications but not treatment of the underlying disorder itself. An OUD Cascade of Care framework could help structure local and national efforts to combat the opioid epidemic by identifying key targets, interventions, and quality indicators across populations and settings to achieve these ends. Improved data collection and reporting methodology will be imperative.
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Affiliation(s)
| | - Edward V. Nunes
- Columbia University Department of Psychiatry
- New York State Psychiatric Institute
| | - Adam Bisaga
- Columbia University Department of Psychiatry
- New York State Psychiatric Institute
| | - Frances R. Levin
- Columbia University Department of Psychiatry
- New York State Psychiatric Institute
| | - Mark Olfson
- Columbia University Department of Psychiatry
- New York State Psychiatric Institute
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Ellis MS, Cicero TJ, Dart RC, Green JL. Understanding multi-pill ingestion of prescription opioids: Prevalence, characteristics, and motivation. Pharmacoepidemiol Drug Saf 2018; 28:117-121. [PMID: 30411819 DOI: 10.1002/pds.4687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 07/27/2018] [Accepted: 09/05/2018] [Indexed: 11/07/2022]
Abstract
PURPOSE Oral use is the primary route of administration among non-medical prescription opioid users. While progression to non-oral routes and shifts to stronger opioids have been previously studied as ways to cope with tolerance, the prevalence and patterns of those who cope by increasing the number of pills/tablets ingested at one time (ie, multi-pill use) has not been assessed. METHODS A subset (N = 231) of treatment-seeking opioid users from a national opioid surveillance system, participating in the Researchers and Participants Interacting Directly (RAPID) Program, completed an online survey centered on multi-pill use. RESULTS Over two-thirds of non-medical prescription opioid users had a history of multi-pill use (67.7%), defined as ingesting four or more of the same pill, intact and at the same time. Among these (n = 154), the median maximum number of pills taken at one time was eight, with over 20% ingesting 11 or more pills in a single instance. Nearly half engaged in multi-pill ingestion more than once a day in the past month (43.8%), with accessibility to lower dose pills being the primary motivator (85.4%). Hydrocodone immediate-release (IR) compounds were by far the most frequently endorsed (90.3%), followed by oxycodone IR tablets with acetaminophen (76.0%) and oxycodone IR tablets containing no acetaminophen/ibuprofen (56.5%). CONCLUSIONS These results indicate that the ingestion of multiple opioid pills/tablets is extremely common among treatment-seeking opioid users. This, and other forms of non-medical oral use of prescription opioids, should be taken under consideration when developing prevention and intervention efforts targeting the opioid epidemic.
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Affiliation(s)
- Matthew S Ellis
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Theodore J Cicero
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Richard C Dart
- Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, Colorado
| | - Jody L Green
- Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, Colorado
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Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research. Addict Behav 2018; 83:5-17. [PMID: 29174666 DOI: 10.1016/j.addbeh.2017.11.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023]
Abstract
Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information on participants' behavior and mood in their natural environments. Data from portable/wearable electronic sensors measuring participants' internal and external environments can be combined with EMA (e.g., by timestamps recorded on questionnaires) to provide objective information useful in determining the momentary context of behavior and mood and/or validating participants' self-reports. Here, we review three objective ambulatory monitoring techniques that have been combined with EMA, with a focus on detecting drug use and/or measuring the behavioral or physiological correlates of mental events (i.e., emotions, cognitions): (1) collection and processing of biological samples in the field to measure drug use or participants' physiological activity (e.g., hypothalamic-pituitary-adrenal axis activity); (2) global positioning system (GPS) location information to link environmental characteristics (disorder/disadvantage, retail drug outlets) to drug use and affect; (3) ambulatory electronic physiological monitoring (e.g., electrocardiography) to detect drug use and mental events, as advances in machine learning algorithms make it possible to distinguish target changes from confounds (e.g., physical activity). Finally, we consider several other mobile/wearable technologies that hold promise to be combined with EMA, as well as potential challenges faced by researchers working with multiple mobile/wearable technologies simultaneously in the field.
