1
|
Hohmeier KC, Cernasev A, Leibold C, Moore TM, Schlesinger E, Arce I, Geminn W, Chisholm-Burns M, Cochran G. Patient reported goals for medications for opioid use disorder: A theory of proximal goal attainment. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100345. [PMID: 37876851 PMCID: PMC10590992 DOI: 10.1016/j.rcsop.2023.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
Background There exist substantial patient barriers to accessing medications for opioid use disorder (MOUD), including travel distance, stigma, and availability of MOUD providers. Yet, despite these barriers, there exists a subset of patients who possess the requisite motivation to seek and remain adherent to treatment. Objective To explore patient-derived goals in MOUD treatment-adherent patients. Methods This study used in-depth interviews with patients receiving methadone who were enrolled in opioid treatment programs (OTPs) across Tennessee. Participants were recruited from 12 different OTPs to participate in telephonic semi-structured interviews to a point of saturation. Participants had to be adherent to treatment, in treatment for 6 months or greater, and English speaking. Analysis occurred inductively using a constructivist approach to Grounded Theory. Results In total, 17 patient interviews were conducted in the spring of 2021. Participants described goal setting across three general stages of treatment: (1) addressing acute physical and emotional needs upon treatment entry, (2) development of supportive structure and routine to develop healthy skills facilitated by treatment team, and (3) identifying and pursuing future-focused goals not directly linked to treatment. A Proximal Goals in MOUD Framework is introduced. Conclusion In this qualitative study on patient reported goals in MOUD it was found that goals are transitory and relative to the stage of treatment. Further research is needed to better understand goal evolution over the course of treatment and its impact on treatment retention.
Collapse
Affiliation(s)
- Kenneth C. Hohmeier
- University of Tennessee Health Science Center, College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Nashville, TN 37211, USA
| | - Alina Cernasev
- University of Tennessee Health Science Center, College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Nashville, TN 37211, USA
| | - Christina Leibold
- University of Tennessee Health Science Center, College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Nashville, TN 37211, USA
| | - Todd M. Moore
- University of Tennessee, Department of Psychology, Knoxville, TN 37996, USA
| | - Erica Schlesinger
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Ileana Arce
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Wesley Geminn
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Marie Chisholm-Burns
- Oregon Health & Science University, Office of the Provost, Portland, OR 97239, USA
| | - Gerald Cochran
- University of Utah, Division of Epidemiology, Salt Lake City, UT 84112, USA
| |
Collapse
|
2
|
Mocanu V, Bozinoff N, Wood E, Jutras-Aswad D, Le Foll B, Lim R, Cheol Choi J, Yin Mok W, Eugenia Socias M. Opioid agonist therapy switching among individuals with prescription-type opioid use disorder: Secondary analysis of a pragmatic randomized trial. Drug Alcohol Depend 2023; 248:109932. [PMID: 37224674 DOI: 10.1016/j.drugalcdep.2023.109932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Engagement and retention in opioid agonist therapy (OAT) remains a challenge. This study evaluated the impact of initial randomized OAT allocation on subsequent switching among people with prescription-type opioid use disorder (POUD). METHODS Secondary analysis of a 24-week Canadian multicenter, pragmatic, randomized trial conducted between 2017 and 2020 comparing flexible take-home buprenorphine/naloxone versus supervised methadone models of care for POUD. We used Cox Proportional Hazards modeling to assess for impact of treatment assignment on time to OAT switching, adjusting for important confounders. For clinical correlates, we analyzed data from baseline questionnaires on demographic, substance use, and health factors as well as urine drug screen. RESULTS Of 272 randomized participants, 210 initiated OAT within 14 days per trial protocol, of whom 103 participants were randomized to buprenorphine/naloxone and 107 to methadone. Within 24-week follow-up, 41 (20.5%) of all participants switched OAT with 25 (24.3%, median 27 days, 88.4 per 100 person-years) and 16 participants (15.0%, median 53.5 days, 46.1 per 100 person-years) switching from buprenorphine/naloxone and methadone arms, respectively. In adjusted analysis, allocation to buprenorphine/naloxone was associated with significantly higher risk of switching (aHR = 2.31, 95% CI 1.22 - 4.38). CONCLUSIONS OAT switching was common in this sample of individuals with POUD, with individuals randomly allocated to buprenorphine/naloxone being more than twice as likely to switch versus methadone. This may reflect a stepped care approach in OUD management. More research is needed to evaluate overall retention and outcomes with the different observed risks of switching between methadone and buprenorphine/naloxone.
Collapse
Affiliation(s)
- Victor Mocanu
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Nikki Bozinoff
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, University of British Columbia, Vancouver, BC, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Bernard Le Foll
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Acute Care Program, CAMH, Toronto, ON, Canada
| | - Ron Lim
- Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jin Cheol Choi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Wing Yin Mok
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
3
|
Blawatt S, Arreola LAG, Magel T, MacDonald S, Harrison S, Schechter MT, Oviedo-Joekes E. Changes in daily dose in open-label compared to double-blind: The role of clients' expectations in injectable opioid agonist treatment. Addict Behav Rep 2023; 17:100490. [PMID: 37124402 PMCID: PMC10140796 DOI: 10.1016/j.abrep.2023.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Though double-blind studies have indicated that hydromorphone and diacetylmorphine produce similar effects when administered through injectable opioid agonist treatment (iOAT) programs, participant preference may influence some aspects of medication dispensation such as dose. Methods This is a retrospective longitudinal analysis. Participants (n = 131) were previously enrolled in a double-blind clinical trial for iOAT who continued to receive treatment in an open-label follow up study. Data included medication dispensation records from 2012 to 2020. Using linear regression and paired t-tests, average daily dose totals of hydromorphone and diacetylmorphine were examined comparatively between double-blind and open-label periods. A subgroup analysis explored dose difference by preference using the proxy, blinding guess, a variable used to facilitate the measurement of treatment masking during the clinical trial by asking which medication the participant thought they received. Results During the open-label period, participants prescribed diacetylmorphine received 49.5 mg less than during the double-blind period (95% CI -12.6,-86.4). Participants receiving hydromorphone did not see a significant dose decrease. Participants who guessed they received hydromorphone during the clinical trial, but learned they were on diacetylmorphine during the open-label period, saw a decrease in total daily dose of 78.3 mg less (95% CI -134.3,-22.4) during the open-label period. Conclusion If client preference is considered in the treatment of chronic opioid use disorder, clients may be able to better moderate their dose to suit their individual needs. Together with their healthcare providers, clients can participate in their treatment trajectories collaboratively to optimize client outcomes and promote person-centered treatment options.
