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Pasman E, Lee G, Singer S, Burson N, Agius E, Resko SM. Attitudes toward medications for opioid use disorder among peer recovery specialists. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:391-400. [PMID: 38640497 DOI: 10.1080/00952990.2024.2332597] [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: 10/11/2023] [Revised: 01/30/2024] [Accepted: 03/06/2024] [Indexed: 04/21/2024]
Abstract
Background: Peer recovery specialists (PRSs) are substance use service providers with lived experience in recovery. Although a large body of research demonstrates the efficacy of medications for opioid use disorder (MOUD), emerging research suggests PRSs' attitudes toward MOUD are ambivalent or mixed. Few studies have quantitatively assessed factors influencing PRSs' attitudes.Objectives: This study identifies personal and professional characteristics associated with attitudes toward MOUD among PRSs.Methods: PRSs working at publicly funded agencies in Michigan completed a self-administered web-based survey (N = 266, 60.5% women). Surveys assessed socio-demographics, treatment and recovery history, attitudes toward clients, and attitudes toward MOUD. Multiple linear regression was used to identify factors associated with attitudes toward MOUD.Results: A minority of PRSs (21.4%) reported a history of treatment with MOUD, while nearly two-thirds reported current 12-step involvement (62.5%). Compared to PRSs without a history of MOUD treatment, PRSs who had positive (b = 4.71, p < .001) and mixed (b = 3.36, p = .010) experiences with MOUD had more positive attitudes; PRSs with negative experiences with MOUD had less positive attitudes (b = -3.16, p = .003). Current 12-step involvement (b = -1.63, p = .007) and more stigmatizing attitudes toward clients (b = -.294, p < .001) were associated with less positive attitudes toward MOUD. Black PRSs had less positive attitudes than White PRSs (b = -2.50, p = .001), and women had more positive attitudes than men (b = 1.19, p = .038).Conclusion: PRSs' attitudes toward MOUD varied based on the nature of their lived experience. Findings highlight considerations for training and supervising PRSs who serve individuals with opioid use disorder.
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Affiliation(s)
- Emily Pasman
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Guijin Lee
- Department of Counseling and Human Development Services, University of Georgia, Athens, GA, USA
| | - Samantha Singer
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Nick Burson
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Elizabeth Agius
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Stella M Resko
- School of Social Work, Wayne State University, Detroit, MI, USA
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA
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Treitler P, Crystal S, Cantor J, Chakravarty S, Kline A, Morton C, Powell KG, Borys S, Cooperman NA. Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose. JAMA Netw Open 2024; 7:e243614. [PMID: 38526490 PMCID: PMC10964115 DOI: 10.1001/jamanetworkopen.2024.3614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Importance Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking. Objective To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization. Design, Setting, and Participants This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023. Exposure Hospital OORP implementation. Main Outcomes and Measures The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access. Results A total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities. Conclusions and Relevance In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.
