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Ivasiy R, Madden LM, DiDomizio E, Johnson KA, Machavariani E, Ahmad B, Oliveros D, Ram A, Kil N, Altice FL. The cascade of care for commercially-insured persons with opioid use disorder and comorbid HIV and HCV infections. Drug Alcohol Depend 2024; 263:112410. [PMID: 39159600 DOI: 10.1016/j.drugalcdep.2024.112410] [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: 04/19/2024] [Revised: 07/17/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) significantly impacts individual and public health and exacerbated further by concurrent infectious diseases. A syndemic approach is needed to address the intertwined OUD, HIV, and HCV epidemics, including the expanded use of medications for opioid use disorder (MOUD). METHODS To identify MOUD scale-up opportunities, we conducted a retrospective cohort study, representing commercially insured persons, and created the OUD care continuum, including HIV and HCV influences in adults (18-64 years) newly diagnosed with OUD in 2019 using Merative MarketSan data. RESULTS Among 124,467,633 individuals, the prevalence of OUD was 0.4 % (95 % CI: 0.36 %-0.46 %; N = 497,871), with 327,277 (65.7 %, 95 % CI: 65.60 %-65.87 %) newly diagnosed in 2019. Among these newly diagnosed individuals (54 % men, mean age 44±0.01), 53,568 (27.0 %, 95 % CI: 26.4 %-27.5 %) were prescribed MOUD, with retention rates at 1, 3, and 6 months being 89.0 % (95 % CI: 88.2 %-89.8 %), 66.0 % (95 % CI: 64.8 %-67.2 %), and 50.3 % (95 % CI: 48.3 %-51.6 %), respectively. Buprenorphine was the most prescribed MOUD (79.6 %, 95 % CI: 78.6 %-80.7 %), followed by XR-NTX (14.9 %, 95 % CI:14.0 %-15.8 %) and methadone (5.5 %, 95 % CI: 4.9 %-6.1 %). Six-month retention was highest for methadone (73.4 %, 95 % CI: 73.0 %-73.8 %), however, followed by buprenorphine (55.7 %, 95 % CI: 55.3 %-57.1 %) and substantially lower for XR-NTX (12.6 %, 95 % CI: 10.6 %-14.6 %). Screening for HIV and HCV was low among OUD enrollees (11.1 %, 14.4 %), slightly higher for MOUD initiators (18.0 %, 21.6 %). Being prescribed MOUD was correlated with HCV infection (AOR: 2.54; 95 % CI: 2.41-2.68), HCV/HIV coinfection (AOR: 1.89; 95 % CI: 1.41-2.53), and hospitalization for OUD-related services (AOR: 1.14; 95 % CI: 1.11-1.17), yet hospitalization for OUD-related services was positively correlated with XR-NTX (AOR: 2.72; 95 % CI: 2.56-2.85) prescription and negatively with methadone (AOR: 0.19; 95 % CI: 0.16-0.23) prescription. Having HIV was negatively correlated with being prescribed methadone (AOR: 0.33; 95 % CI: 0.13-0.86). CONCLUSIONS Substantial gaps in the OUD cascade persist, underscoring better implementation opportunities for MOUD prescription in hospital-based settings and expanding access to methadone beyond highly regulated sites given its low coverage yet high treatment retention.
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Affiliation(s)
- Roman Ivasiy
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States.
| | - Lynn M Madden
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States
| | - Elizabeth DiDomizio
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Kimberly A Johnson
- College of Behavioral and Community Science, Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, United States
| | - Eteri Machavariani
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Bachar Ahmad
- Yale School of Medicine, New Haven, CT, United States
| | - David Oliveros
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - A Ram
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States
| | - Natalie Kil
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, United States; APT Foundation, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States; Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States; Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, United States.
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Stopka TJ, Rottapel R, Friedmann PD, Pivovarova E, Evans EA. Perceptions of extended-release buprenorphine among people who received medication for opioid use disorder in jail: a qualitative study. Addict Sci Clin Pract 2024; 19:68. [PMID: 39267138 PMCID: PMC11395844 DOI: 10.1186/s13722-024-00486-2] [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: 12/02/2023] [Accepted: 07/08/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Incarceration provides an opportunity for health interventions, including opioid use disorder (OUD) treatment and prevention of opioid-related overdoses post-release. All FDA-approved forms of medication for OUD (MOUD) treatment were mandated in several Massachusetts jails in 2019, with some jails offering extended-release buprenorphine (XR-Bup). Little is known about patient perspectives on and experiences with XR-Bup in carceral settings. METHODS We conducted semi-structured interviews in 2022 with community-dwelling people who received MOUD during a recent incarceration in a Massachusetts jail. We asked participants about their experiences with and perspectives on XR-Bup while in jail. Qualitative data were double-coded deductively and reviewed inductively to identify emergent themes, which were structured using the Theoretical Framework of Acceptability (TFA). RESULTS Participants (n = 38) had a mean age of 41.5 years, were 86% male, 84% White, 24% Hispanic, and 95% continued to receive MOUD at the time of their interview, including 11% receiving XR-Bup. Participants who viewed XR-Bup favorably appreciated avoiding the taste of sublingual buprenorphine; avoiding procedural difficulties and indignities associated with daily dosing in carceral settings (e.g., mouth checks, stigmatizing treatment from correctional staff); avoiding daily reminders of their addiction; experiencing less withdrawal; having extra time for other activities, such as work; and reduction of diversion of MOUD within the jail setting. Participants who viewed XR-Bup less favorably preferred to maintain their daily dosing routine; liked daily time out of their housing unit; wanted to know what was "going into my body everyday"; and feared needles and adverse events. Participants also reported that jail clinicians used XR-Bup for patients who were previously caught diverting sublingual buprenorphine, suggesting limited patient participation in decision-making around XR-Bup initiation in some jails. CONCLUSION People who received MOUD in Massachusetts jails had both favorable and unfavorable views and experiences with XR-Bup. Understanding these preferences can inform protocols in jails that are considering implementation of XR-Bup treatment.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Rebecca Rottapel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Peter D Friedmann
- Office of Research, University of MA Chan Medical School - Baystate and Baystate Health, Springfield, MA, USA
| | - Ekaterina Pivovarova
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
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Shearer R, Hagedorn H, Englander H, Siegler T, Kibben R, Fawole A, Patten A, Fitzpatrick A, Laes J, Fernando J, Appleton N, Oot E, Titus H, Krawczyk N, Weinstein Z, McNeely J, Baukol P, Ghitza U, Gustafson D, Bart G, Bazzi A. Barriers and facilitators to implementing treatment for opioid use disorder in community hospitals. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209520. [PMID: 39265915 DOI: 10.1016/j.josat.2024.209520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/19/2024] [Accepted: 09/08/2024] [Indexed: 09/14/2024]
Abstract
INTRODUCTION Methadone and buprenorphine are effective treatment for opioid use disorder (OUD), yet they are vastly under-utilized across US hospitals. To inform a national trial assessing the effectiveness of implementation strategies to increase adoption of an inpatient hospital-based opioid treatment (HBOT) model (NCT04921787), we explored barriers and facilitators to expanding medication for opioid use disorder (MOUD) within community hospitals across the United States. METHODS From November 2021 to March 2022, we used purposeful and snowball sampling to identify and interview participants involved in inpatient care of patients with OUD from twelve community hospitals. We conducted semi-structured interviews on providers' experiences and perspectives on current treatment approaches as well as potential influences on MOUD expansion in their hospitals. We used thematic analysis to identify key barriers and facilitators that could impact implementation of an HBOT model, and organized these findings based on the Consolidated Framework for Implementation Research (CFIR). RESULTS From qualitative interviews with 57 participants (30 physicians, 7 pharmacists, 6 nurses, and 14 professionals involved in the care of patients with OUD), we identified key barriers and facilitators mapped to CFIR's internal and outer settings. The most salient inner setting domains included tension for change and relative priority, compatibility, available resources, organizational culture, access to knowledge and information, relational connections and communications, and information technology infrastructure. Outer setting domains included policies and laws, financing, and partnerships and connections. CONCLUSIONS Identifying potential barriers and facilitators can inform hospital-specific strategies to support implementation of HBOT. Implementation strategies that address barriers such as staff availability, knowledge, and attitudes may support increased HBOT adoption. On a broader scale, national policy changes such as increased financing and public reporting of quality metrics would address other barriers we identified and may also encourage hospitals to adopt HBOT models.
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Affiliation(s)
- Riley Shearer
- University of Minnesota School of Public Health, Minneapolis, MN 55407, USA
| | - Hildi Hagedorn
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA
| | | | | | - Roxanne Kibben
- Hennepin Healthcare Research Institute, Minneapolis, MN 55415, USA
| | - Adetayo Fawole
- New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Alisa Patten
- Oregon Health and Science University, Portland, OR 97239, USA
| | - Amy Fitzpatrick
- Boston Medical Center and the Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - JoAn Laes
- Hennepin Healthcare Research Institute, Minneapolis, MN 55415, USA
| | - Jasmine Fernando
- New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Noa Appleton
- New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Emily Oot
- Boston University, Boston, MA 02215, USA
| | - Hope Titus
- Oregon Health and Science University, Portland, OR 97239, USA
| | - Noa Krawczyk
- New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Zoe Weinstein
- Boston Medical Center and the Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Jennifer McNeely
- New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Paulette Baukol
- Hennepin Healthcare Research Institute, Minneapolis, MN 55415, USA
| | - Udi Ghitza
- National Institute on Drug Abuse, North Bethesda, MD 20852, USA
| | | | - Gavin Bart
- Hennepin Healthcare, Minneapolis, MN 55415, USA
| | - Angela Bazzi
- University of California San Diego, La Jolla, CA 92093, USA.
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Shearer RD, Bart G, Beebe TJ, Virnig BA, Shippee ND, Winkelman TNA. Cross sectional analysis of an addiction consultation service, substance co-use patterns, and receipt of medications for opioid use disorder during hospitalization. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209505. [PMID: 39241929 DOI: 10.1016/j.josat.2024.209505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/19/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Despite effective medications for opioid use disorder (MOUD), treatment engagement remains low. As the overdose crisis is increasingly characterized by opioids co-used with other substances, it is important to understand whether existing models effectively support treatment for patients who use multiple substances. Hospital-based addiction consultation services (ACS) have shown promise at increasing MOUD initiation and treatment engagement, but the effectiveness for patients with specific co-use patterns remains unknown. METHODS Using 2016-2023 admissions data from a large safety net hospital, we estimated a random-effects logistic regression model to determine whether specific co-use (methamphetamine, cocaine, alcohol, sedative, and other) moderated the effect of being seen by ACS on the receipt of MOUD. Adjusting for patient sociodemographic, health, and admission characteristics we estimated the proportion of patients who received MOUD across specific co-use groups. RESULTS Of 7679 total admissions indicating opioid use, of which 5266 (68.6 %) indicated co-use of one or more substances and 2387 (31.1 %) were seen by the ACS. Among admissions not seen by the ACS, a smaller proportion of admissions with any co-use received MOUD (23.5 %; 95 % CI: 21.9-25.1) compared to admissions with opioid use alone (34.0 %; 95 % CI: 31.9-36.1). However, among admissions seen by the ACS a similar proportion of admissions with any co-use received MOUD (57.8 %; 95 % CI: 55.5-60.1) as admissions with opioid use alone (56.2 %; 95 % CI: 52.2-60.2). The increase in proportion of admissions receiving MOUD associated with being seen by the ACS was larger for admissions with methamphetamine (38.6 percentage points; 95 % CI: 34.6-42.6) or cannabis co-use (39.0 percentage points; 95 % CI: 32.9-45.1) compared to admissions without methamphetamine (25.7 percentage points; 95 % CI: 22.2-29.2) or cannabis co-use (29.1 percentage points; 95 % CI: 26.1-32.1). CONCLUSIONS The ACS is an effective hospital-based treatment model for increasing the proportion of admissions which receive MOUD. This study shows that ACSs are also able to support increased receipt of MOUD for patients who use other substances in addition to opioids. Future research is needed to further understand what transition strategies best support treatment linkage for patients who use multiple substances.
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Affiliation(s)
- Riley D Shearer
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN 55455, USA; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA.
| | - Gavin Bart
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, 900 S 8(th) St, Minneapolis, MN 55415, USA
| | - Timothy J Beebe
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN 55455, USA
| | - Beth A Virnig
- College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Gainsville, FL 32611, USA
| | - Nathan D Shippee
- University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN 55455, USA
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, 716 S 7(th) St, Minneapolis, MN 55415, USA
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Lowenstein M, Popova E, Jalloh A, Mazzella S, Botcheos D, Bertocchi J, Westfahl S, Garcia KP, Truchil R, Chertok J. The Mobile Overdose Response Program: A mobile, low-threshold opioid use disorder treatment model in Philadelphia. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209429. [PMID: 38857828 DOI: 10.1016/j.josat.2024.209429] [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: 12/31/2023] [Revised: 04/04/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Low-threshold substance use treatment programs may help overcome barriers for marginalized individuals. The aims of this study were to 1) describe participant characteristics and treatment outcomes for a multi-site, Philadelphia-based mobile program providing street-based buprenorphine initiation, stabilization, and referral to ongoing care and 2) examine associations between patient characteristics and successful linkage. METHODS We conducted a retrospective cohort study of patients receiving buprenorphine through Prevention Point Philadelphia's mobile overdose response program from 9/2020-12/2021. We abstracted electronic medical record data, including patient characteristics, mobile program treatment, and care linkage. We used descriptive statistics to characterize the sample and assessed the association between patient characteristics and successful care linkage using multi-variable logistic regression. RESULTS Two hundred thirty-seven patients initiated buprenorphine in the program across six sites. Mean age was 46. Participants were majority men (67 %); 59 % identified as Black, 33 % identified as White, and 15 % reported Hispanic ethnicity. Most were publicly insured (74 %) and 30 % were unstably housed. Basedline engagement in primary care (32 %), psychiatric treatment (5 %), and counseling (2 %) were low. Most participants reported heroin or fentanyl use at intake (87 %), with high rates of IV drug use (37 %)., and co-occurring substance use and prior buprenorphine treatment experience were common.. 86 % completed ≥1 mobile follow-up visit, and 69 % completed ≥4 mobile program visits. 51 % of patients attended at least one visit at an outside site, and 30 % had ≥2 visits for buprenorphine prescriptions at an outside site. 35 % of the referrals were internal, meaning they went to University-based practices staffed by the mobile unit physicians. In a multivariable logistic regression model, internal referral was associated with significantly increased odds of effective care linkage (aOR 2.47, 95 % CI 1.20-5.09). CONCLUSIONS Targeted community outreach with low-threshold substance use care facilitated treatment access among marginalized individuals. Participants showed high levels of engagement with the mobile program, but rates of outside care linkage, while comparable to retention in other low-threshold models, were lower. The only predictor of effective care linkage was referral to brick-and-mortar clinics staffed by mobile unit physicians. These findings support the importance of outreach beyond traditional health care settings to engage high-risk patients with OUD.