Collapse
Affiliation(s)
- Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | | | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver BCV6B 1G6, Canada
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- Corresponding author at: St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
| |
Collapse
|
4
|
Huo S, Heil J, Salzman MS, Carroll G, Haroz R. METHADONE INITIATION IN THE EMERGENCY DEPARTMENT FOR OPIOID USE DISORDER: A CASE SERIES. J Emerg Med 2023; 64:391-396. [PMID: 37019500 DOI: 10.1016/j.jemermed.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND In an era of fentanyl and continually rising rates of opioid overdose deaths, increasing access to evidence-based treatment for opioid use disorder (OUD) should be prioritized. Emergency department (ED) buprenorphine initiation for patients with OUD is considered best-practice. Methadone, though also evidence-based and effective, is under-utilized due to strict federal regulation, significant stigma, and lack of physician training. We describe the novel utilization of CFR Title 21 1306.07 (b), also known as the "72-hour rule," to initiate methadone for OUD in the ED. CASE SERIES We describe the cases of 3 patients with a history of OUD who were initiated on methadone for OUD in the ED, linked to an opioid treatment program, and attended an intake appointment. Why Should an Emergency Physician Be Aware of This? The ED can be a crucial point of intervention for vulnerable patients with OUD who may not interact with the health care system in other settings. Methadone and buprenorphine are both first-line options for medication for OUD, and methadone may be preferred in patients who have been unsuccessful with buprenorphine in the past or those at higher risk of treatment dropout. Patients may also prefer methadone to buprenorphine based on previous experience or understanding of the medications. ED physicians may utilize the "72-hour rule" to administer and initiate methadone for up to 3 consecutive days while arranging referral to treatment. EDs can develop methadone initiation and bridge programs utilizing similar strategies to those that have been described in developing buprenorphine programs.
Collapse
Affiliation(s)
- Samantha Huo
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, New Jersey; Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica Heil
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, New Jersey
| | - Matthew S Salzman
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, New Jersey; Cooper Medical School of Rowan University, Camden, New Jersey; Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology
| | - Gerard Carroll
- Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology; Department of Emergency Medicine, Division of EMS and Disaster Medicine, Cooper University Health Care, Camden, New Jersey
| | - Rachel Haroz
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, New Jersey; Cooper Medical School of Rowan University, Camden, New Jersey; Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology
| |
Collapse
|
5
|
Black clients in expansion states who used opioids were more likely to access medication for opioid use disorder after ACA implementation. J Subst Abuse Treat 2022; 133:108533. [PMID: 34218991 PMCID: PMC8664894 DOI: 10.1016/j.jsat.2021.108533] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/20/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Black people in the United States who use opioids receive less treatment and die from overdoses at higher rates than White people. Medication for opioid use disorder (MOUD) decreases overdose risk. Implementation of the Affordable Care Act (ACA) in the United States was associated with an increase in MOUD. To what extent racial disparity exists in MOUD following ACA implementation remains unclear. Using a national sample of people seeking treatment for opioids (clients), we compared changes in MOUD after the ACA to determine whether implementation was associated with increased MOUD for Black clients relative to White clients. METHODS We identified 878,110 first episodes for clients with opioids as primary concern from SAMHDA's Treatment Episodes Dataset-Admissions (TEDS-A; 2007-2018). We performed descriptive and logistic regression analyses to estimate odds of MOUD for Black and White clients by Medicaid expansion status. We interacted ACA implementation with racial group and performed subpopulation analyses for Medicaid enrollees and criminal justice-referred clients. RESULTS In expansion states post-ACA, MOUD increased from 33.6% to 51.3% for White clients and from 36.2% to 61.7% for Black clients. Pre-ACA, Black clients were less likely than White clients to use MOUD (adjusted odds ratio (aOR) = 0.88, 99th Confidence Interval (CI) = [0.85, 0.91]), and post-ACA, the change in odds of MOUD did not differ. Criminal justice-referred clients experienced less of a change in odds of MOUD among Black clients than among White clients (aOR = 0.74, CI = [0.62, 0.89]). Among Medicaid-insured clients, the change in odds of MOUD among Black clients was larger (aOR = 1.16, CI = [1.03, 1.30]). In the non-expansion states before 2014, Black clients were less likely to receive MOUD (aOR = 0.86, CI = [0.77, 0.95]) than White clients. After 2014, the change in odds of MOUD increased more for Black clients relative to White clients (aOR = 1.24, CI = [1.07, 1.44]). We did not find significant changes in MOUD for clients referred through the criminal justice system or with Medicaid. CONCLUSION The ACA was associated with increased use of MOUD among Black clients and reduction in treatment disparity between Black and White clients. For criminal justice-referred Black clients, disparities in MOUD persist. Black clients with Medicaid in expansion states had the greatest reduction in disparities.
Collapse
|
6
|
Cioe K, Biondi BE, Easly R, Simard A, Zheng X, Springer SA. A systematic review of patients' and providers' perspectives of medications for treatment of opioid use disorder. J Subst Abuse Treat 2020; 119:108146. [PMID: 33138929 PMCID: PMC7609980 DOI: 10.1016/j.jsat.2020.108146] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/02/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The opioid epidemic is a public health crisis. Medications for opioid use disorder (MOUD) include: 1) buprenorphine, 2) methadone, and 3) extended-release naltrexone (XR-NTX). Research should investigate patients' and providers' perspectives of MOUD since they can influence prescription, retention, and recovery. METHODS This systematic review focused on patients' and providers' perceptions of MOUD. The review eligibility criteria included inclusion of the outcome of interest, in English, and involving persons ≥18 years. A PubMed database search yielded 1692 results; we included 152 articles in the final review. RESULTS There were 63 articles about buprenorphine, 115 articles about methadone, and 16 about naltrexone. Misinformation and stigma associated with MOUD were common patient themes. Providers reported lack of training and resources as barriers to MOUD. CONCLUSION This review suggests that patients have significant misinformation regarding MOUD. Due to the severity of the opioid epidemic, research must consider the effects of patients' and providers' perspectives on treatment for OUD, including the effects on the type of MOUD prescribed, patient retention and adherence, and ultimately the number of patients treated for OUD, which will aid in curbing the opioid epidemic.
Collapse
Affiliation(s)
- Katharine Cioe
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Breanne E Biondi
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, United States of America
| | - Rebecca Easly
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Amanda Simard
- Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, United States of America
| | - Xiao Zheng
- Yale University, New Haven, CT 06520, United States of America
| | - Sandra A Springer
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, United States of America; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, United States of America.