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Affiliation(s)
- Peter Treitler
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Boston University School of Social Work, Boston, Massachusetts
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Joel Cantor
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Sujoy Chakravarty
- Department of Health Sciences, Rutgers University, Camden, New Jersey
| | - Anna Kline
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Cory Morton
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Kristen Gilmore Powell
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Suzanne Borys
- Division of Mental Health and Addiction Services, New Jersey Department of Human Services, Trenton
| | - Nina A. Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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Moffitt T, Fallin-Bennett A, Fanucchi L, Walsh SL, Cook C, Oller D, Ross A, Gallivan M, Lauckner J, Byard J, Wheeler-Crum P, Lofwall MR. The development of a recovery coaching training curriculum to facilitate linkage to and increase retention on medications for opioid use disorder. Front Public Health 2024; 12:1334850. [PMID: 38425462 PMCID: PMC10903364 DOI: 10.3389/fpubh.2024.1334850] [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: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Medication treatment for opioid use disorder (MOUD) decreases opioid overdose risk and is the standard of care for persons with opioid use disorder (OUD). Recovery coach (RC)-led programs and associated training curriculums to improve outcomes around MOUD are limited. We describe our comprehensive training curriculum including instruction and pedagogy for novel RC-led MOUD linkage and retention programs and report on its feasibility. Methods–pedagogy and training development The Kentucky HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) created the Linkage and Retention RC Programs with a local recovery community organization, Voices of Hope-Lexington. RCs worked to reduce participant barriers to entering or continuing MOUD, destigmatize and educate on MOUD and harm reduction (e.g., safe injection practices), increase recovery capital, and provide opioid overdose education with naloxone distribution (OEND). An extensive hybrid (in-person and online, both synchronous and asynchronous), inclusive learning-focused curriculum to support the programs (e.g., motivational interviewing sessions, role plays, MOUD competency assessment, etc.,) was created to ensure RCs developed the necessary skills and could demonstrate competency before deployment in the field. The curriculum, pedagogy, learning environment, and numbers of RCs trained and community venues receiving a trained RC are reported, along with interviews from three RCs about the training program experience. Results The curriculum provides approximately 150 h of training to RCs. From December 2020 to February 2023, 93 RCs and 16 supervisors completed the training program; two were unable to pass a final competency check. RCs were deployed at 45 agencies in eight Kentucky HCS counties. Most agencies (72%) sustained RC services after the study period ended through other funding sources. RCs interviewed reported that the training helped them better explain and dispel myths around MOUD. Conclusion Our novel training and MOUD programs met a current unmet need for the RC workforce and for community agencies. We were able to train and deploy RCs successfully in these new programs aimed at saving lives through improving MOUD linkage and retention. This paper addresses a need to enhance the training requirements around MOUD for peer support specialists.
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Affiliation(s)
- Trevor Moffitt
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Amanda Fallin-Bennett
- College of Nursing, University of Kentucky, Lexington, KY, United States
- Voices of Hope, Lexington, KY, United States
| | - Laura Fanucchi
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Sharon L. Walsh
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Christopher Cook
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Devin Oller
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Anna Ross
- Voices of Hope, Lexington, KY, United States
| | - Molly Gallivan
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - John Lauckner
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Jeremy Byard
- Arthur Street Hotel, Louisville, KY, United States
| | | | - Michelle R. Lofwall
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
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King C, Douglas D, Avalone L, Appleton N, Linn-Walton R, Barron C, McNeely J. Telephonic Outreach to Engage Patients with Substance Use Disorder Post-Hospitalization During the COVID-19 Pandemic. J Behav Health Serv Res 2023; 50:540-547. [PMID: 37106160 PMCID: PMC10139664 DOI: 10.1007/s11414-023-09837-4] [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] [Accepted: 03/22/2023] [Indexed: 04/29/2023]
Abstract
During the initial COVID-19 surge, one public hospital in NYC updated their post-discharge outreach approach for patients with substance use disorder, as part of the CATCH (Consult for Addiction Treatment and Care in Hospitals) program. Beginning April 1, 2020, three peers and two addiction counselors attempted telephonic outreach to patients who received a CATCH consultation during hospitalization from program launch (October 7, 2019) through March 31, 2020 (n = 329). Outreach calls could include counseling, in-depth peer support, and referrals to substance use services (SUS)-a significant expansion of the services offered via outreach pre-pandemic. CATCH staff successfully reached 29.5% of patients and provided 77.6% of them with supportive counseling and referrals. Thirty percent of unsuccessful calls were due to inactive numbers, and only 8% of patients without housing were reached. Telephonic outreach established a low-barrier connection between patients and SUS that may be valuable during any period, including non-COVID times. Future interventions that address social determinants such as housing and cell phone access concomitantly with substance use should be considered by addiction consultation services to potentially reduce acute care utilization and improve health outcomes.
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Affiliation(s)
- Carla King
- Office of Behavioral Health, NYC Health + Hospitals, NY, New York, USA.
