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Aleksanyan J, Choi S, Lincourt P, Burke C, Ramsey KS, Hussain S, Jordan AE, Morris M, D’Aunno T, Glied S, McNeely J, Elbel B, Mijanovich T, Adhikari S, Neighbors CJ. Lost in transition: A protocol for a retrospective, longitudinal cohort study for addressing challenges in opioid treatment for transition-age adults. PLoS One 2024; 19:e0297567. [PMID: 39141672 PMCID: PMC11324150 DOI: 10.1371/journal.pone.0297567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND In the United States, there has been a concerning rise in the prevalence of opioid use disorders (OUD) among transition-age (TA) adults, 18 to 25-years old, with a disproportionate impact on individuals and families covered by Medicaid. Of equal concern, the treatment system continues to underperform for many young people, emphasizing the need to address the treatment challenges faced by this vulnerable population at a pivotal juncture in their life course. Pharmacotherapy is the most effective treatment for OUD, yet notably, observational studies reveal gaps in the receipt of and retention in medications for opioid use disorder (MOUD), resulting in poor outcomes for many TA adults in treatment. Few current studies on OUD treatment quality explicitly consider the influence of individual, organizational, and contextual factors, especially for young people whose social roles and institutional ties remain in flux. METHODS We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay. DISCUSSION Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S.
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Affiliation(s)
- Josh Aleksanyan
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Patricia Lincourt
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Constance Burke
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Shazia Hussain
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Ashly E. Jordan
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Maria Morris
- New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America
| | - Thomas D’Aunno
- New York University Wagner School of Public Policy, New York, New York, United States of America
| | - Sherry Glied
- New York University Wagner School of Public Policy, New York, New York, United States of America
| | - Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- New York University Wagner School of Public Policy, New York, New York, United States of America
| | - Tod Mijanovich
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York, United States of America
| | - Samrachana Adhikari
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- New York University Wagner School of Public Policy, New York, New York, United States of America
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Bakken R, Benth JŠ, Fauske H, Lien L, Landheim AS. Individual Trajectories of Specialist Substance Use Disorder and Mental Health Treatment Utilization Among Young Adults With Substance Use Problems: A Cohort Study. J Dual Diagn 2024; 20:251-265. [PMID: 38704859 DOI: 10.1080/15504263.2024.2341092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The aim of the study was to identify groups of young adults with distinct longitudinal patterns of use of treatment for substance use disorders and mental health (MH) problems and to investigate potential explanatory factors for different patterns of treatment use over time, including sociodemographic factors. METHODS The sample consisted of 447 young adults aged 16-29 years who entered long-term residential substance use disorder treatment facilities in Norway from 2011 to 2016. In this study, we obtained data collected by the Norwegian Patient Registry and Statistics Norway. These data were linked with the electronic health record data of the substance use disorder treatment facilities from which the participants were recruited. Growth mixture modeling was performed. The identified groups were further compared using analysis of variance or χ2 test. RESULTS Four groups of participants for total treatment use, substance use disorder treatment use, and MH treatment use were identified. Most participants from the overall sample were classified as members of a group characterized by a low and stable pattern of treatment use over time. A group with a high and stable pattern of treatment use was identified in total and MH treatment use. The proportion of participants with higher levels of substance use disorder treatment use at the end of the study period than at the beginning was larger (35%) than in the case of MH treatment use (14.2%). Younger age was associated with a decreasing pattern of MH treatment use and with an increasing pattern of substance use disorder treatment use over time. There were larger proportions of female participants in groups with a stable high use of MH treatment and in groups with an initially increasing trend of substance use disorder treatment use. Findings revealed that most participants across the identified groups were recipients of welfare benefits, had low educational attainment, and were not working. CONCLUSIONS Results demonstrated significant variation in trajectories of treatment use among young adults with substance use disorder. Differences in treatment use could indicate differences in symptom severity and complexity. In this study, treatment use was associated with socioeconomic factors, sex, and age. Integrative approaches, including interagency and interdisciplinary collaboration, will often be necessary to sufficiently address the multidimensionality of substance use disorder.