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Affiliation(s)
- Margaret Lowenstein
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Ellena Popova
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Aminata Jalloh
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Rachael Truchil
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Judy Chertok
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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McNeely J, Wang SS, Rostam Abadi Y, Barron C, Billings J, Tarpey T, Fernando J, Appleton N, Fawole A, Mazumdar M, Weinstein ZM, Kalyanaraman Marcello R, Dolle J, Cooke C, Siddiqui S, King C. Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:1106-1115. [PMID: 39073796 PMCID: PMC11287446 DOI: 10.1001/jamainternmed.2024.3422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/29/2024] [Indexed: 07/30/2024]
Abstract
Importance Medications for opioid use disorder (MOUD) are highly effective, but only 22% of individuals in the US with opioid use disorder receive them. Hospitalization potentially provides an opportunity to initiate MOUD and link patients to ongoing treatment. Objective To study the effectiveness of interprofessional hospital addiction consultation services in increasing MOUD treatment initiation and engagement. Design, Setting, and Participants This pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) trial was conducted in 6 public hospitals in New York, New York, and included 2315 adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Data analysis was conducted in December 2023. Hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Bayesian analysis accounted for the clustering of patients within hospitals and open cohort nature of the study. The addiction consultation service intervention was compared with TAU using posterior probabilities of model parameters from hierarchical logistic regression models that were adjusted for age, sex, and study period. Eligible participants had an admission or discharge diagnosis of opioid use disorder or opioid poisoning/adverse effects, were hospitalized at least 1 night in a medical/surgical inpatient unit, and were not receiving MOUD before hospitalization. Interventions Hospitals implemented an addiction consultation service that provided inpatient specialty care for substance use disorders. Consultation teams comprised a medical clinician, social worker or addiction counselor, and peer counselor. Main Outcomes and Measures The dual primary outcomes were (1) MOUD treatment initiation during the first 14 days after hospital discharge and (2) MOUD engagement for the 30 days following initiation. Results Of 2315 adults, 628 (27.1%) were female, and the mean (SD) age was 47.0 (12.4) years. Initiation of MOUD was 11.0% in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program vs 6.7% in TAU, engagement was 7.4% vs 5.3%, respectively, and continuation for 6 months was 3.2% vs 2.4%. Patients hospitalized during CATCH had 7.96 times higher odds of initiating MOUD (log-odds ratio, 2.07; 95% credible interval, 0.51-4.00) and 6.90 times higher odds of MOUD engagement (log-odds ratio, 1.93; 95% credible interval, 0.09-4.18). Conclusions This randomized clinical trial found that interprofessional addiction consultation services significantly increased postdischarge MOUD initiation and engagement among patients with opioid use disorder. However, the observed rates of MOUD initiation and engagement were still low; further efforts are still needed to improve hospital-based and community-based services for MOUD treatment. Trial Registration ClinicalTrials.gov Identifier: NCT03611335.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Scarlett S. Wang
- New York University Robert F. Wagner Graduate School of Public Service, New York
| | - Yasna Rostam Abadi
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Charles Barron
- Office of Behavioral Health, New York City Health + Hospitals, New York, New York
| | - John Billings
- New York University Robert F. Wagner Graduate School of Public Service, New York
| | - Thaddeus Tarpey
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Jasmine Fernando
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Noa Appleton
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Adetayo Fawole
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Zoe M. Weinstein
- Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston Medical Center, Boston, Massachusetts
| | | | - Johanna Dolle
- Office of Population Health, New York City Health + Hospitals, New York, New York
| | - Caroline Cooke
- Office of Population Health, New York City Health + Hospitals, New York, New York
| | - Samira Siddiqui
- Office of Behavioral Health, New York City Health + Hospitals, New York, New York
| | - Carla King
- Department of Population Health, New York University Grossman School of Medicine, New York
- Office of Behavioral Health, New York City Health + Hospitals, New York, New York
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Dahlem CH, Dwan M, Dobbs B, Rich R, Jaffe K, Shuman CJ. Using RE-AIM Framework to Evaluate Recovery Opioid Overdose Team Plus: A Peer-Led Post-overdose Quick Response Team. Community Ment Health J 2024:10.1007/s10597-024-01319-x. [PMID: 39044057 DOI: 10.1007/s10597-024-01319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024]
Abstract
Peer recovery coaches utilize their lived experiences to support overdose survivors, a role gaining prominence across communities. A convergent mixed methods design, informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, was used to evaluate the Recovery Opioid Overdose Team Plus (ROOT +), through an iterative evaluation using web-based surveys and qualitative interviews. Reach: Over 27 months, ROOT + responded to 83% of suspected overdose referrals (n = 607) and engaged with 41% of survivors (n = 217) and 7% of survivors' family/friends (n = 38). Effectiveness: Among those initially engaged with ROOT +, 36% of survivors remained engaged, entered treatment, or were in recovery at 90 days post-overdose (n = 77). Adoption: First responders completed 77% of ROOT + referrals (n = 468). Implementation: Barriers included lack of awareness of ROOT + , working phones, and access to treatment from community partner interviews (n = 15). Maintenance: Adaptations to ROOT + were made to facilitate implementation. Peer-led teams are promising models to engage with overdose survivors.
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Affiliation(s)
- Chin Hwa Dahlem
- School of Nursing, University of Michigan, 400 N. Ingalls Rm 3174, Ann Arbor, MI, USA.
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan, Ann Arbor, MI, USA.
| | - Mary Dwan
- School of Nursing, University of Michigan, 400 N. Ingalls Rm 3174, Ann Arbor, MI, USA
| | | | | | - Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Clayton J Shuman
- School of Nursing, University of Michigan, 400 N. Ingalls Rm 3174, Ann Arbor, MI, USA
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Kopak AM, Thomas SD. Jail Characteristics and Availability of Opioid Treatment Services: Results from a Nationally Representative Survey. J Behav Health Serv Res 2024; 51:313-324. [PMID: 38519625 DOI: 10.1007/s11414-024-09881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
The current wave of the opioid epidemic has contributed to a record number of drug-related overdoses and a significant proportion of people who experience opioid use disorder are admitted to local jails. These correctional facilities serve as the principal entry point to the criminal justice system as nearly every person who is taken into custody is admitted to a local detention center. Although jails are recognized as primary intervention points for people who may require treatment for opioid use disorder, services in these facilities remain deficient. The absence of jail-based treatment has become a pressing concern as the number of drug-related deaths in custody continues to rise and the risk of post-release overdose also remains high. The present study draws on the opioid-related module of the 2019 Bureau of Justice Statistics' Census of Jails to assess the relationships between the characteristics of 2588 local detention centers and the availability of treatment services. These specific approaches included screening for opioid use disorder, providing medication to manage withdrawal symptoms, administering medication for opioid use disorder (MOUD), providing overdose reversal medication at the time of release, and linking people with community-based care following release from the detention center. The results demonstrate facilities located in the Northeast, larger jails, those in urban areas, and detention centers with higher turnover rates are significantly more likely to provide a wider variety of opioid treatment services. These findings have important implications for the prioritization of policies and the allocation of resources to support the adoption of opioid treatment services in local jails.
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Affiliation(s)
- Albert M Kopak
- UNC Health Sciences at the Mountain Area Health Education Center (MAHEC), 121 Hendersonville Road, Asheville, NC, 28803, USA.
| | - Sierra D Thomas
- UNC Health Sciences at the Mountain Area Health Education Center (MAHEC), 121 Hendersonville Road, Asheville, NC, 28803, USA
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Pro G, Cantor J, Buttram M, Brown CC, Gu M, Mancino M, Zaller N. Geographic and Racial/Ethnic Differences in Access to Methamphetamine Detoxification Services, United States, 2021. Med Care 2024; 62:464-472. [PMID: 38761164 DOI: 10.1097/mlr.0000000000002013] [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: 05/20/2024]
Abstract
INTRODUCTION Methamphetamine detoxification before entering formal and longer term treatment may have a positive impact on treatment retention and success. Understanding geographic distribution of methamphetamine specialty detox services and differential access by race/ethnicity is critical for establishing policies that ensure equitable access across populations. METHODS We used the Mental health and Addiction Treatment Tracking Repository to identify treatment facilities that offered any substance use detoxification in 2021 (N=2346) as well as the census block group in which they were located. We sourced data from the US Census Bureau to identify the percentage of a census block group that was White, Black, and Hispanic. We used logistic regression to model the availability of methamphetamine-specific detox, predicted by the percentage of a block group that was Black and Hispanic. We adjusted for relevant covariates and defined state as a random effect. We calculated model-based predicted probabilities. RESULTS Over half (60%) of detox facilities offered additional detox services specifically for methamphetamine. Sixteen states had <10 methamphetamine-specific detox facilities. The predicted probability of methamphetamine-specific detox availability was 60% in census block groups with 0%-9% Black residents versus only 46% in census block groups with 90%-100% Black residents, and was 61% in census block groups with 0%-9% Hispanic residents versus 30% in census block groups with 90%-100% Hispanic residents. CONCLUSIONS During an unprecedented national methamphetamine crisis, access to a critical health care service was disproportionately lower in communities that were predominately Black and Hispanic. We orient our findings around a discussion of health disparities, residential segregation, and the upstream causes of the systematic exclusion of minoritized communities from health care.
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Affiliation(s)
- George Pro
- Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Mance Buttram
- Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR
- Center for Public Health and Technology, University of Arkansas, Fayetteville, AR
| | - Clare C Brown
- Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mofan Gu
- Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Michael Mancino
- Center for Addiction Research, Psychiatric Research Institute, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Nickolas Zaller
- Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
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Kimmel SD, Walley AY, White LF, Yan S, Grella C, Majeski A, Stein MD, Bettano A, Bernson D, Drainoni ML, Samet JH, Larochelle MR. Medication for Opioid Use Disorder After Serious Injection-Related Infections in Massachusetts. JAMA Netw Open 2024; 7:e2421740. [PMID: 39046742 PMCID: PMC11270137 DOI: 10.1001/jamanetworkopen.2024.21740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/10/2024] [Indexed: 07/25/2024] Open
Abstract
Importance Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap. Objectives To examine rehospitalization, death rates, and MOUD receipt for individuals with SIRIs and to assess characteristics associated with MOUD receipt. Design, Setting, and Participants This retrospective cohort study used the Massachusetts Public Health Data Warehouse, which included all individuals with a claim in the All-Payer Claims Database and is linked to individual-level data from multiple government agencies, to assess individuals aged 18 to 64 years with opioid use disorder and hospitalization for endocarditis, osteomyelitis, epidural abscess, septic arthritis, or bloodstream infection (ie, SIRI) between July 1, 2014, and December 31, 2019. Data analysis was performed from November 2021 to May 2023. Exposure Demographic and clinical factors potentially associated with posthospitalization MOUD receipt. Main Outcomes and Measures The main outcome was MOUD receipt measured weekly in the 12 months after hospitalization. We used zero-inflated negative binomial regression to examine characteristics associated with any MOUD receipt and rates of treatment in the 12 months after hospitalization. Secondary outcomes were receipt of any buprenorphine formulation, methadone, and extended-release naltrexone examined individually. Results Among 8769 individuals (mean [SD] age, 43.2 [12.0] years; 5066 [57.8%] male) who survived a SIRI hospitalization, 4305 (49.1%) received MOUD, 5919 (67.5%) were rehospitalized, and 973 (11.1%) died within 12 months. Of those treated with MOUD in the 12 months after hospitalization, the mean (SD) number of MOUD initiations during follow-up was 3.0 (1.7), with 956 of 4305 individuals (22.2%) receiving treatment at least 80% of the time. MOUD treatment after SIRI hospitalization was significantly associated with MOUD in the prior 6 months (buprenorphine: adjusted odds ratio [AOR], 16.51; 95% CI, 13.81-19.74; methadone: AOR, 28.46; 95% CI, 22.41-36.14; or naltrexone: AOR, 2.05; 95% CI, 1.56-2.69). Prior buprenorphine (incident rate ratio [IRR], 1.17; 95% CI, 1.11-1.24) or methadone (IRR, 1.89; 95% CI, 1.79-2.01) use was associated with higher treatment rates after hospitalization, and prior naltrexone use (IRR, 0.86; 95% CI, 0.77-0.95) was associated with lower rates. Conclusions and Relevance This study found that in the year after a SIRI hospitalization in Massachusetts, mortality and rehospitalization were common, and only half of patients received MOUD. Treatment with MOUD before a SIRI was associated with posthospitalization MOUD initiation and time receiving MOUD. Efforts are needed to initiate MOUD treatment during SIRI hospitalizations and subsequently retain patients in treatment.
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Affiliation(s)
- Simeon D. Kimmel
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Alexander Y. Walley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Shapei Yan
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Christine Grella
- Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles
- Lighthouse Institute, Chestnut Health Systems, Chicago, Illinois
| | - Adam Majeski
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Michael D. Stein
- Department of Health, Law and Policy, Boston University School of Public Health, Boston, Massachusetts
| | - Amy Bettano
- Office of Population Health, Department of Public Health, Commonwealth of Massachusetts, Boston
| | - Dana Bernson
- Office of Population Health, Department of Public Health, Commonwealth of Massachusetts, Boston
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
- Department of Health, Law and Policy, Boston University School of Public Health, Boston, Massachusetts
- Evans Center for Implementation and Improvement Sciences, Boston University, Boston, Massachusetts
| | - Jeffrey H. Samet
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Marc R. Larochelle
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
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11
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James H, Morgan J, Nolan S. Characterising individuals with a substance use disorder accessing hospital-based addiction care: Preliminary description of the outcomes for patients accessing addiction care prospective cohort study. Drug Alcohol Rev 2024. [PMID: 38867512 DOI: 10.1111/dar.13888] [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: 09/16/2023] [Revised: 05/01/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Individuals with a substance use disorder (SUD) often face barriers to accessing health care, resulting in unmet needs and delayed care. Hospital-based services have the potential to engage individuals with a SUD in ongoing treatment, but there is limited literature characterising this population. METHODS The Outcomes for Patients Accessing Addiction Care study was a prospective hospital-based cohort study conducted at St. Paul's Hospital in Vancouver, Canada. Participants were recruited from January 2018 to March 2020. Data were collected through an interviewer-administered questionnaire, including socio-demographic information, substance use history and mental health screening. RESULTS The cohort included 536 participants, with 31% aged 30-39 years, 63% identifying as White and 74% reporting male sex at birth. Nearly half of the participants were either homeless or living in single room occupancy. Use of substances more than once per week was reported for tobacco/nicotine (86%), marijuana (43%), non-medical use of prescription drugs (29%), illicit stimulants (52%) and illicit opioids (61%). DISCUSSION AND CONCLUSION This preliminary report provides a description of a hospital-based cohort of individuals with a SUD accessing addiction care. The findings highlight demographic characteristics, mental health issues, substance use patterns and barriers to accessing services. Understanding these factors can inform the development of patient-centred interventions and improve engagement and retention in addiction care. Further research is needed to explore interventions and program effectiveness in this population.