- Department of Population Health, Section On Tobacco, Alcohol, and Drug Use, NYU Grossman School of Medicine, NY, New York, USA.
| | - Drezzell Douglas
- Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | - Lynsey Avalone
- Office of Behavioral Health, NYC Health + Hospitals, NY, New York, USA
| | - Noa Appleton
- Department of Population Health, Section On Tobacco, Alcohol, and Drug Use, NYU Grossman School of Medicine, NY, New York, USA
| | | | - Charles Barron
- Office of Behavioral Health, NYC Health + Hospitals, NY, New York, USA
| | - Jennifer McNeely
- Department of Population Health, Section On Tobacco, Alcohol, and Drug Use, NYU Grossman School of Medicine, NY, New York, USA
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Loverock A, Marshall T, Viste D, Safi F, Rioux W, Sedaghat N, Kennedy M, Ghosh SM. Electronic harm reduction interventions for drug overdose monitoring and prevention: A scoping review. Drug Alcohol Depend 2023; 250:110878. [PMID: 37441959 DOI: 10.1016/j.drugalcdep.2023.110878] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Novel strategies are required to address rising overdose deaths across the globe. We sought to identify the breadth and depth of the existing evidence around electronic harm reduction (e-harm reduction) interventions that aimed to reduce the harms associated with substance use. METHODS We conducted a scoping review according to the PRISMA-ScR and PRISMA for Searching guidelines. A health sciences librarian systematically searched seven health databases from inception until January 20, 2023. Citation chaining and reference lists of included studies were searched to identify additional articles. Two reviewers independently screened, extracted and charted the data. Additionally, we conducted a gray literature search and environmental scan to supplement the findings. RESULTS A total of 51 studies met the criteria for inclusion (30 peer-reviewed articles and 21 non-peer reviewed). Most peer-reviewed studies were conducted in Western countries (USA = 23, Canada = 3, Europe = 3, China = 1) and among adult samples (adult = 27, youth/adults =1, unspecified = 2). Study designs were predominantly quantitative (n = 24), with a minority using qualitative (n = 4) or mixed methods (n = 2). Most e-harm reduction interventions were harm reduction (n = 15), followed by education (n = 6), treatment (n = 2), and combined/other approaches (n = 7). Interventions utilized web-based/mobile applications (n = 15), telephone/telehealth (n = 10), and other technology (n = 5). CONCLUSIONS While e-harm reduction technology is promising, further research is required to establish the efficacy and effectiveness of these novel interventions.
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Affiliation(s)
- Alexandra Loverock
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta T6G 1C9, Canada.
| | - Tyler Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Dylan Viste
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada
| | - Fahad Safi
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | - Will Rioux
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | - Navid Sedaghat
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
| | | | - S Monty Ghosh
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW Edmonton, Alberta T6G 2R7, Canada
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Suzuki J, Martin B, Loguidice F, Smelson D, Liebschutz JM, Schnipper JL, Weiss RD. A Peer Recovery Coach Intervention for Hospitalized Patients with Opioid Use Disorder: A Pilot Randomized Controlled Trial. J Addict Med 2023; 17:604-607. [PMID: 37788617 PMCID: PMC10544697 DOI: 10.1097/adm.0000000000001162] [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] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVES Patients with opioid use disorder (OUD) are increasingly being hospitalized for acute medical illnesses. Despite initiation of medications for OUD (MOUDs), many discontinue treatment after discharge. To evaluate whether a psychosocial intervention can improve MOUD retention after hospitalization, we conducted a pilot randomized controlled trial of a peer recovery coach intervention. METHODS An existing peer recovery coach intervention was adapted for this trial. Hospitalized adults with OUD receiving MOUD treatment were randomized to receive either a recovery coach intervention or treatment-as-usual. For those in the intervention arm, the coach guided the participant to complete a relapse prevention plan, maintained contact throughout the 6-month follow-up period, encouraged MOUD continuation, and helped to identify community resources. Those receiving treatment-as-usual were discharged with a referral to outpatient treatment. Primary outcome was retention in MOUD treatment at 6 months. Secondary outcomes were the proportion of participants readmitted to the hospital and the number of days until treatment discontinuation and to hospital readmission. RESULTS Twenty-five individuals who provided consent and randomized to the recovery coach intervention (n = 13) or treatment-as-usual (n = 12) were included in the analysis. No significant differences were found in the proportion of participants retained in MOUD treatment at 6 months (38.5% vs 41.7%, P = 0.87), proportion of participants readmitted at 6 months (46.2% vs 41.2%, P = 0.82), or the time to treatment discontinuation (log-rank P = 0.92) or readmission (log-rank P = 0.85). CONCLUSIONS This pilot trial failed to demonstrate that a recovery coach intervention improved MOUD treatment retention compared with treatment-as-usual among hospitalized individuals with OUD.