| |
Collapse
|
7
|
Andraka-Christou B, Nguyen T, Harris S, Madeira J, Totaram R, Randall-Kosich O, Atkins D, Ford J. College students’ perceived knowledge of and perceived helpfulness of treatments for opioid use disorder at two American universities. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:589-603. [DOI: 10.1080/00952990.2020.1757686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida
- Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida
| | - Thuy Nguyen
- School of Public & Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana
| | - Shana Harris
- Department of Internal Medicine, University of Central Florida (Secondary Joint Appointment), Orlando, Florida
- Department of Anthropology, University of Central Florida, Orlando, Florida
| | - Jody Madeira
- Maurer School of Law, Indiana University-Bloomington, Bloomington, Indiana
| | - Rachel Totaram
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida
| | | | - Danielle Atkins
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida
| | - Jason Ford
- Department of Sociology, University of Central Florida, Orlando, Florida
| |
Collapse
|
8
|
Bromley E, Tarn DM, McCreary M, Hurley B, Ober AJ, Watkins KE. Attitudes about medications for alcohol use disorder among individuals with serious mental illness: A health belief model analysis. J Subst Abuse Treat 2020; 114:108007. [PMID: 32527506 DOI: 10.1016/j.jsat.2020.108007] [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] [Received: 09/19/2019] [Revised: 03/09/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medications for alcohol use disorder (MAUD) are underutilized in mental health settings. Increasing use of MAUD requires increasing both the availability of these medications and the demand by individuals who could benefit. Few studies have explored the views of individuals with severe mental illness and alcohol use disorder about MAUD. We sought to examine, among individuals treated in publicly funded community mental health clinics, perceived need for and attitudes toward MAUD. METHODS We conducted 8 focus groups with 87 participants treated in public mental health clinics in Los Angeles County. We aimed to include individuals with a current or past AUD diagnosis and individuals helping others (e.g., a family member) who drink. We examined responses using domains associated with the Health Belief Model to identify factors that shape acceptance of MAUD. RESULTS Participants were 53% female; most were minorities. Average age was 47 years (SD = 11). Twenty-four reported never drinking, 13 of whom had a current or past diagnosis of AUD. Twenty-two reported drinking 4 or more times per week. Three-quarters had not heard of naltrexone. Participants understood that alcohol use has severe adverse consequences and perceived themselves to be highly susceptible to these consequences. Regarding attitudes toward MAUD, participants described an internal locus of control (e.g., their own desires, actions, and effort) as central to addressing problem drinking; this shaped their views that MAUD would have only modest benefits and potentially high burden. Those individuals who had tried MAUD expressed the most optimism about its effectiveness. CONCLUSIONS Participants worried MAUD would impede the development of self-control over drinking by fostering dependence on medication and undermining self-discipline. Client education and counseling that emphasizes MAUD as a tool to build clients' self-control may increase demand for these medications in mental health settings.
Collapse
Affiliation(s)
- Elizabeth Bromley
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, United States of America; RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America.
| | - Derjung M Tarn
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, United States of America
| | - Michael McCreary
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, United States of America
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, United States of America; Los Angeles County Department of Health Services, 313 N Figueroa Street, Los Angeles, CA 90012, United States of America
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America
| |
Collapse
|
9
|
Joudrey PJ, Chadi N, Roy P, Morford KL, Bach P, Kimmel S, Wang EA, Calcaterra SL. Pharmacy-based methadone dispensing and drive time to methadone treatment in five states within the United States: A cross-sectional study. Drug Alcohol Depend 2020; 211:107968. [PMID: 32268248 PMCID: PMC7529685 DOI: 10.1016/j.drugalcdep.2020.107968] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Within the United States, there is a shortage of opioid treatment programs (OTPs), facilities which dispense methadone for opioid use disorder. It is unknown how pharmacy-based methadone dispensing, as available internationally, could affect methadone access. We aimed to compare drive times to the nearest OTP with drive times to the nearest chain pharmacy in urban and rural census tracts. METHODS Cross-sectional geospatial analysis of 2018 OTP location data and 2017 pharmacy location data. We included census tracts with non-zero population in Indiana, Kentucky, Ohio, Virginia, and West Virginia, states with highest rates of opioid overdose deaths. Our outcome was minimum drive time in minutes from census tract mean center of population to the nearest dispensing facility. RESULTS Among 7918 census tracts, median (IQR) drive time to OTPs increased from urban to increasingly rural census tract classification [16.1 min (10.2-25.9) to 48.4 min (34.0-63.3);p < .001]. Median (IQR) drive time to OTPs was greater than drive time to chain pharmacies among all census tracts: 19.6 min (11.6-35.1) versus 4.4 min (2.9-7.7) respectively; p < .001. The median (IQR) difference in drive time was greater for increasingly rural census tracts [11.5 min (6.1-19.2) to 35.2 min (19.6-49.7); p <.001] with pharmacy-based methadone dispensing. CONCLUSION Rural census tracts have disproportionately long drive times to OTPs. Drawing from policies to increase methadone access in countries like Canada and Australia, this geographic methadone disparity could be mitigated through implementation of pharmacy-based methadone dispensing.
Collapse
Affiliation(s)
- Paul J Joudrey
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Harkness Hall A, New Haven, CT, 06520, USA.
| | - Nicholas Chadi
- Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de la Cote Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Payel Roy
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Kenneth L Morford
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Harkness Hall A, New Haven, CT, 06520, USA
| | - Paxton Bach
- Department of Medicine, University of British Columbia and the British Columbia Center on Substance Use, 1045 Howe St Suite 400, Vancouver, BC, V6Z 2A9, Canada
| | - Simeon Kimmel
- Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Building, 2nd Floor, Boston, MA, 02118, USA
| | - Emily A Wang
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Harkness Hall A, New Haven, CT, 06520, USA
| | - Susan L Calcaterra
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office One, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| |
Collapse
|
10
|
Homayra F, Hongdilokkul N, Piske M, Pearce LA, Zhou H, Min JE, Krebs E, Nosyk B. Determinants of selection into buprenorphine/naloxone among people initiating opioid agonist treatment in British Columbia. Drug Alcohol Depend 2020; 207:107798. [PMID: 31927163 DOI: 10.1016/j.drugalcdep.2019.107798] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies assessing the comparative effectiveness of methadone versus buprenorphine/naloxone for opioid use disorder in real-world settings are rare - challenged by structural differences in delivery across settings and factors influencing treatment selection. We identified determinants of selection into buprenorphine/naloxone and quantified contributions of individual and provider-level covariates in a setting delivering both medications within the same healthcare settings. METHODS Utilizing linked health administrative datasets, we conducted a retrospective cohort study of people with opioid use disorder (PWOUD) receiving opioid agonist treatment (OAT) in British Columbia, Canada, from 2008-2017. Determinants of buprenorphine/naloxone selection were identified using a generalized linear mixed model with random intercept terms for providers and individuals. We determined the influence of individual demographics, clinical history, measures of provider experience and preference, and dates of key policy changes. RESULTS A total of 39,605 individuals experienced 178,976 OAT episodes (methadone:139,439(77.9 %);buprenorphine/naloxone:39,537(22.1 %)). Male sex, less OAT experience, younger age, mental health conditions and chronic pain were associated with higher odds of buprenorphine/naloxone prescription. For providers, higher client-attachment, more complex OAT case-mixes, and higher buprenorphine/naloxone prescribing-preference were also associated with higher odds of buprenorphine/naloxone prescription. Observed individual-level covariates explained 9.7 % of variance in odds of buprenorphine/naloxone selection, while observed provider-level covariates explained 20.0 %. Controlling for covariates, residual unmeasured between-individual variance accounted for 18.5 % of the explained variation in the odds of buprenorphine/naloxone selection, while unmeasured between-provider variance accounted for 28.4 %. CONCLUSION Provider characteristics were more influential in selection of buprenorphine/naloxone over methadone informing subsequent analyses of comparative effectiveness of these regimens.
