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Wheeler PB, Miller-Roenigk B, Jester J, Stevens-Watkins D. Knowledge, experiences, and perceptions of medications for opioid use disorder among Black Kentuckians. Ann Med 2024; 56:2322051. [PMID: 38442301 PMCID: PMC10916927 DOI: 10.1080/07853890.2024.2322051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake. METHODS Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis. RESULTS Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%). DISCUSSION Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.
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Affiliation(s)
- Paris B. Wheeler
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Brittany Miller-Roenigk
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
| | - Jasmine Jester
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
| | - Danelle Stevens-Watkins
- Department of Educational, School, and Counseling Psychology, University of KY, Lexington, KY, USA
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Giraldo A, Shah P, Zerbo E, Nyaku AN. The role of recovery peer navigators in retention in outpatient buprenorphine treatment: a retrospective cohort study. Ann Med 2024; 56:2355566. [PMID: 38823420 PMCID: PMC11146239 DOI: 10.1080/07853890.2024.2355566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Racial and ethnic disparities are evident in the accessibility of treatment for opioid use disorder (OUD). Even when medications for OUD (MOUD) are accessible, racially and ethnically minoritized groups have higher attrition rates from treatment. Existing literature has primarily identified the specific racial and ethnic groups affected by these disparities, but has not thoroughly examined interventions to address this gap. Recovery peer navigators (RPNs) have been shown to improve access and overall retention on MOUD. PATIENTS AND METHODS In this retrospective cohort study, we evaluate the role of RPNs on patient retention in clinical care at an outpatient program in a racially and ethnically diverse urban community. Charts were reviewed of new patients seen from January 1, 2019 through December 31, 2019. Sociodemographic and clinical visit data, including which providers and services were utilized, were collected, and the primary outcome of interest was continuous retention in care. Bivariate analysis was done to test for statistically significant associations between variables by racial/ethnic group and continuous retention in care using Student's t-test or Pearson's chi-square test. Variables with p value ≤0.10 were included in a multivariable regression model. RESULTS A total of 131 new patients were included in the study. RPNs improved continuous retention in all-group analysis (27.6% pre-RPN compared to 80.2% post-RPN). Improvements in continuous retention were observed in all racial/ethnic subgroups but were statistically significant in the non-Hispanic Black (NHB) group (p < 0.001). Among NHB, increases in continuous retention were observed post-RPN in patients with male sex (p < 0.001), public health insurance (p < 0.001), additional substance use (p < 0.001), medical comorbidities (p < 0.001), psychiatric comorbidities (p = 0.001), and unstable housing (p = 0.005). Multivariate logistic regression demonstrated that patients who lacked insurance had lower odds of continuous retention compared to patients with public insurance (aOR = 0.17, 95% CI 0.039-0.70, p = 0.015). CONCLUSIONS RPNs can improve clinical retention for patients with OUD, particularly for individuals experiencing several sociodemographic and clinical factors that are typically correlated with discontinuation of care.
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Affiliation(s)
- Arley Giraldo
- Department of Psychiatry, NYU Grossman School of Medicine, NYC, NY, USA
| | - Payal Shah
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Erin Zerbo
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Independent Private Practice, Montclair, NJ, USA
| | - Amesika N. Nyaku
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Ahmad NJ, Shapiro H, Griffin ML, Weiss RD, Macias-Konstantopoulos WL. Racial and ethnic differences in self-reported barriers to substance use treatment among emergency department patients. Am J Addict 2024. [PMID: 39104150 DOI: 10.1111/ajad.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/11/2024] [Accepted: 06/23/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES As overdose rates rise among non-White Americans, understanding barriers to substance use disorder (SUD) treatment access by race and ethnicity is important. This study explores self-reported barriers to SUD treatment by race and ethnicity in emergency department (ED) populations. METHODS We conducted a secondary, exploratory analysis of a randomized trial of patients not seeking SUD treatment who endorsed active drug use at six academic EDs. Responses to the Barriers to Treatment Inventory were compared by race, ethnicity, and drug severity, using χ2 tests (N = 858), followed by adjusted logistic regression models. RESULTS Absence of a perceived drug problem (39% non-Hispanic Black, 38% Hispanic, 50% non-Hispanic White; p ≤ .001) was the most prevalent barrier to SUD treatment. Non-Hispanic Black participants were less likely to state that they could handle their drug use on their own (OR = 0.69, CI = 0.50-0.95), and were more likely to report disliking personal questions than non-Hispanic White participants (OR = 1.49, CI = 1.07-2.09). Non-Hispanic Black participants were less likely than Hispanic participants to agree that treatment availability (OR = 0.46, CI = 0.28-0.76) and family disapproval (OR = 0.38, CI = 0.16-0.91) were treatment barriers. DISCUSSION AND CONCLUSIONS Screening and counseling may help address the barrier, common to all groups, that drug use was not seen as problematic. Expanding access to diverse treatment options may also address the range of barriers reported by our study population. SCIENTIFIC SIGNIFICANCE Our study is one of the first in the U.S. to examine both individual and structural barriers to accessing treatment and to examine the association with drug use severity by race/ethnicity.
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Affiliation(s)
- Neha Jia Ahmad
- Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah Shapiro
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
| | - Margaret L Griffin
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Wendy L Macias-Konstantopoulos
- Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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4
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Takemoto E, Bolton A, Goetz CT. Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019-21. Addiction 2024; 119:1400-1409. [PMID: 38808397 DOI: 10.1111/add.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
AIMS The aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity. DESIGN AND SETTING Analysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019-21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year. CASES The analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021. MEASUREMENTS Evidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) was based on the death certificate. FINDINGS In the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40-50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5-0.9; 2020: OR = 0.5, 95% CI = 0.4-0.7; 2021: OR = 0.6, 95% CI = 0.5-0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents. CONCLUSION After controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people.
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Affiliation(s)
- Erin Takemoto
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Ashley Bolton
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Carrie Thomas Goetz
- Office of Drug Surveillance and Misuse Prevention, Pennsylvania Department of Health, Harrisburg, PA, USA
- Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
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Tarfa A, Lier AJ, Shenoi SV, Springer SA. Considerations when prescribing opioid agonist therapies for people living with HIV. Expert Rev Clin Pharmacol 2024; 17:549-564. [PMID: 38946101 PMCID: PMC11299801 DOI: 10.1080/17512433.2024.2375448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/28/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) include opioid agonist therapies (OAT) (buprenorphine and methadone), and opioid antagonists (extended-release naltrexone). All forms of MOUD improve opioid use disorder (OUD) and HIV outcomes. However, the integration of services for HIV and OUD remains inadequate. Persistent barriers to accessing MOUD underscore the immediate necessity of addressing pharmacoequity in the treatment of OUD in persons with HIV (PWH). AREAS COVERED In this review article, we specifically focus on OAT among PWH, as it is the most commonly utilized form of MOUD. Specifically, we delineate the intersection of HIV and OUD services, emphasizing their integration into the United States Ending the HIV Epidemic (EHE) plan by offering comprehensive screening, testing, and treatment for both HIV and OUD. We identify potential drug interactions of OAT with antiretroviral therapy (ART), address disparities in OAT access, and present the practical benefits of long-acting formulations of buprenorphine, ART, and pre-exposure prophylaxis for improving HIV prevention and treatment and OUD management. EXPERT OPINION Optimizing OUD outcomes in PWH necessitates careful attention to diagnosing OUD, initiating OUD treatment, and ensuring medication retention. Innovative approaches to healthcare delivery, such as mobile pharmacies, can integrate both OUD and HIV and reach underserved populations.
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Affiliation(s)
- Adati Tarfa
- Yale University School of Medicine; 135 College Street, Suite 280, New Haven, New Haven, CT 06510
| | - Audun J. Lier
- Renaissance School of Medicine at Stony Brook University; Northport VA Medical Center, 79 Middleville Road, Northport, NY 11768
| | - Sheela V. Shenoi
- Yale School of Medicine, VA Connecticut Health System, 950 Campbell Avenue, West Haven, CT 06516
| | - Sandra A. Springer
- Yale University School of Medicine; 135 College Street, Suite 280, New Haven, New Haven, CT 06510
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Irani E, Macleod C, Slat S, Kehne A, Madden E, Jaffe K, Bohnert A, Lagisetty P. The effect of a pilot brief educational intervention on preferences regarding treatments for opioid use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100235. [PMID: 38737490 PMCID: PMC11087910 DOI: 10.1016/j.dadr.2024.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
Purpose Negative perceptions around medications for opioid use disorder (MOUD) amongst the public could deter patients with opioid use disorder (OUD) from engaging with MOUD. Thus, we evaluated whether a brief intervention could improve preferences for MOUD in people who may or may not use opioids. Methods We employed a pre-post design to assess the effect of a brief educational intervention on preferences for methadone, buprenorphine, naltrexone, and non-medication treatment in an online sample of US adults stratified by race, who may or may not use opioids. Respondents ranked their preferences in OUD treatment before and after watching four one-minute educational videos about treatment options. Changes in treatment preferences were analyzed using Bhapkar's test and post hoc McNemar's tests. A binary logistic generalized estimating equation (GEE) assessed factors associated with preference between treatments. Results The sample had 530 responses. 194 identified as White, 173 Black, 163 Latinx. Treatment preferences changed significantly towards MOUD (p<.001). This effect was driven by changes toward buprenorphine (OR=2.38; p<.001) and away from non-medication treatment (OR=0.20; p<.001). There was no significant difference in effect by race/ethnicity. People with lower opioid familiarity were significantly more likely to change their preferences towards MOUD following the intervention. Conclusion Respondent preferences for MOUD increased following the intervention suggesting that brief educational interventions can change treatment preferences towards MOUD. These findings offer insights into perceptions of OUD treatment in a racially stratified sample and serve as a foundation for future educational materials that target MOUD preferences in the general public.