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women’s Hospital, Boston MA
- Harvard Medical School, Boston MA
| | - Bianca Martin
- Department of Psychiatry, Brigham and Women’s Hospital, Boston MA
| | - Frank Loguidice
- Department of Psychiatry, Brigham and Women’s Hospital, Boston MA
| | - David Smelson
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA
| | - Jane M. Liebschutz
- Division of General Internal Medicine, University of Pittsburgh, UPMC, Pittsburgh, PA
| | - Jeffrey L. Schnipper
- Harvard Medical School, Boston MA
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston MA
| | - Roger D. Weiss
- Harvard Medical School, Boston MA
- McLean Hospital, Belmont MA 02478
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Slater TM, Rodney T, Finnell DS. Promoting the integration of peer support specialists into the healthcare team. Nursing 2023; 53:50-55. [PMID: 36700816 DOI: 10.1097/01.nurse.0000903972.32588.ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ABSTRACT The 21st Century Cures Act to address the opioid crisis spurred the expansion of the peer support specialist (PSS) workforce. Nurses are in key positions to promote the successful integration of the PSS into the healthcare team. This article describes the role of the PSS, including key functions that overlap with those of nurses and ways they can help mitigate stigma, which remains a significant barrier to patients' access to treatment.
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Affiliation(s)
- Tammy M Slater
- At Johns Hopkins School of Nursing in Baltimore, Md., Tammy Slater is an assistant professor and the Adult-Gerontology Acute Care Nurse Practitioner Track Coordinator, Tamar Rodney is an assistant professor and the Advanced Practice Psychiatric Mental Track Coordinator, and Deborah S. Finnell is a Professor Emerita
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Kang KI, Kang CM. Roles and Effects of Peer Recovery Coach Intervention in the Field of Substance Abuse: An Integrative Literature Review. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:256-264. [PMID: 36243312 DOI: 10.1016/j.anr.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE There are ongoing public initiatives to help substance abusers by involving peer recovery coaches (PRCs) in the field of substance abuse worldwide. This study examines the contents and delivery methods of PRC intervention programs and their effects from the participants' standpoint. METHODS An integrative literature search was conducted in seven electronic databases using English and Korean search terms. Two researchers independently reviewed the extracted papers and rated their quality based on predetermined inclusion and exclusion criteria, resulting in the selection of nine papers. RESULTS Research on PRC participation in substance abuse treatment were predominantly US-based, and all articles derived were quantitative studies. The main roles of PRCs included liaising between treatment and community resources, assisting with stress management and coping skills, counseling and case management, and recovery and recurrence prevention education. In addition, the PRC-delivered intervention was tested with various outcome variables. It reduced participants' substance use and enhanced their treatment adherence rates, self-efficacy, quality of life, and stress control. CONCLUSIONS This study confirmed the need to extend existing studies by testing the effects of PRC-delivered intervention through multidisciplinary efforts in more regions and establishing PRCs' role definition and concretization. The results of this study will serve as significant basic data in developing and applying for nursing intervention programs with PRCs in clinical and community nursing settings in the future.
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Affiliation(s)
- Kyung Im Kang
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Republic of Korea.
| | - Chan Mi Kang
- Department of Nursing, Dong-Eui Institute of Technology, Republic of Korea.