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Affiliation(s)
- Regine Bakken
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Jūratė Š Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Halvor Fauske
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
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Sidlak A, Dibble B, Dhaliwal M, Bottone P, Marino R, Henry L, Howell J. Analysis of rising cases of adolescent opioid use presentations to the emergency department and their management. Drug Alcohol Depend 2024; 258:111136. [PMID: 38518662 DOI: 10.1016/j.drugalcdep.2024.111136] [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: 12/02/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE We sought to answer the question of how adolescents (ages 12-17 years old) with opioid-related presentations are currently managed in the ED. The two main outcomes were the proportion of visits where naloxone and buprenorphine were both used and prescribed, and the rate of revisits to the emergency department in the six months following ED presentation. METHODS This was a multi-center retrospective cross-sectional study. We studied patients presenting to the ED who were 12-17 years old with an opioid-related presentation. RESULTS Two-hundred and thirty-one patients were identified out of 571 encounters screened. Of these presentations, 77/231 (33%) were girls and 154/231 (67%) were boys. The majority of patients were Latino (64%; n=147); 26% were white (n=59), 6% were middle eastern or Arab (14), and 4% were black (10). Incidence of opioid use disorder per 100,000 presentations increased by 2800% from 2014 to 2022 (21/100,000 +/- 10 [2014] to 600/100,000 +/- 50 [2022]). A plurality of cases was related to opioid withdrawal (42%; 97). On discharge from the ED, 29% of patients received naloxone. For patients in withdrawal, 4% received a prescription for buprenorphine. Twenty-nine percent of patients had a return to the ED in the six months following initial visit. CONCLUSIONS Adolescent opioid-related presentations to the ED are rapidly increasing. Increasing ED presentations, compounded by a high 6-month revisit rate, pose a management challenge amid limited outpatient resources for this population. Opioid agonist therapy and naloxone are not routinely provided. Increasing the use of both are two ways to improve the quality of care for this population.
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Affiliation(s)
- Alexander Sidlak
- Inova Fairfax Hospital, Emergency Department, Falls Church, VA, United States.
| | - Brent Dibble
- Inova Fairfax Hospital, Emergency Department, Falls Church, VA, United States
| | - Mannet Dhaliwal
- University of Virginia Medical School, Charlottesville, VA, United States
| | - Paul Bottone
- Children's Hospital of Pennsylvania, Division of Adolescent Medicine, Philadelphia, PA, United States
| | - Ryan Marino
- University Hospitals, Division of Toxicology and Addiction Medicine, Cleveland, OH, United States
| | - Linda Henry
- Inova Fairfax Hospital, Medicine Service Line, Falls Church, VA, United States
| | - John Howell
- Inova Fairfax Hospital, Emergency Department, Falls Church, VA, United States
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Fishman M, Wenzel K, Gauthier P, Borodovsky J, Murray O, Subramaniam G, Levy S, Fredyma E, McLeman B, Marsch LA. Engagement, initiation, and retention in medication treatment for opioid use disorder among young adults: A narrative review of challenges and opportunities. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209352. [PMID: 38494051 DOI: 10.1016/j.josat.2024.209352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Opioid Use Disorder (OUD) is a catastrophic public health problem for young adults (YAs) and their families. While medication for OUD (MOUD) is safe, effective, and recognized as the standard of care, its' uptake and success have been limited in YAs compared to older adults. METHODS This narrative review summarizes the existing literature and highlights select studies regarding barriers to YA MOUD, potential explanations for those barriers, and strategies to overcome them. RESULTS Barriers are prominent along the entire cascade of care, including: treatment engagement and entry, MOUD initiation, and MOUD retention. Hypothesized explanations for barriers include: developmental vulnerability, inadequate treatment system capacity, stigma against MOUD, among others. Interventions to address barriers include: promotion of family involvement, increasing provider capacity, integration of MOUD into primary care, assertive outreach, and others. CONCLUSIONS Integrating an adapted version of family coaching from the Community Reinforcement Approach and Family Training (CRAFT) and other models into YA MOUD treatment serves as an example of an emerging novel practice that holds promise for broadening the funnel of engagement in treatment and initiation of MOUD, and enhancing treatment outcomes. This and other developmentally-informed approaches should be evaluated as part of a high-priority clinical and research agenda for improving OUD treatment for YAs.
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Affiliation(s)
- Marc Fishman
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA; Johns Hopkins University School of Medicine, Dept of Psychiatry, 3800 Frederick Avenue, Baltimore, MD 21229, USA.