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Affiliation(s)
- Hannah James
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey Morgan
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Salvi A, Gillenwater LA, Cockrum BP, Wiehe SE, Christian K, Cayton J, Bailey T, Schwartz K, Dir AL, Ray B, Aalsma MC, Reda K. Development of a Real-Time Dashboard for Overdose Touchpoints: User-Centered Design Approach. JMIR Hum Factors 2024; 11:e57239. [PMID: 38861717 PMCID: PMC11200046 DOI: 10.2196/57239] [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: 02/08/2024] [Revised: 03/24/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Overdose Fatality Review (OFR) is an important public health tool for shaping overdose prevention strategies in communities. However, OFR teams review only a few cases at a time, which typically represent a small fraction of the total fatalities in their jurisdiction. Such limited review could result in a partial understanding of local overdose patterns, leading to policy recommendations that do not fully address the broader community needs. OBJECTIVE This study explored the potential to enhance conventional OFRs with a data dashboard, incorporating visualizations of touchpoints-events that precede overdoses-to highlight prevention opportunities. METHODS We conducted 2 focus groups and a survey of OFR experts to characterize their information needs and design a real-time dashboard that tracks and measures decedents' past interactions with services in Indiana. Experts (N=27) were engaged, yielding insights on essential data features to incorporate and providing feedback to guide the development of visualizations. RESULTS The findings highlighted the importance of showing decedents' interactions with health services (emergency medical services) and the justice system (incarcerations). Emphasis was also placed on maintaining decedent anonymity, particularly in small communities, and the need for training OFR members in data interpretation. The developed dashboard summarizes key touchpoint metrics, including prevalence, interaction frequency, and time intervals between touchpoints and overdoses, with data viewable at the county and state levels. In an initial evaluation, the dashboard was well received for its comprehensive data coverage and its potential for enhancing OFR recommendations and case selection. CONCLUSIONS The Indiana touchpoints dashboard is the first to display real-time visualizations that link administrative and overdose mortality data across the state. This resource equips local health officials and OFRs with timely, quantitative, and spatiotemporal insights into overdose risk factors in their communities, facilitating data-driven interventions and policy changes. However, fully integrating the dashboard into OFR practices will likely require training teams in data interpretation and decision-making.
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Affiliation(s)
- Amey Salvi
- School of Informatics, Computing, and Engineering, Indiana University Indianapolis, Indianapolis, IN, United States
| | - Logan A Gillenwater
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brandon P Cockrum
- Indiana Clinical and Translational Science Institute, Indianapolis, IN, United States
| | - Sarah E Wiehe
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- Indiana Clinical and Translational Science Institute, Indianapolis, IN, United States
| | | | - John Cayton
- Indiana Management Performance Hub, Indianapolis, IN, United States
| | - Timothy Bailey
- Indiana Management Performance Hub, Indianapolis, IN, United States
| | - Katherine Schwartz
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Allyson L Dir
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bradley Ray
- RTI International, Research Triangle Park, NC, United States
| | - Matthew C Aalsma
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Khairi Reda
- School of Informatics, Computing, and Engineering, Indiana University Indianapolis, Indianapolis, IN, United States
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13
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Englander H, Thakrar AP, Bagley SM, Rolley T, Dong K, Hyshka E. Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl: A Review. JAMA Intern Med 2024; 184:691-701. [PMID: 38683591 DOI: 10.1001/jamainternmed.2023.7282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Importance The rise of fentanyl and other high-potency synthetic opioids across US and Canada has been associated with increasing hospitalizations and unprecedented overdose deaths. Hospitalization is a critical touchpoint to engage patients and offer life-saving opioid use disorder (OUD) care when admitted for OUD or other medical conditions. Observations Clinical best practices include managing acute withdrawal and pain, initiating medication for OUD, integrating harm reduction principles and practices, addressing in-hospital substance use, and supporting hospital-to-community care transitions. Fentanyl complicates hospital OUD care. Fentanyl's high potency intensifies pain, withdrawal, and cravings and increases the risk for overdose and other harms. Fentanyl's unique pharmacology has rendered traditional techniques for managing opioid withdrawal and initiating buprenorphine and methadone inadequate for some patients, necessitating novel strategies. Further, co-use of opioids with stimulants drugs is common, and the opioid supply is unpredictable and can be contaminated with benzodiazepines, xylazine, and other substances. To address these challenges, clinicians are increasingly relying on emerging practices, such as low-dose buprenorphine initiation with opioid continuation, rapid methadone titration, and the use of alternative opioid agonists. Hospitals must also reconsider conventional approaches to in-hospital substance use and expand clinicians' understanding and embrace of harm reduction, which is a philosophy and set of practical strategies that supports people who use drugs to be safer and healthier without judgment, coercion, or discrimination. Hospital-to-community care transitions should ensure uninterrupted access to OUD care after discharge, which requires special consideration and coordination. Finally, improving hospital-based addiction care requires dedicated infrastructure and expertise. Preparing hospitals across the US and Canada to deliver OUD best practices requires investments in clinical champions, staff education, leadership commitment, community partnerships, quality metrics, and financing. Conclusions and Relevance The findings of this review indicate that fentanyl creates increased urgency and new challenges for hospital OUD care. Hospital clinicians and systems have a central role in addressing the current drug crisis.
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Affiliation(s)
- Honora Englander
- Section of Addiction Medicine in General Internal Medicine and the Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland
| | - Ashish P Thakrar
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sarah M Bagley
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | | | - Kathryn Dong
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Barrett M, Kemerer S, Colvard M. Implementation and evaluation of interprofessional overdose review team recommendations following intentional or accidental overdose events. Ment Health Clin 2024; 14:224-228. [PMID: 38835812 PMCID: PMC11147656 DOI: 10.9740/mhc.2024.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 06/06/2024] Open
Abstract
Drug overdose death rates in the United States remain high despite efforts to mitigate this risk. Many communities and hospitals across the country have implemented overdose review teams, including local overdose fatality review teams or postoverdose intervention programs, to address the opioid crisis. The goal of most of these teams is to identify missed opportunities or patient-specific interventions to prevent future opioid overdose fatalities. Few overdose review teams review a combination of both fatal and nonfatal overdose events. The Veterans Affairs Tennessee Valley Healthcare System implemented a novel overdose review team (ORT) that collaboratively reviews all overdose incidents regardless of fatality, intent, or substance involved. This practice description characterizes reported facility overdose events and patient-specific risk-mitigation strategies recommended by the ORT, highlights the implementation rate and time to implementation of ORT recommendations, and discusses potential areas for process improvement. This practice highlights the potential impact of a pharmacist-led, interdisciplinary ORT following accidental or intentional overdose events involving any substance or medication. Key patient-specific interventions implemented following ORT recommendations included overdose prevention education and naloxone distribution, prescribing of medications for opioid use disorder and/or alcohol use disorder, reducing medication supply to limit lethal means access, and facilitation of mental health and/or substance use disorder specialty appointments. Further research to evaluate clinical outcomes related to specific ORT interventions should be considered.
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Affiliation(s)
- Monica Barrett
- (Corresponding author) Clinical Pharmacy Practitioner, Veterans Affairs Tennessee Valley Healthcare System, Murfreesboro, Tennessee,
| | - Sarah Kemerer
- Clinical Pharmacy Practitioner, Ralph H. Johnson Veterans Affairs Medical Center, Hinesville, Georgia
| | - Michelle Colvard
- Clinical Pharmacy Specialist, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
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15
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Machavariani E, Miceli J, Altice FL, Neblett Fanfair R, Speers S, Nichols L, Jenkins H, Villanueva M. Using Data-To-Care Strategies to Optimize the HIV Care Continuum in Connecticut: Results From a Randomized Controlled Trial. J Acquir Immune Defic Syndr 2024; 96:40-50. [PMID: 38324241 PMCID: PMC11009056 DOI: 10.1097/qai.0000000000003391] [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: 09/27/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Re-engaging people with HIV who are newly out-of-care remains challenging. Data-to-care (D2C) is a potential strategy to re-engage such individuals. METHODS A prospective randomized controlled trial compared a D2C strategy using a disease intervention specialist (DIS) vs standard of care where 23 HIV clinics in 3 counties in Connecticut could re-engage clients using existing methods. Using a data reconciliation process to confirm being newly out-of-care, 655 participants were randomized to DIS (N = 333) or standard of care (N = 322). HIV care continuum outcomes included re-engagement at 90 days, retention in care, and viral suppression by 12 months. Multivariable regression models were used to assess factors predictive of attaining HIV care continuum outcomes. RESULTS Participants randomized to DIS were more likely to be re-engaged at 90 days (adjusted odds ratios [aOR] = 1.42, P = 0.045). Independent predictors of re-engagement at 90 days were age older than 40 years (aOR = 1.84, P = 0.012) and perinatal HIV risk category (aOR = 3.19, P = 0.030). Predictors of retention at 12 months included re-engagement at 90 days (aOR = 10.31, P < 0.001), drug injection HIV risk category (aOR = 1.83, P = 0.032), detectable HIV-1 RNA before randomization (aOR = 0.40, P = 0.003), and county (Hartford aOR = 1.74, P = 0.049; New Haven aOR = 1.80, P = 0.030). Predictors of viral suppression included re-engagement at 90 days (aOR = 2.85, P < 0.001), retention in HIV care (aOR = 7.07, P < 0.001), and detectable HIV-1 RNA prerandomization (aOR = 0.23, P < 0.001). CONCLUSIONS A D2C strategy significantly improved re-engagement at 90 days. Early re-engagement improved downstream benefits along the HIV care continuum like retention in care and viral suppression at 12 months. Moreover, other factors predictive of care continuum outcomes can be used to improve D2C strategies.
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Affiliation(s)
- Eteri Machavariani
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Janet Miceli
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Frederick L. Altice
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Lisa Nichols
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Heidi Jenkins
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Merceditas Villanueva
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
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Bart G, Korthuis PT, Donohue JM, Hagedorn HJ, Gustafson DH, Bazzi AR, Enns E, McNeely J, Ghitza UE, Magane KM, Baukol P, Vena A, Harris J, Voronca D, Saitz R. Exemplar Hospital initiation trial to Enhance Treatment Engagement (EXHIT ENTRE): protocol for CTN-0098B a randomized implementation study to support hospitals in caring for patients with opioid use disorder. Addict Sci Clin Pract 2024; 19:29. [PMID: 38600571 PMCID: PMC11007900 DOI: 10.1186/s13722-024-00455-9] [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: 02/10/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Hospitalizations involving opioid use disorder (OUD) are increasing. Medications for opioid use disorder (MOUD) reduce mortality and acute care utilization. Hospitalization is a reachable moment for initiating MOUD and arranging for ongoing MOUD engagement following hospital discharge. Despite existing quality metrics for MOUD initiation and engagement, few hospitals provide hospital based opioid treatment (HBOT). This protocol describes a cluster-randomized hybrid type-2 implementation study comparing low-intensity and high-intensity implementation support strategies to help community hospitals implement HBOT. METHODS Four state implementation hubs with expertise in initiating HBOT programs will provide implementation support to 24 community hospitals (6 hospitals/hub) interested in starting HBOT. Community hospitals will be randomized to 24-months of either a low-intensity intervention (distribution of an HBOT best-practice manual, a lecture series based on the manual, referral to publicly available resources, and on-demand technical assistance) or a high-intensity intervention (the low-intensity intervention plus funding for a hospital HBOT champion and regular practice facilitation sessions with an expert hub). The primary efficacy outcome, adapted from the National Committee on Quality Assurance, is the proportion of patients engaged in MOUD 34-days following hospital discharge. Secondary and exploratory outcomes include acute care utilization, non-fatal overdose, death, MOUD engagement at various time points, hospital length of stay, and discharges against medical advice. Primary, secondary, and exploratory outcomes will be derived from state Medicaid data. Implementation outcomes, barriers, and facilitators are assessed via longitudinal surveys, qualitative interviews, practice facilitation contact logs, and HBOT sustainability metrics. We hypothesize that the proportion of patients receiving care at hospitals randomized to the high-intensity arm will have greater MOUD engagement following hospital discharge. DISCUSSION Initiation of MOUD during hospitalization improves MOUD engagement post hospitalization. Few studies, however, have tested different implementation strategies on HBOT uptake, outcome, and sustainability and only one to date has tested implementation of a specific type of HBOT (addiction consultation services). This cluster-randomized study comparing different intensities of HBOT implementation support will inform hospitals and policymakers in identifying effective strategies for promoting HBOT dissemination and adoption in community hospitals. TRIAL REGISTRATION NCT04921787.