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Price A, de Bell S, Shaw N, Bethel A, Anderson R, Coon JT. What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1264. [PMID: 36909883 PMCID: PMC9316011 DOI: 10.1002/cl2.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Peer support interventions involve people drawing on shared personal experience to help one another improve their physical or mental health, or reduce social isolation. If effective, they may also lessen the demand on health and social care services, reducing costs. However, the design and delivery of peer support varies greatly, from the targeted problem or need, the setting and mode of delivery, to the number and content of sessions. Robust evidence is essential for policymakers commissioning peer support and practitioners delivering services in health care and community settings. This map draws together evidence on different types of peer support to support the design and delivery of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent, high quality evidence on the effectiveness and cost-effectiveness of the use of peer support in health and social care. Search Methods We searched MEDLINE, seven further bibliographic databases, and Epistemonikos for systematic reviews (in October 2020), randomised controlled trials (in March 2021) and economic evaluations (in May 2021) on the effectiveness of peer support interventions in health and social care. We also conducted searches of Google Scholar, two trial registers, PROSPERO, and completed citation chasing on included studies. Selection Criteria Systematic reviews, randomised controlled trials and economic evaluations were included in the map. Included studies focused on adult populations with a defined health or social care need, were conducted in high-income countries, and published since 2015. Any measure of effectiveness was included, as was any form of peer support providing the peer had shared experience with the participant and a formalised role. Data Collection and Analysis Data were extracted on the type of peer support intervention and outcomes assessed in included studies. Standardised tools were used to assess study quality for all studies: assessing the methodological quality of systematic reviews 2 for systematic reviews; Cochrane risk of bias tool for randomised controlled trials; and consensus health economic criteria list for economic evaluations. Main Results We included 91 studies: 32 systematic reviews; 52 randomised controlled trials; and 7 economic evaluations. Whilst most included systematic reviews and economic evaluations were assessed to be of low or medium quality, the majority of randomised controlled trials were of higher quality. There were concentrations of evidence relating to different types of peer support, including education, psychological support, self-care/self-management and social support. Populations with long-term health conditions were most commonly studied. The majority of studies measured health-related indicators as outcomes; few studies assessed cost-effectiveness. Studies were unevenly distributed geographically, with most being conducted in the USA. Several gaps were evident regarding the delivery of peer support, particularly the integration of peers and professionals in delivering support and interventions of longer duration. Authors' Conclusions Although there is evidence available to inform the commissioning and delivery of peer support in health and social care, there are also clear gaps that need to be addressed to further support provision, particularly regarding cost-effectiveness. The effectiveness of peer support in different countries, with varying health and social care systems, is a priority for future research, as is the integration of peers with professionals in delivering peer support.
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Affiliation(s)
- Anna Price
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Siân de Bell
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
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Rationale, design, and methodology of a randomized pilot trial of an integrated intervention combining computerized behavioral therapy and recovery coaching for people with opioid use disorder: The OVERCOME study. Contemp Clin Trials Commun 2022; 28:100918. [PMID: 35573387 PMCID: PMC9097607 DOI: 10.1016/j.conctc.2022.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/25/2022] [Accepted: 04/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Opioid use disorder (OUD) has led to a staggering death toll in terms of drug-related overdoses. Despite the demonstrated benefits and effectiveness of buprenorphine, retention is suboptimal, and patients typically present with high rates of ongoing polysubstance use during treatment. A pilot trial provided preliminary support for the efficacy of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to buprenorphine in reducing substance use. Recovery coaching services provided by individuals with substance use experience and successful recovery have also shown to positively influence recovery outcomes for people with OUD by increasing buprenorphine initiation and reducing opioid use. Methods The OVERCOME study is a randomized clinical trial (RCT) aimed to tests an integrated intervention combining CBT4CBT and Recovery Coaching relative to treatment-as-usual (TAU) among individuals with OUD on buprenorphine. The primary outcome measure is the percentage of samples with any drug tested as positive at each research visit conducted during treatment (visits 1 to 8). Secondary outcomes include the percentage of samples with any drug tested as positive at 1- and 3- month follow-up and retention to buprenorphine at 3- month follow-up. Results We describe the rationale, design, and methodology of the OVERCOME Study. Conclusion This trial will provide evidence of the efficacy of an integrated intervention combining CBT4CBT and Recovery Coaching for reducing substance use and increasing buprenorphine adherence which has the potential to reduce mortality among people with OUD.
