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Saunders EC, Budney AJ, Cavazos-Rehg P, Scherer E, Bell K, John D, Marsch LA. Evaluating preferences for medication formulation and treatment model among people who use opioids non-medically: A web-based cross-sectional study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209383. [PMID: 38670531 PMCID: PMC11180569 DOI: 10.1016/j.josat.2024.209383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 02/19/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Over the past decade, treatment for opioid use disorder has expanded to include long-acting injectable and implantable formulations of medication for opioid use disorder (MOUD), and integrated treatment models systematically addressing both behavioral and physical health. Patient preference for these treatment options has been underexplored. Gathering data on OUD treatment preferences is critical to guide the development of patient-centered treatment for OUD. This cross-sectional study assessed preferences for long-acting MOUD and integrated treatment using an online survey. METHODS An online Qualtrics survey assessed preferences for MOUD formulation and integrated treatment models. The study recruited participants (n = 851) in October and November 2019 through advertisements or posts on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (mTurk). Eligible participants scored a two or higher on the opioid pain reliever or heroin scales of the Tobacco, Alcohol Prescription Medication and other Substance Use (TAPS) Tool. Structured survey items obtained patient preference for MOUD formulation and treatment model. Using stated preference methods, the study assessed preference via comparison of preferred options for MOUD and treatment model. RESULTS In the past year, 824 (96.8 %) participants reported non-prescribed use of opioid pain relievers (mean TAPS score = 2.72, SD = 0.46) and 552 (64.9 %) reported heroin or fentanyl use (mean TAPS score = 2.73, SD = 0.51). Seventy-four percent of participants (n = 631) reported currently or previously receiving OUD treatment, with 407 (48.4 %) receiving MOUD. When asked about preferences for type of MOUD formulation, 452 (53.1 %) preferred a daily oral formulation, 115 (13.5 %) preferred an implant, 114 (13.4 %) preferred a monthly injection and 95 (11.2 %) preferred a weekly injection. Approximately 8.8 % (n = 75) would not consider MOUD regardless of formulation. The majority of participants (65.2 %, n = 555) preferred receiving treatment in a specialized substance use treatment program distinct from their medical care, compared with receiving care in an integrated model (n = 296, 34.8 %). CONCLUSIONS Though most participants expressed willingness to try long-acting MOUD formulations, the majority preferred short-acting formulations. Likewise, the majority preferred non-integrated treatment in specialty substance use settings. Reasons for these preferences provide insight on developing effective educational tools for patients and suggesting targets for intervention to develop a more acceptable treatment system.
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Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
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Irani E, Macleod C, Slat S, Kehne A, Madden E, Jaffe K, Bohnert A, Lagisetty P. The effect of a pilot brief educational intervention on preferences regarding treatments for opioid use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100235. [PMID: 38737490 PMCID: PMC11087910 DOI: 10.1016/j.dadr.2024.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
Purpose Negative perceptions around medications for opioid use disorder (MOUD) amongst the public could deter patients with opioid use disorder (OUD) from engaging with MOUD. Thus, we evaluated whether a brief intervention could improve preferences for MOUD in people who may or may not use opioids. Methods We employed a pre-post design to assess the effect of a brief educational intervention on preferences for methadone, buprenorphine, naltrexone, and non-medication treatment in an online sample of US adults stratified by race, who may or may not use opioids. Respondents ranked their preferences in OUD treatment before and after watching four one-minute educational videos about treatment options. Changes in treatment preferences were analyzed using Bhapkar's test and post hoc McNemar's tests. A binary logistic generalized estimating equation (GEE) assessed factors associated with preference between treatments. Results The sample had 530 responses. 194 identified as White, 173 Black, 163 Latinx. Treatment preferences changed significantly towards MOUD (p<.001). This effect was driven by changes toward buprenorphine (OR=2.38; p<.001) and away from non-medication treatment (OR=0.20; p<.001). There was no significant difference in effect by race/ethnicity. People with lower opioid familiarity were significantly more likely to change their preferences towards MOUD following the intervention. Conclusion Respondent preferences for MOUD increased following the intervention suggesting that brief educational interventions can change treatment preferences towards MOUD. These findings offer insights into perceptions of OUD treatment in a racially stratified sample and serve as a foundation for future educational materials that target MOUD preferences in the general public.
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Affiliation(s)
- Emaun Irani
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Colin Macleod
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Stephanie Slat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Adrianne Kehne
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erin Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University, 3939 Woodward Ave, Detroit, MI 48201, USA
| | - Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy Bohnert
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Pande LJ, Arnet RE, Piper BJ. An Examination of the Complex Pharmacological Properties of the Non-Selective Opioid Modulator Buprenorphine. Pharmaceuticals (Basel) 2023; 16:1397. [PMID: 37895868 PMCID: PMC10610465 DOI: 10.3390/ph16101397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The goal of this review is to provide a recent examination of the pharmacodynamics as well as pharmacokinetics, misuse potential, toxicology, and prenatal consequences of buprenorphine. Buprenorphine is currently a Schedule III opioid in the US used for opioid-use disorder (OUD) and as an analgesic. Buprenorphine has high affinity for the mu-opioid receptor (MOR), delta (DOR), and kappa (KOR) and intermediate affinity for the nociceptin (NOR). Buprenorphine's active metabolite, norbuprenorphine, crosses the blood-brain barrier, is a potent metabolite that attenuates the analgesic effects of buprenorphine due to binding to NOR, and is responsible for the respiratory depressant effects. The area under the concentration curves are very similar for buprenorphine and norbuprenorphine, which indicates that it is important to consider this metabolite. Crowding sourcing has identified a buprenorphine street value (USD 3.95/mg), indicating some non-medical use. There have also been eleven-thousand reports involving buprenorphine and minors (age < 19) at US poison control centers. Prenatal exposure to clinically relevant dosages in rats produces reductions in myelin and increases in depression-like behavior. In conclusion, the pharmacology of this OUD pharmacotherapy including the consequences of prenatal buprenorphine exposure in humans and experimental animals should continue to be carefully evaluated.