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Affiliation(s)
- Gavin Bart
- Department of Medicine, Hennepin Healthcare and University of Minnesota, 701 Park Avenue, Minneapolis, MN, 55415, USA.
| | - P Todd Korthuis
- Department of Medicine, Addiction Medicine Section, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, 97239-3098, Portland, OR, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, 15261, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, University of Minnesota, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Dave H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin, 1513 University Ave., Madison, WI, 53706, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego; La Jolla, CA, USA
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
| | - Eva Enns
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, Minneapolis, MN, 55408, USA
| | - Jennifer McNeely
- Department of Population Health, Section on Alcohol, Tobacco and Drug Use, NYU School of Medicine, 180 Madison Avenue, 17th floor, New York, NY, 10016, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Udi E Ghitza
- National Institute on Drug Abuse (NIDA) Center for the Clinical Trials Network (CCTN), Bethesda, MD, 20892, USA
| | - Kara M Magane
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
| | - Paulette Baukol
- Berman Center for Outcomes & Clinical Research, 701 Park Ave, Ste. PP7.700, Minneapolis, MN, 55415, USA
| | - Ashley Vena
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
| | - Jacklyn Harris
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
| | - Delia Voronca
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
- Currently: Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, Deceased, NY, 10591-6707, USA
| | - Richard Saitz
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
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Mason M, Pandya K, Lundberg A. Older adult drug overdose: an application of latent class analysis to identify prevention opportunities. Harm Reduct J 2024; 21:61. [PMID: 38481307 PMCID: PMC10936079 DOI: 10.1186/s12954-024-00973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Older adult overdose death rates have increased significantly in recent years. However, research for prevention of drug overdose death specific to older adults is limited. Our objective is to identify profiles based on missed intervention points (touchpoints) to inform prevention of future older adult unintentional overdose deaths. METHODS We used latent class analysis methods to identify profiles of decedents aged 55 + years in the Illinois Statewide Unintentional Drug Overdose Reporting System. This system collects data on 92.6% of all unintentional overdose deaths in Illinois and includes data from death certificates, coroner/medical examiner, toxicology, and autopsy reports. Data include decedent demographics, circumstances leading up to and surrounding the fatal overdose and details regarding the overdose. Variables in the latent class analysis model included sex, race, alcohol test result, social isolation, recent emergency department (ED) visit, chronic pain, and pain treatment. RESULTS We identified three distinct decent profiles. Class 1 (13% of decedents) included female decedents who were in pain treatment, had physical health problems, and had greater likelihood of a recent ED visit before their death. Class 2 (35% of decedents) decedents were most likely to be socially connected (live with others, employed, had social or family relationships) but less likely to have recent healthcare visits. Class 3 (52% of decedents) decedents had higher social isolation (lived alone, unemployed, unpartnered), were mostly male, had fewer known physical health conditions, and more alcohol positivity at time of death. White decedents are clustered in class 1 while Black decedents are predominant in classes 2 and 3. CONCLUSIONS These profiles link to potential touchpoint opportunities for substance use disorder screening harm reduction and treatment. Class 1 members were most likely to be reachable in healthcare settings. However, most decedents were members of Classes 2 and 3 with less engagement in the healthcare system, suggesting a need for screening and intervention in different contexts. For Class 2, intervention touchpoints might include education and screening in work or social settings such as senior centers given the higher degree of social connectivity. For Class 3, the most isolated group, touchpoints may occur in the context of harm reduction outreach and social service delivery.
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Affiliation(s)
- Maryann Mason
- Buehler Center for Health Policy and Economics, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA.
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA.
| | - Kaveet Pandya
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA
| | - Alexander Lundberg
- Buehler Center for Health Policy and Economics, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St. 9th floor, Chicago, IL, 60611, USA
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18
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Krawczyk N, Rivera BD, Chang JE, Lindenfeld Z, Franz B. Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals. J Addict Med 2024; 18:115-121. [PMID: 38015653 PMCID: PMC10939963 DOI: 10.1097/adm.0000000000001250] [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: 11/30/2023]
Abstract
BACKGROUND Hospitals are a key touchpoint to reach patients with substance use disorders (SUDs) and link them with ongoing community-based services. Although there are many acute care interventions to initiate SUD treatment in hospital settings, less is known about what services are offered to transition patients to ongoing care after discharge. In this study, we explore what SUD care transition strategies are offered across nonprofit US hospitals. METHODS We analyzed administrative documents from a national sample of US hospitals that indicated SUD as a top 5 significant community need in their Community Health Needs Assessment reports (2019-2021). Data were coded and categorized based on the nature of described services. We used data on hospitals and characteristics of surrounding counties to identify factors associated with hospitals' endorsement of transition interventions for SUD. RESULTS Of 613 included hospitals, 313 prioritized SUD as a significant community need. Fifty-three of these hospitals (17%) offered acute care interventions to support patients' transition to community-based SUD services. Most (68%) of the 53 hospitals described transition strategies without further detail, 23% described scheduling appointments before discharge, and 11% described discussing treatment options before discharge. No hospital characteristics were associated with offering transition interventions, but such hospitals were more likely to be in the Northeast, in counties with higher median income, and states that expanded Medicaid. CONCLUSIONS Despite high need, most US hospitals are not offering interventions to link patients with SUD from acute to community care. Efforts to increase acute care interventions for SUD should identify and implement best practices to support care continuity.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine
| | - Bianca D. Rivera
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine
| | - Ji E. Chang
- Department of Public Health Policy and Management, New York University School of Global Public Health
| | - Zoe Lindenfeld
- Department of Public Health Policy and Management, New York University School of Global Public Health
| | - Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine; Appalachian Institute to Advance Health Equity Science (ADVANCE)
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19
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Thakarar K, Appa A, Abdul Mutakabbir JC, Goff A, Brown J, Tuell C, Fairfield K, Wurcel A. Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections. Clin Infect Dis 2024; 78:e12-e26. [PMID: 38018174 DOI: 10.1093/cid/ciad664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Kinna Thakarar
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine at San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
| | - Jacinda C Abdul Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla, California, USA
- Division of the Black Diaspora and African American Studies, University of California-San Diego, La Jolla, California, USA
| | - Amelia Goff
- Section of Addiction Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Jessica Brown
- Department of Care Management, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Kathleen Fairfield
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Alysse Wurcel
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medicine, Boston, Massachusetts, USA
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20
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Ericson ØB, Eide D, Lobmaier P, Clausen T. Mortality risk and causes of death among people who use opioids in a take-home naloxone cohort. Drug Alcohol Depend 2024; 255:111087. [PMID: 38228056 DOI: 10.1016/j.drugalcdep.2024.111087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND People who use opioids (PWUO) have an excess mortality from a range of causes. The cumulative effect of behavioral, social, and health risk factors complicates the interpretation of the effects of suitable interventions. This study explores mortality causes among a cohort of PWUO in the take-home naloxone (THN) program. METHODS This was a prospective cohort study of PWUO who received THN between 2015 and 2023. Participant data was linked with death registry data. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all causes, internal causes, and accidental opioid overdoses (AOOs). In addition to age and gender, risk factors like main route of administration, polydrug use, self-experienced overdoses, and using while alone were fitted in a Cox Regression model to explore factors associated with mortality. RESULTS The 2194 participants had a considerably higher mortality ratio for all causes investigated when compared to the general population (SMR=10.9, 95 % CI = 9.3,12.6). AOOs were the most prevalent cause of death (49 %). Those who reported frequent opioid use while alone had an elevated risk of dying of 2.6 (95 % CI = 1.1,6.4) compared to those who never used while alone. CONCLUSIONS Frequent opioid use while alone was associated with elevated mortality risk, supporting the importance of overdose prevention education with naloxone distribution, and additional efforts to improve environmental and social areas for safer drug-use practices among PWUO. The variety of mortality causes found in this study illustrates the need for multifaceted and targeted interventions for people at risk of overdosing.
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Affiliation(s)
- Øystein Bruun Ericson
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway.
| | - Desiree Eide
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway
| | - Philipp Lobmaier
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway; Diakonhjemmet Hospital, Division of Mental Health and Substance Abuse, P.O. box 23 Vinderen, Oslo 0319, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. box 1039 Blindern, Oslo 0315, Norway
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21
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Booth RG, Shariff SZ, Carter B, Hwang SW, Orkin AM, Forchuk C, Gomes T. Opioid-related overdose deaths among people experiencing homelessness, 2017 to 2021: A population-based analysis using coroner and health administrative data from Ontario, Canada. Addiction 2024; 119:334-344. [PMID: 37845790 DOI: 10.1111/add.16357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/28/2023] [Indexed: 10/18/2023]
Abstract
AIMS To measure the change in proportion of opioid-related overdose deaths attributed to people experiencing homelessness and to compare the opioid-related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death. DESIGN, SETTING AND PARTICIPANTS Population-based, time-trend analysis using coroner and health administrative databases from Ontario, Canada from 1 July 2017 and 30 June 2021. MEASUREMENTS Quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness. We also obtained socio-demographic and health characteristics of decedents, health-care encounters preceding death, substances directly contributing to death and circumstances surrounding deaths. FINDINGS A total of 6644 individuals (median age = 40 years, interquartile range = 31-51; 74.1% male) experienced an accidental opioid-related overdose death, among whom 884 (13.3%) were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness increased from 7.2% (26/359) in July-September 2017 to 16.8% (97/578) by April-June 2021 (trend test P < 0.01). Compared with housed decedents, those experiencing homelessness were younger (61.3 versus 53.1% aged 25-44), had higher prevalence of mental health or substance use disorders (77.1 versus 67.1%) and more often visited hospitals (32.1 versus 24.5%) and emergency departments (82.6 versus 68.5%) in the year prior to death. Fentanyl and its analogues more often directly contributed to death among people experiencing homelessness (94.0 versus 81.4%), as did stimulants (67.4 versus 51.6%); in contrast, methadone was less often present (7.8 versus 12.4%). Individuals experiencing homelessness were more often in the presence of a bystander during the acute toxicity event that led to death (55.8 versus 49.7%); and where another individual was present, more often had a resuscitation attempted (61.7 versus 55.1%) or naloxone administered (41.2 versus 28.9%). CONCLUSIONS People experiencing homelessness account for an increasing proportion of fatal opioid-related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021.
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Affiliation(s)
- Richard G Booth
- Arthur Labatt Family School of Nursing, Western University, London, Canada
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- London Health Sciences Centre, Lawson Health Research Institute, London, Canada
| | - Salimah Z Shariff
- Arthur Labatt Family School of Nursing, Western University, London, Canada
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- London Health Sciences Centre, Lawson Health Research Institute, London, Canada
| | - Brooke Carter
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- London Health Sciences Centre, Lawson Health Research Institute, London, Canada
| | - Stephen W Hwang
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Aaron M Orkin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Emergency Medicine, St Joseph's Health Centre, Toronto, Canada
| | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, Canada
- London Health Sciences Centre, Lawson Health Research Institute, London, Canada
| | - Tara Gomes
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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22
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Krawczyk N, Rivera BD, Chang JE, Grivel M, Chen YH, Nagappala S, Englander H, McNeely J. Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology. Addict Sci Clin Pract 2023; 18:67. [PMID: 37919755 PMCID: PMC10621088 DOI: 10.1186/s13722-023-00422-w] [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: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. METHODS We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000 and 2021 that studied interventions linking patients with SUD from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. RESULTS Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) or alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. CONCLUSIONS Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA.
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, Room 5-53, New York, USA.
| | - Bianca D Rivera
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA
| | - Ji E Chang
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York, NY, 10003, USA
| | - Margaux Grivel
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, 10003, USA
| | - Yu-Heng Chen
- Department of Criminal Justice, Temple University, Philadelphia, PA, 19102, USA
| | | | - Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jennifer McNeely
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA
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23
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Bromberg DJ, Galvez de Leon SJ, Litz T, Azbel L, Liberman AR, Polonsky M, Dvoriak S, Saichuk N, Taxman F, Altice FL. Aligning public health and public safety: Probation as a touchpoint to identify and link patients with opioid use disorder to opioid agonist treatment. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002349. [PMID: 37910486 PMCID: PMC10619786 DOI: 10.1371/journal.pgph.0002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/10/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND People in criminal justice settings (CJS) have high rates of opioid use disorder (OUD) and HIV. Probation is part of the CJS and congregates many individuals with high rates of mental health and substance use disorders relative to the general population; nevertheless, probation remains a major improvement to incarceration. As a steppingstone to full decarceration efforts, community supervision settings like probation can be leveraged as "touchpoints" to identify and link people with OUD (and other co-morbid conditions) to treatment and reduce criminal activity. METHODOLOGY To determine the feasibility of a modified screening, brief intervention and referral to treatment (SBIRT) strategy to link probationers to opioid agonist therapies (OAT) in the newly created probation system in Ukraine, we conducted a single-arm SBIRT intervention in eight probation centers in four Ukrainian administrative regions. For those screening positive for OUD, interest in OAT was assessed before and after a brief intervention. Those interested in OAT were referred to community OAT services. Participants with OUD also underwent HIV testing. PRINCIPAL FINDINGS Of the 1,298 consecutive individuals screened, 208 (16.0%) met criteria for opioid dependence. Of these, 122 (58.7%) enrolled in brief intervention, of which 54 (44.3%) had HIV and 14 (25.9%) of these were newly diagnosed. After the brief intervention, interest in starting OAT increased significantly from a median of 7.0 to 8.0 (P = <0.001) using a 10-point scale. Thirty (N = 30; 24.6%) of the enrolled participants initiated OAT and 21 of these (70%) were retained in treatment for 6 months. SIGNIFICANCE The prevalence of OUD (and HIV) is high among people in probation in Ukraine. SBIRT can identify a large number of people eligible for OAT, many of whom were willing to initiate and remain on OAT. Integrating SBIRT into probation can potentially assist with OAT scale-up and help address HIV prevention efforts.