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11
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Gormley MA, Pericot-Valverde I, Diaz L, Coleman A, Lancaster J, Ortiz E, Moschella P, Heo M, Litwin AH. Effectiveness of peer recovery support services on stages of the opioid use disorder treatment cascade: A systematic review. Drug Alcohol Depend 2021; 229:109123. [PMID: 34700201 DOI: 10.1016/j.drugalcdep.2021.109123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peer recovery support services (PRSS) have been increasingly incorporated during the recovery process for opioid use disorder (OUD), yet little is known about the effects of PRSS on clinical outcomes of individuals who misuse opioids. This study systematically synthesized existing literature reporting the effectiveness of PRSS interventions on stages of the OUD treatment cascade. METHODS A search conducted on five databases identified studies from database inception to January 26th 2021 that evaluated the effects of PRSS on PRSS engagement, medication for OUD (MOUD) initiation, MOUD retention, opioid and non-opioid misuse, and remission. Characteristics of PRSS interventions, study design, and clinical outcomes were extracted. Methodological quality was assessed with the quality assessment tool for quantitative studies by the Effective Public Health Practice Project. RESULTS Of 123 titles, 22 were subjected to full-text review and 12 ultimately met inclusion criteria. Only two studies were randomized control trials, half compared the outcomes of PRSS participants to those of a counterfactual group. Most PRSS were unstandardized and broadly described, involving linkage to treatment (91.7%) or follow-up support (91.7%). MOUD initiation was reported the most often (66.7%), followed by PRSS engagement (33.3%) and opioid use (25.0%). No studies reported findings for MOUD retention or remission. Findings for available outcomes were inconsistent and difficult to compare due to the heterogeneity of PRSS interventions and methodological limitations. CONCLUSION Effectiveness of PRSS interventions on stages of the OUD treatment cascade remain inconclusive. Additional research is necessary before supporting the implementation of PRSS on a broad scale.
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Affiliation(s)
- Mirinda Ann Gormley
- Clemson University College of Behavioral, Social, and Health Science, Department of Public Health Sciences, 503 Edwards Hall, Clemson SC, 29631, USA; Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA.
| | - Irene Pericot-Valverde
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Clemson University School of Health Research, 605 Grove Road Suite 301, Clemson, SC, 29605, USA
| | - Liam Diaz
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Greenville County Behavioral Health AmeriCorps VISTA Program, 130 Industrial Dr. Suite B, Greenville, SC, 29607, USA
| | - Ashley Coleman
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Jonathan Lancaster
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Clemson University College of Behavioral, Social, and Health Science, Department of Psychology, 418 Brackett Hall, Clemson SC, 29634, USA
| | - Erik Ortiz
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Phillip Moschella
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Prisma Health Department of Emergency Medicine, 701 Grove Rd., Greenville, SC, 29605, USA; University of South Carolina School of Medicine Greenville, Department of Medicine, 701 Grove road, Greenville, SC, 29605, USA
| | - Moonseong Heo
- Clemson University College of Behavioral, Social, and Health Science, Department of Public Health Sciences, 503 Edwards Hall, Clemson SC, 29631, USA; Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Alain H Litwin
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; University of South Carolina School of Medicine Greenville, Department of Medicine, 701 Grove road, Greenville, SC, 29605, USA; Clemson University School of Health Research, 605 Grove Road Suite 301, Clemson, SC, 29605, USA; Prisma Health Department of Internal Medicine, 876 W Faris Rd., Greenville, SC, 29605, USA
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Holtyn AF, Toegel F, Novak MD, Leoutsakos JM, Fingerhood M, Silverman K. Remotely delivered incentives to promote buprenorphine treatment engagement in out-of-treatment adults with opioid use disorder. Drug Alcohol Depend 2021; 225:108786. [PMID: 34087746 PMCID: PMC8282759 DOI: 10.1016/j.drugalcdep.2021.108786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Opioid overdose remains a leading cause of death. Office-based buprenorphine could expand access to treatment to the many opioid users who are not in treatment and who are at risk for opioid overdose. However, many people in need of buprenorphine treatment do not enroll in treatment. This randomized pilot trial evaluated efficacy of a remotely delivered incentive intervention in promoting engagement in buprenorphine treatment in out-of-treatment adults with opioid use disorder. METHODS Participants (N = 41) were offered referrals to buprenorphine treatment and randomly assigned to Control or Incentive groups for 6 months. Incentive participants were offered incentives for enrolling in buprenorphine treatment, verified by providing documentation showing that they received a buprenorphine prescription, and providing videos taking daily buprenorphine doses. Participants used a smartphone application to record and submit a video of their buprenorphine prescription and daily buprenorphine administration. Incentive earnings were added remotely to reloadable credit cards. RESULTS Incentive participants were significantly more likely to enroll in treatment compared to control participants (71.4 % versus 30.0 % of participants; OR [95 % CI]: 6.24 [1.46-26.72], p = .014). Few participants in either group adhered to buprenorphine treatment, and the two groups continued to use opioids, including fentanyl at high and comparable rates. The two groups did not differ in the percentage of urine samples that were positive for buprenorphine, opiates, fentanyl, or methadone at monthly assessments conducted during the 6-month intervention. CONCLUSIONS Remotely delivered incentives can connect out-of-treatment adults with opioid use disorder to treatment, but additional supports are needed to promote buprenorphine adherence.