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Affiliation(s)
- Emaun Irani
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Colin Macleod
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Stephanie Slat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Adrianne Kehne
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erin Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University, 3939 Woodward Ave, Detroit, MI 48201, USA
| | - Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy Bohnert
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Aronowitz SV, French R, Schachter A, Seeburger E, O'Donnell N, Perrone J, Lowenstein M. Mapping Buprenorphine Access at Philadelphia Pharmacies. J Addict Med 2024; 18:269-273. [PMID: 38345212 PMCID: PMC11150095 DOI: 10.1097/adm.0000000000001284] [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] [Indexed: 03/20/2024]
Abstract
OBJECTIVES Buprenorphine is not reliably stocked in many pharmacies, and pharmacy-level barriers may deter patients from opioid use disorder care. We surveyed all outpatient pharmacies in Philadelphia to describe variation in buprenorphine access and developed a map application to aid in identifying pharmacies that stock the medication. METHODS Using a dataset from the Bureau of Professional and Occupational Affairs, we conducted a telephone survey of operating outpatient pharmacies (N = 422) about their buprenorphine stocking and dispensing practices. We used ArcGIS Pro 3.0.3 to join US Census Bureau ZIP code-level race and ethnicity data, conduct descriptive analyses, and create a map application. RESULTS We collected data from 351 pharmacies (83% response rate). Two hundred thirty-eight pharmacies (68%) indicated that they regularly stock buprenorphine; 6 (2%) would order it when a prescription is sent. Ninety-one (26%) said that they do not stock or order buprenorphine, and 16 (5%) were unsure. We identified 137 "easier access" pharmacies (39%), meaning they regularly stock buprenorphine, dispense to new patients, and have no dosage maximums. Zip codes with predominantly White residents had a median (interquartile range) of 3 (2-4) "easier access" pharmacies, and those with predominantly Black residents a median (interquartile range) of 2 (1-4.5). Nine zip codes had no "easier access" pharmacies, and 3 had only one; these 3 zip codes are areas with predominantly Black residents. CONCLUSIONS Buprenorphine access is not equitable across Philadelphia and a quarter of pharmacies choose not to carry the medication. Our map application may be used to identify pharmacies in Philadelphia that stock buprenorphine.
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Affiliation(s)
- Shoshana V Aronowitz
- From the University of Pennsylvania School of Nursing, Philadelphia, PA (SA); University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (RF, AS, ES, NO, JP, ML); University of Pennsylvania Center for Emergency Care Policy and Research, Philadelphia, PA (ES); University of Pennsylvania Urban Health Lab, Philadelphia, PA (SA, ES); and University of Pennsylvania Center for Addiction Medicine and Policy, Philadelphia, PA (SA, RF, NO, JP, ML)
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8
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Umeh UO. Examining disparities in regional anaesthesia and pain medicine. Br J Anaesth 2024; 132:1033-1040. [PMID: 38508942 DOI: 10.1016/j.bja.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 03/22/2024] Open
Abstract
In high-resource countries, health disparities exist in both treatment approaches and health outcomes. Race and ethnicity can serve as proxies for other socioeconomic factors and social determinants of health such as income, education, social support, and residential neighbourhood, which strongly influence health outcomes and disparities. In regional anaesthesia and pain medicine, disparities exist across several surgical specialties including obstetrics, paediatrics, and orthopaedic surgery. Understanding these disparities will facilitate development of solutions aimed at eliminating disparities at the patient, physician/provider, and healthcare system levels.
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Affiliation(s)
- Uchenna O Umeh
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
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Eschliman EL, Choe K, DeLucia A, Addison E, Jackson VW, Murray SM, German D, Genberg BL, Kaufman MR. First-hand accounts of structural stigma toward people who use opioids on Reddit. Soc Sci Med 2024; 347:116772. [PMID: 38502980 PMCID: PMC11031276 DOI: 10.1016/j.socscimed.2024.116772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
People who use opioids face multilevel stigma that negatively affects their health and well-being and drives opioid-related overdose. Little research has focused on lived experience of the structural levels of stigma toward opioid use. This study identified and qualitatively analyzed Reddit content about structural stigma toward opioid use. Iterative, human-in-the-loop natural language processing methods were used to identify relevant posts and comments from an opioid-related subforum. Ultimately, 273 posts and comments were qualitatively analyzed via directed content analysis guided by a prominent conceptualization of stigma. Redditors described how structures-including governmental programs and policies, the pharmaceutical industry, and healthcare systems-stigmatize people who use opioids. Structures were reported to stigmatize through labeling (i.e., particularly in medical settings), perpetuating negative stereotypes, separating people who use opioids into those who use opioids "legitimately" versus "illegitimately," and engendering status loss and discrimination (e.g., denial of healthcare, loss of employment). Redditors also posted robust formulations of structural stigma, mostly describing how it manifests in the criminalization of substance use, is often driven by profit motive, and leads to the pervasiveness of fentanyl in the drug supply and the current state of the overdose crisis. Some posts and comments highlighted interpersonal and structural resources (e.g., other people who use opioids, harm reduction programs, telemedicine) leveraged to navigate structural stigma and its effects. These findings reveal key ways by which structural stigma can pervade the lives of people who use opioids and show the value of social media data for investigating complex social processes. Particularly, this study's findings related to structural separation may help encourage efforts to promote solidarity among people who use opioids. Attending to first-hand accounts of structural stigma can help interventions aiming to reduce opioid-related stigma be more responsive to these stigmatizing structural forces and their felt effects.
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Affiliation(s)
- Evan L Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Karen Choe
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, USA
| | - Alexandra DeLucia
- Center for Language and Speech Processing, Johns Hopkins University, USA
| | | | - Valerie W Jackson
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Michelle R Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
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Chatterjee A, Baker T, Rudorf M, Walt G, Stotz C, Martin A, Kinnard EN, McAlearney AS, Bosak J, Medley B, Pinkhover A, Taylor JL, Samet JH, Lunze K. Mobile treatment for opioid use disorder: Implementation of community-based, same-day medication access interventions. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209272. [PMID: 38128649 PMCID: PMC10947870 DOI: 10.1016/j.josat.2023.209272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/20/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Medications for Opioid Use Disorder (MOUD) are lifesaving, but <20 % of individuals in the US who could benefit receive them. As part of the NIH-supported HEALing Communities Study (HCS), coalitions in several communities in Massachusetts and Ohio implemented mobile MOUD programs to overcome barriers to MOUD receipt. We defined mobile MOUD programs as units that provide same-day access to MOUD at remote sites. We aimed to (1) document the design and organizational structure of mobile programs providing same-day or next-day MOUD, and (2) explore the barriers and facilitators to implementation as well as the successes and challenges of ongoing operation. METHODS Program staff from five programs in two states (n = 11) participated in semi-structured interviews. Two authors conducted thematic analysis of the transcripts based on the domains of the social-ecological model and the semi-structured interview guide. RESULTS Mobile MOUD units sought to improve immediate access to MOUD ("Our answer is pretty much always, 'Yes, we'll get you started right here, right now,'"), advance equity ("making sure that we have staff who speak other languages, who are on the unit and have some resources that are in different languages,"), and decrease opioid overdose deaths. Salient program characteristics included diverse staff, including staff with lived experience of substance use ("She just had that personal knowledge of where we should be going"). Mobile units offered harm reduction services, broad medical services (in particular, wound care), and connection to transportation programs and incorporated consistency in service provision and telemedicine access. Implementation facilitators included trusting relationships with partner organizations (particularly pharmacies and correctional facilities), nuanced understanding of local politics, advertising, protocol flexibility, and on-unit prescriber hours. Barriers included unclear licensing requirements, staffing shortages and competing priorities for staff, funding challenges due to inconsistency in grant funding and low reimbursement ("It's not really possible that billing in and of itself is going to be able to sustain it"), and community stigma toward addiction services generally. CONCLUSIONS Despite organizational, community, and policy barriers, participants described mobile MOUD units as an innovative way to expand access to life-saving medications, promote equity in MOUD treatment, and overcome stigma.
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Affiliation(s)
- Avik Chatterjee
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America.
| | - Trevor Baker
- Boston Medical Center, Boston, MA, United States of America
| | - Maria Rudorf
- Boston Medical Center, Boston, MA, United States of America
| | - Galya Walt
- Boston Medical Center, Boston, MA, United States of America
| | - Caroline Stotz
- Boston Medical Center, Boston, MA, United States of America
| | - Anna Martin
- Boston Medical Center, Boston, MA, United States of America
| | | | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Julie Bosak
- Boston Medical Center, Boston, MA, United States of America
| | - Bethany Medley
- Columbia University School of Social Work, New York, NY, United States of America
| | - Allyson Pinkhover
- Brockton Neighborhood Health Center, Brockton, MA, United States of America; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jessica L Taylor
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Jeffrey H Samet
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Karsten Lunze
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
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11
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Spear SE, Salcedo P, Graves SM, Xie H. Is that a treatment program? Examining the physical landscape of opioid treatment programs in Los Angeles. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209256. [PMID: 38072382 DOI: 10.1016/j.josat.2023.209256] [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: 06/29/2023] [Revised: 10/24/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Little attention has been paid to the built environment of outpatient opioid treatment programs, despite the need to increase access to medications for opioid use disorder, particularly among people of color. The aims of this study were to rate the attractiveness of publicly-funded opioid treatment programs (OTPs) in Los Angeles County and explore whether less attractive OTPs are found in disadvantaged neighborhoods. METHODS We conducted observations of the exteriors of all OTPs located in specialty substance use disorder treatment clinics in Los Angeles County in 2021 (N = 44). We created an attractiveness index based on attractiveness of the building exteriors and the surrounding grounds, the presence of disorder such as garbage and graffiti, and the presence of bars on the windows. We tested whether less attractive facilities were more likely to be situated in disadvantaged neighborhoods with high concentrations of racial/ethnic minorities. RESULTS Most building exteriors were found to have an ordinary level of attractiveness or rated as unattractive. The grounds were largely unattractive. We found a significant negative association between attractiveness and neighborhood disadvantage. CONCLUSION This project was a preliminary study of the physical conditions of OTPs in Los Angeles. We found was that the physical conditions of OTPs in LA County were generally poor. Research has identified many individual and structural barriers to treatment for people with opioid use disorders. Future research should empirically test the association between the built environment of treatment clinics and access to treatment, particularly in communities of color.
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Affiliation(s)
- Suzanne E Spear
- Department of Health Sciences, California State University, Northridge, United States of America.
| | - Priscilla Salcedo
- Environmental Health and Safety Department, University of California Santa Barbara, United States of America
| | - Steven M Graves
- Department of Geography and Environmental Studies, California State University, Northridge, United States of America
| | - Hui Xie
- Department of Recreation and Tourism Management, California State University, Northridge, United States of America
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12
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Kleinman ME, Smith C, Yampolskaya S, Sharp A, Carlson M, Moore K. Typologies of Family Dependency Treatment Court Participants: Parental Characteristics and Differential Child Placement Outcomes. Subst Use Misuse 2024; 59:1072-1082. [PMID: 38433337 DOI: 10.1080/10826084.2024.2320378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background: Family Dependency Treatment Court (FDTC) is a problem-solving court for parents who have child welfare involvement and designed to address parental substance misuse by providing treatment and wrap-around services, with the goal of reunifying parents with their children. Objectives: This study aimed to identify different classes of FDTC parents and compare how child placement outcomes differ by class. Parental characteristics and permanent placement outcomes for 354 parents participating in a Central Florida FDTC were assessed using administrative data. An exploratory latent class analysis was conducted to classify parents. Results: Results revealed three distinct classes of FDTC participants: 1) co-occurring issues, 2) racial/ethnic minority participants, and 3) prescription opioid, meth, and heroin users. Regression analyses showed that parents with co-occurring issues were over two times more likely to achieve permanency (OR = 2.05, p < .05), and were two times less likely to terminate their parental rights (TPR) compared to the other two classes. Conclusions: Implications for tailoring FDTC procedures to parents' individual needs, combating racial/ethnic disparities in access to services and placement outcomes, and improved child welfare and placement outcomes are discussed.