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Affiliation(s)
- Leana J. Pande
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA; (L.J.P.); (R.E.A.)
- Touro College of Osteopathic Medicine, Middletown, NY 10027, USA
| | - Rhudjerry E. Arnet
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA; (L.J.P.); (R.E.A.)
| | - Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA; (L.J.P.); (R.E.A.)
- Center for Pharmacy Innovation and Outcomes, Danville, PA 17821, USA
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Flam-Ross JM, Marsh E, Weitz M, Savinkina A, Schackman BR, Wang J, Madushani RWMA, Morgan JR, Barocas JA, Walley AY, Chrysanthopoulou SA, Linas BP, Assoumou SA. Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder. JAMA Netw Open 2023; 6:e2329583. [PMID: 37703018 PMCID: PMC10500382 DOI: 10.1001/jamanetworkopen.2023.29583] [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: 04/07/2023] [Accepted: 07/12/2023] [Indexed: 09/14/2023] Open
Abstract
Importance In 2017, the US Food and Drug Administration (FDA) approved a monthly injectable form of buprenorphine, extended-release buprenorphine; published data show that extended-release buprenorphine is effective compared with no treatment, but its current cost is higher and current retention is lower than that of transmucosal buprenorphine. Preliminary research suggests that extended-release buprenorphine may be an important addition to treatment options, but the cost-effectiveness of extended-release buprenorphine compared with transmucosal buprenorphine remains unclear. Objective To evaluate the cost-effectiveness of extended-release buprenorphine compared with transmucosal buprenorphine. Design, Setting, and Participants This economic evaluation used a state transition model starting in 2019 to simulate the lifetime of a closed cohort of individuals with OUD presenting for evaluation for opioid agonist treatment with buprenorphine. The data sources used to estimate model parameters included cohort studies, clinical trials, and administrative data. The model relied on pharmaceutical costs from the Federal Supply Schedule and health care utilization costs from published studies. Data were analyzed from September 2021 to January 2023. Interventions No treatment, treatment with transmucosal buprenorphine, or treatment with extended-release buprenorphine. Main Outcomes and Measures Mean lifetime costs per person, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Results The simulated cohort included 100 000 patients with OUD receiving (61% male; mean [SD] age, 38 [11] years) or not receiving medication treatment (58% male, mean [SD] age, 48 [18] years). Compared with no medication treatment, treatment with transmucosal buprenorphine yielded an ICER of $19 740 per QALY. Compared with treatment with transmucosal buprenorphine, treatment with extended-release buprenorphine yielded lower effectiveness by 0.03 QALYs per person at higher cost, suggesting that treatment with extended-release buprenorphine was dominated and not preferred. In probabilistic sensitivity analyses, treatment with transmucosal buprenorphine was the preferred strategy 60% of the time. Treatment with extended-release buprenorphine was cost-effective compared with treatment with transmucosal buprenorphine at a $100 000 per QALY willingness-to-pay threshold only after substantial changes in key parameters. Conclusions and Relevance In this economic evaluation of extended-release buprenorphine compared with transmucosal buprenorphine for the treatment of OUD, extended-release buprenorphine was not associated with efficient allocation of limited resources when transmucosal buprenorphine was available. Future initiatives should aim to improve retention rates or decrease costs associated with extended-release buprenorphine.
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Affiliation(s)
- Juliet M. Flam-Ross
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Now with London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elizabeth Marsh
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Michelle Weitz
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | | | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Jianing Wang
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | | | - Jake R. Morgan
- Boston University School of Public Health, Boston, Massachusetts
| | - Joshua A. Barocas
- Section of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora
| | - Alexander Y. Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | | | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
| | - Sabrina A. Assoumou
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Pilarinos A, Bingham B, Kwa Y, Joe R, Grant C, Fast D, Buxton JA, DeBeck K. Interest in using buprenorphine-naloxone among a prospective cohort of street-involved young people in Vancouver, Canada. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209005. [PMID: 36921770 PMCID: PMC10773610 DOI: 10.1016/j.josat.2023.209005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/20/2022] [Accepted: 02/15/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Limited research examines buprenorphine-naloxone interest among adolescents and young adults (AYA). This longitudinal study examined factors associated with initial buprenorphine-naloxone interest and the time to a positive change in buprenorphine-naloxone interest or enrollment, in addition to identifying reasons for buprenorphine-naloxone disinterest. METHODS The study derived data from a cohort of street-involved AYA in Vancouver, Canada between December 2014 and June 2018. The analysis was restricted to AYA who reported weekly or daily illicit opioid use in the last six months but had not initiated buprenorphine-naloxone. The study examined factors associated with initial buprenorphine-naloxone interest using multivariable logistic regression, while multivariable Cox regression identified factors associated with the time to a positive change in buprenorphine-naloxone interest or actual enrollment over follow-up among AYA initially disinterested in buprenorphine-naloxone. RESULTS Of 281 participants who reported weekly illicit opioid use but were not on buprenorphine-naloxone, 52 (18.5 %) AYA reported initial buprenorphine-naloxone interest, while 68 (24.2 %) AYA who were initially disinterested in buprenorphine-naloxone reported interest or enrollment over follow-up. In multivariable logistic regression, initial interest was positively associated with older age (Adjusted Odds Ratio [AOR] = 1.09, 95 % Confidence Interval [CI]: 1.03-1.15), but negatively associated with self-reported Indigenous identity (AOR = 0.22, 95 % CI: 0.07-0.68). In multivariable Cox regression, recent detoxification program access (Adjusted Hazard Ratio [AHR] = 0.85, 95 % CI: 0.73-0.98) was positively associated with the time to a positive change in buprenorphine-naloxone interest or enrollment. Common reasons for buprenorphine-naloxone disinterest included not wanting opioid agonist treatments (OAT) (initial n = 67, follow-up n = 105); not wanting to experience precipitated withdrawal (initial n = 42, follow-up n = 54), being satisfied with or preferring other OAT (initial n = 33, follow-up n = 52), not knowing what buprenorphine-naloxone is (initial n = 27, follow-up n = 9), previous negative treatment experiences (initial n = 19, follow-up n = 20), and wanting to continue opioid use (initial n = 13, follow-up n = 9), among others. CONCLUSIONS We documented persistent disinterest in buprenorphine-naloxone among AYA, though participants' reasons for disinterest provide insight into the potential benefits of expanding micro-dosing induction; ensuring treatment is culturally safe; and communicating changes in buprenorphine-naloxone programming to AYA. Nevertheless, a need remains to improve the continuum of harm reduction and treatment supports for AYA.