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Affiliation(s)
- August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kropp F, Wilder C, Theobald J, Lewis D, Winhusen TJ. The feasibility and safety of training patients in opioid treatment to serve as peer recovery support service interventionists. Subst Abus 2021; 43:527-530. [PMID: 34236298 DOI: 10.1080/08897077.2021.1949667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of peer interventionists may be helpful in addressing problems associated with substance use disorders. However, implementation issues such as training, supervision, and the impact of delivering the intervention on the interventionists themselves require additional examination. This report describes the training methods and peer interventionist outcomes in a pilot study of a single-session Peer Recovery Support Services (PRSS) telephone intervention to facilitate enrollment in medication for opioid use disorder (MOUD) treatment. Methods: This was a secondary analysis of a pilot study testing a PRSS intervention in adults using illicit opioids who reported a recent non-fatal opioid overdose (N = 80, with 40 PRSS participants). Candidates recruited from MOUD treatment programs were trained to deliver the PRSS intervention. Assessments of adverse events, global health, and peer satisfaction were used to evaluate the effects of serving as an interventionist. Fidelity and proportion of cases enrolling in MOUD were calculated for each interventionist. Results: Four consented candidates were trained to deliver the PRSS intervention to thirty-six study participants (90% PRSS arm). All interventionists successfully maintained fidelity to the PRSS intervention and reported no negative effects. Interventionists experienced differential success in encouraging treatment enrollment ranging from 16%-60% of their cases. Conclusions: This pilot study demonstrates promise in utilizing peer interventionists to deliver a brief PRSS intervention with limited training and no reported negative effects on the interventionists themselves. Factors contributing to the differential success of the interventionists are unclear. Future research on the variable efficacy of peer interventionists is warranted to identify, quantify, and evaluate specific interactional elements associated with peer efficacy. Additionally, further evaluation of training, supervision practices, and the effects of serving as a PRSS interventionist, is needed. Trial Registration: Clinical Trials.gov http://www.clinicaltrials.gov; Identifier: NCT02922959.
