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McKendrick G, Stull SW, Sharma A, Dunn KE. Availability and Opportunities for Expansion of Buprenorphine for the Treatment of Opioid Use Disorder. Semin Neurol 2024; 44:419-429. [PMID: 38876459 DOI: 10.1055/s-0044-1787569] [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: 06/16/2024]
Abstract
There is an urgent need to expand access to treatment for persons with opioid use disorder (OUD). As neurologists may frequently encounter patients with chronic pain who have developed OUD, they are in a position to serve as advocates for treatment. Buprenorphine is the most scalable medication for OUD in the United States, yet expansion has plateaued in recent years despite growing treatment needs. Reluctance of providers to establish treatment with new patients, challenges with rural expansion, stigma related to buprenorphine-based care, and pharmacy pressures that incentivize low dispensing and inventories may have stalled expansion. This review introduces these challenges before outlining actionable and evidenced-based strategies that warrant investigation, including methods to improve patient access to care (remotely delivered care, mobile delivery programs, Bridge programs) and provider retention and confidence in prescribing (expert consults, Extension for Community Healthcare Outcomes, a telementoring model, hub-and-spoke services), as well as novel innovations (virtual reality, artificial intelligence, wearable technologies). Overall, fortifying existing delivery systems while developing new transformative models may be necessary to achieve more optimal levels of buprenorphine treatment expansion.
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Affiliation(s)
- Greer McKendrick
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samuel W Stull
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | | | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Acheson LS, Gordon C, McKetin R, Brett J, Christmass M, Rodgers C, Lintzeris N, Dunlop A, Farrell M, Shoptaw S, Ezard N, Siefried KJ. Measuring Objective and Subjective Sleep during Lisdexamfetamine Treatment of Acute Methamphetamine Withdrawal: A Feasibility Study. Eur Addict Res 2024; 30:121-125. [PMID: 38498995 DOI: 10.1159/000536328] [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: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Sleep disturbance is common during methamphetamine (MA) use and withdrawal; however, the feasibility of combined subjective-objective measurement of sleep-wake has not been shown in this population. Actigraphy is a well-established, non-invasive measure of sleep-wake cycles with good concordance with polysomnography. This study aimed to investigate the feasibility and utility of using actigraphy and sleep diaries to investigate sleep during MA withdrawal. METHODS We conducted a feasibility and utility study of actigraphy and sleep diaries during a clinical trial of lisdexamfetamine for MA withdrawal. Participants were inpatients for 7 days, wore an actigraph (Philips Actiwatch 2) and completed a modified Consensus Sleep Diary each morning. Participants were interviewed between days 3-5. RESULTS Ten participants (mean age 37 years, 90% male) were enrolled. No participant removed the device prematurely. Participants interviewed (n = 8) reported that the actigraph was not difficult or distracting to wear or completion of daily sleep diary onerous. Actigraphic average daily sleep duration over 7 days was 568 min, sleep onset latency 22.4 min, wake after sleep onset (WASO) 75.2 min, and sleep efficiency 83.6%. Sleep diaries underreported daily sleep compared with actigraphy (sleep duration was 56 min (p = 0.008) and WASO 47 min (p < 0.001) less). Overall sleep quality was 4.4 on a nine-point Likert scale within the diary. CONCLUSIONS Continuous actigraphy is feasible to measure sleep-wake in people withdrawing from MA, with low participant burden. We found important differences in self-reported and actigraphic sleep, which need to be explored in more detail.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Brett
- Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, Perth, Washington, Australia
- National Drug Research Institute, Curtin University, Perth, Washington, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
- Drug and Alcohol Services, Sydney, New South Wales, Australia
- Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
- Drug and Alcohol Clinical Services, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
| | - Steven Shoptaw
- Department of Family Medicine, The University of California Los Angeles, Los Angeles, California, USA
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, New South Wales, Australia
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Bergeria CL, Strain EC. Opioid Use Disorder: Pernicious and Persistent. Am J Psychiatry 2022; 179:708-714. [PMID: 36181330 DOI: 10.1176/appi.ajp.20220699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Cecilia L Bergeria
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Eric C Strain
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
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