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Affiliation(s)
- Mary E Kleinman
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
| | - Curtis Smith
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
| | - Svetlana Yampolskaya
- Department of Child and Family Studies, University of South Florida, Tampa, FL, USA
| | - Amanda Sharp
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
| | - Melissa Carlson
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
| | - Kathleen Moore
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, Tampa, FL, USA
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13
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Nedjat S, Wang Y, Eshtiaghi K, Fleming M. Is there a disparity in medications for opioid use disorder based on race/ethnicity and gender? A systematic review and meta-analysis. Res Social Adm Pharm 2024; 20:236-245. [PMID: 38101952 DOI: 10.1016/j.sapharm.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Access to medications for opioid use disorder (MOUD) among racial/ethnic minorities is a growing concern. OBJECTIVES Inequalities in receiving MOUD among gender and racial/ethnic groups were examined in this systematic review. METHODS Studies were retrieved by searching various databases and reference lists of reviews and selected full texts. Adjusted Odds Ratios (AORs) comparing MOUDs among racial/ethnic minorities to Whites were extracted or estimated from their findings. Meta-analysis was performed using STATA 17. RESULTS After screening 2438 records, 19 studies were included in this review in two categories. The first category consists of 11 studies comparing receiving MOUD between different races/ethnicities and genders at the individual level. The meta-analysis regarding AORs comparing Blacks, Hispanics, Asians, Native Americans/Alaska-Natives, Hawaiians, and mixed-race patients with Whites were 0.56 (95 % CI: 0.45-0.68), 0.72 (95 % CI: 0.55-0.94), 0.85 (95 % CI: 0.72-0.99), 0.88 (95%CI: 0.73-1.04), 0.27 (95 % CI: 0.03-2.18), and 0.97 (95 % CI: 0.81-1.16), respectively. The AOR of receiving MOUD for all minorities compared to Whites was 0.70 (95 % CI: 0.61-0.80). Overall AOR comparing MOUD for females to males was 0.95 (95 % CI: 0.87-1.04). The second category of articles compared buprenorphine and methadone treatment among ethnic/racial minorities and Whites. CONCLUSIONS Compared to Whites, Blacks, Hispanics, and Asians have limited access to MOUD. The findings suggest that methadone is the predominant medication for racial/ethnic minorities, while Whites and high-income communities receive buprenorphine more. It is crucial to re-design policies to bridge the gap in access to MOUD.
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Affiliation(s)
- Saharnaz Nedjat
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Yun Wang
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Khashayar Eshtiaghi
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Marc Fleming
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA.
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14
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Hayes BT, Li P, Nienaltow T, Torres-Lockhart K, Khalid L, Fox AD. Low-dose buprenorphine initiation and treatment continuation among hospitalized patients with opioid dependence: A retrospective cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209261. [PMID: 38103838 PMCID: PMC10947892 DOI: 10.1016/j.josat.2023.209261] [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: 05/11/2023] [Revised: 09/20/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Buprenorphine is an effective treatment for both opioid use disorder (OUD) and chronic pain, but buprenorphine's pharmacology complicates treatment initiation for some patients. Low-dose buprenorphine initiation is a novel strategy that may reduce precipitated withdrawal. Few studies describe what patient populations benefit most from low-dose initiations and the clinical parameters that impact treatment continuation. This study aimed to 1) describe experiences with low-dose buprenorphine initiation, including both successes and failures among hospitalized patients in an urban underserved community; 2) identify patient- and treatment-related characteristics associated with unsuccessful initiation and treatment discontinuation; and 3) assess buprenorphine treatment continuation after discharge. METHODS This is a retrospective cohort study with opioid-dependent (meaning OUD or receiving long-term opioid therapy for chronic pain) patients who underwent low-dose buprenorphine initiation during hospital admission from October 2021 through April 2022. The primary outcome was successful completion of low-dose initiation. Bivariate analysis identified patient- and treatment-related factors associated with unsuccessful initiation. Secondary outcomes were buprenorphine treatment discontinuation at post-discharge follow-up, 30- and 90-days. RESULTS Of 28 patients who underwent low-dose buprenorphine initiation, 68 % successfully completed initiation. Unsuccessful initiation was associated with receipt of methadone during admission and higher morphine milligram equivalents (MME) of supplemental opioids. Of 22 patients with OUD, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 46 %, 36 %, and 36 %. Of 6 patients with chronic pain, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 100 %, 100 %, and 83 %. CONCLUSION Low-dose buprenorphine initiation can be successful in opioid-dependent hospitalized patients. Patients taking methadone or requiring higher MME of supplemental opioids may have more difficulty with the low-dose buprenorphine initiation approach, but these findings should be replicated in larger studies. This study suggests patient- and treatment-related factors that clinicians could consider when determining the optimal treatment strategy for patients wishing to transition to buprenorphine.
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Affiliation(s)
| | - Phoebe Li
- Montefiore Medical Center, United States of America
| | | | | | - Laila Khalid
- Montefiore Medical Center, United States of America
| | - Aaron D Fox
- Montefiore Medical Center, United States of America
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Fixler AL, Jacobs LA, Jones DB, Arnold A, Underwood EE. There goes the neighborhood? The public safety enhancing effects of a mobile harm reduction intervention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104329. [PMID: 38232437 DOI: 10.1016/j.drugpo.2024.104329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/10/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Buprenorphine is a gold-standard treatment for opioid use disorders, but most people with these disorders do not access it. Barriers to treatment access may be diminished by low-threshold mobile treatment programs but concern regarding their impact on local public safety challenges their adoption. METHODS This quasi-experimental study uses difference-in-differences analyses to measure the impact of four mobile buprenorphine clinics in Pittsburgh on neighborhood arrest rates. The study period spans 2018 to 2022, with a pre-intervention period of 11 to 12 quarters and a post-intervention period of 7 to 8 quarters (dependent on neighborhood). A treatment group of 84 census block groups in the areas surrounding clinics during the time period after their establishment were compared to a control group of city census blocks not within one mile of a clinic plus treated block groups in the two years prior to clinic establishment. Outcome variables include drug, non-drug, and total arrests, measured quarterly per 100 in population. RESULTS Compared to block groups further than 1 mile from a clinic, arrests fell by 34.13 % (b = -0.358, 95 % CI = -0.557, -0.158), drug arrests by 33.85 % (b = -0.087, 95 % CI = -0.151, -0.023), and non-drug related arrests by 22.29 % (b = -0.179, 95 % CI = -0.302, -0.057). Drug arrests declined significantly on days when the clinics were not present (b = -0.015, 95 % CI = -0.025, -0.006), with no significant change on clinic operational days (b = -0.002, 95 % CI = -0.016, -0.013). Total arrests declined significantly on days when clinics were and were not present (b = -0.045, 95 % CI = -0.078, -0.012; and b = -0.052, CI = -0.082, -0.023, respectively). CONCLUSIONS Mobile clinics providing medication for opioid use disorders were associated with reduced neighborhood arrest rates. Expansion of mobile services could promote health equity and public safety.
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Affiliation(s)
- Alex L Fixler
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States.
| | - Leah A Jacobs
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States
| | - Daniel B Jones
- Graduate School of Public and International Affairs, University of Pittsburgh, 3424 Wesley W. Posvar Hall, 230 South Bouquet Street, Pittsburgh, PA 15260, United States
| | - Aaron Arnold
- Prevention Point Pittsburgh, 5913 Penn Avenue, Pittsburgh, PA 15206, United States
| | - Emily E Underwood
- School of Social Work, University of Pittsburgh. 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, United States
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Hsu M, Jung OS, Kwan LT, Jegede O, Martin B, Malhotra A, Suzuki J. Access challenges to opioid use disorder treatment among individuals experiencing homelessness: Voices from the streets. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209216. [PMID: 37981243 DOI: 10.1016/j.josat.2023.209216] [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: 03/07/2023] [Revised: 07/25/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Achieving equitable access to medications for opioid use disorder (MOUD) such as buprenorphine is a pressing issue. Evidence suggests disparities in MOUD access based on race and socioeconomic status, further exacerbated by the COVID-19 pandemic. However, the drivers behind this access gap remain poorly understood. This study explores barriers to treatment access among individuals with opioid use disorder (OUD) experiencing homelessness. METHODS We interviewed 28 individuals in and around the Boston Public Health Commission (BPHC) Engagement Center, an area known for its high density of active substance use and homelessness. We asked about people's experiences, perceptions, and attitudes toward OUD treatment. We conducted a thematic analysis of our interview data. RESULTS Fifty-four percent of participants sampled were not prescribed MOUD. None of the participants reported having an active prescription of sublingual buprenorphine or buprenorphine/naloxone. White participants were more likely to have been prescribed buprenorphine in the past compared to participants of other races even in this socioeconomically homogeneous sample. Themes that emerged in our data included challenges to accessing MOUD due to reduced services during the COVID-19 pandemic, lost or stolen medications, fewer inpatient withdrawal management beds for women, transportation challenges, fear of adverse effects of MOUD, the perception that taking MOUD replaces one addiction for another, and community disapproval of MOUD. Participants also reported stigma and discrimination based on race, gender, and socioeconomic status. CONCLUSION Systems and individual-level factors contribute to the MOUD treatment gap across race and socioeconomic status. The COVID-19 pandemic posed additional access challenges. This study provides important, actionable insights about the barriers faced by a particularly vulnerable population of individuals with OUD experiencing homelessness.
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Affiliation(s)
- Michael Hsu
- Department of Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA, USA.
| | - Olivia S Jung
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Li Ting Kwan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Bianca Martin
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Aniket Malhotra
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Joji Suzuki
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
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17
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Suarez E, Bartholomew TS, Plesons M, Ciraldo K, Ostrer L, Serota DP, Chueng TA, Frederick M, Onugha J, Tookes HE. Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study. Ann Med 2023; 55:733-743. [PMID: 36856571 PMCID: PMC9980015 DOI: 10.1080/07853890.2023.2182908] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/22/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
Background: At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP.Methods: A retrospective chart review of participants who received the THR intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy.Results: A total of 109 participants received the adapted THR intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider via telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]).Conclusions: Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of THR to increase uptake of buprenorphine by PWID and promote retention in care.KEY MESSAGESThe Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program settingUsing telehealth was associated with increased three-month buprenorphine retentionBaseline stimulant use was negatively associated with three-month buprenorphine retention.