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Affiliation(s)
- Daniel J. Bromberg
- Yale University School of Public Health, New Haven, Connecticut, United States of America
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, United States of America
| | - Samy J. Galvez de Leon
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, United States of America
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Taylor Litz
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Lyu Azbel
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Amanda R. Liberman
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Maxim Polonsky
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Faye Taxman
- George Mason University Schar School of Policy and Government, Arlington, Virginia, United States of America
| | - Frederick L. Altice
- Yale University School of Public Health, New Haven, Connecticut, United States of America
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, United States of America
- Yale University School of Medicine, New Haven, Connecticut, United States of America
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24
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Carroll JJ, Cummins ER, Formica SW, Green TC, Bagley SM, Beletsky L, Rosenbloom D, Xuan Z, Walley AY. The police paradox: A qualitative study of post-overdose outreach program implementation through public health-public safety partnerships in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104160. [PMID: 37597344 DOI: 10.1016/j.drugpo.2023.104160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/27/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Post-overdose outreach has emerged in the United States as an increasingly common response to non-fatal overdose. This qualitative study investigates the implementation of such programs through public health-public safety partnerships in Massachusetts. METHODS We conducted semi-structured interviews with post-overdose outreach team members, overdose survivors, and family members who received outreach. Interview transcripts were inductively analyzed to identify emergent themes and subsequently organized within the framework of Ecological Systems Theory. RESULTS Forty-nine interviews were conducted, including 15 police officers (80% male, 100% non-Hispanic White); 23 public health partners (48% male, 87% non-Hispanic White); 8 overdose survivors who received outreach services and 3 parents of survivors who received services (collectively 27% male, 64% non-Hispanic White). Implementation factors identified across all levels (macrosystem, exosystem, mesosystem, and microsystem) of Ecological Systems Theory included key program facilitators, such as access to police data and funding (macro), interagency collaboration (exo), shared recognition of community needs (exo), supportive relationships among team members (meso), and program champions (micro). Common barriers included inherent contradictions between policing and public health mandates (macro), poor local treatment and service capacity (exo), divergent staff views of program goals (exo), overdose survivors' prior negative experiences with law enforcement (meso), difficulty locating overdose survivors (meso), and police officers' lack of qualifications or training in providing psycho-social services (micro). CONCLUSIONS Most post-overdose outreach programs in this study were dependent on funding and data-sharing partnerships, which police agencies largely controlled. Yet, police participation, especially during outreach visits presented numerous challenges for engaging overdose survivors and establishing non-coercive linkages with evidence-based services, which may undermine the public health goals of these programs. These findings should inform state and federal efforts to expand the role of law enforcement in behavioral health initiatives.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology & Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC 27605, United States; Department of Medicine, Brown University, 222 Richmond St., Providence, RI 02903, United States.
| | - Emily R Cummins
- Ariadne Labs, Harvard T.H. Chan School of Public Health, 405 Park Drive, Boston, MA 02215, United States
| | - Scott W Formica
- Social Science Research and Evaluation, Inc., 84 Mill St., Lincoln, MA 01773, United States
| | - Traci C Green
- The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, 415 South Street MS 035, Waltham, MA 02453, United States
| | - Sarah M Bagley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and the Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Health in Justice Action Lab, Northeastern University, 416 Huntington Ave, Boston, MA 02115, United States
| | - David Rosenbloom
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Alexander Y Walley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
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25
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Kimmel SD, Xuan Z, Yan S, Lambert AM, Formica SW, Green TC, Carroll JJ, Bagley SM, Rosenbloom D, Beletsky L, Walley AY. Characteristics of post-overdose outreach programs and municipal-level opioid overdose in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104164. [PMID: 37713939 DOI: 10.1016/j.drugpo.2023.104164] [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: 03/06/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Post-overdose outreach programs have proliferated in response to opioid overdose. Implementing these programs is associated with reductions in overdose rates, but the role of specific program characteristics in overdose trends has not been evaluated. METHODS Among 58 Massachusetts municipalities with post-overdose outreach programs, we examined associations between five domains of post-overdose outreach program characteristics (outreach contact rate, naloxone distribution, coercive practices, harm reduction activities, and social service provision or referral) and rates of fatal opioid overdoses and opioid-related emergency medical system responses (i.e., ambulance activations) per calendar quarter from 2013 to 2019 using segmented regression analyses with adjustment for municipal covariates and fixed effects. For both outcomes, each domain was modeled: a) individually, b) with other characteristics, and c) with other characteristics and municipal-level fixed effects. RESULTS There were no significant associations (p < 0.05) between outreach contact rate, naloxone distribution, coercive practices, or harm reduction activities with municipal fatal overdose trends. Municipalities with programs providing or referring to more social services experienced 21% fewer fatal overdoses compared to programs providing or referring to more social services (Rate Ratio (RR) 0.79, 95% Confidence Interval (CI) 0.66-0.93, p = 0.01). Compared to municipalities in quarters when programs had no outreach contacts, municipalities with some, but less than the median outreach contacts, experienced 14% lower opioid-related emergency responses (RR 0.86, 95% CI 0.78-0.96, p = 0.01). Associations between naloxone distribution, coercive practices, harm reduction practices, or social services and opioid-related emergency responses were not consistently significant across modeling approaches. CONCLUSION Municipalities with post-overdose outreach programs providing or referring to more social services had lower fatal opioid overdose rates. Municipalities in quarters when programs outreached to overdose survivors had fewer opioid-related emergency responses, but only among programs with below the median number of outreach contacts. Social service linkage should be core to post-overdose programs. Evaluations should assess program characteristics to optimize program design.
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Affiliation(s)
- Simeon D Kimmel
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Building - 4th Floor, Boston, MA 02118, United States
| | - Shapei Yan
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States
| | - Audrey M Lambert
- AHOPE, Department of Recovery Services, Boston Public Health Commission, 774 Albany St, Boston, MA 02118, United States
| | - Scott W Formica
- Social Science Research and Evaluation, Inc, 84 Mill Street, Lincoln, MA 01773, United States
| | - Traci C Green
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 024537, United States; Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; COBRE on Opioids and Overdose at Rhode Island Hospital, 1125 North Main St., Providence, RI 02904, United States
| | - Jennifer J Carroll
- Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; Department of Sociology and Anthropology, North Carolina State University, Raleigh, NC, United States
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 801 Albany St, Boston, MA 02118, United States
| | - David Rosenbloom
- Department of Health, Law, Policy and Management, Boston University School of Public Health, 348W, 715 Albany Street, Boston, MA 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and The Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Division of Global Public Health and Infectious Diseases, University of California, San Diego School of Medicine, 9500 Gillman Drive, La Jolla, CA 92093, United States
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States
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Evans EA, Geissler KH. Use of Big Data and Ethical Issues for Populations With Substance Use Disorder. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1321-1324. [PMID: 36921899 PMCID: PMC10497717 DOI: 10.1016/j.jval.2023.02.019] [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: 01/13/2023] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
With expanding data availability and computing power, health research is increasingly relying on big data from a variety of sources. We describe a state-level effort to address aspects of the opioid epidemic through public health research, which has resulted in an expansive data resource combining dozens of administrative data sources in Massachusetts. The Massachusetts Public Health Data Warehouse is a public health innovation that serves as an example of how to address the complexities of balancing data privacy and access to data for public health and health services research. We discuss issues of data protection and data access, and provide recommendations for ethical data governance. Keeping these issues in mind, the use of this data resource has the potential to allow for transformative research on critical public health issues.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Kimberley H Geissler
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
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DiDomizio E, Chandra DK, Nichols L, Villanueva M, Altice FL. Challenges to Achieving HCV Micro-Elimination in People With HIV in the United States: Provider Perspectives and the Role of Implicit Bias. Health Promot Pract 2023; 24:998-1008. [PMID: 37440258 DOI: 10.1177/15248399231169928] [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: 07/14/2023]
Abstract
The prevalence of HIV/HCV (hepatitis C virus) co-infection is high particularly in persons who inject drugs (PWID) and is increasing because of the evolving opioid epidemic in the United States. The introduction of effective antiviral medications for HCV has raised the strategic goal of HCV micro-elimination, and efforts to understand the barriers to treatment are critical. In this study, we explored the provider perspective of factors that inhibit HCV micro-elimination efforts in people with HIV (PWH), including the role of implicit bias and related stigma in providers' health care decision making. We used the mixed-methods approach of nominal group technique (NGT) with 14 participants from 11 different clinics engaged in two virtual focus group sessions (n = 5 and n = 9). Responses from the NGTs were rank ordered during the sessions to identify providers' perspectives of major barriers and facilitators, then identified possible implicit bias after the NGTs concluded. There were 12 responses given for micro-elimination barriers with the three most prioritized being housing instability, medication nonadherence concerns, and inability to motivate patients. Of these, eight were categorized as potential implicit biases. Among the 14 responses given for facilitators of treatment, the three major solutions included distributive models of care, improved provider knowledge, and increased patient engagement. Although the solutions offered were insightful, there was consensus that the individual lives of patients were the root cause of most barriers to care. We recommend further research on behavioral design interventions that promote patients' involvement in decision making and focus on patients' eligibility criteria for HCV treatment as opposed to providers' perceived barriers to treatment.
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Affiliation(s)
| | - Divya K Chandra
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Lisa Nichols
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Frederick L Altice
- Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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Paradise RK, Desmarais J, O'Malley SE, Hoyos-Cespedes A, Nurani A, Walley AY, Clarke J, Taylor S, Dooley D, Bazzi AR, Kimmel SD. Perspectives and recommendations of opioid overdose survivors experiencing unsheltered homelessness on housing, overdose, and substance use treatment in Boston, MA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104127. [PMID: 37523844 DOI: 10.1016/j.drugpo.2023.104127] [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: 03/08/2023] [Revised: 06/04/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Opioid overdose causes one in four deaths among people experiencing homelessness in Boston, MA. To reduce overdose risks, the experience and perspectives of people experiencing homelessness should be incorporated into housing, overdose prevention, and substance use treatment efforts. METHODS In 2021, we conducted qualitative interviews with 59 opioid overdose survivors to inform equitable access to treatment services. In response to policy debate surrounding a public drug scene near a key recruitment site, we conducted a targeted thematic analysis of transcribed interview data from a subset of participants experiencing unsheltered homelessness (n=29) to explore their perspectives and recommendations on housing, overdose prevention, and substance use treatment. RESULTS Among 29 participants who identified as non-Hispanic Black (n=10), Hispanic/Latinx (n=10), or as non-Hispanic White (n=9), the median number of self-reported opioid overdoses in the past three months was 2.0 (SD 3.7). Three themes emerged from this targeted analysis: (1) Participants described inadequate housing resources and unwelcoming shelter environments. (2) Participants near a large public drug scene explained how unsheltered homelessness was chaotic, dangerous, and disruptive to recovery goals. (3) Participants provided recommendations for improving housing and addiction treatment systems and including their perspectives in the development of solutions to the intersecting housing and opioid overdose crises. CONCLUSIONS The overdose prevention, housing and substance use treatment systems must address the needs of opioid overdose survivors experiencing unsheltered homelessness. Overdose survivors experiencing unsheltered homelessness described a chaotic public drug scene but resorted to residing in nearby encampments because the existing shelter, housing, and addiction treatment systems were unwelcoming, difficult to navigate, or unaffordable. Despite efforts to provide low-threshold housing in Boston, additional low-barrier housing services (i.e., including harm reduction resources and without "sobriety" requirements) could promote the health and safety of people who use drugs and are experiencing homelessness.
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Affiliation(s)
- Ranjani K Paradise
- Institute for Community Health, 350 Main Street, Malden, MA 02148, United States; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, United States
| | - Jeffrey Desmarais
- Institute for Community Health, 350 Main Street, Malden, MA 02148, United States
| | - Shannon E O'Malley
- Boston Public Health Commission, 1010 Massachusetts Avenue, Boston, MA 02118, United States
| | | | - Alykhan Nurani
- Boston Medical Center, 801 Massachusetts Avenue, 2(nd) Floor Crosstown Building, Boston MA 02118, United States
| | - Alexander Y Walley
- Boston Medical Center, 801 Massachusetts Avenue, 2(nd) Floor Crosstown Building, Boston MA 02118, United States; Boston University Chobanian and Avedisian School of Medicine, 801 Massachusetts Avenue, 2nd Floor Crosstown Building, Boston, MA 02118, United States
| | - Jaylen Clarke
- Boston Public Health Commission, 1010 Massachusetts Avenue, Boston, MA 02118, United States
| | - Sunday Taylor
- Boston Public Health Commission, 1010 Massachusetts Avenue, Boston, MA 02118, United States
| | - Daniel Dooley
- Boston Public Health Commission, 1010 Massachusetts Avenue, Boston, MA 02118, United States
| | - Angela R Bazzi
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Boston University School of Public Health, 801 Massachusetts Avenue, 4(th) Floor Crosstown Building, Boston, MA 02118, United States
| | - Simeon D Kimmel
- Boston Medical Center, 801 Massachusetts Avenue, 2(nd) Floor Crosstown Building, Boston MA 02118, United States; Boston University Chobanian and Avedisian School of Medicine, 801 Massachusetts Avenue, 2nd Floor Crosstown Building, Boston, MA 02118, United States.
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Mason M, Post LA, Aggarwal R. Health care and harm reduction provider perspectives on treating older adults who use non-medical opioids: a qualitative study set in Chicago. BMC Health Serv Res 2023; 23:876. [PMID: 37598163 PMCID: PMC10439613 DOI: 10.1186/s12913-023-09843-4] [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: 06/01/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Opioid overdose death rates are increasing for adults aged 55 and older, with especially high rates in large urban areas. In parallel, admissions to treatment programs for older adults using illicit substances are increasing as well. Despite these trends, there is a lack of information about older adults who use non-medical opioids (NMO) and even less knowledge about their health and service encounters. Conducted in Chicago, Illinois, this qualitative study explores the perspectives of health care and harm reduction service providers who work with older adults using non-medical opioids. METHODS The study used snowball sampling to locate participants with expertise in working with older adults who use non-medical opioids. In total, we conducted 26 semi-structured interviews from September 2021-August 2022. We explored questions regarding participants' perceptions of older adult opioid use patterns, comorbidities, and involvement in harm reduction outreach and opioid use disorder treatment. RESULTS Many of the providers we interviewed consider older adults who use NMO as a distinct population that employ unique use behaviors with the intent to protect them from opioid overdose. However, these same unique behaviors may potentiate their risk for overdose in today's climate. Providers report initial encounters that are not care seeking for opioid use and primarily oriented around health conditions. Older adults who use non-medical opioids are seen as complex patients due to the need to diagnostically untangle symptoms of substance use from co-morbidities and conditions associated with aging. Treatment for this population is also viewed as complicated due to the interactions between aging, comorbidities, and substance use. Providers also noted that older adults who use NMO have use behaviors that make them less visible to outreach and treatment service providers, potentially putting them at increased risk for overdose and health conditions associated with opioid use. CONCLUSIONS Findings from this study are intended to inform future research on care provision for older adults who use non-medical opioids and may be especially applicable to large urban reas with histories of opioid use dating back to earlier drug epidemics of the 1970s, 1980s, and 1990s.
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Affiliation(s)
- Maryann Mason
- Feinberg School of Medicine, Northwestern University, Chicago, 60611, USA.
- Buehler Center for Health Policy and Economics, Northwestern University, 420 E. Superior St., Rubloff Building 9th floor, Room 939, Chicago, IL, 60611, USA.
| | - Lori Ann Post
- Department of Emergency Medicine, The Buehler Center for Health Policy & Economics, Institute for Global Health, Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, 9-915 Rubloff Building, 420 E. Superior St, Chicago, Il, 60611, USA
| | - Rahul Aggarwal
- Weinberg School of Arts and Sciences, Northwestern University, 1918 Sheridan Rd, Evanston, IL, 60208, USA
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Casey S, Regan S, Gale E, Adams ZM, Lambert E, Omede FO, Wakeman SE. Rapid Methadone Induction in a General Hospital Setting: A Retrospective, Observational Analysis. Subst Abus 2023; 44:177-183. [PMID: 37728091 DOI: 10.1177/08897077231185655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Outpatient methadone guidelines recommend starting at a low dose and titrating slowly. As fentanyl prevalence and opioid-related mortality increases, there is a need for individuals to rapidly achieve a therapeutic methadone dose. Hospitalization offers a monitored setting for methadone initiation, however dosing practices and safety are not well described. METHODS Retrospective, observational analysis of hospitalized patients with opioid use disorder seen by an inpatient addiction consult team in an academic medical center who were newly initiated on methadone between 2016 and 2022. We calculated initial daily dose, maximum daily dose, timing interval of dose escalation, whether patients were connected to an opioid treatment program (OTP) prior to discharge, whether adverse effects or safety events occurred during the hospitalization, and whether such events were definitely or probably related versus possibly related or unrelated to methadone. RESULTS One hundred twelve patients were included. The mean initial daily methadone dose administered was 32 mg (range: 10-90 mg). The mean maximum dose reached was 76.8 mg (range 30-165 mg). The mean number of days from initial to peak dose was 5.6 days (range 1-19 days). Overall, 30% of patients experienced a safety event, most commonly sedation. Only 4 safety events were deemed probably or definitely related to methadone. In regression analyses, there was no significant difference between starting doses among patients with or without sedation but there was a relationship between last dose and the likelihood of any possibly related event, with those ending at a dose of 100 mg or higher having a higher likelihood event, compared to those ending at lower doses (47.8% vs 12.4%, P < .001). Seventy-six percent were connected to OTP before discharge. CONCLUSION Among hospitalized patients initiating methadone, rapid dose titration was infrequently associated with related safety events and most were connected to community-based methadone treatment before discharge.