| | - Kevin Wenzel
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA
| | - Phoebe Gauthier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Owen Murray
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Geetha Subramaniam
- Center for Clinical Trials Network, National Institute on Drug Abuse, 301 North Stonestreet Ave, Bethesda, MD 20892, USA
| | - Sharon Levy
- Boston Children's Hospital, Division of Addiction Medicine, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Emma Fredyma
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH 03766, USA
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Buchholz C, Bell LA, Adatia S, Bagley SM, Wilens TE, Nurani A, Hadland SE. Medications for Opioid Use Disorder for Youth: Patient, Caregiver, and Clinician Perspectives. J Adolesc Health 2024; 74:320-326. [PMID: 37815763 PMCID: PMC10842045 DOI: 10.1016/j.jadohealth.2023.08.047] [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: 04/14/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Clinical trial data support use of medications for opioid use disorder (MOUD) in adolescents and young adults ("youth"), but qualitative data are lacking on the acceptability and importance of MOUD to youth, caregivers, and clinicians. We assessed how these stakeholders viewed the role of MOUD in treatment and recovery. METHODS We recruited youth aged from 15 to 25 years with opioid use disorder who had received buprenorphine, naltrexone, or methadone and caregivers from a primary care-based youth addiction treatment program. We also recruited clinicians with addiction expertise from social work, nursing, pediatrics, internal medicine, and psychiatry. We conducted semistructured interviews assessing special considerations for MOUD use in youth. Three coders performed inductive and deductive thematic analysis of transcripts. RESULTS Among 37 participants, including 15 youth (age range, 17-25 years), nine caregivers, and 13 clinicians, we identified three themes. (1) Medications support recovery in the short term: Youth described MOUD as beneficial in managing withdrawal symptoms. Notably, some youth and caregivers preferred to limit MOUD duration. (2) Medication adherence is affected by type of medication, dosing regimen, and route of administration. Participants endorsed long-acting, injectable MOUD for ease of use and youth's ability to continue engagement in "normal activities" without daily medication. (3) Caregiver involvement can support medication decisions and adherence. Youth and some clinicians described the need to assess caregiver involvement before incorporating them into treatment; caregivers and other clinicians described caregivers as critical in supporting accountability. DISCUSSION MOUD is evidence-based, and its provision should be developmentally responsive and youth- and family-centered, incorporating caregivers when appropriate.
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Affiliation(s)
- Connor Buchholz
- Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lauren A Bell
- Department of Pediatrics-Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Safina Adatia
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah M Bagley
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Timothy E Wilens
- Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alykhan Nurani
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Scott E Hadland
- Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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Saberi P, Stoner MCD, McCuistian CL, Balaban C, Ming K, Wagner D, Chakraborty B, Smith L, Sukhija-Cohen A, Neilands TB, Gruber VA, Johnson MO. iVY: protocol for a randomised clinical trial to test the effect of a technology-based intervention to improve virological suppression among young adults with HIV in the USA. BMJ Open 2023; 13:e077676. [PMID: 37802624 PMCID: PMC10565330 DOI: 10.1136/bmjopen-2023-077676] [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: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Young adults with HIV (YWH) experience worse clinical outcomes than adults and have high rates of substance use (SU) and mental illness that impact their engagement in care and adherence to antiretroviral therapy (ART). The intervention for Virologic Suppression in Youth (iVY) aims to address treatment engagement/adherence, mental health (MH) and SU in a tailored manner using a differentiated care approach that is youth friendly. Findings will provide information about the impact of iVY on HIV virological suppression, MH and SU among YWH who are disproportionately impacted by HIV and at elevated risk for poor health outcomes. METHODS AND ANALYSIS The iVY study will test the effect of a technology-based intervention with differing levels of resource requirements (ie, financial and personnel time) in a randomised clinical trial with an adaptive treatment strategy among 200 YWH (18-29 years old). The primary outcome is HIV virological suppression measured via dried blood spot. This piloted and protocolised intervention combines: (1) brief weekly sessions with a counsellor via a video-chat platform (video-counselling) to discuss MH, SU, HIV care engagement/adherence and other barriers to care; and (2) a mobile health app to address barriers such as ART forgetfulness, and social isolation. iVY has the potential to address important, distinct and changing barriers to HIV care engagement (eg, MH, SU) to increase virological suppression among YWH at elevated risk for poor health outcomes. ETHICS AND DISSEMINATION This study and its protocols have been approved by the University of California, San Francisco Institutional Review Board. Study staff will work with a Youth Advisory Panel to disseminate results to YWH, participants and the academic community. TRIAL REGISTRATION NUMBER NCT05877729.
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Affiliation(s)
- Parya Saberi
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Caravella L McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Celeste Balaban
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Kristin Ming
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Danielle Wagner
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Bibhas Chakraborty
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, NC, USA
- Centre for Quantitative Medicine and Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Statistics and Data Science, National University of Singapore, Singapore
| | - Louis Smith
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | | | - Torsten B Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Valerie A Gruber
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
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Hogue A, Bobek M, MacLean A, Schumm JA, Wenzel K, Fishman M. Relationship-Oriented Recovery System for Youth (RORSY): Clinical Protocol for Transition-Age Youth with Opioid Use Disorders. HSOA JOURNAL OF ADDICTION & ADDICTIVE DISORDERS 2023; 10:144. [PMID: 38707487 PMCID: PMC11068080 DOI: 10.24966/aad-7276/100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This article introduces the Relationship-Oriented Recovery System for Youth (RORSY) protocol, which is designed to increase uptake of Medications for Opioid Use Disorder (MOUD) and related services among adolescents and young adults. Youth exhibit alarmingly poor rates of MOUD initiation and adherence, OUD services involvement and long-term recovery success. RORSY attends to three developmentally unique recovery needs of this age group: assess and bolster youth recovery capital, prioritize involvement of concerned significant others, and use digital direct-to-consumer recovery supports. RORSY contains five evidence-informed intervention modules that can be flexibly tailored to meet the individual and relationship needs of a given youth: Relational Orientation, Youth Recovery Management Planning, Relational Recovery Management Planning, Relationship Skills Building, and Digital Recovery Support Planning. The article concludes with practice and policy recommendations for making relationship-building a top clinical priority for addressing youth OUD.