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Affiliation(s)
- Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S. Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marina Plesons
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Department of Family and Community Medicine & Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lily Ostrer
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P. Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A. Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Morgan Frederick
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason Onugha
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hansel E. Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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18
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Golan OK, Sheng F, Dick AW, Sorbero M, Whitaker DJ, Andraka-Christou B, Pigott T, Gordon AJ, Stein BD. Differences in medicaid expansion effects on buprenorphine treatment utilization by county rurality and income: A pharmacy data claims analysis from 2009-2018. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100193. [PMID: 37876376 PMCID: PMC10590758 DOI: 10.1016/j.dadr.2023.100193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
Background Although use of buprenorphine for treating opioid use disorder increased over the past decade, buprenorphine utilization remains limited in lower-income and rural areas. We examine how the Affordable Care Act Medicaid expansion influenced buprenorphine initiation rates by county income and evaluate how associations differ by county rural-urban status. Methods This study used nationwide 2009-2018 IQVIA retail pharmacy data and a comparative interrupted time series framework-a hybrid framework combining regression discontinuity and difference-in-difference approaches. We used piecewise linear estimation to quantify changes in buprenorphine initiation rates before and after Medicaid expansion. Results The sample included observations from 376,704 county-months. We identified 5,227,340 new buprenorphine treatment episodes, with an average of 9.2 new buprenorphine episodes per month per 100,000 county residents. Among urban counties, those with the lowest median incomes experienced significantly larger increases in buprenorphine initiation rates associated with Medicaid expansion than counties with higher median incomes (5-year rates difference est=3525.3, se=1695.3, p = 0.04). However, among rural counties, there was no significant association between buprenorphine initiation rates and county median income after Medicaid expansion (5-year rates difference est=979.0, se=915.8, p = 0.29). Conclusions Medicaid expansion was associated with a reduction in income-related buprenorphine disparities in urban counties, but not in rural counties. To achieve more equitable buprenorphine access, future policies should target low-income rural areas.
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Affiliation(s)
- Olivia K. Golan
- NORC at the University of Chicago, Chicago, IL, United States
- School of Public Health, Georgia State University, Atlanta, Georgia
| | | | | | | | | | - Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL, United States
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, United States
| | - Therese Pigott
- School of Public Health, Georgia State University, Atlanta, Georgia
| | - Adam J. Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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Tierney M, Castillo E, Leonard A, Huang E. Closing the Opioid Treatment Gap Through Advance Practice Nursing Activation: Curricular Design and Initial Outcomes. J Addict Nurs 2023; 34:240-250. [PMID: 38015575 DOI: 10.1097/jan.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Buprenorphine, an effective medication for opioid use disorder (MOUD), reduces opioid-related harms including overdose, but a significant gap exists between MOUD need and treatment, especially for marginalized populations. Historically, low MOUD treatment capacity is rising, driven by advanced practice registered nurses (APRNs). A graduate nursing course was designed to increase equitable buprenorphine treatment delivery by APRNs. We report on baseline findings of a curriculum evaluation study with a pretest-posttest design. DESIGN Computerized surveys assessed trainee satisfaction with the course, trainee knowledge for providing MOUD, and trainee satisfaction in working with people who use drugs. METHODS Quantitative survey results utilizing Likert scales are presented. RESULTS Baseline precourse surveys revealed less than half (44%) of APRN students agreed/strongly agreed that they had a working knowledge of drugs and drug-related problems and 37% agreed/strongly agreed that they knew enough about the causes of drug problems to carry out their roles when working with people who use drugs. Approximately two thirds of APRN students agreed/strongly agreed that they want to work with people who use drugs (63%), that it is satisfying to work with people who use drugs (66%), and that it is rewarding to work with people who use drugs (63%). Nearly all students reported high satisfaction with the course. CONCLUSION APRN students reported high satisfaction with a novel course grounded in health equity that has potential to reduce health disparities and accelerate the closure of the MOUD treatment gap, particularly for racial/ethnic minorities, rural populations, and transition-age youth.
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Nkemjika S, Tumenta T, Salazar L, Okosun IS. Waiting times disparities for medication-assisted therapy among opioid use disorder treatment population in the United States. J Addict Dis 2023; 41:322-333. [PMID: 36082620 DOI: 10.1080/10550887.2022.2116904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Opioid use disorder (OUD) treatment has been described as beneficial in reducing the burden of OUD and its related complications. Thus far, there is a paucity of literature on the time-to-treatment differences from the period of seeking treatment to when the patient starts treatment. Hence, it is deemed a form of barrier to the accessibility of OUD treatment programs. We aim to study the relationship between accessibility for medication-assisted treatment and the disparity concerning days waiting to enter OUD treatment. The treatment episode data set (TEDS) was utilized for this study. The full sample of 2018 TEDS-D (N = 382,547) is representative of OUD patients that utilized SUD treatment facilities within the 50 states of the United States. Univariate and multivariable logistic analysis of the independent variables, and other covariates with the dependent variables were explored to estimate the adjusted odds ratio relationship. Medication-assisted opioid therapy use among respondents was significantly different with waiting 1-7 days [AOR = 1.321 (95% CI = 1.248-1.400)] and >7 days [AOR = 0.729 (95% CI = 0.665-0.799)] to enter OUD treatment compared to waiting for less than a day. Among adults seeking OUD treatment admissions, our study showed that waiting times vary with MAT use as there was early entry compared to >1week wait time. Similarly, significant associations were reported across different sociodemographic attributes except for biological sex.
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Affiliation(s)
- Stanley Nkemjika
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Terrence Tumenta
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Laura Salazar
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Ike S Okosun
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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21
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Sud A, Chiu K, Friedman J, Dupouy J. Buprenorphine deregulation as an opioid crisis policy response - A comparative analysis between France and the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104161. [PMID: 37619440 DOI: 10.1016/j.drugpo.2023.104161] [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: 02/16/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND In passing the Maintstreaming Addiction Treatment Act, the United States has abolished its federal X waiver, considered a major barrier to the wider buprenorphine prescribing needed to respond to opioid-related harms. Advocates for this policy have drawn on the French response of deregulating buprenorphine prescribing to address increasing overdose mortality around the turn of the millennium. So far, such policy advocacy has incompletely accounted for contextual and health system differences between the two countries. METHODS Using the health system dynamics framework, this analysis compares France from 1995 to 2003 (the relevant period of buprenorphine reform) to the US from 2018 until today (the comparison period to explore potential impacts of reform). We used it to guide examination of a) contextual issues relating to opioid use epidemiology and b) health system factors including prescriber supply, sector organization, and insurance coverage for primary care to draw relevant policy learning for the contemporary US. RESULTS We identified that the US had a 22.5-fold higher mortality rate and a 2.3-fold higher opioid use disorder (OUD) rate compared to France, despite having rates of prescribed buprenorphine per-capita higher than, and per-person with OUD comparable to, than that of France. These wide gulfs between the scales and nature of the problems between France and the US suggest that relaxing restrictions on buprenorphine prescribing through abolishing the X waiver will be insufficient for achieving hoped-for reductions in overdose mortality. CONCLUSION Health system strengthening with a focus on improvements in primary care prescriber supply, coverage, and coordination are likely higher yield policy complements to relaxing buprenorphine regulation. Such an approach would better prepare the US to adapt to ongoing dynamics and uncertainties in the opioid crisis and to optimize the already relatively high levels of buprenorphine prescribing.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Humber River Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Kellia Chiu
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, United States
| | - Julie Dupouy
- University Department of General Medicine, University of Toulouse, Faculty of Medicine, Toulouse, France; Inserm UMR1295, University of Toulouse III, Faculty of Medicine, Toulouse, France
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22
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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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23
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Britz JB, O'Loughlin KM, Henry TL, Richards A, Sabo RT, Saunders HG, Tong ST, Brooks EM, Lowe J, Harrell A, Bethune C, Moeller FG, Krist AH. Rising Racial Disparities in Opioid Mortality and Undertreatment of Opioid Use Disorder and Mental Health Comorbidities in Virginia. AJPM FOCUS 2023; 2:100102. [PMID: 37790667 PMCID: PMC10546578 DOI: 10.1016/j.focus.2023.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction There were more than 100,000 fatal drug overdoses in the U.S. in 2021 alone. In recent years, there has been a shift in opioid mortality from predominantly White rural communities to Black urban communities. This study aimed to identify the Virginia communities disproportionately affected by the overdose crisis and to better understand the systemic factors contributing to disparities in opioid mortality. Methods Using the state all-payer claims database, state mortality records, and census data, we created a multivariate model to examine the community-level factors contributing to racial disparities in opioid mortality. We used generalized linear mixed models to examine the associations between socioecologic factors and fatal opioid overdoses, opioid use disorder diagnoses, opioid-related emergency department visits, and mental health diagnoses. Results Between 2015 and 2020, racial disparities in mortality widened. In 2020, Black males were 1.5 times more likely to die of an opioid overdose than White males (47.3 vs 31.6 per 100,000; p<0.001). The rate of mental health disorders strongly correlated with mortality (β=0.53, p<0.001). Black individuals are not more likely to be diagnosed with opioid use disorder (β=0.01, p=0.002) or with mental health disorders (β= -0.12, p<0.001), despite higher fatal opioid overdoses. Conclusions There are widening racial disparities in opioid mortality. Untreated mental health disorders are a major risk factor for opioid mortality. Findings show pathways to address inequities, including early linkage to care for mental health and opioid use disorders. This analysis shows the use of comprehensive socioecologic data to identify the precursors to fatal overdoses, which could allow earlier intervention and reallocation of resources in high-risk communities.