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Chatterjee A, Yu EJ, Tishberg L. Exploring opioid use disorder, its impact, and treatment among individuals experiencing homelessness as part of a family. Drug Alcohol Depend 2018; 188:161-168. [PMID: 29778009 DOI: 10.1016/j.drugalcdep.2018.04.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioid Use Disorder (OUD) causes significant morbidity and mortality among people experiencing homelessness. We aimed to explore the unique way in which OUD impacts individuals experiencing homelessness as part of a family. METHODS We conducted semi-structured interviews with adults experiencing OUD staying in Boston-area family shelters along with dependent children. We used Borkan's Immersion-Crystallization method to uncover themes from interview transcripts. RESULTS We conducted 14 interviews. Eleven participants identified as female and three as male. Mean age was 35 (range 24-51) and median number of children was 2.5 (range 1-5). Emergent themes fell in three categories: 1) Initiation of OUD: Many patients were introduced to opioids through physician prescriptions, with recreational use coming first for some. Parents and partners also contributed to opioid use. 2) Impact of OUD: Overdose, homelessness, and unemployment were common impacts of OUD. Many patients described co-morbid chronic pain and mental illness. Psychosocial trauma, prominently due to loss of child custody, was common. 3) Treatment for OUD: Childcare, transportation to treatment at distant sites, and requirements that interfered with life responsibilities were barriers to treatment that shelter-based opioid treatment (SBOT) allowed patients to overcome. Family unity was universally seen as motivation for treatment. CONCLUSIONS According to a sample of adults experiencing OUD in the context of family homelessness, an ideal OUD treatment program would overcome logistical barriers, provide comprehensive treatment for comorbidities, support employment and housing needs, and focus care on the family. Future work should explore the generalizability and financial feasibility of this model.
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Affiliation(s)
- Avik Chatterjee
- Boston Health Care for the Homeless Program, 780 Albany St, Boston, MA 02118, United States; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States; Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States.
| | - Eun Jin Yu
- Harvard College, 20 Garden St, Cambridge, MA 02138, United States
| | - Lindsay Tishberg
- Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467, United States
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Krebs E, Min JE, Evans E, Li L, Liu L, Huang D, Urada D, Kerr T, Hser YI, Nosyk B. Estimating State Transitions for Opioid Use Disorders. Med Decis Making 2017; 37:483-497. [PMID: 28027027 PMCID: PMC5536954 DOI: 10.1177/0272989x16683928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM The aim was to estimate transitions between periods in and out of treatment, incarceration, and legal supervision, for prescription opioid (PO) and heroin users. METHODS We captured all individuals admitted for the first time for publicly funded treatment for opioid use disorder (OUD) in California (2006 to 2010) with linked mortality and criminal justice data. We used Cox proportional hazards and competing risks models to assess the effect of primary PO use (v. heroin) on the hazard of transitioning among 5 states: (1) opioid detoxification treatment; (2) opioid agonist treatment (OAT); (3) legal supervision (probation or parole); (4) incarceration (jail or prison); and (5) out-of-treatment. Transitions were conditional on survival, and death was modeled as an absorbing state. RESULTS Both primary PO (n = 11,733) and heroin (n = 19,926) users spent most of their median 2.3 y of observation out of treatment. Primary PO users were significantly younger (median age 30 v. 34 y), and a higher percentage were female (43.1% v. 31.5%; P < 0.001), white (74.6% v. 63.1%; P < 0.001), and had completed high school (31.8% v. 18.9%; P < 0.001). When compared to primary heroin users, PO users had a higher hazard of transitioning from detoxification to OAT (Hazard Ratio (HR), 1.65; 95% CI, 1.54 to 1.77), and had a lower hazard of transitioning from out-of-treatment to either detoxification (0.75 [0.70, 0.81]) or OAT (0.90 [0.85, 0.96]). CONCLUSION Our findings can be applied directly in state transition modeling to improve the validity of health economic evaluations. Although PO users tended to remain in treatment for longer durations than heroin users, they also tended to remain out of treatment for longer after transitioning to an out-of-treatment state. Despite the proven effectiveness of time-unlimited treatment, individuals with OUD spend most of their time out of treatment.