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Affiliation(s)
| | | | | | - Jeremiah A Schumm
- OneFifteen, Inc./Samaritan Behavioral Health, Inc., Wright
State University, Dayton, USA
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Rabinowitz JA, Ellis JD, Strickland JC, Hochheimer M, Zhou Y, Young AS, Curtis B, Huhn AS. Patterns of demoralization and anhedonia during early substance use disorder treatment and associations with treatment attrition. J Affect Disord 2023; 335:248-255. [PMID: 37192690 PMCID: PMC10330426 DOI: 10.1016/j.jad.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Although depressive symptoms represent a promising therapeutic target to promote recovery from substance use disorders (SUD), heterogeneity in their diagnostic presentation often hinders the ability to effectively tailor treatment. We sought to identify subgroups of individuals varying in depressive symptom phenotypes (i.e., demoralization, anhedonia), and examined whether these subgroups were associated with patient demographics, psychosocial health, and treatment attrition. METHODS Patients (N = 10,103, 69.2 % male) were drawn from a dataset of individuals who presented for admission to SUD treatment in the US. Participants reported on their demoralization and anhedonia approximately weekly for the first month of treatment, and on their demographics, psychosocial health, and primary substance at intake. Longitudinal latent profile analysis examined patterns of demoralization and anhedonia with treatment attrition as a distal outcome. RESULTS Four subgroups of individuals emerged: (1) High demoralization and anhedonia, (2) Remitting demoralization and anhedonia, (3) High demoralization, low anhedonia, and (4) Low demoralization and anhedonia. Relative to the Low demoralization and anhedonia subgroup, all the other profiles were more likely to discontinue treatment. Numerous between-profile differences were observed with regard to demographics, psychosocial health, and primary substance. LIMITATIONS The racial and ethnic background of the sample was skewed towards White individuals; future research is needed to determine the generalizability of our findings to minoritized racial and ethnic groups. CONCLUSIONS We identified four clinical profiles that varied in the joint course of demoralization and anhedonia. Findings suggest specific subgroups might benefit from additional interventions and treatments that address their unique mental health needs during SUD recovery.
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Affiliation(s)
- Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin Hochheimer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yijun Zhou
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea S Young
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hogue A, Bobek M, Porter N, MacLean A, Wenzel K, Fishman M, Coatsworth JD, Langer DA. Launching Relationship-Oriented Behavioral Services for Youth Opioid Use Disorder: Innovations in Medication Decision-Making and Adherence Planning. CHILD & FAMILY BEHAVIOR THERAPY 2023; 45:199-225. [PMID: 37767113 PMCID: PMC10531035 DOI: 10.1080/07317107.2023.2172704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 09/29/2023]
Abstract
This article presents behavioral interventions designed to enhance uptake and retention on medication for opioid use disorder (MOUD) among transition-age youth (16-25 years) enrolled in treatment services. The article describes three relationship-oriented interventions designed to address barriers to MOUD uptake, enhance MOUD adherence planning, and strengthen OUD recovery among youth: Relational Orientation; Medication Education and Decision-making Support, and Family Leadership and Ownership of Adherence to Treatment. These interventions are inter-connected can be delivered flexibly. The article concludes with three case examples that illustrate how these modular interventions can be tailored to meet the needs of diverse client profiles.
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Affiliation(s)
- Aaron Hogue
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Molly Bobek
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Nicole Porter
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Alexandra MacLean
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Kevin Wenzel
- Department of Psychiatry, Maryland Treatment Centers, Baltimore, Maryland, USA
| | - Marc Fishman
- Department of Psychiatry, Maryland Treatment Centers, Baltimore, Maryland, USA
| | - J. Douglas Coatsworth
- Knoxville Boyd Center for Business and Economic Research, Social Work, University of Tennessee, Knoxville, Tennessee, USA
| | - David. A. Langer
- Department of Psychology, Suffolk University, Boston, Massachusetts, USA
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Marchand K, Turuba R, Katan C, Fogarty O, Fairbank J, Tallon C, Mathias S, Barbic S. "The system always undermined what I was trying to do as an individual": identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada. Addict Sci Clin Pract 2023; 18:1. [PMID: 36593469 PMCID: PMC9806820 DOI: 10.1186/s13722-022-00359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. METHODS This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers' (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. RESULTS Three overarching themes were identified, reflecting service providers' goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers' priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. CONCLUSION These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths' needs (micro-level).