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Affiliation(s)
- Andreas Pilarinos
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Brittany Bingham
- Vancouver Coastal Health, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada; Division of Social Medicine, Department of Medicine, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T1Z3, Canada
| | - Yandi Kwa
- Vancouver Coastal Health, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Ronald Joe
- Vancouver Coastal Health, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Cameron Grant
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Division of Social Medicine, Department of Medicine, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T1Z3, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC V6B 5K3, Canada.
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Molfenter T, Kim H, Kim JS, Kisicki A, Knudsen HK, Horst J, Brown R, Madden LM, Toy A, Haram E, Jacobson N. Enhancing Use of Medications for Opioid Use Disorder Through External Coaching. Psychiatr Serv 2023; 74:265-271. [PMID: 36196533 PMCID: PMC10836327 DOI: 10.1176/appi.ps.202100675] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This randomized controlled trial tested whether external coaching influences addiction treatment providers' utilization of medications to treat opioid use disorder (MOUDs). METHODS This study recruited 75 unique clinical sites in Florida, Ohio, and Wisconsin, including 61 sites in specialty treatment agencies and 14 behavioral health sites within health systems. The trial used external coaching to increase use of MOUDs in the context of a learning collaborative and compared it with no coaching and no learning collaborative (control condition). Outcome measures of MOUD capacity and utilization were monthly tabulations of licensed buprenorphine slots (i.e., the number of patients who could be treated based on the buprenorphine waiver limits of the site's providers), buprenorphine use, and injectable naltrexone administration. RESULTS The coaching and control arms showed no significant difference at baseline. Although buprenorphine slots increased in both arms during the 30-month trial, growth increased twice as fast at the coaching sites, compared with the control sites (average monthly rate of 6.1% vs. 3.0%, respectively, p<0.001). Buprenorphine use showed a similar pattern; the monthly growth rate in the coaching arm was more than twice the rate in the control arm (5.3% vs. 2.4%, p<0.001). Coaching did not have an impact on injectable naltrexone, which grew less than 1% in both arms over the trial period. CONCLUSIONS External coaching can increase organizational capacity for and growth of buprenorphine use. Future research should explore the dimensions of coaching practice, dose, and delivery modality to better understand and enhance the coaching function.
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Affiliation(s)
- Todd Molfenter
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Hanna Kim
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Jee-Seon Kim
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Abby Kisicki
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Hannah K Knudsen
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Julie Horst
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Randy Brown
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Lynn M Madden
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Alex Toy
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Eric Haram
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
| | - Nora Jacobson
- (Molfenter, Kisicki, Horst, Toy), Department of Educational Psychology (H. Kim, J.-S. Kim), Department of Family Medicine and Community Health (Brown), Institute for Clinical and Translational Research and School of Nursing (Jacobson), University of Wisconsin-Madison, Madison; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington (Knudsen); APT Foundation and Department of Internal Medicine, Yale University, New Haven, Connecticut (Madden); Haram Consulting, Bowdoinham, Maine (Haram)
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Rubel SK, Eisenstat M, Wolff J, Calevski M, Mital S. Scope of, Motivations for, and Outcomes Associated with Buprenorphine Diversion in the United States: A Scoping Review. Subst Use Misuse 2023; 58:685-697. [PMID: 36803159 PMCID: PMC10961708 DOI: 10.1080/10826084.2023.2177972] [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] [Indexed: 02/22/2023]
Abstract
BACKGROUND Expanding access to medications to treat opioid use disorder (OUD), such as buprenorphine, is an evidence-based response to the mounting drug overdose crisis. However, concerns about buprenorphine diversion persist and contribute to limited access. METHODS To inform decisions about expanding access, a scoping review was conducted on publications describing the scope of, motivations for, and outcomes associated with diverted buprenorphine in the U.S. RESULTS In the 57 included studies, definitions for diversion were inconsistent. Most studied use of illicitly-obtained buprenorphine. Across studies, the scope of buprenorphine diversion ranged from 0% to 100%, varying by sample type and recall period. Among samples of people receiving buprenorphine for OUD treatment, diversion peaked at 4.8%. Motivations for using diverted buprenorphine were self-treatment, management of drug use, to get high, and when drug of choice was unavailable. Associated outcomes examined trended toward positive or neutral, including improved attitudes toward and retention in MOUD. CONCLUSIONS Despite inconsistent definitions of diversion, studies reported a low scope of diversion among people receiving MOUD, with inability to access treatment as a motivating factor for using diverted buprenorphine, and increased retention in MOUD as an outcome associated with use of diverted buprenorphine. Future research should explore reasons for diverted buprenorphine use in the context of expanded treatment availability to address persistent barriers to evidence-based treatment for OUD.