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Affiliation(s)
| | - Jeong E. Min
- British Columbia Centre for Excellence in HIV/AIDS
| | | | - Libo Li
- UCLA Integrated Substance Abuse Programs
| | - Lei Liu
- Northwestern University Feinberg School of Medicine
| | | | | | - Thomas Kerr
- UCLA Integrated Substance Abuse Programs
- Division of AIDS, Faculty of Medicine, University of British Columbia
| | | | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Health Sciences, Simon Fraser University
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Sharma A, Kelly SM, Mitchell SG, Gryczynski J, O'Grady KE, Schwartz RP. Update on Barriers to Pharmacotherapy for Opioid Use Disorders. Curr Psychiatry Rep 2017; 19:35. [PMID: 28526967 PMCID: PMC7075636 DOI: 10.1007/s11920-017-0783-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The recent heroin and prescription opioid misuse epidemic has led to a sharp increase in the number of opioid overdose deaths in the USA. Notwithstanding the availability of three FDA-approved medications (methadone, buprenorphine, and naltrexone) to treat opioid use disorder, these medications are underutilized. This paper provides an update from the recent peer-reviewed literature on barriers to the use of these medications. FINDINGS These barriers are interrelated and can be categorized as financial, regulatory, geographic, attitudinal, and logistic. While financial barriers are common to all three medications, other barriers are medication-specific. The adverse impact of the current opioid epidemic on public health can be reduced by increasing access to effective pharmacotherapy for opioid use disorder.
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Affiliation(s)
- Anjalee Sharma
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Sharon M Kelly
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Jan Gryczynski
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Robert P Schwartz
- Friends Research Institute, Inc, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.
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Dunlop AJ, Brown AL, Oldmeadow C, Harris A, Gill A, Sadler C, Ribbons K, Attia J, Barker D, Ghijben P, Hinman J, Jackson M, Bell J, Lintzeris N. Effectiveness and cost-effectiveness of unsupervised buprenorphine-naloxone for the treatment of heroin dependence in a randomized waitlist controlled trial. Drug Alcohol Depend 2017; 174:181-191. [PMID: 28371689 DOI: 10.1016/j.drugalcdep.2017.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Access to opioid agonist treatment can be associated with extensive waiting periods with significant health and financial burdens. This study aimed to determine whether patients with heroin dependence dispensed buprenorphine-naloxone weekly have greater reductions in heroin use and related adverse health effects 12-weeks after commencing treatment, compared to waitlist controls and to examine the cost-effectiveness of this strategy. METHODS An open-label waitlist RCT was conducted in an opioid treatment clinic in Newcastle, Australia. Fifty patients with DSM-IV-TR heroin dependence (and no other substance dependence) were recruited. The intervention group (n=25) received take-home self-administered sublingual buprenorphine-naloxone weekly (mean dose, 22.7±5.7mg) and weekly clinical review. Waitlist controls (n=25) received no clinical intervention. The primary outcome was heroin use (self-report, urine toxicology verified) at weeks four, eight and 12. The primary cost-effectiveness outcome was incremental cost per additional heroin-free-day. RESULTS Outcome data were available for 80% of all randomized participants. Across the 12-weeks, treatment group heroin use was on average 19.02days less/month (95% CI -22.98, -15.06, p<0.0001). A total 12-week reduction in adjusted costs including crime of $A5,722 (95% CI 3299, 8154) in favor of treatment was observed. Excluding crime, incremental cost per heroin-free-day gained from treatment was $A18.24 (95% CI 4.50, 28.49). CONCLUSION When compared to remaining on a waitlist, take-home self-administered buprenorphine-naloxone treatment is associated with significant reductions in heroin use for people with DSM-IV-TR heroin dependence. This cost-effective approach may be an efficient strategy to enhance treatment capacity.
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Affiliation(s)
- Adrian J Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Brain and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Amanda L Brown
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Centre for Brain and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Christopher Oldmeadow
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Clinical Research Design, IT and Statistical Support (CRεDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Anthony Harris
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia.
| | - Anthony Gill
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Craig Sadler
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Alcohol and Drug Unit, Calvary Mater Newcastle, Waratah, NSW, Australia.
| | - Karen Ribbons
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Clinical Research Design, IT and Statistical Support (CRεDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Medicine, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia.
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Peter Ghijben
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia.
| | - Jennifer Hinman
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
| | - Melissa Jackson
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
| | - James Bell
- Addictions Department, Institute of Psychiatry, Kings College London, London, United Kingdom; Drug Health Services, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Surry Hills, NSW, Australia; Central Clinical School,Discipline of Addiction Medicine, University of Sydney, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Schwartz RP, Kelly SM, Mitchell SG, Gryczynski J, O’Grady KE, Gandhi D, Olsen Y, Jaffe JH. Patient-centered methadone treatment: a randomized clinical trial. Addiction 2017; 112:454-464. [PMID: 27661788 PMCID: PMC5296234 DOI: 10.1111/add.13622] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/14/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12 months following admission, compared with methadone treatment-as-usual. DESIGN Two-arm open-label randomized trial. SETTING Two methadone treatment programs (MTPs) in Baltimore, MD, USA. PARTICIPANTS Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males. INTERVENTION Newly admitted MTP patients were assigned randomly to either patient-centered methadone treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n = 151). MEASUREMENTS The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in treatment. FINDINGS There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05). CONCLUSIONS Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.