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Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada. .,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Roxanne Turuba
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | - Oonagh Fogarty
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | | | - Steve Mathias
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
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11
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Knight DK, Belenko S, Dennis ML, Wasserman GA, Joe GW, Aarons GA, Bartkowski JP, Becan JE, Elkington KS, Hogue A, McReynolds LS, Robertson AA, Yang Y, Wiley TRA. The comparative effectiveness of Core versus Core+Enhanced implementation strategies in a randomized controlled trial to improve substance use treatment receipt among justice-involved youth. BMC Health Serv Res 2022; 22:1535. [PMID: 36527067 PMCID: PMC9758864 DOI: 10.1186/s12913-022-08902-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt. METHODS Part of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change. RESULTS Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems. CONCLUSIONS Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.
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Affiliation(s)
- Danica K. Knight
- grid.264766.70000 0001 2289 1930Karyn Purvis Institute of Child Development, Texas Christian University, Fort Worth, USA
| | - Steven Belenko
- grid.264727.20000 0001 2248 3398Department of Criminal Justice, Temple University, Philadelphia, USA
| | | | - Gail A. Wasserman
- grid.21729.3f0000000419368729Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | - George W. Joe
- grid.264766.70000 0001 2289 1930Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - Gregory A. Aarons
- grid.266100.30000 0001 2107 4242Child and Adolescent Services Research Center, University of California, San Diego, USA
| | - John P. Bartkowski
- grid.215352.20000000121845633Department of Sociology, University of Texas at San Antonio, San Antonio, USA
| | - Jennifer E. Becan
- grid.264766.70000 0001 2289 1930Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - Katherine S. Elkington
- grid.21729.3f0000000419368729Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Aaron Hogue
- grid.475801.fPartnership to End Addiction, New York, USA
| | - Larkin S. McReynolds
- grid.239585.00000 0001 2285 2675Mailman School of Public Health, Columbia University, NYS Psychiatric Institute, New York, USA
| | - Angela A. Robertson
- grid.260120.70000 0001 0816 8287Social Science Research Center, Mississippi State University, Starkville, USA
| | - Yang Yang
- grid.264766.70000 0001 2289 1930Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - Tisha R. A. Wiley
- grid.420090.f0000 0004 0533 7147Service Research Branch, National Institute on Drug Abuse, Bethesda, USA
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12
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Gray E, Wilson M, Landis TT, Little-Gott A. "It's Like Your Whole Body Hates You": Experiences of Withdrawal, Distress, and Barriers to Relief Among Adults Receiving Methadone for Opioid Use Disorder. J Addict Nurs 2022; 33:309-316. [PMID: 37140418 DOI: 10.1097/jan.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT A qualitative descriptive study was conducted concurrent with a larger study investigating the effects of hyperbaric oxygen treatment on withdrawal symptoms for adults receiving daily methadone for opioid use disorder. The aims of this study were to (a) evaluate the perceptions of withdrawal symptoms and sleep characteristics of study participants and (b) explore the experiences of participation in the parent trial of hyperbaric oxygen treatment.Adults with opioid use disorder can experience distressing symptoms related to withdrawal as well as co-occurring symptoms; sleep impairment is frequently reported. Few studies have examined how adults who receive medication for opioid use disorder experience sleep. A preliminary study of adults receiving daily methadone found that withdrawal symptoms were improved after hyperbaric oxygen treatment. This study explores the narrative of opioid users who report their overall experiences with withdrawal and sleep as well as their experiences of hyperbaric therapy.A convenience sample of six participants was recruited, who represented a small subgroup of participants who completed the larger hyperbaric treatment study. Data were collected via semistructured interviews. Data were analyzed using the qualitative content analysis guidelines proposed by Schreier (2012). All participants described poor overall sleep hygiene and disturbed sleep. More than half of the respondents reported improved or eliminated withdrawal symptoms, and all reported improvement in sleep quality after participation in the sleep study.This companion study confirms that subjective sleep disturbance may be prevalent for adults with opioid use disorder. Participants felt the experience of hyperbaric oxygen treatment produced a positive effect on sleep.