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Affiliation(s)
- Sarah Casey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Regan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Evan Gale
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Zoe M Adams
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Eugene Lambert
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Faith O Omede
- Department of Internal Medicine, Mass General Community Physicians, Salem, MA, USA
| | - Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Krawczyk N, Rivera BD, Chang JE, Grivel M, Chen YH, Nagappala S, Englander H, McNeely J. Strategies to support substance use disorder care transitions from acute-care to community-based settings: A Scoping review and typology. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.24.23289042. [PMID: 37162840 PMCID: PMC10168484 DOI: 10.1101/2023.04.24.23289042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. Methods We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000-2021 that studied interventions linking SUD patients from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. Results Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) followed by alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. Conclusions Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York NY 10065
| | - Bianca D. Rivera
- Department of Population Health, NYU Grossman School of Medicine, New York NY 10065
| | - Ji E. Chang
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York NY 10003
| | - Margaux Grivel
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York NY 10003
| | - Yu-Heng Chen
- Department of Criminal Justice, Temple University, Philadelphia, PA 19102
| | | | - Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, OR 97239
| | - Jennifer McNeely
- Department of Population Health, NYU Grossman School of Medicine, New York NY 10065
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Ray B, Christian K, Bailey T, Alton M, Proctor A, Haggerty J, Lowder E, Aalsma MC. Antecedents of fatal overdose in an adult cohort identified through administrative record linkage in Indiana, 2015-2022. Drug Alcohol Depend 2023; 247:109891. [PMID: 37120921 PMCID: PMC11343318 DOI: 10.1016/j.drugalcdep.2023.109891] [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: 12/22/2022] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The United States continues to experience unprecedented rates of overdose mortality and need to identify effective policies or practices that can be implemented. This study aims to measure the prevalence, frequency, timing, and rate of touchpoints that occurred prior to a fatal overdose where communities might intervene. METHODS In collaboration with Indiana state government, we conducted record-linkage of statewide administrative datasets to vital records (January 1, 2015, through August 26, 2022) to identify touchpoints (jail booking, prison release, prescription medication dispensation, emergency department visits, and emergency medical services). We examined touchpoints within 12-months prior to a fatal overdose among an adult cohort and explored variation over time and by demographic characteristics. RESULTS Over the 92-month study period there were 13,882 overdose deaths (89.3% accidental poisonings, X40-X44) in our adult cohort that were record-linked to multiple administrative datasets and revealed nearly two-thirds (64.7%; n=8980) experienced an emergency department visit, the most prevalent touchpoint followed by prescription medication dispensation, emergency medical services responses, jail booking, and prison release. However, with approximately 1 out of every 100 returning citizens dying from drug overdose within 12-months of release, prison release had the highest touchpoint rate followed by emergency medical services responses, jail booking, emergency department visits, and prescription medication dispensation. CONCLUSION Record-linking administrative data from routine practice to vital records from overdose mortality is a viable means of identifying where resources should be situated to reduce fatal overdose, with potential to evaluate the effectiveness of overdose prevention efforts.
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Affiliation(s)
- Bradley Ray
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC27709, United States.
| | - Kaitlyn Christian
- Indiana Management Performance Hub, 100 North Senate Avenue, Room N855, Indianapolis, IN46204, United States
| | - Timothy Bailey
- Indiana Management Performance Hub, 100 North Senate Avenue, Room N855, Indianapolis, IN46204, United States
| | - Madison Alton
- Indiana Division of Mental Health and Addiction, 402 West Washington Street W353, Indiana, IN46204, United States
| | - Alison Proctor
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC27709, United States
| | - John Haggerty
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC27709, United States
| | - Evan Lowder
- Department of Criminology, Law and Society, George Mason University, 4400 University Drive, 4F4, Fairfax, VA22030, United States
| | - Matthew C Aalsma
- Department of Pediatrics, Indiana University School of Medicine, 340 W. 10th StreetIndianapolisIN46202, United States
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Davis MT, Bohler R, Hodgkin D, Hamilton G, Horgan C. The role of health plans in addressing the opioid crisis: A qualitative study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209022. [PMID: 36935064 PMCID: PMC10198902 DOI: 10.1016/j.josat.2023.209022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Health plans are key players in substance use treatment in the United States, and the opioid crisis presents new challenges for them. This article is part of the HEALing Communities Study (HCS) funded by NIH, which seeks to facilitate communities' adoption of activities that might reduce overdose deaths, including overdose prevention education and naloxone distribution, medication for opioid use disorder, and safer opioid prescribing. We examine how health plans in one state (Massachusetts) are adapting to encourage and sustain activities that help communities to address opioid use disorder (OUD). METHODS We conducted semi-structured interviews with managers of behavioral health services at eight health plans in Massachusetts that that have Medicare, Medicaid, and commercial lines of business. Two plans in this sample contract with a specialized behavioral health organization ("carve-out"). The interviewees also completed a survey on policies regarding access to treatment and opioid prescribing. Interviews were recorded and transcribed and analyzed using thematic analysis. Analysis of the data included intended influence of the policies at three levels: member level (micro), group or community level (meso), and system or institutional level (macro). RESULTS All health plans developed strategies to increase access to treatment for OUD, primarily through eliminating or decreasing cost-sharing, eliminating pre-authorization for MOUD, and increasing supply of providers. Health plans encourage qualified practitioners to offer MOUD, but most do not provide incentives or training. Identifying high risk populations is a focus of health plans in this sample. Naloxone is a covered benefit in all health plans, although with variation in monthly limits and cost-sharing. Most health plans take measures to influence opioid prescribing. Health plans' activities are predominately aimed at the micro (member) level with little ability to influence at the macro (wider system-level changes). CONCLUSION This study provides insight into how health plans develop strategies to address the rise in OUD and fatal opioid overdoses, many of which are key in the HCS initiative. How active a role health plans play in addressing the opioid crisis varies, even within the insurance industry in one state (Massachusetts).
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Affiliation(s)
- Margot Trotter Davis
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, United States of America.
| | - Robert Bohler
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Dominic Hodgkin
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Greer Hamilton
- Boston University School of Social Work, United States of America
| | - Constance Horgan
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, United States of America
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Larochelle MR, Jones CM, Zhang K. Change in opioid and buprenorphine prescribers and prescriptions by specialty, 2016-2021. Drug Alcohol Depend 2023; 248:109933. [PMID: 37267746 DOI: 10.1016/j.drugalcdep.2023.109933] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Safer opioid analgesic prescribing and increasing use of medications for opioid use disorder, including buprenorphine, are strategies prioritized to reduce opioid overdose deaths in the United States. Specialty-specific trends in the number of prescribers and prescriptions for opioid analgesics and buprenorphine are not well characterized. METHODS We used data from the IQVIA Longitudinal Prescription database for January 1, 2016 through December 31, 2021. We identified opioid and buprenorphine prescriptions based on NDC codes. We classified prescribers into one of 14 mutually exclusive specialty groups. We calculated the number of prescribers and number of prescriptions for opioids and buprenorphine by specialty and year. RESULTS From 2016 to 2021, the total number of opioid analgesic prescriptions dispensed decreased by 32% to 121,693,308 and the number of unique opioid analgesic prescribers decreased 7% to 966,369. Over the same time period, the number of buprenorphine prescriptions dispensed increased 36% to 13,909,724 and unique number of buprenorphine prescribers increased 86% to 59,090. Across most specialties we identified a contraction in the number of opioid prescriptions dispensed and opioid prescribers and an expansion in the number of buprenorphine prescriptions dispensed. Among high-volume opioid prescribing specialties, the largest decrease in opioid prescribers was 32% among Pain Medicine clinicians. By 2021, Advanced Practice Practitioners overtook Primary Care clinicians as the highest volume buprenorphine prescribers. CONCLUSIONS More work is needed to understand the impact of clinicians who stop prescribing opioids. While the trend in buprenorphine prescribing is encouraging, further expansion is warranted to meet the underlying need.
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Affiliation(s)
- Marc R Larochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kun Zhang
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Barnett ML, Meara E, Lewinson T, Hardy B, Chyn D, Onsando M, Huskamp HA, Mehrotra A, Morden NE. Racial Inequality in Receipt of Medications for Opioid Use Disorder. N Engl J Med 2023; 388:1779-1789. [PMID: 37163624 PMCID: PMC10243223 DOI: 10.1056/nejmsa2212412] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Since 2010, Black persons in the United States have had a greater increase in opioid overdose-related mortality than other groups, but national-level evidence characterizing racial and ethnic disparities in the use of medications for opioid use disorder (OUD) is limited. METHODS We used Medicare claims data from the 2016-2019 period for a random 40% sample of fee-for-service beneficiaries who were Black, Hispanic, or White; were eligible for Medicare owing to disability; and had an index event related to OUD (nonfatal overdose treated in an emergency department or inpatient setting, hospitalization with injection drug use-related infection, or inpatient or residential rehabilitation or detoxification care). We measured the receipt of medications to treat OUD (buprenorphine, naltrexone, and naloxone), the receipt of high-risk medications (opioid analgesics and benzodiazepines), and health care utilization, all in the 180 days after the index event. We estimated differences in outcomes according to race and ethnic group with adjustment for beneficiary age, sex, index event, count of chronic coexisting conditions, and state of residence. RESULTS We identified 25,904 OUD-related index events among 23,370 beneficiaries, with 3937 events (15.2%) occurring among Black patients, 2105 (8.1%) among Hispanic patients, and 19,862 (76.7%) among White patients. In the 180 days after the index event, patients received buprenorphine after 12.7% of events among Black patients, after 18.7% of those among Hispanic patients, and after 23.3% of those among White patients; patients received naloxone after 14.4%, 20.7%, and 22.9%, respectively; and patients received benzodiazepines after 23.4%, 29.6%, and 37.1%, respectively. Racial differences in the receipt of medications to treat OUD did not change appreciably from 2016 to 2019 (buprenorphine receipt: after 9.1% of index events among Black patients vs. 21.6% of those among White patients in 2016, and after 14.1% vs. 25.5% in 2019). In all study groups, patients had multiple ambulatory visits in the 180 days after the index event (mean number of visits, 6.6 after events among Black patients, 6.7 after events among Hispanic patients, and 7.6 after events among White patients). CONCLUSIONS Racial and ethnic differences in the receipt of medications to treat OUD after an index event related to this disorder among patients with disability were substantial and did not change over time. The high incidence of ambulatory visits in all groups showed that disparities persisted despite frequent health care contact. (Funded by the National Institute on Drug Abuse and the National Institute on Aging.).
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Affiliation(s)
- Michael L Barnett
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Ellen Meara
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Terri Lewinson
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Brianna Hardy
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Deanna Chyn
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Moraa Onsando
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Haiden A Huskamp
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Ateev Mehrotra
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Nancy E Morden
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
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Cooper JA, Onyeka I, Cardwell C, Paterson E, Kirk R, O'Reilly D, Donnelly M. Record linkage studies of drug-related deaths among adults who were released from prison to the community: a scoping review. BMC Public Health 2023; 23:826. [PMID: 37147595 PMCID: PMC10161544 DOI: 10.1186/s12889-023-15673-0] [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: 11/09/2022] [Accepted: 04/13/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND There are public health concerns about an increased risk of mortality after release from prison. The objectives of this scoping review were to investigate, map and summarise evidence from record linkage studies about drug-related deaths among former adult prisoners. METHODS MEDLINE, EMBASE, PsychINFO and Web of Science were searched for studies (January 2011- September 2021) using keywords/index headings. Two authors independently screened all titles and abstracts using inclusion and exclusion criteria and subsequently screened full publications. Discrepancies were discussed with a third author. One author extracted data from all included publications using a data charting form. A second author independently extracted data from approximately one-third of the publications. Data were entered into Microsoft Excel sheets and cleaned for analysis. Standardised mortality ratios (SMRs) were pooled (where possible) using a random-effects DerSimonian-Laird model in STATA. RESULTS A total of 3680 publications were screened by title and abstract, and 109 publications were fully screened; 45 publications were included. The pooled drug-related SMR was 27.07 (95%CI 13.32- 55.02; I 2 = 93.99%) for the first two weeks (4 studies), 10.17 (95%CI 3.74-27.66; I 2 = 83.83%) for the first 3-4 weeks (3 studies) and 15.58 (95%CI 7.05-34.40; I 2 = 97.99%) for the first 1 year after release (3 studies) and 6.99 (95%CI 4.13-11.83; I 2 = 99.14%) for any time after release (5 studies). However, the estimates varied markedly between studies. There was considerable heterogeneity in terms of study design, study size, location, methodology and findings. Only four studies reported the use of a quality assessment checklist/technique. CONCLUSIONS This scoping review found an increased risk of drug-related death after release from prison, particularly during the first two weeks after release, though drug-related mortality risk remained elevated for the first year among former prisoners. Evidence synthesis was limited as only a small number of studies were suitable for pooled analyses for SMRs due to inconsistencies in study design and methodology.