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Affiliation(s)
| | | | | | | | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, Department of Psychology, College Park, MD USA
| | - Devang Gandhi
- University of Maryland School of Medicine, Department of Psychiatry, Baltimore, MD USA
| | - Yngvild Olsen
- Institute for Behavioral Resources, REACH, Baltimore, MD USA
| | - Jerome H. Jaffe
- Friends Research Institute, Baltimore, MD USA
- University of Maryland School of Medicine, Department of Psychiatry, Baltimore, MD USA
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Higgins ST, Davis DR, Kurti AN. Financial Incentives for Reducing Smoking and Promoting Other Health-Related Behavior Change in Vulnerable Populations. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2372732216683518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Substantial reductions in U.S. cigarette smoking and associated chronic diseases over the past 50 years have benefited health. Unfortunately, those reductions have distributed unevenly throughout the population. Smoking remains prevalent and even increasing among certain vulnerable populations: economically disadvantaged groups, those with other substance-use disorders or mental illness, certain ethnic and racial minorities, and gender and sexual minorities. Moreover, other unhealthy behavior patterns (physical inactivity, unhealthy food choices, risky sexual behavior, poor adherence to medical preventive regimens) and associated chronic diseases are also overrepresented in many of these same populations. Disparities in unhealthy behavior patterns contribute to health disparities and escalating health care costs, underscoring the need for more effective behavior-change strategies. This report reviews research on the efficacy of financial incentives for reducing smoking in vulnerable populations, while also touching on applications of that behavior-change strategy for promoting other health-related behavior changes in vulnerable populations.
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Sigmon SC, Ochalek TA, Meyer AC, Hruska B, Heil SH, Badger GJ, Rose G, Brooklyn JR, Schwartz RP, Moore BA, Higgins ST. Interim Buprenorphine vs. Waiting List for Opioid Dependence. N Engl J Med 2016; 375:2504-2505. [PMID: 28002704 PMCID: PMC5373028 DOI: 10.1056/nejmc1610047] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | - Gail Rose
- University of Vermont, Burlington, VT
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Higgins ST. Editorial: 2nd Special Issue on behavior change, health, and health disparities. Prev Med 2015; 80:1-4. [PMID: 26257372 PMCID: PMC4778247 DOI: 10.1016/j.ypmed.2015.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 07/26/2015] [Accepted: 07/28/2015] [Indexed: 11/19/2022]
Abstract
This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policy makers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, USA.
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Sigmon SC. Interim treatment: Bridging delays to opioid treatment access. Prev Med 2015; 80:32-6. [PMID: 25937593 PMCID: PMC4592374 DOI: 10.1016/j.ypmed.2015.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite the undisputed effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. To mitigate these risks, the Food and Drug Administration in 1993 approved interim treatment, involving daily medication+emergency counseling only, when only a waitlist is otherwise available. We review the published research in the 20years since the approval of interim opioid treatment. METHODS A literature search was conducted to identify all randomized trials evaluating the efficacy of interim treatment for opioid-dependent patients awaiting comprehensive treatment. RESULTS Interim opioid treatment has been evaluated in four controlled trials to date. In three, interim treatment was compared to waitlist or placebo control conditions and produced greater outcomes on measures of illicit opioid use, retention, criminality, and likelihood of entry into comprehensive treatment. In the fourth, interim treatment was compared to standard methadone maintenance and produced comparable outcomes in illicit opioid use, retention, and criminal activity. CONCLUSIONS Interim treatment significantly reduces patient and societal risks when conventional treatment is unavailable. Further research is needed to examine the generality of these findings, further enhance outcomes, and identify the patient characteristics which predict treatment response.
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Affiliation(s)
- Stacey C Sigmon
- Department of Psychiatry, University of Vermont College of Medicine, Vermont Center on Behavior and Health, USA.
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