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13
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An Exploration of Young Adults With Opioid use Disorder and How Their Perceptions of Family Members' Beliefs Affects Medication Treatment. J Addict Med 2022; 16:689-694. [PMID: 35749777 PMCID: PMC9653106 DOI: 10.1097/adm.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Young adults with opioid use disorder (OUD) have low engagement and retention in medication treatment. Families are uniquely situated to play an important role in treatment decisions. This qualitative study explored how young adults with OUD perceive their families’ beliefs about OUD and medication treatment, and how those beliefs impacted young adults’ beliefs about their own treatment decisions.
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14
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Pandika D, Bailey JA, Oesterle S, Kuklinski MR. Young adult opioid misuse indicates a general tendency toward substance use and is strongly predicted by general substance use risk. Drug Alcohol Depend 2022; 235:109442. [PMID: 35461085 DOI: 10.1016/j.drugalcdep.2022.109442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/22/2022] [Accepted: 04/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine whether young adult opioid misuse reflects a general tendency toward substance use and is influenced by general substance use risk or whether it is a different phenomenon from other drug use. METHODS At ages 23 (2016) and 26 (2019), a panel of young adults (n = 3794 to 3833) in the United States self-reported their past-month substance use (opioid misuse, heavy drinking, cigarettes, cannabis) and substance-specific risk factors (perceptions of harm; approval of use; and use of each substance by friends and romantic partners). Structural equation models examined non-opioid and opioid-specific associations between latent risk and substance use factors. RESULTS Opioid misuse and opioid-specific risk factors shared significant variance with latent substance use and latent substance use risk, respectively, which were strongly associated. A statistically significant residual correlation between opioid-specific risk and opioid misuse remained. CONCLUSION Young adult opioid misuse reflects a general tendency toward substance use and is strongly predicted by risk for substance use. Opioid-specific risk factors play only a small independent role. Existing evidence-based substance use interventions may be effective in preventing opioid misuse among young adults.
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Affiliation(s)
- Danielle Pandika
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Jennifer A Bailey
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite 401, Seattle, WA 98115, USA
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, 400 E Van Buren St, Suite 800, Phoenix, AZ 85004, USA
| | - Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite 401, Seattle, WA 98115, USA
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15
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Fishman M, Wenzel K, Scodes J, Pavlicova M, Campbell ANC, Rotrosen J, Nunes E. Examination of Correlates of OUD Outcomes in Young Adults: Secondary Analysis From the XBOT Trial. Am J Addict 2021; 30:433-444. [PMID: 34075644 DOI: 10.1111/ajad.13176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Opioid use disorder (OUD) treatment outcomes are poorer for young adults than older adults. Developmental differences are broadly implicated, but particular vulnerability factor interactions are poorly understood. This study sought to identify moderators of OUD relapse between age groups. METHODS This secondary analysis compared young adults (18-25) to older adults (26+) from a comparative effectiveness trial ("XBOT") that randomized (N = 570) participants to extended-release naltrexone or sublingual buprenorphine-naloxone. We explored the relationship between 25 prespecified patient baseline characteristics and relapse to regular opioid use by age group and treatment condition, using logistic regression. RESULTS Young adults (n = 111) had higher rates of 24-week relapse than older adults (n = 459) (70.3% vs 58.8%) and differed on a number of specific characteristics, including more smokers, more intravenous opioid use, and more cannabis use. No significant moderators predicted relapse, in either three-way or two-way interactions. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE No baseline factors were identified as moderating the relationship between age group and opioid relapse, nor any interactions between baseline characteristics, age group, and treatment condition to predict opioid relapse. Poorer treatment outcomes for young adults are likely associated with multiple developmental vulnerabilities rather than any single predominant factor. Although not reaching significance, several characteristics (using heroin, smoking tobacco, high levels of depression/anxiety, or treatment because of family/friends) showed higher odds ratio point estimates for relapse in young adults than older adults. This is the first study to explore moderators of worse OUD treatment outcomes in young adults, highlighting the need to identify predictor variables that could inform treatment enhancements. (Am J Addict 2021;00:1-12).