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Affiliation(s)
- Jacqueline B. Britz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Kristen M. O'Loughlin
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Tracey L. Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Alicia Richards
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Roy T. Sabo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Heather G. Saunders
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Sebastian T. Tong
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - E. Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jason Lowe
- Division of Behavioral Health, Virginia Department of Medical Assistance (DMAS), Richmond, Virginia
| | - Ashley Harrell
- Division of Behavioral Health, Virginia Department of Medical Assistance (DMAS), Richmond, Virginia
| | - Christine Bethune
- Division of Behavioral Health, Virginia Department of Medical Assistance (DMAS), Richmond, Virginia
| | - F. Gerard Moeller
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Alex H. Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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24
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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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25
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Bulgin D, Patrick SW, McElroy T, McNeer E, Dupont WD, Murry VM. Patient and Community Factors Affecting Treatment Access for Opioid Use Disorder. Obstet Gynecol 2023; 142:339-349. [PMID: 37473410 PMCID: PMC10372722 DOI: 10.1097/aog.0000000000005227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/30/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To examine whether access to treatment for women with opioid use disorder (OUD) varied by race and ethnicity, community characteristics, and pregnancy status. METHODS We conducted a secondary data analysis of a simulated patient caller study of buprenorphine-waivered prescribers and opioid-treatment programs in 10 U.S. states. We conducted multivariable analyses, accounting for potential confounders, to evaluate factors associated with likelihood of successfully securing an appointment. Descriptive statistics and significance testing examined 1) caller characteristics and call outcome by assigned race and ethnicity and clinic type (combined, opioid-treatment programs, and buprenorphine-waivered prescribers) and 2) clinic and community characteristics and call outcome by community race and ethnicity distribution (majority White vs majority Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander) and clinic type. A multiple logistic regression model was fitted to assess the likelihood of obtaining an appointment by callers' race and ethnicity and pregnancy status with the exposure of interest being majority Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander community distribution. RESULTS In total, 3,547 calls reached clinics to schedule appointments. Buprenorphine-waivered prescribers were more likely to be in communities that were more than 50% White (88.9% vs 77.3%, P<.001), and opioid-treatment programs were more likely to be in communities that were less than 50% White (11.1% vs 22.7%, P<.001). Callers were more likely to be granted appointments in majority Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander communities (adjusted odds ratio [aOR] 1.06, 95% CI 1.02-1.10 per 10% Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander community population) and at opioid-treatment programs (aOR 4.94, 95% CI 3.52-6.92) and if they were not pregnant (aOR 1.79, 95% CI 1.53-2.09). CONCLUSION Clinic distribution and likelihood of acceptance for treatment varied by community race and ethnicity distribution. Access to treatment for OUD remains challenging for pregnant people and in many historically marginalized U.S. communities.
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Affiliation(s)
| | - Stephen W. Patrick
- Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Mildred Stahlman Divison of Neonatology, Vanderbilt University Medical Center, Nashville, TN
| | - Tamarra McElroy
- Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Elizabeth McNeer
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - William D. Dupont
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Velma McBride Murry
- Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
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26
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Chang JE, Cronin CE, Pagán JA, Simon J, Lindenfeld Z, Franz B. Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals: 2015-2021. J Addict Med 2023; 17:e217-e223. [PMID: 37579091 DOI: 10.1097/adm.0000000000001128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs. METHODS We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports. We utilized t or χ 2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs across waves. We used multilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave. RESULTS Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospital- and community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015-2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates. CONCLUSIONS Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use.
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Affiliation(s)
- Ji Eun Chang
- From the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY (JEC, JAP, ZL); College of Health Sciences and Professions, Ohio University, Athens, OH (CC); Heritage College of Osteopathic Medicine, Ohio University, Athens, OH (JS, BF); and Ohio University Appalachian Institute to Advance Health Equity Science (BF, CEC)
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27
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Choi S, O’Grady MA, Cleland CM, Knopf E, Hong S, D’Aunno T, Bao Y, Ramsey KS, Neighbors CJ. Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes. PLoS One 2023; 18:e0286859. [PMID: 37294821 PMCID: PMC10256218 DOI: 10.1371/journal.pone.0286859] [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: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. METHODS AND ANALYSIS We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases-Medicaid, treatment registry, THD reporting-with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. DISCUSSION This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE-particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Elizabeth Knopf
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Sueun Hong
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Thomas D’Aunno
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports (OASAS), New York, NY, United States of America
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
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28
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Harris RA, Long JA, Bao Y, Mandell DS. Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses. JAMA HEALTH FORUM 2023; 4:e231235. [PMID: 37294585 PMCID: PMC10257097 DOI: 10.1001/jamahealthforum.2023.1235] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
Importance In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures. Objective To assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups. Design, Setting, and Participants Interrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women. Exposure On March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients. Main Outcome Measures Monthly methadone-involved overdose deaths. Results From January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study's 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, -0.55 [95% CI, -0.95 to -0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (-0.42 [95% CI, -0.68 to -0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, -0.27 [95% CI, -1.13 to 0.59]; Hispanic women, 0.29 [95% CI, -0.46 to 1.04]; White men, -0.08 [95% CI, -1.05 to 0.88]; and White women, -0.43 [95% CI, -1.26 to 0.40]). Conclusions and Relevance In this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judith A. Long
- Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - David S. Mandell
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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29
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Rudolph KE, Williams NT, Díaz I, Luo SX, Rotrosen J, Nunes EV. Optimally Choosing Medication Type for Patients With Opioid Use Disorder. Am J Epidemiol 2023; 192:748-756. [PMID: 36549900 PMCID: PMC10423632 DOI: 10.1093/aje/kwac217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with opioid use disorder (OUD) tend to get assigned to one of 3 medications based on the treatment program to which the patient presents (e.g., opioid treatment programs tend to treat patients with methadone, while office-based practices tend to prescribe buprenorphine). It is possible that optimally matching patients with treatment type would reduce the risk of return to regular opioid use (RROU). We analyzed data from 3 comparative effectiveness trials from the US National Institute on Drug Abuse Clinical Trials Network (CTN0027, 2006-2010; CTN0030, 2006-2009; and CTN0051 2014-2017), in which patients with OUD (n = 1,459) were assigned to treatment with either injection extended-release naltrexone (XR-NTX), sublingual buprenorphine-naloxone (BUP-NX), or oral methadone. We learned an individualized rule by which to assign medication type such that risk of RROU during 12 weeks of treatment would be minimized, and then estimated the amount by which RROU risk could be reduced if the rule were applied. Applying our estimated treatment rule would reduce risk of RROU compared with treating everyone with methadone (relative risk (RR) = 0.79, 95% confidence interval (CI): 0.60, 0.97) or treating everyone with XR-NTX (RR = 0.71, 95% CI: 0.47, 0.96). Applying the estimated treatment rule would have resulted in a similar risk of RROU to that of with treating everyone with BUP-NX (RR = 0.92, 95% CI: 0.73, 1.11).
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Affiliation(s)
- Kara E Rudolph
- Correspondence to Dr. Kara Rudolph, 722 W. 168th Street, Room 522, New York, NY 10032 (e-mail: )
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30
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Jones KF, O'Reilly Jacob M, Spetz J, Hailer L, Tierney M. Eliminate the buprenorphine DEA X waiver: Justification using a policy analysis approach. J Nurs Scholarsh 2023; 55:655-664. [PMID: 36624606 PMCID: PMC10159879 DOI: 10.1111/jnu.12871] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/28/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Drug overdoses have reached a historic milestone of over 100,000 deaths in a single year, 75,673 related to opioids. The acceleration in opioid-related deaths coupled with stark health inequities demands a close examination of opioid use disorder (OUD) treatment barriers and swift consideration of policy changes. DESIGN The aim of this buprenorphine policy analysis is to summarize existing buprenorphine barriers and present policy solutions to improve access and actualize the contributions of Advanced Practice Registered Nurses (APRNs). METHODS The policy analysis follows five sequential steps: (1) defining the problem, (2) identifying key stakeholders, (3) assessing the landscape of relevant policies, (4) describing viable policy options, and (5) making final recommendations. RESULTS Although there are laudable efforts to improve buprenorphine access, such as the new buprenorphine guidelines issued in April 2021, without larger-scale changes to federal, state, and scope of practice laws, overdose rates will continue to rise. We recommend a multipronged policy approach to improve buprenorphine treatment access, including eliminating the DEA X waiver, improving OUD education, and adopting full practice authority for APRNs in all states. CONCLUSION Incremental change is no longer sufficient to address opioid overdose deaths. Bolder and coordinated policy action is possible and necessary to empower the full clinical workforce to apply evidence-based life-saving treatments for OUD. The critical contributions of nurses in advancing equitable access to OUD care are emphasized in the National Academy of Medicine's Report, Future of Nursing: Charting a Path to Achieve Health Equity. Nurses are named as instrumental in improving buprenorphine access. Policy changes that acknowledge and build on evidence-based treatment expansion strategies are sorely needed. CLINICAL RELEVANCE One of the most robust tools to combat opioid overdose deaths is buprenorphine, a partial opioid agonist, and gold standard medication treatment for OUD, but only 5% of the prescribing workforce possess the required Drug Enforcement Agency (DEA) X waiver. A growing body of evidence demonstrates that Advanced Practice Registered Nurses are accelerating the growth in waiver update and buprenorphine use, despite the considerable barriers and limitations described in this policy analysis.
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Affiliation(s)
- Katie Fitzgerald Jones
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Mongan Institute for Aging and Serious Illness, Boston, Massachusetts, USA
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA
| | - Monica O'Reilly Jacob
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | | | - Matthew Tierney
- Office of Population Health, UCSF Health, University of California San Francisco, San Francisco, California, USA
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Wakeman SE, Beletsky L. Beyond the X - Next Steps in Policy Reforms to Address the Overdose Crisis. N Engl J Med 2023; 388:1639-1641. [PMID: 37125771 DOI: 10.1056/nejmp2301479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Sarah E Wakeman
- From the Department of Medicine, Massachusetts General Hospital (S.E.W.), Harvard Medical School (S.E.W.), and the School of Law and the Bouvé College of Health Sciences, Northeastern University (L.B.) - all in Boston; and the Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla (L.B.)
| | - Leo Beletsky
- From the Department of Medicine, Massachusetts General Hospital (S.E.W.), Harvard Medical School (S.E.W.), and the School of Law and the Bouvé College of Health Sciences, Northeastern University (L.B.) - all in Boston; and the Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla (L.B.)