Collapse
Affiliation(s)
- F Homayra
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - N Hongdilokkul
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M Piske
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - L A Pearce
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - H Zhou
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - J E Min
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - E Krebs
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - B Nosyk
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 9706, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| |
Collapse
|
11
|
Abstract
Opioid use disorder (OUD) is a chronic relapsing disorder that, whilst initially driven by activation of brain reward neurocircuits, increasingly engages anti-reward neurocircuits that drive adverse emotional states and relapse. However, successful recovery is possible with appropriate treatment, although with a persisting propensity to relapse. The individual and public health burdens of OUD are immense; 26.8 million people were estimated to be living with OUD globally in 2016, with >100,000 opioid overdose deaths annually, including >47,000 in the USA in 2017. Well-conducted trials have demonstrated that long-term opioid agonist therapy with methadone and buprenorphine have great efficacy for OUD treatment and can save lives. New forms of the opioid receptor antagonist naltrexone are also being studied. Some frequently used approaches have less scientifically robust evidence but are nevertheless considered important, including community preventive strategies, harm reduction interventions to reduce adverse sequelae from ongoing use and mutual aid groups. Other commonly used approaches, such as detoxification alone, lack scientific evidence. Delivery of effective prevention and treatment responses is often complicated by coexisting comorbidities and inadequate support, as well as by conflicting public and political opinions. Science has a crucial role to play in informing public attitudes and developing fuller evidence to understand OUD and its associated harms, as well as in obtaining the evidence today that will improve the prevention and treatment interventions of tomorrow.
Collapse
|
12
|
Muthulingam D, Bia J, Madden LM, Farnum SO, Barry DT, Altice FL. Using nominal group technique to identify barriers, facilitators, and preferences among patients seeking treatment for opioid use disorder: A needs assessment for decision making support. J Subst Abuse Treat 2019; 100:18-28. [PMID: 30898324 PMCID: PMC6432946 DOI: 10.1016/j.jsat.2019.01.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The opioid crisis requires rapid scale-up of evidence-based interventions to treat opioid use disorder (OUD), of which pharmacologic therapies with methadone, buprenorphine or long-acting naltrexone are most effective. With recently-developed formulations, there are unprecedented treatment options. Even when pharmacologic treatment is accessible, however, uptake remains low, suggesting individual-level barriers. Decision aids are an evidence-based strategy that may overcome these barriers. This study aims to inform such a tool by describing and rank-ordering patients' considerations when deciding whether to start medication and, if starting, choosing a medication. METHODS Adults with OUD (N = 81) attending an addiction treatment center or syringe exchange program completed focus groups using nominal group technique, a consensus method that generates and ranks response. The qualitative component generates a broad array of responses, followed by rank-ordering to prioritize responses. Responses to questions about starting any medications and the pros and cons of five specific medications were ranked and coded. RESULTS The decision to initiate pharmacologic therapy and choose among medications was influenced by six key attributes in decreasing priority: (1) benefits, (2) side effects of treatment, (3) medication delivery strategies, (4) convenience, (5) how expectations for treatment are met, and (6) how medication (especially methadone) can represents trading one addiction for another. CONCLUSIONS Pharmacologic properties, logistical factors, and managing expectations were important themes in decision-making for starting, choosing, and staying on medications, and to a lesser degree, negative views about medications, specifically OAT, as an addiction itself. Desire for more control over treatment persisted in all themes. This study identified specific knowledge gaps, expectations, and priorities which are important for developing a decision aid for OUD treatment relevant to the target group. Nominal group technique is an established mixed-methodology that we have applied to a new population and purpose, that of conducting needs assessment for decision aid development.
Collapse
Affiliation(s)
- Dharushana Muthulingam
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
| | - Joshua Bia
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Lynn M Madden
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA
| | - Scott O Farnum
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, Inc, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
13
|
Davari M, Khorasani E, Tigabu BM. Factors Influencing Prescribing Decisions of Physicians: A Review. Ethiop J Health Sci 2019; 28:795-804. [PMID: 30607097 PMCID: PMC6308758 DOI: 10.4314/ejhs.v28i6.15] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The pharmaceutical bill is increasing at an alarming rate. The physician practice variation has a pronounced effect on healthcare spending. A number of factors can influence the prescribing behavior of physicians. The aim of this review was to identify the factors affecting the prescribing decision of physicians. Methods Electronic databases including Scopus, PubMed/MEDLINE CENTRAL, Cochrane Libraries and Google scholar were searched systematically for literatures on factors influencing prescribing decisions of physicians from 2000 to 2016. There was no restriction on the study designs. Results Thirty-three studies met the inclusion criteria from 1122 search results. A total of 33 factors were identified. The most frequent factors were patients' clinical condition, pharmaceutical industries, physician attributes, patient preference and cost of medicine. Conclusion Physicians' personal attributes, cost of the medicine and pharmaceutical industries' marketing and promotion strategies were mostly mentioned to influence prescribing decision. The identified factors showed that prescribing is not only geared for patient benefit, but also towards personal interest. The use of valid and reliable practice guidelines could reduce the negative impact of wide ranges of factors and promote the rational prescribing effectively.
Collapse
Affiliation(s)
- Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Pharmaceutical Research Center, Tehran University of Medical Sciences
| | - Elahe Khorasani
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Pharmaceutical Research Center, Tehran University of Medical Sciences.,Faculty of Pharmacy, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bereket Molla Tigabu
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Pharmaceutical Research Center, Tehran University of Medical Sciences.,Tehran University of Medical Sciences, International Campus.,Haramaya University, School of Pharmacy, Ethiopia
| |
Collapse
|
14
|
Streisel SE. Intent to Refer: Exploring Bias Toward Specific Medication-Assisted Treatments by Community Corrections Employees. Subst Use Misuse 2018; 53:2421-2430. [PMID: 29958042 DOI: 10.1080/10826084.2018.1482346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND As opioid use increases in the United States, especially in the correctional population, the most effective treatment approaches need to be utilized. Research has shown that medication-assisted treatment (MAT) provides better outcomes than traditional treatment approaches alone, but is underutilized among correctional-supervised populations. OBJECTIVE This article looks at how previously identified barriers to implementing MAT can create potential biases regarding the intent to refer individuals to either buprenorphine or methadone among treatment and correctional staff within community corrections. The varying advantages of each medication are discussed to highlight the importance of individualized treatment planning. METHODS Data were collected from 959 treatment specialists and community-corrections officers between 2010 and 2013. The participants were employed by one of 20 community corrections agencies that were selected and randomized within a cluster design. The data were part of a larger study that tested how the experimental condition of organizational linkages impacted the use of MAT in the criminal justice system. In order to analyze the data, multinomial logistic regression was used. RESULTS Results showed that some community corrections employees were likely to refer clients to use methadone, but not buprenorphine (or vice versa) which was influenced by work setting, level of education, training, and negative perceptions of MAT as a substitute addiction. However, these biases could be minimized by proper training. CONCLUSION These findings suggest that proper training should be mandatory for these employees and include information about various MATs while also addressing the negative perception that MAT is a substitute addiction.