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Affiliation(s)
- Stephanie K Rubel
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew Eisenstat
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Wolff
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Calevski
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sasha Mital
- National Center for Injury Prevention and Control, Division of Overdose Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Cuperfain AB, Katznelson G, Costa T, Wong P, Beyraghi N, George TP, Lofwall MR, Chopra N. Factors to guide the use of extended-release buprenorphine formulations for specific patient populations. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2174908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Ari B. Cuperfain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gali Katznelson
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tianna Costa
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Wong
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Narges Beyraghi
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Tony P. George
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle R. Lofwall
- Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Nitin Chopra
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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9
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Johnson B, Flensburg OL, Capusan AJ. Patient perspectives on depot buprenorphine treatment for opioid addiction – a qualitative interview study. Subst Abuse Treat Prev Policy 2022; 17:40. [PMID: 35614466 PMCID: PMC9131643 DOI: 10.1186/s13011-022-00474-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Recently developed buprenorphine depot injections have the potential to reduce risk for diversion and misuse, and to increase adherence with fewer visits for supervised intake. However, it is unclear how patients perceive this new form of medication. The purpose of this study was to explore patients’ experiences of depot injections and their reasons for continuing, discontinuing, or declining depot injection treatment. Methods We conducted semi-structured qualitative interviews with 32 people, 14 of whom had ongoing depot injection treatment, 11 who had discontinued depot-injections and switched to other medication and seven who had declined treatment with depot formulations. Interviews were transcribed, coded, and analysed using NVivo, based on this overall stratification into three participant groups. Results The main categories relate to the effects and side effects of the depot formulation, social and practical factors, psychological benefits and disadvantages, and interactions with treatment staff. Social and practical factors were of importance for choosing depot formulations, such as increased freedom and their making it easier to combine treatment with work and family life, as well as psychological advantages including “feeling normal”. Initial withdrawal symptoms that resolved themselves after a number of injections were reported by most participants. Reliable information and patient-staff relationships characterized by trust helped patients to cope with these initial problems. Those who discontinued treatment often did so near the beginning of the treatment, reporting withdrawal symptoms and insufficient effects as the main reasons. Coercion and insufficient information contributed to a negative pharmaceutical atmosphere at one of the clinics, which may have adversely influenced perceptions of depot formulations and decreased willingness to accept and continue treatment. Conclusions Buprenorphine depot injections may have social, practical, and psychological benefits compared to other formulations. However, depot injections are not perceived as an attractive option by all patients. Trust, consistent and adequate information, and awareness of the implications of the pharmaceutical atmosphere should be considered when introducing new medications. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00474-2.
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10
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Poliwoda S, Noor N, Jenkins JS, Stark CW, Steib M, Hasoon J, Varrassi G, Urits I, Viswanath O, Kaye AM, Kaye AD. Buprenorphine and its formulations: a comprehensive review. Health Psychol Res 2022; 10:37517. [PMID: 35999975 PMCID: PMC9392838 DOI: 10.52965/001c.37517] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Buprenorphine, a novel long-acting analgesic, was developed with the intention of two purposes: analgesia and opioid use disorder. Regarding its pharmacodynamics, it is a partial agonist at mu receptors, an inverse agonist at kappa receptors, and an antagonist at delta receptors. For the purpose of analgesia, three formulations of buprenorphine were developed: IV/IM injectable formulation (Buprenex®), transdermal patch formulation (Butrans®), and buccal film formulation (Belbuca®). Related to opioid dependence, the formulations developed were subcutaneous extended release (Sublocade®), subdermal implant (Probuphine®), and sublingual tablets (Subutex®). Lastly, in order to avoid misuse of buprenorphine for opioid dependence, two combination formulations paired with naloxone were developed: film formulation (Suboxone®) and tablet formulation (Zubsolv®). In this review, we present details of each formulation along with their similarities and differences between each other and clinical considerations.
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Affiliation(s)
| | - Nazir Noor
- Department of Anesthesiology, Mount Sinai Medical Center
| | | | - Cain W Stark
- Medical College of Wisconsin, 8701 West Watertown Plank Road, Wauwatosa, WI 53226
| | - Mattie Steib
- Louisiana State University Health Shreveport School of Medicine
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Beth Israel Deaconess Medical Center
| | | | - Ivan Urits
- Department of Anesthesiology, 1501 Kings Hwy, Shreveport, LA 71103, Louisiana State University Health Shreveport
| | - Omar Viswanath
- Clinical Professor of Anesthesiology, LSU Health Sciences Center School of Medicine, Creighton University School of Medicine, Innovative Pain and Wellness
| | - Adam M Kaye
- Department of Pharmacy Practice, Stockton, CA, 95211,, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Alan D Kaye
- Department of Anesthesiology, Shreveport, LA, Louisiana State University Health Sciences Center - Shreveport
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11
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Shulman M, Hu MC, Sullivan MA, Akerman SC, Fratantonio J, Barbieri V, Nunes EV, Bisaga A. Patient characteristics associated with initiation of XR-naltrexone for opioid use disorder in clinical trials. Drug Alcohol Depend 2022; 233:109343. [PMID: 35131528 PMCID: PMC8957614 DOI: 10.1016/j.drugalcdep.2022.109343] [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: 10/04/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Extended-release injectable naltrexone (XR-naltrexone) is effective for treatment of patients with opioid use disorder (OUD), but initiation remains a barrier due to the challenge of tolerating opioid withdrawal prior to administration. Understanding factors associated with successful initiation of XR-naltrexone could facilitate its implementation through patient-treatment matching. METHODS We combined data from five consecutive studies that sought to initiate patients with active opioid use onto XR-naltrexone using a rapid procedure consisting of minimal buprenorphine, non-opioid medications for treating opioid withdrawal, and ascending low doses of oral naltrexone. Associations between patient characteristics and initiating naltrexone were estimated with logistic regression models. To evaluate whether associations differed between inpatient and outpatient settings, patient characteristic-by-setting interactions were also estimated. RESULTS 409 patients were included in the analyses and 228 (56%) received the first injection. A significantly greater percent of inpatients (62%) vs outpatients (48%) initiated XR-naltrexone. Initiation success was significantly more likely on an inpatient basis for heroin (60.9% inpatient vs 36.2% outpatient), intravenous (56.3% inpatient vs 22.5% outpatient), and speedball users (68.1% inpatient vs 32.3% outpatient). Prescription opioid users showed similar, higher initiation rates across settings (68.9% inpatient; 73.7% outpatient). CONCLUSIONS An inpatient setting may be the preferred strategy for rapid initiation of XR-naltrexone for opioid users with greater severity, including heroin or speedball injection users or those who use opioids intravenously. Initiation on an outpatient basis may be more likely to succeed for prescription opioid users.