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Affiliation(s)
- Janine A Cooper
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.
| | - Ifeoma Onyeka
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Present address: Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK
| | - Christopher Cardwell
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Euan Paterson
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Richard Kirk
- Healthcare in Prison, South Eastern Health and Social Care Trust, Dundonald, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
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Rojas CR, Coffin A, Taylor A, Ortiz P, Jenicek G, Hart J, Callahan JM, Shaw KN. Resident Communication With Patients and Families Preferring Languages Other Than English. Hosp Pediatr 2023:191228. [PMID: 37125495 DOI: 10.1542/hpeds.2022-007003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Patients and families preferring languages other than English (LOE) often experience inequitable communication with their health care providers, including the underutilization of professional interpretation. This study had 2 aims: to characterize resident-perceived communication with families preferring LOE and to evaluate the impact of language preference on frequency of resident interactions with hospitalized patients and families. METHODS This was a cross-sectional study at a quaternary care children's hospital. We developed a questionnaire for residents regarding their interactions with patients preferring LOE. We concurrently developed a communication tracking tool to measure the frequency of resident communication events with hospitalized patients. Data were analyzed with logistic and Poisson regression models. RESULTS Questionnaire results demonstrated a high level of resident comfort with interpretation, though more than 30% of residents reported "sometimes" or "usually" communicating with families preferring LOE without appropriate interpretation (response rate, 47%). The communication tracking tool was completed by 36 unique residents regarding 151 patients, with a 95% completion rate. Results demonstrated that patients and families preferring LOE were less likely to be present on rounds compared with their counterparts preferring English (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.07-0.39). Similarly, patients and families preferring LOE were less likely to receive a resident update after rounds (adjusted odds ratio, 0.29; 95% CI, 0.13-0.62) and received fewer resident updates overall (incidence rate ratio, 0.45; 95% CI, 0.30-0.69). CONCLUSIONS Hospitalized patients and families preferring LOE experience significant communication-related inequities. Ongoing efforts are needed to promote equitable communication with this population and should consider the unique role of residents.
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Affiliation(s)
- Christina R Rojas
- Department of Pediatrics
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia; and
| | | | | | | | | | - Jessica Hart
- Department of Pediatrics
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M Callahan
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathy N Shaw
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Church B, Clark R, Mohn W, Potee R, Friedmann P, Soares WE. Methadone Induction for a Patient With Precipitated Withdrawal in the Emergency Department: A Case Report. J Addict Med 2023; 17:367-370. [PMID: 37267195 PMCID: PMC10248191 DOI: 10.1097/adm.0000000000001109] [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: 12/24/2022]
Abstract
In the era of illicit fentanyl, reports on difficulties with buprenorphine inductions for patients with opioid use disorder are emerging. Methadone is the only other approved medication treatment with efficacy similar to buprenorphine but without risks of precipitated withdrawal. Unfortunately, outpatient methadone inductions can take days to weeks to complete, due in part to regulations that limit administration to opioid treatment programs. We describe a patient with opioid use disorder who presented to the emergency department in precipitated withdrawal who completed a same-day methadone induction with next-day dosing at an opioid treatment program as part of an emergency department methadone protocol. As opioid-related deaths rise, emergency department-initiated methadone is feasible for patients with opioid use disorder.
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Affiliation(s)
- Benjamin Church
- From the University of Massachusetts Chan Medical School-Baystate, Springfield, MA (BC, RC, PF, WES); Baystate Medical Center, Springfield, MA (WM); Behavioral Health Network, Springfield, MA (RP); Department of Emergency Medicine, Baystate Medical Center, Springfield, MA (WES)
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Xuan Z, Yan S, Formica SW, Green TC, Beletsky L, Rosenbloom D, Bagley SM, Kimmel SD, Carroll JJ, Lambert AM, Walley AY. Association of Implementation of Postoverdose Outreach Programs With Subsequent Opioid Overdose Deaths Among Massachusetts Municipalities. JAMA Psychiatry 2023; 80:468-477. [PMID: 36920385 PMCID: PMC10018400 DOI: 10.1001/jamapsychiatry.2023.0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/11/2022] [Indexed: 03/16/2023]
Abstract
Importance Nonfatal opioid overdose is the leading risk factor for subsequent fatal overdose and represents a critical opportunity to reduce future overdose and mortality. Postoverdose outreach programs emerged in Massachusetts beginning in 2013 with the main purpose of linking opioid overdose survivors to addiction treatment and harm reduction services. Objective To evaluate whether the implementation of postoverdose outreach programs among Massachusetts municipalities was associated with lower opioid fatality rates compared with municipalities without postoverdose outreach programs. Design, Setting, and Participants This retrospective interrupted time-series analysis was performed over 26 quarters (from January 1, 2013, through June 30, 2019) across 93 municipalities in Massachusetts. These 93 municipalities were selected based on a threshold of 30 or more opioid-related emergency medical services (EMS) responses in 2015. Data were analyzed from November 2021 to August 2022. Exposures The main exposure was municipality postoverdose outreach programs. Municipalities had various program inceptions during the study period. Main Outcomes and Measures The primary outcome was quarterly municipal opioid fatality rate per 100 000 population. The secondary outcome was quarterly municipal opioid-related EMS response (ambulance trips) rates per 100 000 population. Results The mean (SD) population size across 93 municipalities was 47 622 (70 307), the mean (SD) proportion of female individuals was 51.5% (1.5%) and male individuals was 48.5% (1.5%), and the mean (SD) age proportions were 29.7% (4.0%) younger than 25 years, 26.0% (4.8%) aged 25 to 44 years, 14.8% (2.1%) aged 45 to 54 years, 13.4% (2.1%) aged 55 to 64 years, and 16.1% (4.4%) aged 65 years or older. Postoverdose programs were implemented in 58 municipalities (62%). Following implementation, there were no significant level changes in opioid fatality rate (adjusted rate ratio [aRR], 1.07; 95% CI, 0.96-1.19; P = .20). However, there was a significant slope decrease in opioid fatality rate (annualized aRR, 0.94; 95% CI, 0.90-0.98; P = .003) compared with the municipalities without the outreach programs. Similarly, there was a significant slope decrease in opioid-related EMS response rates (annualized aRR, 0.93; 95% CI, 0.89-0.98; P = .007). Several sensitivity analyses yielded similar findings. Conclusions and Relevance In this study, among Massachusetts municipalities with high numbers of opioid-related EMS responses, implementation of postoverdose outreach programs was significantly associated with lower opioid fatality rates over time compared with municipalities that did not implement such programs. Program components, including cross-sectoral partnerships, operational best practices, involvement of law enforcement, and related program costs, warrant further evaluation to enhance effectiveness.
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Affiliation(s)
- Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, Boston, Massachusetts
- Boston University School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Shapei Yan
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston, Massachusetts
| | - Scott W. Formica
- Social Science Research and Evaluation, Inc, Lincoln, Massachusetts
| | - Traci C. Green
- The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, Waltham, Massachusetts
- Brown University, Department of Medicine, Providence, Rhode Island
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and The Action Lab, Boston, Massachusetts
- University of California San Diego, School of Medicine, Division of Infectious Disease and Global Public Health, La Jolla
| | - David Rosenbloom
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, Massachusetts
| | - Sarah M. Bagley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston, Massachusetts
- Boston Medical Center and Boston University School of Medicine, Department of Pediatrics, Division of General Pediatrics, Boston, Massachusetts
| | - Simeon D. Kimmel
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston, Massachusetts
- Boston Medical Center and Boston University School of Medicine, Department of Medicine, Section of Infectious Diseases, Boston, Massachusetts
| | - Jennifer J. Carroll
- Brown University, Department of Medicine, Providence, Rhode Island
- North Carolina State University, Department of Sociology and Anthropology, Raleigh
| | | | - Alexander Y. Walley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston, Massachusetts
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CERDÁ MAGDALENA, KRAWCZYK NOA, KEYES KATHERINE. The Future of the United States Overdose Crisis: Challenges and Opportunities. Milbank Q 2023; 101:478-506. [PMID: 36811204 PMCID: PMC10126987 DOI: 10.1111/1468-0009.12602] [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: 02/24/2023] Open
Abstract
Policy Points People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm-reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm-reduction services. Priorities for action include investing in evidence-based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.
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Affiliation(s)
- MAGDALENA CERDÁ
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | - NOA KRAWCZYK
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
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Howell BA, Black AC, Grau LE, Lin HJ, Greene C, Lee H, Heimer R, Hawk KE, D'Onofrio G, Fiellin DA, Becker WC. Concordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis. Drug Alcohol Depend 2023; 244:109788. [PMID: 36738634 PMCID: PMC9975083 DOI: 10.1016/j.drugalcdep.2023.109788] [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: 10/06/2022] [Revised: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Opioid overdoses are a leading cause of preventable death in the United States. There is limited research linking decedents' receipt of controlled substances and presence of controlled substances on post-mortem toxicology (PMT). METHODS We linked data on opioid-detected deaths in Connecticut between May 3, 2016, and December 31, 2017 from the Office of the Chief Medical Examiner, Department of Consumer Protection, and Department of Mental Health and Addiction Services. Exposure was defined as receipt of an opioid or benzodiazepine prescription within 90 days prior to death. Our primary outcome was concordance between medication received and metabolites in PMT. RESULTS Our analysis included 1412 opioid-detected overdose deaths. 47 % received an opioid or benzodiazepine 90 days prior to death; 36 % received an opioid and 27 % received a benzodiazepine. Concordance between receipt of an opioid or benzodiazepine and its presence in PMT was observed in 30 % of opioid-detected deaths. Concordance with an opioid was present in 17 % of opioid-detected deaths and concordance with a benzodiazepine was present in 21 % of opioid-detected deaths. Receipt of an opioid or benzodiazepine and concordance with PMT were less common in fentanyl or heroin-detected deaths and more common in pharmaceutical opioid-detected deaths. DISCUSSION Our results suggest medically supplied opioids and benzodiazepines potentially contributed to a substantial number, though minority, of opioid-detected deaths during the study period. Efforts to reduce opioid and benzodiazepine prescribing may reduce risk of opioid-detected deaths in this group, but other approaches will be needed to address most opioid-detected deaths that involved non-pharmaceutical opioids.
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Affiliation(s)
- Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, the United States of America; Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America.
| | - Anne C Black
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; VA Connecticut Healthcare System, West Haven, CT, the United States of America
| | - Lauretta E Grau
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America
| | - Hsiu-Ju Lin
- School of Social Work, University of Connecticut, Storrs, CT, the United States of America; Department of Mental Health and Addiction Services, Hartford, CT, the United States of America
| | - Christina Greene
- U.S. Food and Drug Administration, Silver Spring, MD, the United States of America
| | - Hana Lee
- U.S. Food and Drug Administration, Silver Spring, MD, the United States of America
| | - Robert Heimer
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America
| | - Kathryn E Hawk
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - Gail D'Onofrio
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - David A Fiellin
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - William C Becker
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; VA Connecticut Healthcare System, West Haven, CT, the United States of America
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James H, Morgan J, Ti L, Nolan S. Transitions in care between hospital and community settings for individuals with a substance use disorder: A systematic review. Drug Alcohol Depend 2023; 243:109763. [PMID: 36634575 DOI: 10.1016/j.drugalcdep.2023.109763] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Individuals with a substance use disorder (SUD) have high rates of hospital service utilization including emergency department (ED) presentations and hospital admissions. Acute care settings offer a critical opportunity to engage individuals in addiction care and improve health outcomes especially given that the period of transition from hospital to community is challenging. This review summarizes literature on interventions for optimizing transitions in care from hospital to community for individuals with a SUD. METHODS The literature search focused on key terms associated with transitions in care and SUD. The search was conducted on three databases: MEDLINE, CINAHL, and PsychInfo. Eligible studies evaluated interventions acting prior to or during transitions in care from hospital to community and reported post-discharge engagement in specialized addiction care and/or return to hospital and were published since 2010. RESULTS Title and abstract screening were conducted for 2337 records. Overall, 31 studies met inclusion criteria, including 7 randomized controlled trials and 24 quasi-experimental designs which focused on opioid use (n = 8), alcohol use (n = 5), or polysubstance use (n = 18). Interventions included pharmacotherapy initiation (n = 7), addiction consult services (n = 9), protocol implementation (n = 3), screening, brief intervention, and referral to treatment (n = 2), patient navigation (n = 4), case management (n = 1), and recovery coaching (n = 3). CONCLUSIONS Both pharmacologic and psychosocial interventions implemented around transitions from acute to community care settings can improve engagement in care and reduce hospital readmission and ED presentations. Future research should focus on long-term health and social outcomes to improve quality of care for individuals with a SUD.
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Affiliation(s)
- Hannah James
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V6H 0A5, Canada
| | - Jeffrey Morgan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6Z 1Z3, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V6H 0A5, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V6H 0A5, Canada.
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Post-overdose follow-up in the community with peer recovery specialists: the Lake Superior Diversion and Substance Use Response Team. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100139. [PMID: 36994366 PMCID: PMC10040321 DOI: 10.1016/j.dadr.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023]
Abstract
Background As the overdose epidemic continues to worsen, nonfatal overdose calls for service represent a critical touchpoint for intervention. While most studies have focused on law enforcement led post-overdose follow-up, the current study describes the programmatic characteristics and outcomes of a non-law enforcement post overdose program comprised of peer specialists embedded within a local police department. Methods We examined information on 341 follow-up responses occurring over a 16-month study period using administrative data. We assessed programmatic characteristics including demographic information on clients, referral source, engagement type, and goal completion. Results The results indicate that over 60% of client referrals ended in the goal of in-person contact. Of those, about 80% went on to complete an engagement goal with the peer specialist. We found no significant variation in client demographics and referral source or follow-up engagement (in-person or not); however, client referrals from law enforcement first responders, the most common source, are significantly less likely to result in an in-person contact, though, if contact is made, similarly likely to complete an engagement goal. Conclusions Post overdose response programs that do not involve law enforcement are exceedingly rare. Given that some research has shown that police involvement in post overdose response can have unexpected, associated harms, it is important to assess the effectiveness of post overdose programs that do not involve the police. Findings here suggest that this type of program is successful at locating and engaging community members into recovery support services who have experienced an overdose.
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Bergler-Klein J, Gotcheva N, Kalējs O, Kalarus Z, Kovačić D, Peršić V, Shlyakhto E, Uuetoa T, Huisman MV, Lip GYH, Vinereanu D. Efficacy of Low-Dose Versus Traditional Buprenorphine Induction in the Hospital: A Quantitative and Qualitative Study. Am J Ther 2023; 30:e1-e9. [PMID: 36608069 PMCID: PMC10782934 DOI: 10.1097/mjt.0000000000001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Emerging evidence suggests low-dose buprenorphine (LDB) induction can expand opportunities for buprenorphine induction in patients who are taking taking methadone, short-acting opioid agonists, or who have anxiety about opioid withdrawal. STUDY QUESTION How is a rapid LDB protocol using transdermal buprenorphine tolerated in the hospital? STUDY DESIGN A prospective study of 20 patient encounters (n = 20 patients) with traditional buprenorphine induction before implementation of study protocol (control group) and 37 patient encounters (n = 34 patients) with LDB induction protocol (pilot group). Summary statistics were used to describe demographics, clinical opioid withdrawal scale and pain scores within 24 hours preprotocol and within 24 hours postprotocol initiation, hospital length of stay after protocol initiation, receipt of a buprenorphine prescription at discharge, and prescription activity at 30 days. T test and chi-square tests were used to analyze comparisons. A subset of pilot group patients completed a survey about their experience. RESULTS There were no statistically significant differences in pain and clinical opioid withdrawal scale scores between the pilot and control groups. There were 5 instances of precipitated withdrawal in the pilot group. There was no statistically significant difference in mean discharge time after protocol initiation between the pilot and control groups (P = 0.60). Most patients surveyed described a positive experience with LDB induction. CONCLUSION Hospitalization is a critical time to initiate buprenorphine for patients with opioid use disorder. Our data adds to the growing evidence that LDB induction is feasible for patients taking methadone and short-acting opioid agonists, and that a more rapid induction protocol is generally well-tolerated by patients although precipitated withdrawal is a risk. Finally, our rapid induction protocol did not seem to increase hospital length of stay compared with traditional induction.