Collapse
Affiliation(s)
- S E Streisel
- a Department of Sociology and Criminal Justice , University of Delaware , Newark , Delaware , USA
| |
Collapse
|
15
|
Kenney SR, Anderson BJ, Bailey GL, Stein MD. Buprenorphine treatment formulations: Preferences among persons in opioid withdrawal management. J Subst Abuse Treat 2018; 94:55-59. [PMID: 30243418 PMCID: PMC6152924 DOI: 10.1016/j.jsat.2018.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the current study, we examined factors predicting willingness to receive buprenorphine treatment and preferences for various buprenorphine formulations (oral, injection, implant) among persons in opioid withdrawal management. METHODS Participants were three hundred thirty-eight persons entering brief inpatient opioid withdrawal management programs at two sites. We used t-tests and Pearson χ2 - tests of independence to compare participants willing and unwilling to be prescribed buprenorphine in the future. Among persons willing to receive buprenorphine, we used multinomial logistic regression to estimate the adjusted effects of potential correlates of type of buprenorphine formulation preferred. RESULTS Participants averaged 33.9 (±9.5) years of age, 70.4% were male, 82.8% were White, and 11.0% were Latino/a. In all, 55.6% of participants had been prescribed buprenorphine in the past, and 54.7% were willing to use prescribed buprenorphine in the future. Those reporting past month illicit buprenorphine use and prior overdose were more willing to use prescribed buprenorphine. Of these (n = 180), most preferred daily buprenorphine formulations (tablet or film) (48.6%) over a weekly or monthly injection (23.1%) or bi-annual implant (28.3%). CONCLUSIONS Past buprenorphine prescription does not predict future willingness to restart. Among those willing to use buprenorphine, newer formulations of buprenorphine appealed to more than half of the participants.
Collapse
Affiliation(s)
- Shannon R Kenney
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America; Warren Alpert Medical School of Brown University, Providence, RI, 02912, United States of America.
| | - Bradley J Anderson
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI, 02912, United States of America; Stanley Street Treatment & Resources, Inc, Fall River, MA 02720, United States of America
| | - Michael D Stein
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America; Boston University School of Public Health, Boston, MA 02118, United States of America
| |
Collapse
|
16
|
Bell J, Belackova V, Lintzeris N. Supervised Injectable Opioid Treatment for the Management of Opioid Dependence. Drugs 2018; 78:1339-1352. [DOI: 10.1007/s40265-018-0962-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
17
|
Treating Opioid Dependence with Buprenorphine in the Safety Net: Critical Learning from Clinical Data. J Behav Health Serv Res 2018; 44:351-363. [PMID: 28488155 DOI: 10.1007/s11414-017-9553-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Research has examined the safety, efficacy, feasibility, and cost-effectiveness of buprenorphine for the treatment of opioid dependence, but few studies have examined patient and provider experiences, especially in community health centers. Using de-identified electronic health record system (EHRS) data from 70 OCHIN community health centers (n = 1825), this cross-sectional analysis compared the demographics, comorbidities, and service utilization of patients receiving buprenorphine to those not receiving medication-assisted treatment (MAT). Compared to non-MAT patients, buprenorphine patients were younger and less likely to be Hispanic or live in poverty. Buprenorphine patients were less likely to have Medicaid insurance coverage, more likely to self-pay, and have private insurance coverage. Buprenorphine patients were less likely to have problem medical comorbidities or be coprescribed high-risk medications. It is important for providers, clinic administrators, and patients to understand the clinical application of medications for opioid dependence to ensure safe and effective care within safety net clinics.
Collapse
|
18
|
Safety of a Rapidly Dissolving Buprenorphine/Naloxone Sublingual Tablet (BNX-RDT) for Treatment of Opioid Dependence: A Multicenter, Open-label Extension Study. J Addict Med 2018; 11:217-223. [PMID: 28353467 PMCID: PMC5457835 DOI: 10.1097/adm.0000000000000301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To assess the safety of rapidly dissolving buprenorphine/naloxone sublingual tablets (BNX-RDT) in opioid-dependent patients. Methods: This open-label, 24-week extension study enrolled patients who completed primary trials of BNX-RDT. Daily tablet doses ranged from 5.7 to 17.1 mg. The primary endpoint was safety; secondary assessments included opioid cravings, addiction severity, health-related quality of life (QOL), and workplace productivity at screening (final day of the primary trials) through study end, with changes measured from baseline of the primary trials. Results: In all, 665 patients received treatment; 292 (43.9%) completed the study. A total of 258 patients (38.8%) reported 557 treatment-emergent adverse events, most commonly headache (3.2%) and constipation (3.0%). Craving scores showed continued improvement on 100-mm visual analog scale (mean change from primary trial baseline, −52.8 at screening; mean change from extension trial baseline, −60.5 at week 24). Reductions in addiction severity from baseline of both the primary and extension trial were maintained through week 24 on multiple assessments, as were improvements in QOL on Short Form 36. Employment increased by 15% and mean (SD) hours worked per week increased by 4.6 (20.1) from baseline to study end. Mean (SD) scores for impact of opioid dependence on work productivity improved from 4.7 (3.0) at baseline to 0.9 (1.8) at study end (11-point scale). Conclusions: Extended treatment with BNX-RDT demonstrated a safety profile similar to other BNX formulations, reduced opioid cravings, and improved both QOL and work productivity. Continued treatment may enable patients to advance in recovery and return to normal functioning.
Collapse
|
19
|
Hirchak KA, Murphy SM. Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation. J Rural Health 2017; 33:102-109. [PMID: 26987797 PMCID: PMC5568536 DOI: 10.1111/jrh.12178] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/13/2016] [Accepted: 01/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance-use disorder therapy. PURPOSE Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non-AI reservation/trust land areas in Washington State. METHODS The unit of analysis was the ZIP code. The dependent variables were the number of OAT facilities and DATA-waivered physicians in a region per 10,000 residents aged 18-64 in a ZIP code. A region was defined as a ZIP code and its contiguous ZIP codes. The independent variables were binary measures of whether a ZIP code was classified as rural versus urban, or AI reservation/trust land versus non-AI reservation/trust land. Zero-inflated negative binomial regressions with robust standard errors were estimated. RESULTS The number of OAT clinics in a region per 10,000 ZIP-code residents was significantly lower in rural versus urban areas (P = .002). This did not differ significantly between AI reservation/trust land and non-AI reservation/trust land areas (P = .79). DATA-waivered physicians in a region per 10,000 ZIP-code residents was not significantly different between rural and urban (P = .08), or AI reservation/trust land versus non-AI reservation/trust land areas (P = .21). CONCLUSIONS It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA-waivered physicians.