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Affiliation(s)
- Marc Fishman
- Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin Wenzel
- Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland
| | - Jennifer Scodes
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, New York
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - John Rotrosen
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York
| | - Edward Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
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16
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Wenzel K, Selby V, Wildberger J, Lavorato L, Thomas J, Fishman M. Choice of extended release medication for OUD in young adults (buprenorphine or naltrexone): A pilot enhancement of the Youth Opioid Recovery Support (YORS) intervention. J Subst Abuse Treat 2021; 125:108306. [PMID: 34016297 DOI: 10.1016/j.jsat.2021.108306] [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: 07/30/2020] [Revised: 09/18/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Youth Opioid Recovery Support (YORS) intervention is a promising approach for the treatment of opioid use disorder (OUD) in young adults that seeks to improve adherence to extended-release medications for OUD (XR-MOUD) and reduce opioid relapse through assertive outreach techniques. YORS was previously tested with individuals seeking extended-release naltrexone (XR-NTX), but has not been tested on individuals pursuing extended-release buprenorphine (XR-BUP). METHODS This pilot study tested the YORS intervention among a group choosing either XR-MOUD compared to historical treatment as usual (H-TAU) and intervention conditions from a previous study. This study also tested feasibility of a stepped care approach using a protocol for transition to standard care. Twenty-two young adults (ages 18-26) with OUD intending to pursue outpatient treatment with XR-NTX (n = 11) or XR-BUP (n = 11) were recruited from inpatient treatment and received 12-24 weeks of the YORS intervention. RESULTS Participants in YORS compared to H-TAU received more outpatient doses at 12 weeks (1.91 vs. 0.40, p < .001) and 24 weeks (3.76 vs. 0.70, p < .001), had lower relapse rates at 12 weeks (36.4% vs.75.0%; p = .012) and 24 weeks(52.9% vs. 95.0%; p = .003), and had greater cumulative relapse-free survival over 24 weeks (HR = 2.65, 95% CI: 1.17-6.02, p < .05). Rates of continuing MOUD in a standard care setting after the intervention ended were extremely poor. Outcomes did not differ by medication choice. CONCLUSIONS These results are consistent with previous findings and demonstrate feasibility and efficacy of YORS with patient choice of medication. The results highlight the need for innovative strategies to sustain positive outcomes and step-down care successfully in these vulnerable young adults.
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Affiliation(s)
- Kevin Wenzel
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA.
| | - Victoria Selby
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA; University of Maryland School of Nursing, Baltimore, MD, USA
| | - Jared Wildberger
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Luciana Lavorato
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Julia Thomas
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
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17
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Mitchell SG, Monico LB, Gryczynski J, Fishman MJ, O'Grady KE, Schwartz RP. Extended-release naltrexone for youth with opioid use disorder. J Subst Abuse Treat 2021; 130:108407. [PMID: 34118699 DOI: 10.1016/j.jsat.2021.108407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/01/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few published research studies have examined the effectiveness of extended-release naltrexone (XR-NTX) for the treatment of opioid use disorder (OUD) among adolescents and young adults. METHODS This two-group randomized controlled trial recruited 288 youth, ages 15-21, with moderate/severe OUD from a residential addiction treatment program in Baltimore, Maryland. The study randomized the youth within the first week of treatment entry to receive either XR-NTX or treatment-as-usual (TAU; either buprenorphine maintenance treatment or treatment without OUD medication following medically managed withdrawal) prior to discharge, with continued treatment in the community for 6 months. However, due to various reasons spanning patients' and caregivers' preferences and constraints, considerable participant nonadherence to randomized condition occurred (i.e., only 30% of the participants randomized to XR-NTX received an initial injection, while 27% of participants randomized to TAU received an XR-NTX injection at treatment discharge, instead of their assigned treatment). The study used generalized linear mixed modeling (GLiMM) to examine self-reported 90-day opioid, cocaine, marijuana, and alcohol use as well as DSM-5 OUD criteria on "intention-to-treat" (as randomized), "as-received" (XR-NTX vs. not XR-NTX), and "as-medicated" (XR-NTX vs. buprenorphine vs. no medication) bases. RESULTS The condition x time interactions in the intention-to-treat analyses failed to reach significance for past-90-day self-reported use of illicit opioids, cocaine, marijuana, or alcohol, or in meeting DSM-5 OUD criteria at 3 or 6 months [all ps > 0.05]. However, these findings are of limited interpretive value due to participant nonadherence to their randomized condition. When the study analyzed results by the treatment received at discharge, the "as-received" group x time interaction for illicit opioid use was significant [p = .003], with the XR-NTX group reporting less opioid use in the past 90 days at 3 and 6 months. Participants who received their first XR-NTX dose at inpatient discharge (n = 82) received, on average, 1.3 subsequent injections in the community over the 6-month study follow-up period. Only 2 of the 82 study participants received XR-NTX continuously through the 6-month postdischarge follow-up period. Twelve serious adverse events (SAEs) occurred during the study, but the study determined that only 1 was possibly study related (hepatitis C/elevated liver function test results). CONCLUSION None of the condition x time interactions in the intention-to-treat analyses reached significance. Participants' nonadherence may have contributed to the failure to reject the null hypothesis. Irrespective of randomized condition, participants who received XR-NTX for OUD demonstrated low retention in treatment, receiving an average of only 1.3 subsequent injections, yet reported less opioid use at follow-up than participants who did not received XR-NTX. Treatment programs should consider XR-NTX as a treatment option for youth motivated to receive it. Future research should focus on building developmentally informed strategies to improve uptake of and adherence to relapse prevention medication in this population.