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Affiliation(s)
- Matisyahu Shulman
- New York State Psychiatric Institute and Columbia University Irving Medical Center, Riverside Drive, NY 1051, USA; Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Maria A. Sullivan
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY,Previously affiliated with Alkermes Inc. 852 Winter Street, Waltham MA, 02451
| | | | - James Fratantonio
- Previously affiliated with Alkermes Inc. 852 Winter Street, Waltham MA, 02451
| | - Vincent Barbieri
- American University 4400 Massachusetts Ave NW, Washington, DC 20016
| | - Edward V. Nunes
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Adam Bisaga
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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12
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Gaulen Z, Brenna IH, Fadnes LT, Šaltytė Benth J, Solli KK, Kunoe N, Opheim A, Tanum L. The Predictive Value of Degree of Preference for Extended-Release Naltrexone for Treatment Adherence, Opioid Use, and Relapse. Eur Addict Res 2022; 28:56-67. [PMID: 34569487 DOI: 10.1159/000518436] [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: 02/03/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extended-release naltrexone (XR-NTX) is effective for illicit opioid abstinence as an opioid maintenance treatment. To improve treatment outcomes, patient's preference for the modality of treatment is an important factor. OBJECTIVES We aimed to test the relationship between baseline preference for XR-NTX and adherence to treatment, use of illicit opioids, and risk of relapse. METHODS In an open-label, Norwegian clinical trial participants with opioid use disorder were randomized to either monthly injections with XR-NTX or daily sublingual buprenorphine-naloxone (BP-NLX) for 12 weeks. Subsequently, participants could continue with their preferred medication in a 36-week follow-up and in a prolonged period of 104 weeks. RESULTS Of 153 participants who completed detoxification, 72% were men, with a mean age of 36 years. Preference levels were similar across the randomized groups, with no significant associations between preference and adherence to treatment, opioid use, or relapse. The BP-NLX group had a significantly higher risk of first relapse to opioids than the XR-NTX group for all levels of preference (p < 0.001) and a significantly higher number of days of illicit opioid use. In the follow-up period, the adherence rate was twice as high among participants with the highest preference compared to participants with the lowest preference, both among those who switched to XR-NTX and those who continued (hazard ratio 2.2; 1.2-4.0, p = 0.013). Opioid use was significantly higher among participants who switched to XR-NTX with the lowest preference than the medium (p = 0.003) or the highest (p = 0.001) preference. The risk of relapse to opioids, however, was significantly higher among XR-NTX continuing participants with the lowest (p = 0.002) or the medium (p = 0.043) preference than those with the highest preference. CONCLUSIONS Individuals who matched with their preferred treatment used less illicit opioids than those who did not during short-term treatment. However, baseline preference for XR-NTX treatment primarily influenced longer term opioid use and treatment adherence.
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Affiliation(s)
- Zhanna Gaulen
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Ida Halvorsen Brenna
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Blindern, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kristin K Solli
- Department of Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway.,Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway.,Vestfold Hospital Trust, Tonsberg, Norway
| | - Nikolaj Kunoe
- Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway.,Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Arild Opheim
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Tanum
- Department of Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway.,Department of Health Science, Oslo Metropolitan University, Oslo, Norway
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13
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Pascual FS, Muñoz A, Oraa R, Flórez G, Notario P, Seijo P, Gonzalvo B, Assaf C, Gómez M, Casado MÁ. Perception of a New Prolonged-Release Buprenorphine Formulation in Patients with Opioid Use Disorder: The PREDEPO Study. Eur Addict Res 2022; 28:143-154. [PMID: 34724674 PMCID: PMC8985036 DOI: 10.1159/000520091] [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: 04/27/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022]
Abstract
AIM The aim of the study was to assess the acceptance of patients with opioid use disorder (OUD) to switching their opioid dependence treatment (ODT) for a prolonged-release buprenorphine (PRB) injection according to their prior ODT (buprenorphine/naloxone [B/N] or methadone). METHODS This was an observational, retrospective/cross-sectional, multicentre study of adult patients diagnosed with OUD on ODT. Data collected from diaries were analysed to know their interest and opinion on PRB. Questions with fixed response options were included, and several Likert scales were used. RESULTS A total of 98 patients were enrolled (B/N: 50.0%, methadone: 50.0%). The mean age was 46.9 ± 8.43 years and 79.6% were males. PRB was similarly perceived by both groups in most variables analysed, receiving a mean score of 7.2/10 (B/N: 7.4, methadone: 7.0; p = 0.520), and approximately 65% of patients said they were willing to switch to PRB (B/N: 63.3%, methadone: 65.3%; p = 0.833). Of these, a higher percentage in the B/N group considered that switching would be easy/very easy (B/N: 90.3%, methadone: 46.9%; p < 0.001) and that they would start PRB when available (B/N: 64.5%, methadone: 34.3%; p = 0.005). More than 90% would prefer the monthly injection (B/N: 93.6%, methadone: 100%; p = 0.514). One-third of patients in both groups were unsure/would not switch their ODT to PRB (B/N: 36.7%, methadone: 34.7%; p = 0.833). The main reason was administration by injection. CONCLUSION Two-thirds of patients would switch their treatment for PRB, and most patients on B/N considered that switching would be easy. PRB could be a suitable alternative for OUD management.