Collapse
Affiliation(s)
- Katherine A. Hirchak
- Department of Human Development, Washington State University, Pullman, Washington
- Washington State University, Spokane, Washington
| | - Sean M. Murphy
- Washington State University, Spokane, Washington
- Department of Health Policy and Administration, Spokane, Washington
| |
Collapse
|
20
|
Uebelacker LA, Bailey G, Herman D, Anderson B, Stein M. Patients' Beliefs About Medications are Associated with Stated Preference for Methadone, Buprenorphine, Naltrexone, or no Medication-Assisted Therapy Following Inpatient Opioid Detoxification. J Subst Abuse Treat 2016; 66:48-53. [PMID: 27211996 PMCID: PMC4892369 DOI: 10.1016/j.jsat.2016.02.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
Subsequent to initial opioid detoxification, people with opioid use disorder are typically advised to engage in follow-up treatment to prevent relapse. Medication-assisted treatments (MATs) - i.e., the opioid agonist methadone (MMT) or partial agonist/antagonist, buprenorphine/naltrexone (BUP) -- are the maintenance treatment options with the best research support for positive outcomes. A third MAT, injectable extended-release naltrexone (XR-NTX), was approved by the FDA for opioid dependence in 2010 and shows promise. However, relatively few eligible patients choose to initiate one of these MATs following initial detoxification treatment. Consistent with the health belief model, we hypothesized that beliefs about 1) efficacy of each MAT; 2) safety of each MAT; and 3) perceived consistency with being drug-free would predict stated patient preferences for a particular MAT or for no MAT. We also hypothesized that perceived structural barriers (e.g., time, transportation) would decrease the likelihood of stating a preference for a given MAT. To assess these hypotheses, we surveyed 372 people undergoing inpatient opioid detoxification treatment. Results supported hypotheses for all 3 sets of patient beliefs, with the patient group stating that they preferred a particular MAT having significantly more positive beliefs about that MAT relative to other groups (p<.001). The group that preferred "no MAT" had the most negative beliefs about all MATs. Perceived structural barriers were not related to stated preferences, except that people who preferred BUP were more likely to endorse barriers to MMT than any of the other 3 groups. Notably, a relatively high proportion (32%) of participants were most interested in XR-NTX despite a lack of prior experience with this medication. These results suggest that efforts to increase MAT enrollment following detoxification might benefit from including patient beliefs as one set of factors to assess and target for change.
Collapse
Affiliation(s)
- Lisa A Uebelacker
- Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906; Brown University, Department of Psychiatry and Human Behavior, Box G-BH, Providence, RI, 02912.
| | - Genie Bailey
- Brown University, Department of Psychiatry and Human Behavior, Box G-BH, Providence, RI, 02912; Stanley Street Treatment and Resources, 386 Stanley Street, Fall River, MA, 02720
| | - Debra Herman
- Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906; Brown University, Department of Psychiatry and Human Behavior, Box G-BH, Providence, RI, 02912
| | - Bradley Anderson
- Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906
| | - Michael Stein
- Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906; Brown University, Department of Psychiatry and Human Behavior, Box G-BH, Providence, RI, 02912
| |
Collapse
|
21
|
Prakash S, Balhara Y. Perceptions Related to Pharmacological Treatment of Opioid Dependence Among Individuals Seeking Treatment at a Tertiary Care Center in Northern India: A Descriptive Study. Subst Use Misuse 2016; 51:861-9. [PMID: 27100203 DOI: 10.3109/10826084.2016.1155615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Perceptions of individuals with opioid dependence regarding medications used for long-term management of the condition have been explored only by a handful of studies. Interestingly, no study had compared the perceptions regarding buprenorphine, buprenorphine-naloxone, and oral naltrexone in the opioid-dependent subjects from the same setting. OBJECTIVES The present study aimed to examine the perceptions related to treatment of opioid dependence with buprenorphine, buprenorphine-naloxone, and oral naltrexone among individuals seeking help at a tertiary care center. METHODS This was a cross-sectional, observational study with consecutive sampling. Sociodemographic data, Drug Abuse Monitoring System questionnaire, perceptions questionnaire, clinical interview to elicit drug use history, treatment history and details of prior abstinence attempts were completed. RESULTS Eighty-five subjects were recruited in the study. Fear of becoming dependent (35.3%) was the most common harm reported while withdrawal control (82.4%) was the most common benefit reported with buprenorphine preparations. Precipitated withdrawals (21.2%) were the most common harm reported and prevention of relapse (53%) was the most common benefit reported with oral naltrexone. While patients who believed that buprenorphine or naltrexone were harmful reported durations of treatment that were much shorter than those who did not so believe, there was no statistically significant difference in the actual duration and period of abstinence (p = .34; p = .62). Sociodemographic profile, perceptions related to dosing, nature of medication, expectations from treatment, and duration of illness were also described.
Collapse
Affiliation(s)
- Sathya Prakash
- a Department of Psychiatry , All India Institute of Medical Sciences , New Delhi , India
| | - Yatan Balhara
- b National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| |
Collapse
|
22
|
Stein MD, Anderson BJ, Bailey GL. Preferences for Aftercare Among Persons Seeking Short-Term Opioid Detoxification. J Subst Abuse Treat 2015; 59:99-103. [PMID: 26254317 PMCID: PMC4661074 DOI: 10.1016/j.jsat.2015.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022]
Abstract
Without aftercare treatment, the period following discharge from short-term inpatient detoxification for opioid dependence presents a high risk of relapse. Yet the role of patient preference in treatment selection is rarely discussed in the substance-abuse literature. We surveyed 485 persons initiating inpatient opioid detoxification who were predominantly male (71.3%) and had detoxed in the past (73.2%). When asked to choose the one treatment that would work best for them after discharge, 43% of participants selected medication-assisted treatment (MAT), 29% preferred residential, 12% selected drug-free counseling, 12% NA/AA meetings only, and 4% preferred no additional treatment. Residential treatment preference was significantly associated with homelessness, having been in a detox program within the past year, and having pending legal problems, indicating that there is a distinct profile of detox patients who prefer residential treatment despite its limited availability. Detox program staff should work with patients to understand reasons for treatment preferences to optimize aftercare services.
Collapse
Affiliation(s)
- Michael D Stein
- General Medicine Research Unit, Butler Hospital, Providence, RI, 02906; Warren Alpert Medical School of Brown University, Providence, RI, 02912.
| | | | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI, 02912; Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts, 02720
| |
Collapse
|
23
|
Nahar LK, Andrews R, Paterson S. Validated Method for the Quantification of Buprenorphine in Postmortem Blood Using Solid-Phase Extraction and Two-Dimensional Gas Chromatography–Mass Spectrometry. J Anal Toxicol 2015; 39:519-25. [DOI: 10.1093/jat/bkv051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
24
|
Rieckmann TR, Abraham AJ, Kovas AE, McFarland BH, Roman PM. Impact of research network participation on the adoption of buprenorphine for substance abuse treatment. Addict Behav 2014; 39:889-96. [PMID: 24594902 DOI: 10.1016/j.addbeh.2014.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 01/18/2014] [Accepted: 01/29/2014] [Indexed: 11/24/2022]
Abstract
There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner-scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (N=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (N=198). Models included 922 counselors in 172 CTN programs and 1203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors' acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.