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Affiliation(s)
- Frankie Kropp
- 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
| | - Christine Wilder
- 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
| | - Jeff Theobald
- 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
| | - Daniel Lewis
- 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
| | - 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
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Elliott L, Crasta D, Khan M, Roth A, Green T, Kolodny A, Bennett AS. Validation of the Opioid Overdose Risk Behavior Scale, version 2 (ORBS-2). Drug Alcohol Depend 2021; 223:108721. [PMID: 33895681 PMCID: PMC8113089 DOI: 10.1016/j.drugalcdep.2021.108721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the factor structure of a revised and expanded opioid overdose risk behavior scale and assess its associations with known overdose indicators and other clinical constructs. BACKGROUND Opioid-related overdose remains high in the U.S. We lack strong instrumentation for assessing behavioral risk factors. We revised and expanded the opioid overdose risk behavior scale (ORBS-1) for use among a broader range of people who use opioids. SETTING & SAMPLING FRAME Using respondent-driven sampling we recruited adults (18+) reporting current unprescribed opioid use and New York City residence. METHOD Participants (N = 575) completed the ORBS-1, ORBS-2, and a variety of clinical measures and then completed the ORBS-2 and overdose risk outcomes across monthly follow-up assessments over a 13-month period. RESULTS Principal components analysis was used to identify six ORBS-2 subscales, Prescription Opioid Misuse, Risky Non-Injection Use, Injection Drug Use, Concurrent Opioid and Benzodiazepine Use, Concurrent Opioid and Alcohol Use, and Multiple-Drug Polysubstance Use. All subscales showed moderate non-parametric correlations with the ORBS-1 and with corresponding clinical constructs. Five of the subscales were significantly (p < .01) positively associated with self-reported non-fatal overdose. Of note, the Risky Non-Injection Use subscale was the most strongly associated with past-month overdose indicators. CONCLUSIONS Psychometrics for the opioid overdose risk behavior subscales identified suggest the ongoing utility of risk behavioral instrumentation for epidemiological research and clinical practice focused on risk communication and minimization. Use of the entire ORBS-2 measure can provide insight into the proximal/behavioral factors of greatest concern to reduce overdose mortality.
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Affiliation(s)
- Luther Elliott
- New York University School of Global Public Health, Center for Drug Use and HIV/HCV Research (CDUHR), United States.
| | - Dev Crasta
- Department of Veterans Affairs Center of Excellence for Suicide Prevention
| | - Maria Khan
- New York University School of Medicine Department of Population Health
| | | | - Traci Green
- Brandeis University Heller School for Social Policy and Management
| | - Andrew Kolodny
- Brandeis University Heller School for Social Policy and Management
| | - Alex S. Bennett
- New York University School of Global Public Health and Center for Drug Use and HIV/HCV Research (CDUHR),Corresponding Authors – ;
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Winhusen T, Wilder C, Lyons MS, Theobald J, Kropp F, Lewis D. Evaluation of a personally-tailored opioid overdose prevention education and naloxone distribution intervention to promote harm reduction and treatment readiness in individuals actively using illicit opioids. Drug Alcohol Depend 2020; 216:108265. [PMID: 32919098 PMCID: PMC7458095 DOI: 10.1016/j.drugalcdep.2020.108265] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND Opioid overdose prevention education and naloxone distribution (OEND) programs include information on general risk factors, overdose recognition, and naloxone utilization. This study evaluated a personally-tailored OEND (PTOEND) intervention designed to promote harm reduction and treatment readiness for illicit opioid users by also including education about personal overdose-risk factors and medication for opioid use disorder (MOUD). METHOD A secondary analysis of a randomized controlled trial testing a Peer recovery support service (PRSS) intervention, relative to Control, in adult illicit opioid users reporting treatment for an overdose in the prior 6 months. PTOEND, a 30-minute computer-guided intervention, was administered by a research assistant at the randomization visit to all participants (N = 80). Participants completed a telephone visit 3 weeks post-randomization (n = 74) to assess changes in opioid overdose/MOUD knowledge and treatment readiness. Participants completed in-person visits at 3 (n = 66), 6 (n = 58), and 12 (n = 44) months post-randomization to assess illicit opioid use and naloxone utilization (all time points) and overdose-risk behaviors (12 months). We conducted pre-post analyses of the impact of PTOEND controlling for the PRSS effect. RESULTS PTOEND increased knowledge of overdose (79.8% to 81.5%, p < 0.05) and MOUD (66.9% to 75.0%, p < 0.01) and decreased perceived treatment barriers (2.1 to 1.9, p < 0.01); desire to quit all substances increased (7.2 to 7.8, p = 0.05). Self-reported opioid use was significantly decreased at each follow-up (all p < 0.01). Self-reported overdose-risk behaviors decreased significantly (6.2 to 2.4, p < 0.01). A majority of participants (65 %) reported naloxone utilization. CONCLUSIONS PTOEND may be effective for promoting harm reduction and treatment readiness.
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Affiliation(s)
- Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Christine Wilder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine 231, Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Jeff Theobald
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Frankie Kropp
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Daniel Lewis
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
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