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Affiliation(s)
| | - Alvaro Muñoz
- Outcomes Research, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain,*Alvaro Muñoz,
| | - Rodrigo Oraa
- Red de Salud Mental, Biocruces Bizkaia Health Research Institute, CSM Ajuriaguerra Adicciones, RSMB, Bilbao, Spain
| | - Gerardo Flórez
- Servizo Galego de Saúde, Unidad de Conductas Adictivas de Ourense, Ourense, Spain
| | - Pilar Notario
- Subdirección General de Adicciones, Centro de Atención a las Adicciones de Latina, Madrid, Spain
| | - Pedro Seijo
- Diputación de Cádiz, Centro de Tratamiento Ambulatorio de Adicciones de Villamartín, Cádiz, Spain
| | - Begoña Gonzalvo
- Red Adicciones, Institut Assistència Sanitària, Departament de Salut Centro de Atención y Seguimiento a las Drogodependencias, Girona, Spain
| | - Carla Assaf
- Medical Department, Camurus SL, Madrid, Spain
| | - Manuel Gómez
- Outcomes Research, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Miguel Ángel Casado
- Outcomes Research, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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14
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Saunders EC, Budney AJ, Cavazos-Rehg P, Scherer E, Marsch LA. Comparing the feasibility of four web-based recruitment strategies to evaluate the treatment preferences of rural and urban adults who misuse non-prescribed opioids. Prev Med 2021; 152:106783. [PMID: 34499972 PMCID: PMC8545866 DOI: 10.1016/j.ypmed.2021.106783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 02/07/2023]
Abstract
This cross-sectional study examined the feasibility of using four different web-based strategies to recruit rural and urban adults who use opioids non-medically for a survey on opioid use disorder (OUD) treatment preferences, and compared the treatment preferences of rural versus urban participants. Preferences for medication for opioid use disorder (MOUD) formulation and OUD treatment models were assessed through an online survey. Recruitment advertisements were shown on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (MTurk). Participants were categorized by zip code into urban versus rural residence using the Centers for Medicaid and Medicaid Health Resources and Services Administration definitions. OUD treatment preferences were compared using chi-square and t-tests. Among the 851 participants recruited, 815 provided zip codes and were classified as residing in rural (n = 200, 24.5%) or urban (n = 615, 75.4%) regions. A crowdsourcing service (MTurk) recruited the most rural participants, while posts on a social news website (Reddit) recruited the most urban participants (χ23 = 17.0, p < 0.01). While preferred MOUD formulation and OUD treatment model did not differ by rurality, rural participants were more likely to report a willingness to receive OUD treatment integrated with general medical care (χ21 = 18.9, p < 0.0001). This study demonstrated that web-based strategies are feasible for recruiting rural adults who misuse opioids. Results suggest OUD treatment preferences largely did not differ by rural residence, and highlight the importance of enhancing the availability and increasing education about MOUD formulations in rural regions.
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Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
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15
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Soyka M, Franke AG. Recent advances in the treatment of opioid use disorders-focus on long-acting buprenorphine formulations. World J Psychiatry 2021; 11:543-552. [PMID: 34631459 PMCID: PMC8474991 DOI: 10.5498/wjp.v11.i9.543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/06/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023] Open
Abstract
Oral methadone or sublingual buprenorphine are first-line medications for pharmacotherapy of opioid use disorders (OUDs). Three long-acting buprenorphine depot or implant formulations are currently available for the treatment of OUDs: (1) CAM 2038 (Buvidal) for subcutaneous weekly and monthly application; (2) RBP-6000 (Sublocade™) as a monthly depot formulation; and (3) A six-month buprenorphine implant [Probuphine™]. The pharmacology, clinical efficacy and prospects of these medications are discussed.
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Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, University of Munich, München 80336, Germany
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16
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Varney SM, Wiegand TJ, Wax PM, Brent J. Descriptive Analysis of Inpatient and Outpatient Cohorts Seeking Treatment After Prescription Opioid Misuse and Medical Toxicology Evaluation. J Med Toxicol 2021; 17:378-385. [PMID: 34402039 DOI: 10.1007/s13181-021-00850-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Medical toxicology expertise has expanded into the addiction medicine realm including outpatient medication for opioid use disorder (MOUD) and addiction treatment. Concomitantly, the emergency department (ED) and hospital are increasingly seen as important sites for the screening, prevention, and treatment of patients with substance use disorders and addiction. This analysis seeks to characterize patients seen by medical toxicologists for opioid use and opioid use disorder (OUD) in the ED and inpatient consultation setting (inpatient) versus in the OUD clinic (outpatient) setting. METHODS We searched the American College of Medical Toxicology's Toxicology Investigators Consortium Case Registry, a prospective, de-identified, national dataset that includes patients receiving medical toxicology consultation following prescription opioid misuse. The dataset also includes patients seen in outpatient MOUD clinics during the same period between June 2013 and November 2015. Intentional self-harm patients were excluded. We analyzed medical history, drug use patterns, and other factors with odds ratios and confidence intervals. RESULTS Of 110 patients identified, 60 (54.5%) were inpatients and 50 (45.5%) outpatients. Mean age (39 years), gender (68% male), and race breakdown (60% white/non-Hispanic) were similar. The outpatient group was more likely to have Medicare/Medicaid coverage (p<0.0001). By history, the outpatient group was more likely to have past alcohol misuse, intravenous drug use, prescription drug misuse, and prescription opioid misuse. Most inpatient group members sought a recreational high compared to avoiding withdrawal or treating dependence in the outpatient group. CONCLUSION Patients treated in the outpatient compared to inpatient setting were more likely to report adverse sequelae from their drug use including long-term drug use, depression, previous rehabilitation attempts, and seeking to avoid withdrawal.
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Affiliation(s)
- Shawn M Varney
- Department of Emergency Medicine, University of Texas Health - San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Timothy J Wiegand
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Paul M Wax
- Division of Toxicology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Jeffrey Brent
- University of Colorado School of Medicine and Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO, 80045, USA
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17
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Beaulieu E, DiGennaro C, Stringfellow E, Connolly A, Hamilton A, Hyder A, Cerdá M, Keyes KM, Jalali MS. Economic Evaluation in Opioid Modeling: Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:158-173. [PMID: 33518022 PMCID: PMC7864393 DOI: 10.1016/j.jval.2020.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/29/2020] [Accepted: 07/25/2020] [Indexed: 05/08/2023]
Abstract
OBJECTIVES The rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature. METHODS A systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. RESULTS The screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studies' accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. CONCLUSION The review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research.
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Affiliation(s)
- Elizabeth Beaulieu
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Catherine DiGennaro
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Erin Stringfellow
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Ava Connolly
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Ava Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ayaz Hyder
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA; Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.