Collapse
|
25
|
Murphy SM, Fishman PA, McPherson S, Dyck DG, Roll JR. Determinants of buprenorphine treatment for opioid dependence. J Subst Abuse Treat 2013; 46:315-9. [PMID: 24209382 DOI: 10.1016/j.jsat.2013.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/21/2013] [Accepted: 09/03/2013] [Indexed: 11/29/2022]
Abstract
This study assessed the social, demographic and clinical determinants of whether an opioid-dependent patient received buprenorphine versus an alternative therapy. A retrospective cohort analysis of opioid-dependent adults enrolled in Group Health Cooperative between January 1, 2006 and December 1, 2010 was performed. Increasing the number of physicians with DATA waivers in a region and living in a relatively-populated area increased the likelihood of being treated with buprenorphine, indicating that lack of access is a potential barrier. Comorbidity also appeared to be a factor in receipt of treatment, with the effect varying by diagnosis. Finally, patients with an insurance plan allowing health services to be sought from any provider, with increased cost sharing, were significantly more likely to receive buprenorphine, implying that patient demand is a factor. Programs integrating patient education, physician training, and support from addiction specialists would be likely facilitators of increasing access to this cost-effective treatment.
Collapse
Affiliation(s)
- Sean M Murphy
- Department of Health Policy and Administration, Washington State University, P.O. Box 1495, Spokane, WA 99210-1495, USA.
| | | | - Sterling McPherson
- College of Nursing, Washington State University, Spokane, WA 99210-1495, USA
| | - Dennis G Dyck
- Washington State University, Spokane, WA 99210-1495, USA
| | - John R Roll
- Washington State University, Spokane, WA 99210-1495, USA
| |
Collapse
|
26
|
Bailey GL, Herman DS, Stein MD. Perceived relapse risk and desire for medication assisted treatment among persons seeking inpatient opiate detoxification. J Subst Abuse Treat 2013; 45:302-5. [PMID: 23786852 DOI: 10.1016/j.jsat.2013.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/09/2013] [Accepted: 04/04/2013] [Indexed: 11/16/2022]
Abstract
Most patients with opioid addiction do not receive medication at the time of discharge from brief inpatient detoxification programs despite the high risk of relapse and the availability of three FDA-approved medications. We surveyed 164 inpatient opioid detoxification patients to assess desire for pharmacotherapy following detoxification program discharge. Participants were predominantly male (71.3%) and 80% had detoxed in the past. Reporting on their most recent previous inpatient detoxification, 27% had relapsed the day they were discharged, 65% within a month of discharge, and 90% within a year of discharge. 63% reported they wanted medication-assisted treatment (MAT) after discharge from the current admission. The odds of desiring a treatment medication increased by a factor of 1.02 for every 1% increase in perceived relapse risk (p<.01). These data suggest patient preference discussions including relapse risk could increase post-detox abstinence.
Collapse
Affiliation(s)
- Genie L Bailey
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
| | | | | |
Collapse
|
27
|
Dunn KE, Sigmon SC, Strain EC, Heil SH, Higgins ST. The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: a review. Drug Alcohol Depend 2011; 119:1-9. [PMID: 21741781 PMCID: PMC3205338 DOI: 10.1016/j.drugalcdep.2011.05.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 05/24/2011] [Accepted: 05/29/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The association between buprenorphine taper duration and treatment outcomes is not well understood. This review evaluated whether duration of outpatient buprenorphine taper is significantly associated with treatment outcomes. METHODS Studies that were published in peer-reviewed journals, administered buprenorphine as an outpatient taper to opioid-dependent participants, and provided data on at least one of three primary treatment outcome measures (opioid abstinence, retention, peak withdrawal severity) were reviewed. Primary treatment outcomes were evaluated as a function of taper duration using hierarchical linear regressions with pre-taper maintenance duration as a cofactor. RESULTS Twenty-eight studies were reviewed. Taper duration significantly predicted percent of opioid-negative samples provided during treatment, however pre-taper maintenance period predicted percent participants abstinent on the final day of treatment. High rates of relapse were reported. No significant association between taper duration and retention in treatment or peak withdrawal severity was observed. CONCLUSION The data reviewed here suggest taper duration is associated with opioid abstinence achieved during detoxification but not with other markers of treatment outcome. The reviewed studies varied widely on several parameters (e.g., frequency of urinalysis testing, provision of ancillary medications) that may influence treatment outcome and thus could have interfered with the ability to identify relationships between taper duration and outcomes. Future studies evaluating opioid detoxification should utilize rigorous experimental methods and report a wider range of outcome measures in order to help advance our understanding of the association between taper duration and treatment outcomes.
Collapse
Affiliation(s)
- Kelly E. Dunn
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 142 West, Baltimore, MD 21224. Phone: 410-550-5370, Fax: 410-550-7495,
| | - Stacey C. Sigmon
- University of Vermont. UHC-SATC Room 1415, 1 South Prospect Street, Burlington, VT 05401,
| | - Eric C. Strain
- Johns Hopkins University. 5500 Nathan Shock Drive, Baltimore MD, 21224.
| | - Sarah H. Heil
- University of Vermont. UHC-SATC Room 1415, 1 South Prospect Street, Burlington, VT 05401,
| | - Stephen T. Higgins
- University of Vermont. UHC-SATC Room 1415, 1 South Prospect Street, Burlington, VT 05401,
| |
Collapse
|
28
|
Rieckmann TR, Kovas AE, McFarland BH, Abraham AJ. A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment. J Subst Abuse Treat 2011; 41:374-85. [PMID: 21821379 PMCID: PMC3486698 DOI: 10.1016/j.jsat.2011.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 11/16/2022]
Abstract
Despite evidence that buprenorphine is effective and safe and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling to examine National Treatment Center Study data to identify counselor characteristics (attitudes, training, and beliefs) and organizational factors (accreditation, caseload, access to buprenorphine, and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate-dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) was associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine.
Collapse
Affiliation(s)
- Traci R Rieckmann
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
| | | | | | | |
Collapse
|
29
|
Oliva EM, Maisel NC, Gordon AJ, Harris AHS. Barriers to use of pharmacotherapy for addiction disorders and how to overcome them. Curr Psychiatry Rep 2011; 13:374-81. [PMID: 21773951 PMCID: PMC4403628 DOI: 10.1007/s11920-011-0222-2] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Substance use disorders are highly prevalent, debilitating conditions for which effective pharmacotherapies exist with a broad evidence base, yet pharmacotherapy for the treatment of addiction disorders is underutilized. The goals of this review are to describe the barriers that may contribute to poor adoption and utilization of pharmacotherapy for alcohol and opioid dependence at the system, provider, and patient level and to discuss ways to overcome those barriers. Multifaceted efforts directed at all three levels may be needed to speed pharmacotherapy adoption. More research is needed to help us better understand barriers from patients' perspectives. Strategies to promote adoption of pharmacotherapy for addiction disorders should be modified to fit the needs of the practice, system, and individual patients. Pharmacotherapy is a valuable tool in the clinical armamentarium of addiction treatment; thus, overcoming barriers to implementation may improve clinical and social outcomes.