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Buprenorphine involvement in opioid overdose deaths: A retrospective analysis of postmortem toxicology in Marion County, Indiana, 2015-2021. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100131. [PMID: 36777895 PMCID: PMC9910498 DOI: 10.1016/j.dadr.2023.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Amidst an unprecedented overdose epidemic, the opioid partial agonist buprenorphine is a medication for opioid use disorder associated with reductions in overdose. Despite its efficacy, buprenorphine prescribing remains closely regulated, owing to concerns about misuse, and its possible role in overdoses. Methods A retrospective analysis of the Marion County, Indiana coroner's postmortem toxicology data for unintentional opioid-involved overdose deaths from 2015 through 2021. The county was chosen as a novel setting whose corner provided comprehensive overdose data. It contains Indianapolis, a large city in the US Midwest The 2,369 opioid-involved overdoses were analyzed for the presence of buprenorphine and its metabolite, as wel as potent substances associated with illicit drug use and overdose. Results Of the 2,369 postmortem toxicology records analyzed, 55 (2.3%) indicated presence of buprenorphine. Of buprenorphine-involved cases, 51 (92.7%) involved other potent substances such as fentanyl, heroin, cocaine, methadone, and amphetamines; 4 (7.3%) were attributed to buprenorphine and liver failure, diabetic ketoacidosis, or relatively less potent substances. Fentanyl was present in 28 cases (50.9%), benzodiazepines were present in 24 (43.6%). Black opioid decedents were considerably less likely to have buprenorphine in their toxicology than White decedents. Conclusions Buprenorphine was rarely detected in the postmortem toxicology of unintentional opioid overdoses in a major US city in the Midwest. In nearly all cases it was accompanied by other potent substances that more frequently cause fatal overdoses on their own. This study confirms findings from other geographic settings that the overdose mortality risks associated with buprenorphine are low.
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Can accurate demographic information about people who use prescription medications nonmedically be derived from Twitter? Proc Natl Acad Sci U S A 2023; 120:e2207391120. [PMID: 36787355 PMCID: PMC9974473 DOI: 10.1073/pnas.2207391120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Traditional substance use (SU) surveillance methods, such as surveys, incur substantial lags. Due to the continuously evolving trends in SU, insights obtained via such methods are often outdated. Social media-based sources have been proposed for obtaining timely insights, but methods leveraging such data cannot typically provide fine-grained statistics about subpopulations, unlike traditional approaches. We address this gap by developing methods for automatically characterizing a large Twitter nonmedical prescription medication use (NPMU) cohort (n = 288,562) in terms of age-group, race, and gender. Our natural language processing and machine learning methods for automated cohort characterization achieved 0.88 precision (95% CI:0.84 to 0.92) for age-group, 0.90 (95% CI: 0.85 to 0.95) for race, and 94% accuracy (95% CI: 92 to 97) for gender, when evaluated against manually annotated gold-standard data. We compared automatically derived statistics for NPMU of tranquilizers, stimulants, and opioids from Twitter with statistics reported in the National Survey on Drug Use and Health (NSDUH) and the National Emergency Department Sample (NEDS). Distributions automatically estimated from Twitter were mostly consistent with the NSDUH [Spearman r: race: 0.98 (P < 0.005); age-group: 0.67 (P < 0.005); gender: 0.66 (P = 0.27)] and NEDS, with 34/65 (52.3%) of the Twitter-based estimates lying within 95% CIs of estimates from the traditional sources. Explainable differences (e.g., overrepresentation of younger people) were found for age-group-related statistics. Our study demonstrates that accurate subpopulation-specific estimates about SU, particularly NPMU, may be automatically derived from Twitter to obtain earlier insights about targeted subpopulations compared to traditional surveillance approaches.
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Husain JM, Cromartie D, Fitzelle-Jones E, Brochier A, Borba CPC, Montalvo C. A qualitative analysis of barriers to opioid agonist treatment for racial/ethnic minoritized populations. J Subst Abuse Treat 2023; 144:108918. [PMID: 36403456 DOI: 10.1016/j.jsat.2022.108918] [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: 02/05/2022] [Revised: 08/17/2022] [Accepted: 10/23/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Clinical guidelines strongly recommend opioid agonist treatment (OAT) as first-line treatment for opioid use disorder (OUD). However, racial/ethnic minoritized patients are less likely to receive OAT compared to non-Hispanic White patients. Reasons for this treatment gap must be elucidated to address racial/ethnic disparities in OAT. Our objective is to evaluate perceptions of and barriers to OAT across racial/ethnic groups in individuals with OUD (not on OAT). METHODS This qualitative study used semi-structured telephone interviews of adult patients (n = 41) with OUD (not currently being treated with OAT) from the Boston area from September 2020 through February 2021. We developed a codebook through author consensus based on review of themes in initial transcripts. We performed qualitative thematic analysis of the transcripts. We evaluated patients' perceptions of treatment for OUD across the study population and analyzed differences and similarities in perceptions between racial and ethnic groups. RESULTS Across all racial/ethnic categories in our sample, anticipated stigma was the most frequently reported barrier to OAT and most patients preferred non-OAT methods for treatment. Non-Hispanic White participants had more favorable opinions of OAT compared to racial/ethnic minoritized participants. Racial/ethnic minoritized participants reported social support as the main facilitator to addiction treatment, while non-Hispanic White participants reported self-motivation as the most important factor. Racial/ethnic minoritized participants preferred treatment for OUD via non-OAT treatments and their second most preferred option was residential treatment. Non-Hispanic White participants preferred naltrexone and their second most preferred option was non-OAT treatments. CONCLUSIONS Racial/ethnic minoritized patients' preference for residential treatment and social support, along with their distrust of OAT, illustrates a desire for psychosocial and peer recovery-based care that addresses social determinants of health. Addiction specialists may improve engagement with and treatment of racial/ethnic minoritized groups with culturally tailored interventions for OUD that offer psychosocial treatment in combination with OAT, and by partnering with organizations with strong ties to racial/ethnic minoritized communities. This kind of response would reflect the structural and cultural humility that is needed to adequately address the OUD needs of these underserved populations.
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Affiliation(s)
- Jawad M Husain
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Mass General Brigham, Boston, MA, United States of America.
| | - Devin Cromartie
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Emma Fitzelle-Jones
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, United States of America
| | - Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States of America
| | - Christina P C Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Cristina Montalvo
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Tufts Medical Center, Boston, MA, United States of America
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Choe K, Zinn E, Lu K, Hoang D, Yang LH. Impact of COVID-19 pandemic on chronic pain and opioid use in marginalized populations: A scoping review. Front Public Health 2023; 11:1046683. [PMID: 37139395 PMCID: PMC10150088 DOI: 10.3389/fpubh.2023.1046683] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The COVID-19 pandemic has had a variable effect on vulnerable populations, including patients with chronic pain who rely on opioid treatment or have comorbid opioid use disorder. Limited access to care due to isolation measures may lead to increased pain severity, worse mental health symptoms, and adverse opioid-related outcomes. This scoping review aimed to understand the impact of the COVID-19 pandemic on the dual epidemics of chronic pain and opioids in marginalized communities worldwide. Methods Searches of primary databases including PubMed, Web of Science, Scopus, and PsycINFO were performed in March 2022, restricting the publication date to December 1, 2019. The search yielded 685 articles. After title and abstract screening, 526 records were screened by title and abstract, 87 through full-text review, of which 25 articles were included in the final analysis. Results Our findings illuminate the differential distribution of pain burden across marginalized groups and how it serves to heighten existing disparities. Service disruptions due to social distancing orders and infrastructural limitations prevented patients from receiving the care they needed, resulting in adverse psychological and physical health outcomes. Efforts to adapt to COVID-19 circumstances included modifications to opioid prescribing regulations and workflows and expanded telemedicine services. Conclusion Results have implications for the prevention and management of chronic pain and opioid use disorder, such as challenges in adopting telemedicine in low-resource settings and opportunities to strengthen public health and social care systems with a multidisciplinary and multidimensional approach.
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Affiliation(s)
- Karen Choe
- School of Global Public Health, New York University, New York, NY, United States
- *Correspondence: Karen Choe,
| | - Eleanor Zinn
- Teachers College Columbia University, New York, NY, United States
| | - Kevin Lu
- Teachers College Columbia University, New York, NY, United States
| | - Dung Hoang
- Teachers College Columbia University, New York, NY, United States
| | - Lawrence H. Yang
- School of Global Public Health, New York University, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
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History of the discovery, development, and FDA-approval of buprenorphine medications for the treatment of opioid use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100133. [PMID: 36994370 PMCID: PMC10040330 DOI: 10.1016/j.dadr.2023.100133] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
Buprenorphine-based medications were first approved by the United States Food and Drug Administration in 2002 for the treatment of opioid dependence, or opioid use disorder (OUD) as the condition is presently known. This regulatory milestone was the outcome of 36 years of research and development, which also led to the development and approval of several other new buprenorphine-based medications. In this short review, we first describe the discovery and early development stages of buprenorphine. Second, we review key steps that led to the development of buprenorphine as a drug product. Third, we explain the regulatory approval of several buprenorphine-based medications for the treatment of OUD. We also discuss these developments in the context of the evolution of regulations and policies that have progressively improved OUD treatment availability and efficacy, although challenges remain in removing system-level, provider-level, and local-level barriers to quality treatment, to integrating OUD treatment into routine care and other settings, to reducing disparities in access to treatment, and to optimizing person-centered outcomes.
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Bartholomew TS, Andraka-Cristou B, Totaram RK, Harris S, Doblecki-Lewis S, Ostrer L, Serota DP, Forrest DW, Chueng TA, Suarez E, Tookes HE. "We want everything in a one-stop shop": acceptability and feasibility of PrEP and buprenorphine implementation with mobile syringe services for Black people who inject drugs. Harm Reduct J 2022; 19:133. [PMID: 36463183 PMCID: PMC9719627 DOI: 10.1186/s12954-022-00721-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION A recent surge in HIV outbreaks, driven by the opioid and stimulant use crises, has destabilized our progress toward targets set forth by Ending the HIV Epidemic: A Plan for America for the high-priority community of people who inject drugs (PWID), particularly Black PWID. METHODS In order to ascertain the acceptability and feasibility of using a mobile syringe services program (SSP) for comprehensive HIV prevention via PrEP and medications for opioid use disorder (MOUD), our mixed methods approach included a quantitative assessment and semi-structured qualitative interviews with Black PWID (n = 30) in Miami-Dade County who were actively engaged in mobile syringe services. RESULTS Participants felt that delivery of MOUD and PrEP at a mobile SSP would be both feasible and acceptable, helping to address transportation, cost, and stigma barriers common within traditional healthcare settings. Participants preferred staff who are compassionate and nonjudgmental and have lived experience. CONCLUSIONS A mobile harm reduction setting could be an effective venue for delivering comprehensive HIV prevention services to Black PWID, a community that experiences significant barriers to care via marginalization and racism in a fragmented healthcare system.