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Affiliation(s)
- Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Nina Gotcheva
- Department of Cardiology, National Heart Hospital, Sofia, Bulgaria
| | - Oskars Kalējs
- Department of Arrhythmology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Dragan Kovačić
- Department of Cardiology, General Hospital Celje, Celje, Slovenia
| | - Viktor Peršić
- Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, Croatia
- Division of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism “Thalassotherapia Opatija,” Opatija, Croatia
| | - Evgeny Shlyakhto
- Clinical Endocrinology Laboratory, Department of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Menno V. Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; and
- Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital, Bucharest, Romania
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Stopka TJ, Rottapel RE, Ferguson WJ, Pivovarova E, Toro-Mejias LD, Friedmann PD, Evans EA. Medication for opioid use disorder treatment continuity post-release from jail: A qualitative study with community-based treatment providers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103803. [PMID: 35965159 PMCID: PMC10117037 DOI: 10.1016/j.drugpo.2022.103803] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND People released from jail are at elevated opioid overdose risk. Medications for opioid use disorder (MOUD) are effective in reducing overdoses. MOUD treatment was recently mandated in seven Massachusetts jails, but little is known about barriers and facilitators to treatment continuity post-release. We aimed to assess MOUD provider perspectives on treatment continuity among people released from jail. METHODS We conducted qualitative interviews with 36 medical, supervisory, and administrative staff at MOUD programs that serve jail-referred patients. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework to guide development of instruments, codes, and analyses. We employed deductive and inductive coding, and a grounded theory analytical approach to identify salient themes. RESULTS Inner context findings highlighted necessary adjustments among jail staff to approve MOUD treatment, especially with agonist medications that were previously considered contraband. Participants perceived that some staff within jails favored abstinence-based recovery, viewing agonists as a crutch. Bridging results highlighted the importance of inter-agency communication and coordination to ensure information transfer for seamless treatment continuity in the community post-release. Pre-release planning, release on pre-scheduled dates, medication provision to cover gaps between jail release and intake at community MOUD sites, and exchange of treatment information across agencies were viewed as paramount to success. Unexpected early releases and releases from court were viewed as barriers to treatment coordination. Outer context domains were largely tied to social determinants of health. Substantial barriers to treatment continuity included shelter, food security, employment, transportation, and insurance reactivation. CONCLUSION Through qualitative interviews with community-based MOUD staff, we identified salient barriers and facilitators to treatment continuity post-release from jails. Findings point to needed investments in care coordination, staffing, and funding to strengthen jail-to-community-based MOUD treatment, removing barriers to continuity, and decreasing opioid overdose deaths during this high-risk transition.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States.
| | - Rebecca E Rottapel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States
| | - Ekaterina Pivovarova
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States
| | - Lizbeth Del Toro-Mejias
- University of Massachusetts Chan Medical School-Baystate, 55 N Lake Ave, Worcester, MA 01655, United States; Baystate Health, 759 Chestnut St, Springfield, MA, 01199, United States
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate, 55 N Lake Ave, Worcester, MA 01655, United States; Baystate Health, 759 Chestnut St, Springfield, MA, 01199, United States
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, United States
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Doogan NJ, Mack A, Wang J, Crane D, Jackson R, Applegate M, Villani J, Chandler R, Barocas JA. Opioid Use Disorder Among Ohio's Medicaid Population: Prevalence Estimates From 19 Counties Using a Multiplier Method. Am J Epidemiol 2022; 191:2098-2108. [PMID: 36004683 PMCID: PMC10144717 DOI: 10.1093/aje/kwac154] [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: 06/22/2021] [Revised: 06/21/2022] [Accepted: 08/19/2022] [Indexed: 02/01/2023] Open
Abstract
The decades-long overdose epidemic in the United States is driven by opioid misuse. Overdoses commonly, although not exclusively, occur in individuals with opioid use disorder (OUD). To allocate adequate resources and develop appropriately scaled public health responses, accurate estimation of the prevalence of OUD is needed. Indirect methods (e.g., a multiplier method) of estimating prevalence of problematic substance-use behavior circumvent some limitations of household surveys and use of administrative data. We used a multiplier method to estimate OUD prevalence among the adult Medicaid population (ages 18-64 years) in 19 Ohio counties that are highly affected by overdose. We used Medicaid claims data and the US National Vital Statistics System overdose death data, which were linked at the person level. A statistical model leveraged opioid-related death rate information from a group with known OUD to estimate prevalence among a group with unknown OUD status given recorded opioid-related deaths in that group. We estimated that 13.6% of the total study population had OUD in 2019. Men (16.7%) had a higher prevalence of OUD than women (11.4%), and persons aged 35-54 had the highest prevalence (16.7%). Our approach to prevalence estimation has important implications for OUD surveillance and treatment in the United States.
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Affiliation(s)
- Nathan J Doogan
- Correspondence to Dr. Nathan J. Doogan, Ohio Colleges of Medicine Government Resource Center, The Ohio State University, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210 (e-mail: )
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The Massachusetts Department of Public Health Post Overdose Support Team Initiative: A Public Health-Centered Co-Response Model for Post-Overdose Outreach. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:S311-S319. [PMID: 36194799 PMCID: PMC9531990 DOI: 10.1097/phh.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT Post-overdose outreach programs have emerged in response to surging overdose deaths amid fentanyl contamination of the illicit opioid supply. Predominantly centered in police departments in collaboration with public health providers, these programs conduct home-based outreach with survivors and their social networks following an overdose. APPROACH We describe implementation of the Post Overdose Support Team (POST) initiative, an ongoing public health funded and centered approach. Post Overdose Support Team is a person-centered model led by harm reductionists in health and human services agencies in collaboration with municipal first responders. The goal of POST is to engage overdose survivors and their social network to improve general health, connect people to services (including access to treatment, if desired), and reduce risk of subsequent overdose. IMPLEMENTATION Nine agencies in Massachusetts that are part of the state's overdose education and naloxone distribution network implemented POST programs, covering 28 municipalities. The POST teams conduct home-based outreach with individuals who experienced an opioid-related overdose to provide a menu of services, including naloxone rescue kits, overdose response and risk reduction planning, referral to treatment for substance use disorders, including medication for opioid use disorder, and referral to recovery and family supports. EVALUATION From October 2017 to October 2021, the POST teams attempted to reach 5634 overdose survivors via 10 536 outreach visits. Teams successfully engaged 3014 survivors, either directly or through contact with their social network (53.5% success rate). Using data from a real-time encounter-level database, monthly peer-sharing calls with program sites, and annual site visits, we describe the implementation of the POST initiative and provide practice-based recommendations and lessons learned. DISCUSSION Early evidence suggests that the POST initiative is meeting its goal to engage overdose survivors, improve general health, and reduce subsequent overdose risk. Future evaluations should examine long-term outcomes among participants, including service linkages and incremental behavior change.
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Delcher C, Harris DR, Anthony N, Stoops WW, Thompson K, Quesinberry D. Substance use disorders and social determinants of health from electronic medical records obtained during Kentucky's "triple wave". Pharmacol Biochem Behav 2022; 221:173495. [PMID: 36427682 PMCID: PMC10082996 DOI: 10.1016/j.pbb.2022.173495] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Social determinants of health (SDOH) play a critical role in the risk of harmful drug use. Examining SDOH as a means of differentiating populations with multiple co-occurring substance use disorders (SUDs) is particularly salient in the era of prevalent opioid and stimulant use known as the "Third Wave". This study uses electronic medical records (EMRs) from a safety net hospital system from 14,032 patients in Kentucky from 2017 to 2019 in order to 1) define three types of SUD cohorts with shared/unique risk factors, 2) identify patients with unstable housing using novel methods for EMRs and 3) link patients to their residential neighborhood to obtain quantitative perspective on social vulnerability. We identified patients in three cohorts with statistically significant unique risk factors that included race, biological sex, insurance type, smoking status, and urban/rural residential location. Adjusting for these variables, we found a statistically significant, increasing risk gradient for patients experiencing unstable housing by cohort type: opioid-only (n = 7385, reference), stimulant-only (n = 4794, odds ratio (aOR) 1.86 95 % confidence interval (CI): 1.66-2.09), and co-diagnosed (n = 1853, aOR = 2.75, 95 % CI: 2.39 to 3.16). At the neighborhood-level, we used 8 different measures of social vulnerability and found that, for the most part, increasing proportions of patients with stimulant use living in a census tract was associated with more social vulnerability. Our study identifies potentially modifiable factors that can be tailored by substance type and demonstrates robust use of EMRs to meet national goals of enhancing research on social determinants of health.
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Affiliation(s)
- Chris Delcher
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America.
| | - Daniel R Harris
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America
| | - Nicholas Anthony
- Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America
| | - William W Stoops
- Departments of Behavioral Science and Psychiatry, College of Medicine, Department of Psychology, College of Arts & Sciences, University of Kentucky, United States of America
| | - Katherine Thompson
- Department of Statistics, College of Arts & Sciences, University of Kentucky, United States of America
| | - Dana Quesinberry
- Department of Health Management and Policy, College of Public Health, University of Kentucky, United States of America; Kentucky Injury Prevention and Research Center, University of Kentucky, United States of America
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Comparing Practices Used in Overdose Fatality Review Teams to Recommended Implementation Guidelines. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:S286-S294. [PMID: 36194796 PMCID: PMC9531981 DOI: 10.1097/phh.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Overdose fatality review teams are a public health and public safety collaboration that reviews fatality cases using a multidisciplinary team to provide recommendations for overdose prevention. No research exists on the case review practices currently being used in these programs. DESIGN We administered a cross-sectional survey measuring case review practices and perceptions to a convenience sample of overdose fatality review teams. SETTING We administered the online survey to participants at a national virtual forum on overdose fatality review. PARTICIPANTS In this study, we examined 30 county-level overdose fatality review teams from 6 states who completed the survey. MAIN OUTCOME MEASURES We developed measures of case review practices from an overdose fatality review implementation guide. We provided descriptive statistics on the survey items used to measure these practices and examined how practice uptake varied by overdose fatality review team characteristics. RESULTS Most overdose fatality review teams had adequate representation and membership, but none adhered to all of the practices measured from the implementation guide. The largest gap was in perceived effectiveness and implementation of case review recommendations. In addition, teams that had been reviewing cases for longer reported more adherence to recommended practices. CONCLUSIONS Overdose fatality case review is a collaboration between local public health and public safety agencies that holds great promise. However, these teams will require additional training and technical assistance with local community support to ensure that recommendations are actionable.
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Young AM, Brown JL, Hunt T, Sprague Martinez LS, Chandler R, Oga E, Winhusen TJ, Baker T, Battaglia T, Bowers-Sword R, Button A, Fallin-Bennett A, Fanucchi L, Freeman P, Glasgow LM, Gulley J, Kendell C, Lofwall M, Lyons MS, Quinn M, Rapkin BD, Surratt HL, Walsh SL. Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio. BMJ Open 2022; 12:e059328. [PMID: 36123106 PMCID: PMC9486330 DOI: 10.1136/bmjopen-2021-059328] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Opioid-involved overdose deaths continue to surge in many communities, despite numerous evidence-based practices (EBPs) that exist to prevent them. The HEALing Communities Study (HCS) was launched to develop and test an intervention (ie, Communities That HEAL (CTH)) that supports communities in expanding uptake of EBPs to reduce opioid-involved overdose deaths. This paper describes a protocol for a process foundational to the CTH intervention through which community coalitions select strategies to implement EBPs locally. METHODS AND ANALYSIS The CTH is being implemented in 67 communities (randomised to receive the intervention) in four states in partnership with coalitions (one per community). Coalitions must select at least five strategies, including one to implement each of the following EBPs: (a) overdose education and naloxone distribution; expanded (b) access to medications for opioid use disorder (MOUD), (c) linkage to MOUD, (d) retention in MOUD and (e) safer opioid prescribing/dispensing. Facilitated by decision aid tools, the community action planning process includes (1) data-driven goal setting, (2) discussion and prioritisation of EBP strategies, (3) selection of EBP strategies and (4) identification of next steps. Following review of epidemiologic data and information on existing local services, coalitions set goals and discuss, score and/or rank EBP strategies based on feasibility, appropriateness within the community context and potential impact on reducing opioid-involved overdose deaths with a focus on three key sectors (healthcare, behavioural health and criminal justice) and high-risk/vulnerable populations. Coalitions then select EBP strategies through consensus or majority vote and, subsequently, suggest or choose agencies with which to partner for implementation. ETHICS AND DISSEMINATION The HCS protocol was approved by a central Institutional Review Board (Advarra). Results of the action planning process will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. TRIAL REGISTRATION NUMBER NCT04111939.
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Affiliation(s)
- April M Young
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer L Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Timothy Hunt
- School of Social Work, Columbia University, New York, New York, USA
| | | | - Redonna Chandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Emmanuel Oga
- Center for Applied Public Health Research, Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - T John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Trevor Baker
- General Internal Medicine-CARE Unit, Boston Medical Center, Boston, Massachusetts, USA
| | - Tracy Battaglia
- Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Rachel Bowers-Sword
- General Internal Medicine-CARE Unit, Boston Medical Center, Boston, Massachusetts, USA
| | - Amy Button
- Montefiore Hudson Valley Collaborative, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Laura Fanucchi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia Freeman
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - LaShawn M Glasgow
- Community & Workplace Health, Research Triangle International, Research Triangle Park, North Carolina, USA
| | | | - Charles Kendell
- Franklin County Agency for Substance Abuse Policy Board, Frankfort, Kentucky, USA
| | - Michelle Lofwall
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Michael S Lyons
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Maria Quinn
- Center for Behavioral Health, Holyoke Medical Center, Holyoke, Massachusetts, USA
| | - Bruce David Rapkin
- Epiemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hilary L Surratt
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Sharon L Walsh
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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