Collapse
Affiliation(s)
- Elizabeth M. Oliva
- Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (Mailcode 152 MPD), Menlo Park, CA 94025, USA
| | - Natalya C. Maisel
- Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (Mailcode 152 MPD), Menlo Park, CA 94025, USA
| | - Adam J. Gordon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive (Mailcode 151-C-H), Pittsburgh, PA 15206, USA. Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. Center for Research on Health Care, University of Pittsburgh, Pittsburgh, USA
| | - Alex H. S. Harris
- Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (Mailcode 152 MPD), Menlo Park, CA 94025, USA
| |
Collapse
|
30
|
González-Saiz F, Lozano Rojas ÓM, Martín Esteban J, Bilbao Acedos I, Ballesta Gómez R, Gutiérrez Ortega J. Psychiatric comorbidity in a sample of opiate-dependent patients treated with sublingual buprenorphine in a therapeutic community regime. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:81-7. [PMID: 23446143 DOI: 10.1016/j.rpsm.2011.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 12/30/2010] [Accepted: 01/27/2011] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this work is to estimate the prevalence of psychiatric cases in a sample of opiate-dependent patients treated with sublingual buprenorphine in a therapeutic community regime, and to describe their progress during the first month of treatment. METHODS An observational, longitudinal, prospective study was conducted. Of the 119 opiate-dependent patients selected, 46 agreed to start treatment with buprenorphine. For organisational reasons, the psychopathological assessment was carried out on 36 of these patients. The measurement tools used were the MINI, GHQ-28, IPDE and Assessment of the Quality of Life in Psychoactive Substance Addicts (TEQLASP). RESULTS The prevalence rate of any psychiatric disorder was 78%. The prevalence of Axis I diagnoses was 69.4%. The prevalence of cases in Axis II was 58.3%, and 50% of patients had concomitant Axis I and Axis II disorders. The patients with Axis I psychiatric disorders showed a significant reduction in the mean scores of the GHQ-28 scale, and in the B (anxiety/unease), C (social dysfunction), and D (depression) subscales of the GHQ-28. The differences observed between the patients with no psychiatric disorders after one month of treatment were not significant. An improvement in the quality of life wad observed in both groups, although these changes were of a lower magnitude in the group with psychiatric disorders. DISCUSSION The results of this study show a very high frequency of psychiatric disorders. For this reason, psychiatric illness must be actively looked for whenever we assess a drug-dependent patient.
Collapse
|
31
|
Patient perspectives on buprenorphine/naloxone treatment in the context of HIV care. J Acquir Immune Defic Syndr 2011; 56 Suppl 1:S46-53. [PMID: 21317594 DOI: 10.1097/qai.0b013e3182097561] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has shown that buprenorphine/naloxone (bup/nx) is a safe and effective treatment for opioid dependence. Few reports, however, describe the patient perspective on bup/nx treatment and its integration into HIV care settings. METHODS We conducted qualitative interviews with 33 patients to further investigate patient satisfaction and experience with bup/nx treatment and integrated care. Interviews focused on drug use/cessation history; attitudes toward and satisfaction with bup/nx treatment; and perspectives on integrated bup/nx treatment and HIV care. RESULTS Patients were overwhelmingly satisfied with the pharmacologic effects and treatment outcomes of bup/nx, including effectiveness in blocking cravings and controlling opioid use; decreased fear of withdrawal and/or missing doses; and an overall improvement in quality of life. Patients also described being more engaged with both their substance abuse treatment and HIV care, including greater ability to manage their own treatment, keep, appointments, and adhere to antiretroviral medication regimes. Counseling was seen by some patients as an important component of bup/nx treatment. Nearly all were positive about their experience with integrated care, appreciative of an improved drug treatment environment, convenience, and quality of care. CONCLUSIONS Findings suggest that patients report bup/nx to be a viable treatment and many prefer it to other opioid replacement therapies.
Collapse
|
32
|
Ruetsch C, Cacciola J, Tkacz J. A national study of a telephone support service for patients receiving office-based buprenorphine medication-assisted treatment: Study feasibility and sample description. J Subst Abuse Treat 2010; 39:307-17. [DOI: 10.1016/j.jsat.2010.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 07/09/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
|
33
|
Michel L, Villes V, Dabis F, Spire B, Winnock M, Loko MA, Poizot-Martin I, Valantin MA, Bonnard P, Salmon-Céron D, Carrieri MP. Role of treatment for depressive symptoms in relieving the impact of fatigue in HIV-HCV co-infected patients: ANRS Co13 Hepavih, France, 2006-2008. J Viral Hepat 2010; 17:650-60. [PMID: 20002565 DOI: 10.1111/j.1365-2893.2009.01223.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fatigue is a major component of quality of life (QOL) and is associated with depression in HIV-HCV co-infected individuals. We investigated whether treating depressive symptoms (DS) could mitigate the impact of fatigue on daily functioning in co-infected patients, even those at an advanced stage of disease. The analysis was conducted on enrollment data of 328 HIV-HCV co-infected patients recruited in the French nationwide ANRS CO 13 HEPAVIH cohort. Data collection was based on medical records and self-administered questionnaires which included items on socio-behavioural data, the fatigue impact scale (FIS) in three domains (cognitive, physical and social functioning), depressive symptoms (CES-D classification) and use of treatments for depressive symptoms (TDS). After multiple adjustment for gender and unemployment, CD4 cell count <200 per mm(3) was associated with a negative impact of fatigue on the physical functioning dimension (P = 0.002). A higher number of symptoms causing discomfort significantly predicted a higher impact of fatigue on all three dimensions (P < 0.001). This was also true for patients with DS receiving TDS when compared with those with no DS but receiving TDS. A significant decreasing linear trend (P < 0.001) of the impact of fatigue was found across the categories 'DS/TDS', 'DS/no TDS', 'no DS/TDS' and 'no DS/no TDS'. Despite limitations related to the cross-sectional nature of this study, our results suggest that routine screening and treatment for DS can reduce the impact of fatigue on the daily functioning of HIV-HCV co-infected patients and relieve the burden of their dual infection.
Collapse
|
34
|
Winstock AR, Lintzeris N, Lea T. Why do patients report transferring between methadone and buprenorphine? Drug Alcohol Rev 2010; 28:686-7. [PMID: 19930026 DOI: 10.1111/j.1465-3362.2009.00127.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Dasgupta N, Bailey EJ, Cicero T, Inciardi J, Parrino M, Rosenblum A, Dart RC. Post-marketing Surveillance of Methadone and Buprenorphine in the United States. PAIN MEDICINE 2010; 11:1078-91. [DOI: 10.1111/j.1526-4637.2010.00877.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|