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Affiliation(s)
- Tyler S. Bartholomew
- grid.26790.3a0000 0004 1936 8606Division of Health Services Research and Policy, Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th St., #1020, Miami, FL 33136 USA
| | - Barbara Andraka-Cristou
- grid.170430.10000 0001 2159 2859Department of Health Management and Informatics, University of Central Florida, Orlando, FL USA ,grid.170430.10000 0001 2159 2859Department of Internal Medicine, University of Central Florida, Orlando, FL USA
| | - Rachel K. Totaram
- grid.170430.10000 0001 2159 2859Department of Health Management and Informatics, University of Central Florida, Orlando, FL USA
| | - Shana Harris
- grid.170430.10000 0001 2159 2859Department of Internal Medicine, University of Central Florida, Orlando, FL USA ,grid.170430.10000 0001 2159 2859Department of Anthropology, University of Central Florida, Orlando, FL USA
| | - Susanne Doblecki-Lewis
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Lily Ostrer
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - David P. Serota
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - David W. Forrest
- grid.26790.3a0000 0004 1936 8606Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL USA
| | - Teresa A. Chueng
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Edward Suarez
- grid.26790.3a0000 0004 1936 8606Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Hansel E. Tookes
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
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Grieb SM, Harris R, Rosecrans A, Zook K, Sherman SG, Greenbaum A, Lucas GM, Page KR. Awareness, perception and utilization of a mobile health clinic by people who use drugs. Ann Med 2022; 54:138-149. [PMID: 36799361 PMCID: PMC8741230 DOI: 10.1080/07853890.2021.2022188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION People who use drugs (PWUD) face a multitude of barriers to accessing healthcare and other services. Mobile health clinics (MHC) are an innovative, cost-effective health care delivery approach that increases healthcare access to vulnerable populations and medically underserved areas. There is limited understanding, however, of how PWUD perceive and experience MHCs. METHODS Semi-structured interviews were conducted with 31 PWUD - 16 who had received care (clients) on an MHC (The Spot) and 15 who had not (non-clients) - to explore their perceptions and utilization of an MHC partnered with a mobile syringe services program in Baltimore, Maryland. Data analysis of the text was conducted using an iterative thematic constant comparison process informed by grounded theory. RESULTS Clients and non-clients, once aware of the MHC, had positive perceptions of The Spot and its benefits for their individual health as well as for the wellbeing of their community. These sentiments among clients were largely driven by access to low-barrier buprenorphine and service delivery without stigma around drug use. However, lack of general awareness of the spot and specific service offering were barriers to its use among non-clients. DISCUSSION MHCs provide an important opportunity to engage PWUD in healthcare and to expand buprenorphine use; however, even with accessibility near where PWUD access injection equipment, barriers to its use remain. Peer dissemination may be able to facilitate program information sharing and recruitment.KEY MESSAGESPeople who use drugs perceive a mobile health clinic in their neighbourhood as a benefit to their communities and themselves by improving access to healthcare services, providing access to low-threshold buprenorphine dispensation, and offering services without drug use stigma.People who use drugs learned about a mobile health clinic in their neighbourhood largely through word-of-mouth. As a result, people received limited information about the mobile health clinic services creating a barrier to its use.
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Affiliation(s)
- Suzanne M Grieb
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Harris
- Baltimore City Health Department, Baltimore, MD, USA
| | - Amanda Rosecrans
- Baltimore City Health Department, Baltimore, MD, USA.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Zook
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen R Page
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Syros A, Rodriguez MG, Rennick AC, Dima GA, Gibstein AR, de la Parte L, Hermenau MG, Ciraldo KJ, Chueng TA, Tookes HE, Bartholomew TS, Serota DP. Availability of medications for opioid use disorder in outpatient and inpatient pharmacies in South Florida: a secret shopper survey. Addict Sci Clin Pract 2022; 17:63. [PMID: 36401298 PMCID: PMC9673453 DOI: 10.1186/s13722-022-00346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Despite the proven efficacy of medications for opioid use disorder (MOUD) and recent reduction in barriers to prescribers, numerous obstacles exist for patients seeking MOUD. Prior studies have used telephone surveys to investigate pharmacy-related barriers to MOUD. We applied this methodology to evaluate inpatient and outpatient pharmacy barriers to MOUD in South Florida. Methods Randomly selected pharmacies in South Florida (Miami-Dade, Broward, and Palm Beach Counties) were called using a standardized script with a “secret shopper” approach until 200 successful surveys had been completed. The primary outcome was the availability of any buprenorphine products. Second, a list of all 48 acute care hospitals within the aforementioned counties was compiled, and hospitals were contacted by telephone using a second structured script. Results A total of 1374 outpatient pharmacies and 48 inpatient pharmacies were identified. 378 randomly selected outpatient pharmacies were contacted to accrue 200 successful calls (53% success rate). All 48 inpatient pharmacies were contacted to successfully complete 25 inpatient surveys (52%). Of the 200 outpatient pharmacies contacted, 38% had any buprenorphine available. There was a significant difference in buprenorphine availability by county, with Miami-Dade having the least availability and Palm Beach having the most availability (27% vs. 47%, respectively; p = 0.04). Of the 38% with buprenorphine available, 82% had a sufficient supply for a two-week prescription of buprenorphine 8 mg twice daily. Of the pharmacies that did not have buprenorphine, 55% would be willing to order with a median estimated time to receive an order of 2 days (IQR 1.25–3 days). Of the 25 surveyed inpatient pharmacies, 88% reported having buprenorphine on inpatient formulary, and 55% of hospitals had at least one restriction on ordering of buprenorphine beyond federal regulations. Conclusions The results of this study highlight significant pharmacy-related barriers to comprehensive OUD treatment across the healthcare system including both acute care hospital pharmacies and outpatient community pharmacies. Despite efforts to increase the number of MOUD providers, there still remain downstream obstacles to MOUD access.
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Guerrero EG, Kong Y, Frimpong JA, Khachikian T, Wang S, D’Aunno T, Howard DL. Workforce Diversity and disparities in wait time and retention among opioid treatment programs. Subst Abuse Treat Prev Policy 2022; 17:74. [PMID: 36384761 PMCID: PMC9670430 DOI: 10.1186/s13011-022-00500-3] [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] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Workforce diversity is a key strategy to improve treatment engagement among members of racial and ethnic minority groups. In this study, we seek to determine whether workforce diversity plays a role in reducing racial and ethnic differences in wait time to treatment entry and retention in different types of opioid use disorder treatment programs. METHODS We conducted comparative and predictive analysis in a subsample of outpatient opioid treatment programs (OTPs), who completed access and retention survey questions in four waves of the National Drug Abuse Treatment System Survey (162 OTPs in 2000, 173 OTPs in 2005, 282 OTPs in 2014, and 300 OTPs in 2017). We sought to assess the associations between workforce diversity on wait time and retention, accounting for the role of Medicaid expansion and the moderating role of program ownership type (i.e., public, non-profit, for-profit) among OTPs located across the United States. RESULTS We found significant differences in wait time to treatment entry and retention in treatment across waves. Average number of waiting days decreased in 2014 and 2017; post Medicaid expansion per the Affordable Care Act, while retention rates varied across years. Key findings show that programs with high diversity, measured by higher percent of African American staff and a higher percent of African American clients, were associated with longer wait times to enter treatment, compared to low diversity programs. Programs with higher percent of Latino staff and a higher percent of Latino clients were associated with lower retention in treatment compared with low diversity programs. However, program ownership type (public, non-profit and for-profit) played a moderating role. Public programs with higher percent of African American staff were associated with lower wait time, while non-profit programs with higher percent of Latino staff were related to higher retention. CONCLUSIONS Findings show decreases in wait time over the years with significant variation in retention during the same period. Concordance in high workforce and client diversity was associated with higher wait time and lower retention. But these relations inverted (low wait time and high retention) in public and non-profit programs with high staff diversity. Findings have implications for building resources and service capacity among OTPs that serve a higher proportion of minority clients.
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Affiliation(s)
- Erick G. Guerrero
- Research to End Healthcare Disparities Corp, I-Lead Institute, Los Angeles, CA USA
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, CA USA
| | - Jemima A. Frimpong
- Business, Organizations and Society, New York University, Abu Dhabi, United Arab Emirates
| | | | - Suojin Wang
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX USA
| | - Thomas D’Aunno
- Wagner Graduate School of Public Service, New York University, New York City, New York USA
| | - Daniel L. Howard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX USA
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Improving Research on Racial Disparities in Access to Medications to Treat Opioid Use Disorders. J Addict Med 2022:01271255-990000000-00106. [PMID: 36652612 DOI: 10.1097/adm.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aims of the study are to review the current research on the association between access to medications for opioid use disorders (MOUD) and race, to identify gaps in research methods, and to propose new approaches to end racialized disparities in access to MOUD. METHODS We conducted a literature review of English language peer-reviewed published literature from 2010 to 2021 to identify research studies examining the association between race and use of, or access to, MOUD. RESULTS We reviewed 21 studies related to access to MOUD for Black and White populations. Of the 21 studies, 16 found that Black individuals had lower use of, or access to, MOUD than White individuals, 2 found the opposite among patients in specialty addiction treatment, 1 found that the difference changed over time, and 2 found that distance to opioid treatment programs was shorter for Black residents than for White residents. CONCLUSIONS To improve future research, we recommend that researchers (1) be clearer on how race is conceptualized and interpreted; (2) explicitly evaluate the intersection of race and other factors that may influence access such as income, insurance status, and geography; (3) use measures of perceived racism, unconscious bias, and self-identified race; (4) collect narratives to better understand why race is associated with lower MOUD access and identify solutions; and (5) evaluate the effect of policies, programs, and clinical training on reducing racial disparities. A multitude of studies find that Black individuals have lower access to MOUD. Researchers must now identify effective solutions for reducing these disparities.
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Predictors of engagement and retention in care at a low-threshold substance use disorder bridge clinic. J Subst Abuse Treat 2022; 141:108848. [DOI: 10.1016/j.jsat.2022.108848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
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CLIFTON JOHNM, BELCHER ANNABELLEM, GREENBLATT AAROND, WELSH CHRISTOPHERM, COLE THOMASO, DAVIS ALANK. Psilocybin use patterns and perception of risk among a cohort of Black individuals with Opioid Use Disorder. JOURNAL OF PSYCHEDELIC STUDIES 2022; 6:80-87. [PMID: 36686617 PMCID: PMC9850635 DOI: 10.1556/2054.2022.00214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background and aims There is growing evidence that psilocybin, a serotonergic psychedelic substance, may be useful in the treatment of substance use disorders. However, there is a lack of data on the beliefs and attitudes towards psilocybin amongst Black individuals diagnosed with Opioid Use Disorder (OUD). This study characterized psilocybin use patterns and perception of risk amongst a cohort of Black individuals diagnosed with OUD. Methods Using a convenience sampling approach, patients were recruited from an urban methadone treatment program and paid five dollars to complete an anonymous phone-based survey. Results Twenty-eight patients participated (mean age 53.8; N = 28; 35.7% female). Most (N = 23; 82.1%) had "heard of" psilocybin mushrooms before taking the survey, but only five (N = 5; 17.8%) had ever used them. More than 80% perceived a risk or were "unsure" of the risk for sixteen of the seventeen items queried about psilocybin. Approximately half (N = 15; 53.6%) were willing to try therapy incorporating psilocybin and half (N = 14; 50%) said they would be more likely to try if it were FDA approved for OUD. Most (N = 18; 64.3%) preferred to stay on methadone treatment alone, 32.1% (N = 9) wanted to try treatment with both psilocybin and methadone, and only one participant opted for psilocybin treatment without methadone. Conclusion Many Black individuals with Opioid Use Disorder perceive psilocybin as dangerous and may be hesitant to try psilocybin treatment. Culturally informed treatment models, educational interventions and community outreach programs should be developed to increase racial/ethnic minority representation in psilocybin research and treatment.