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18
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Soyka M. Novel Long-Acting Buprenorphine Medications for Opioid Dependence: Current Update. PHARMACOPSYCHIATRY 2020; 54:18-22. [PMID: 33212514 DOI: 10.1055/a-1298-4508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Opioid maintenance treatment with oral methadone or sublingual buprenorphine is the first-line treatment in opioid dependence. Three novel long-acting buprenorphine formulations have been approved or will be available soon: for subcutaneous weekly and monthly application, the depot formulations CAM 2038 (Buvidal®), the monthly depot formulation RBP-6000 (Sublocade™), and a 6-month buprenorphine implant (Probuphine™). Clinical data available so far on the efficacy of these 3 medications are given, and possible clinical implications are discussed.
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19
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Pizzicato LN, Hom JK, Sun M, Johnson CC, Viner KM. Adherence to buprenorphine: An analysis of prescription drug monitoring program data. Drug Alcohol Depend 2020; 216:108317. [PMID: 33035714 DOI: 10.1016/j.drugalcdep.2020.108317] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although buprenorphine is an evidence-based treatment for opioid use disorder (OUD), many individuals discontinue treatment soon after starting. This study assesses predictors of buprenorphine adherence using Prescription Drug Monitoring Program (PDMP) data. METHODS PDMP data for Philadelphia, Pennsylvania were used to measure 180-day adherence to buprenorphine among new initiates. Adherence was classified using percent days covered (PDC), and new initiates with PDC ≥ 0.80 were classified as adherent. Multivariable logistic regression was conducted to determine factors associated with buprenorphine adherence. RESULTS Between January 2017 and December 2018, 10,669 Philadelphia residents initiated buprenorphine and 26.6 % remained adherent after 180 days. Demographic factors associated with greater odds of adherence included age category and female sex (aOR: 1.37; 95 % CI: 1.25-1.50). Those filling an opioid prescription, other than buprenorphine, during the follow-up period had lower odds of adherence than those who did not fill an opioid prescription (aOR: 0.62; 95 % CI: 0.50-0.77). Odds of adherence was greater for those on the film formulation (aOR: 1.37; 95 % CI: 1.25-1.50) than the tablet formulation. Those filling medium (aOR: 1.76; 95 % CI: 1.55-2.00) and high dose (aOR: 5.11; 95 % CI: 4.30-6.17) buprenorphine prescriptions had higher odds of adherence than those filling low dose prescriptions. CONCLUSIONS Individual demographics, receipt of an opioid prescription, buprenorphine formulation, and buprenorphine dose were all associated with adherence to buprenorphine. Ongoing strategies to address OUD need to prioritize increasing retention in long-term evidence-based buprenorphine treatment while also encouraging providers to regularly consult the PDMP to ensure patient compliance.
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Affiliation(s)
- Lia N Pizzicato
- Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction, 123 S. Broad St., Suite 1120, Philadelphia, PA 19109, USA
| | - Jeffrey K Hom
- Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction, 123 S. Broad St., Suite 1120, Philadelphia, PA 19109, USA
| | - Monica Sun
- Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction, 123 S. Broad St., Suite 1120, Philadelphia, PA 19109, USA
| | - Caroline C Johnson
- Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction, 123 S. Broad St., Suite 1120, Philadelphia, PA 19109, USA
| | - Kendra M Viner
- Philadelphia Department of Public Health, Division of Substance Use Prevention and Harm Reduction, 123 S. Broad St., Suite 1120, Philadelphia, PA 19109, USA.
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20
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Del Pozo B, Rich JD. Revising our attitudes towards agonist medications and their diversion in a time of pandemic. J Subst Abuse Treat 2020; 119:108139. [PMID: 33138924 PMCID: PMC7505066 DOI: 10.1016/j.jsat.2020.108139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/29/2020] [Accepted: 09/08/2020] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis. COVID-19 resulted in the significant relaxation of critical MOUD prescribing rules. Retention in treatment was prioritized over preventing MOUD misuse and diversion. Diverted and prescribed agonist MOUDs may both serve as a means of overdose prophylaxis during the pandemic. These prescribing changes offer an opportunity to reconsider our attitudes towards agonist medications and their diversion.
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Affiliation(s)
- Brandon Del Pozo
- The Miriam Hospital, Warren Alpert Medical School of Brown University, 1125 N Main St., Providence, RI 02904, United States of America.
| | - Josiah D Rich
- The Miriam Hospital, Warren Alpert Medical School of Brown University, United States of America
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21
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del Pozo B, Rawson RA. Putting the Horse Before the Unicorn: A Safe Supply Strategy Should Begin With Partial Agonists--A Commentary on Bonn et al. (2020). J Stud Alcohol Drugs 2020; 81:562-563. [PMID: 33028467 PMCID: PMC8076491 DOI: 10.15288/jsad.2020.81.562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
Affiliation(s)
- Brandon del Pozo
- The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Richard A. Rawson
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California
- Vermont Center for Behavior and Health, University of Vermont, Burlington, Vermont
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22
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Kenney SR, Anderson BJ, Bailey GL, Herman DS, Conti MT, Stein MD. Examining Overdose and Homelessness as Predictors of Willingness to Use Supervised Injection Facilities by Services Provided Among Persons Who Inject Drugs. Am J Addict 2020; 30:21-25. [PMID: 32519449 DOI: 10.1111/ajad.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/26/2020] [Accepted: 05/09/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Internationally, supervised injection facilities (SIFs) have demonstrated efficacy in reducing rates of overdose and promoting entry into treatment among persons who inject drugs (PWID); however, they remain unavailable in the United States. Early findings examining American PWID illustrate high overall willingness to use SIFs. The current study expands upon this research by examining PWID's likelihood to use SIFs based on services offered (eg, provides clean needles, linkage to treatment programs) and whether known risk factors (prior overdose, homelessness) influence PWID's willingness to use a SIF. METHODS Participants (n = 184) were patients entering short-term inpatient opioid withdrawal management in Massachusetts between May 2018 and February 2019 who reported injection drug use in the prior 30 days. We examined PWID's likelihood to use a SIF if eight unique services were available, and compared if this differed by overdose history and homelessness status using ordered logistic regression and Pearson's χ2 -tests of independence. RESULTS Participants (34.2 [±8.3 SD] years of age, 68.5% male, 85.9% white, 8.2% Hispanic) reported being most likely to use SIFs that provided safety from police intervention (86.7%), entry into withdrawal management (85.9%), or clean needles (83.2%). Drug works disposal and safety from police were particularly important for PWID with a history of overdose. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Overall, treatment-seeking PWIDs reported greater willingness to utilize SIFs if particular services were provided. These findings point to features of SIFs that may enhance treatment-seeking PWID's amenability to utilizing these services if such sites open in the United States. (Am J Addict 2021;30:21-25).