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Affiliation(s)
| | - Laura B Monico
- Friends Research Institute, 1040 Park Avenue, Suite, 103 Baltimore, MD, USA.
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite, 103 Baltimore, MD, USA.
| | - Marc J Fishman
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite, 103 Baltimore, MD, USA.
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18
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Connery HS, McHugh RK, Welsh JW. Commentary on Monico et al.: The urgent need for developmental competency and effective policy to prevent youth opioid overdose. Addiction 2021; 116:874-875. [PMID: 33474775 DOI: 10.1111/add.15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hilary S Connery
- McLean Hospital Division of Alcohol, Drugs, and Addiction/Harvard Medical School, Boston, MA, USA
| | - R Kathryn McHugh
- McLean Hospital Division of Alcohol, Drugs, and Addiction/Harvard Medical School, Boston, MA, USA
| | - Justine W Welsh
- Addiction Services, Emory Healthcare/Emory University School of Medicine, Atlanta, GA, USA
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19
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Hogue A, Bobek M, Levy S, Henderson CE, Fishman M, Becker SJ, Dauber S, Porter N, Wenzel K. Conceptual framework for telehealth strategies to increase family involvement in treatment and recovery for youth opioid use disorder. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:501-514. [PMID: 33760249 PMCID: PMC9830952 DOI: 10.1111/jmft.12499] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
With opioid use at crisis levels, it is imperative to support youth ages with opioid use disorders (OUD) in taking medication and accessing behavioral services over long periods. This article presents a conceptual framework for telehealth strategies that can be adopted to increase family involvement across a four-stage continuum of youth OUD treatment and recovery: Treatment Preparation, Treatment Initiation, Treatment Stabilization, OUD Recovery. It first identifies provider-delivered tele-interventions that can enhance OUD services in each of the four stages, including family outreach, family engagement, family-focused intervention, and family-focused recovery maintenance. It then introduces several types of direct-to-family tele-supports that can be used to supplement provider-delivered interventions. These include both synchronous tele-supports (remote interactions that occur in real time) such as helplines, peer-to-peer coaching, and online support groups; and asynchronous tele-supports (communications that occur without participants being simultaneously present) such as automated text messaging, self-directed internet-based courses, and digital web support.
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Affiliation(s)
- Aaron Hogue
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Molly Bobek
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig E. Henderson
- Department of Psychology, Sam Houston, State University, Huntsville, TX, USA
| | | | - Sara J. Becker
- Center for Alcohol and Addictions, Studies, Brown University School of Public, Health, Providence, RI, USA
| | - Sarah Dauber
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Nicole Porter
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
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20
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Hadland SE. The Broken Care Continuum for Young Adults With Opioid Addiction. J Adolesc Health 2020; 67:735-736. [PMID: 33220792 PMCID: PMC7874886 DOI: 10.1016/j.jadohealth.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Scott E. Hadland
- Grayken Center for Addiction / Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA, USA, 02118
- Boston University School of Medicine, Division of General Pediatrics, Department of Pediatrics, 88 East Newton Street, Vose Hall Room 322, Boston, MA, USA, 02118
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21
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Wenzel K, Fishman M. Mobile van delivery of extended-release buprenorphine and extended-release naltrexone for youth with OUD: An adaptation to the COVID-19 emergency. J Subst Abuse Treat 2020; 120:108149. [PMID: 33303086 DOI: 10.1016/j.jsat.2020.108149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/31/2020] [Accepted: 09/21/2020] [Indexed: 02/05/2023]
Abstract
The Youth Opioid Recovery Support (YORS) intervention is a novel treatment for young adults with opioid use disorder (OUD) that uses developmentally informed strategies to reduce barriers to treatment engagement. YORS strategies, such as home delivery of extended-release buprenorphine and extended-release naltrexone for OUD, are designed to increase engagement in treatment, but with the COVID-19 pandemic these strategies increase risk of virus exposure and spread to patients and staff entering homes. We present mobile van service delivery as a potential solution to continuing to provide low-barrier care for young adults with OUD while reducing risk associated with COVID-19. Initial feedback from patients and staff is positive and lays the groundwork to test feasibility and acceptability of this intervention rigorously in future work. Mobile van delivery of extended-release medications for OUD may be a promising treatment modification for mitigating risk of COVID-19, as well as a useful option for ongoing enhancement of care.
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Affiliation(s)
- Kevin Wenzel
- Mountain Manor Treatment Center/Maryland Treatment Centers, 3800 Frederick Ave, Baltimore, MD 21229, USA.
| | - Marc Fishman
- Mountain Manor Treatment Center/Maryland Treatment Centers, 3800 Frederick Ave, Baltimore, MD 21229, USA; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N Wolfe St, Baltimore, MD 21205, USA
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