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Affiliation(s)
- JOHN M. CLIFTON
- University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author. 2828 Old Hickory Blvd. Nashville, TN 37221. Tel.: +615-414-6997.
| | | | | | | | - THOMAS O. COLE
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - ALAN K. DAVIS
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH 43210, USA,Department of Psychiatry, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA,Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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Morgan JR, Freibott CE, Jalali A, Jeng PJ, Walley AY, Chatterjee A, Green TC, Nolan ML, Linas BP, Marshall BD, Murphy SM. The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100083. [PMID: 36337350 PMCID: PMC9631422 DOI: 10.1016/j.dadr.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Naloxone distributed to people at risk for opioid overdose has been associated with reduced overdose death rates; however, associations of retail pharmacy-distributed naloxone with overdose mortality have not been evaluated. Methods Our analytic cohort uses retail pharmacy claims data; three health departments' community distribution data; federal opioid overdose data; and American Community Survey data. Data were analyzed by 3-digit ZIP Code and calendar quarter-year (2016Q1-2018Q4), and weighted by population. We regressed opioid-related overdose mortality on retail-pharmacy and community naloxone distribution, and community-level demographics using a linear model, hypothesizing that areas with high overdose rates would have higher current levels of naloxone distribution but that increasing naloxone distribution from one quarter to the next would be associated with lower overdose. Results From Q1-2016 to Q4-2018, the unadjusted naloxone distribution rate increased from 97 to 257 kits per 100,000 persons, while the unadjusted opioid overdose mortality rate fell from 8.1 to 7.2 per 100,000 persons. The concurrent level of naloxone distribution (both pharmacy and community) was positively and significantly associated with fatal opioid overdose rates. We did not detect associations between change in naloxone distribution rates and overdose mortality. Conclusion Naloxone distribution volumes were correlated with fatal opioid overdose, suggesting medication was getting to communities where it was needed most. Amid high rates of overdose driven by fentanyl in the drug supply, our findings suggest additional prevention, treatment, and harm reduction interventions are required-and dramatically higher naloxone volumes needed-to reverse the opioid overdose crisis in the US.
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Affiliation(s)
- Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America
- Corresponding author.
| | - Christina E. Freibott
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Philip J. Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
| | - Avik Chatterjee
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
| | - Traci C. Green
- Brandeis University Heller School for Social Policy and Management, Rhode Island Hospital, RI, United States of America
- Brown University School of Public Health, Department of Epidemiology, RI, United States of America
- COBRE on Opioids and Overdose, Rhode Island Hospital, RI, United States of America
| | - Michelle L. Nolan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Benjamin P. Linas
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, RI, United States of America
- COBRE on Opioids and Overdose, Rhode Island Hospital, RI, United States of America
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
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A bifurcated opioid treatment system and widening insidious disparities. Addict Behav 2022; 130:107296. [PMID: 35255242 DOI: 10.1016/j.addbeh.2022.107296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/24/2022] [Accepted: 02/26/2022] [Indexed: 11/20/2022]
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Lockard R, Priest KC, Gregg J, Buchheit BM. A qualitative study of patient experiences with telemedicine opioid use disorder treatment during COVID-19. Subst Abus 2022; 43:1150-1157. [DOI: 10.1080/08897077.2022.2060447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rachel Lockard
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kelsey C. Priest
- Department of Psychiatry, University of Pittsburgh, Pittsburg, PA, USA
| | | | - Bradley M. Buchheit
- Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- OHSU Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Smith BD, Lewis Q, Offiong A, Willis K, Prioleau M, Powell TW. "It's on every corner": assessing risk environments in Baltimore, MD using a racialized risk environment model. J Ethn Subst Abuse 2022; 23:95-109. [PMID: 35499103 PMCID: PMC9622427 DOI: 10.1080/15332640.2022.2068719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Physical, social, economic, and political environments can increase harm and risk among people who use drugs. These factors may be exacerbated in urban environments with a history of systemic inequality toward African Americans. However, racialized risk environment models have rarely been used within substance use research. To fill this gap, the current qualitative study sought to describe the racialized risk environment of an African American sample of 21 adults with a history of illicit drug use living in Baltimore, MD. Semi-structured interviews were conducted. Data were analyzed using qualitative content analysis to identify themes related to illicit drug use, neighborhood context, violence, social interactions, and income generation. Themes related to the physical (e.g., the increased visibility of drug markets), social (e.g., normalization of drug use within social networks), and economic (e.g., financial hardships) risk environments emerged from this sample. These perceptions and themes can aid in developing and refining substance use programming within racialized settings.
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Nolen S, Zang X, Chatterjee A, Behrends CN, Green TC, Kumar A, Linas BP, Morgan JR, Murphy SM, Walley AY, Yan S, Schackman BR, Marshall BDL. Community-based naloxone coverage equity for the prevention of opioid overdose fatalities in racial/ethnic minority communities in Massachusetts and Rhode Island. Addiction 2022; 117:1372-1381. [PMID: 34825427 PMCID: PMC8983544 DOI: 10.1111/add.15759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Opioid-related overdose death rates continue to rise in the United States, especially in racial/ethnic minority communities. Our objective was to determine if US municipalities with high percentages of non-white residents have equitable access to the overdose antidote naloxone distributed by community-based organizations. METHODS We used community-based naloxone data from the Massachusetts Department of Public Health and the Rhode Island non-pharmacy naloxone distribution program for 2016-18. We obtained publicly available opioid-related overdose death data from Massachusetts and the Office of the State Medical Examiners in Rhode Island. We defined the naloxone coverage ratio as the number of community-based naloxone kits received by a resident in a municipality divided by the number of opioid-related overdose deaths among residents, updated annually. We used a Poisson regression with generalized estimating equations to analyze the relationship between the municipal racial/ethnic composition and naloxone coverage ratio. To account for the potential non-linear relationship between naloxone coverage ratio and race/ethnicity we created B-splines for the percentage of non-white residents; and for a secondary analysis examining the percentage of African American/black and Hispanic residents. The models were adjusted for the percentage of residents in poverty, urbanicity, state and population size. RESULTS Between 2016 and 2018, the annual naloxone coverage ratios range was 0-135. There was no difference in naloxone coverage ratios among municipalities with varying percentages of non-white residents in our multivariable analysis. In the secondary analysis, municipalities with higher percentages of African American/black residents had higher naloxone coverage ratios, independent of other factors. Naloxone coverage did not differ by percentage of Hispanic residents. CONCLUSIONS There appear to be no municipal-level racial/ethnic inequities in naloxone distribution in Rhode Island and Massachusetts, USA.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Avik Chatterjee
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Traci C Green
- Warren Alpert School of Medicine of Brown University, Providence, RI, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Aranshi Kumar
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Y Walley
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Shapei Yan
- Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Cunningham CO, Zhang C, Hollins M, Wang M, Singh-Tan S, Joudrey PJ. Availability of medical cannabis services by racial, social, and geographic characteristics of neighborhoods in New York: a cross-sectional study. BMC Public Health 2022; 22:671. [PMID: 35387635 PMCID: PMC8988426 DOI: 10.1186/s12889-022-13076-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Within the United States (US), because racial/ethnic disparities in cannabis arrests continue, and cannabis legalization is expanding, understanding disparities in availability of legal cannabis services is important. Few studies report mixed findings regarding disparities in availability of legal cannabis services; none examined New York. We examined disparities in availability of medical cannabis services in New York. We hypothesized that New York census tracts with few Black or Hispanic residents, high incomes, high education levels, and greater urbanicity would have more medical cannabis services. Methods In this cross-sectional study, we used data from the 2018 US Census Bureau 5-year American Community Survey and New York Medical Marijuana Program. Main exposures were census tract characteristics, including urban–rural classification, percentage of Black and Hispanic residents, percentage of residents with bachelor’s degrees or higher, and median household income. Main outcomes were presence of at least one medical cannabis certifying provider and dispensary in each census tract. To compare census tracts’ characteristics with (vs. without) certifying providers and dispensaries, we used chi-square tests and t-tests. To examine characteristics independently associated with (vs. without) certifying providers, we used multivariable logistic regression. Results Of 4858 New York census tracts, 1073 (22.1%) had medical cannabis certifying providers and 37 (0.8%) had dispensaries. Compared to urban census tracts, suburban census tracts were 62% less likely to have at least one certifying provider (aOR = 0.38; 95% CI = 0.25–0.57). For every 10% increase in the proportion of Black residents, a census tract was 5% less likely to have at least one certifying provider (aOR = 0.95; 95% CI = 0.92–0.99). For every 10% increase in the proportion of residents with bachelor’s degrees or higher, a census tract was 30% more likely to have at least one certifying provider (aOR = 1.30; 95% CI = 1.21–1.38). Census tracts with (vs. without) dispensaries were more likely to have a higher percentage of residents with bachelor’s degrees or higher (43.7% vs. 34.1%, p < 0.005). Conclusions In New York, medical cannabis services are least available in neighborhoods with Black residents and most available in urban neighborhoods with highly educated residents. Benefits of legal cannabis must be shared by communities disproportionately harmed by illegal cannabis.
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Affiliation(s)
- Chinazo O Cunningham
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
| | - Chenshu Zhang
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Maegan Hollins
- Northwestern University, 633 Clark St, Evanston, IL, 60208, USA
| | - Melinda Wang
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Sumeet Singh-Tan
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Paul J Joudrey
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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Abstract
Opioid Use Disorder Diagnosis and ManagementThe last 20 years have seen a staggering increase in opioid-related morbidity and mortality. Although the consequences of untreated OUDs are significant, OUD is a treatable illness. This article reviews the epidemiology of OUD and its complications, screening, diagnosis, treatment, and harm reduction interventions.
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Affiliation(s)
- Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
- Department of Quality, Patient Experience, and Equity, Mass General Brigham, Boston
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