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Affiliation(s)
- Shannon R Kenney
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Stanley Street Treatment and Resources, Inc, Fall River, Massachusetts
| | - Debra S Herman
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Micah T Conti
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island
| | - Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island.,School of Public Health, Boston University, Boston, Massachusetts
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23
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Bluthenthal RN, Simpson K, Ceasar RC, Zhao J, Wenger L, Kral AH. Opioid withdrawal symptoms, frequency, and pain characteristics as correlates of health risk among people who inject drugs. Drug Alcohol Depend 2020; 211:107932. [PMID: 32199668 PMCID: PMC7259345 DOI: 10.1016/j.drugalcdep.2020.107932] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Opioid withdrawal symptoms are widely understood to contribute to health risk but have rarely been measured in community samples of opioid using people who inject drugs (PWID). METHODS Using targeted sampling methods, 814 PWID who reported regular opioid use (at least 12 uses in the last 30 days) were recruited and interviewed about demographics, drug use, health risk, and withdrawal symptoms, frequency, and pain. Multivariable regression models were developed to examine factors associated with any opioid withdrawal, withdrawal frequency, pain severity, and two important health risks (receptive syringe sharing and non-fatal overdose). RESULTS Opioid withdrawal symptoms were reported by 85 % of participants in the last 6 months, with 29 % reporting at least monthly withdrawal symptoms and 35 % reporting at least weekly withdrawal symptoms. Very or extremely painful symptoms were reported by 57 %. In separate models, we found any opioid withdrawal (adjusted odds ratio [AOR] = 2.75, 95 % confidence interval [CI] = 1.52, 5.00) and weekly or more opioid withdrawal frequency (AOR = 1.94; 95 % CI = 1.26, 3.00) (as compared to less than monthly) to be independently associated with receptive syringe sharing while controlling for confounders. Any opioid withdrawal (AOR = 1.71; 95 % CI = 1.04, 2.81) was independently associated with nonfatal overdose while controlling for confounders. In a separate model, weekly or more withdrawal frequency (AOR = 1.69; 95 % CI = 1.12, 2.55) and extreme or very painful withdrawal symptoms (AOR = 1.53; 95 % CI = 1.08, 2.16) were associated with nonfatal overdose as well. CONCLUSIONS Withdrawal symptoms among PWID increase health risk. Treatment of withdrawal symptoms is urgently needed and should include buprenorphine dispensing.
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Affiliation(s)
- Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, 90032 CA, United States of America.
| | - Kelsey Simpson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, 90032 CA, United States of America
| | - Rachel Carmen Ceasar
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, 90032 CA, United States of America
| | - Johnathan Zhao
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, 90032 CA, United States of America
| | - Lynn Wenger
- Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, 94704 CA, United States of America
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, 94704 CA, United States of America
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24
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Saunders EC, Moore SK, Walsh O, Metcalf SA, Budney AJ, Scherer E, Marsch LA. Perceptions and preferences for long-acting injectable and implantable medications in comparison to short-acting medications for opioid use disorders. J Subst Abuse Treat 2020; 111:54-66. [PMID: 32076361 PMCID: PMC7030185 DOI: 10.1016/j.jsat.2020.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim Treatment for opioid use disorders has recently evolved to include long-acting injectable and implantable formulations of medications for opioid use disorder (MOUD). Incorporating patient preferences into treatment for substance use disorders is associated with increased motivation and treatment satisfaction. This study sought to assess treatment preferences for long-acting injectable and implantable MOUD as compared to short-acting formulations among individuals with OUD. Methods We conducted qualitative, semi-structured telephone interviews with forty adults recruited from across the United States through Craigslist advertisements and flyers posted in treatment programs. Eligible participants scored a two or greater on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool, indicative of a past-year OUD. Interviews were transcribed, coded, and thematically analyzed. Results Twenty-four participants (60%) currently or previously had been prescribed MOUD. Sixteen participants (40%) expressed general opposition to MOUD, citing concerns that MOUD is purely financial gain for pharmaceutical companies and/or a "band aid" solution replacing one drug with another, rather than a path to abstinence. Some participants expressed personal preference for long-acting injectable (n = 16/40: 40%) and implantable formulations (n = 12/40: 30%) over short-acting formulations. About half of the participants were not willing to use injectables (n = 19/40: 48%) or implantables (n = 22/40: 55%), preferring short-acting formulations. Mixed evaluations of long- and short-acting MOUD focused on considerations of medication-related beliefs (privacy, concern over an embedded foreign body), the medication-related burden (convenience, provision of structure and support, medication administration, potential side effects), and medication-taking practices (potential for non-prescribed use, control over dosage, and duration of treatment). Conclusions Though many participants personally prefer short-acting to long-acting MOUD, some were open to including long-acting formulations in the range of options for those with OUD. Participants felt long-acting formulations may reduce medication-related burden and the risk of diversion. Conversely, participants expressed concern about invasive administration and loss of control over their treatment. Results suggest support for expanded access to a variety of formulations of MOUD. The use of shared decision making may also help patients select the formulation best aligned with their experiences, values, and treatment goals.
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Affiliation(s)
- Elizabeth C. Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Sarah K. Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Olivia Walsh
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Stephen A. Metcalf
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Alan J. Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
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25
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Zhao J, Kral AH, Wenger LD, Bluthenthal RN. Characteristics Associated with Nonmedical Methadone Use among People Who Inject Drugs in California. Subst Use Misuse 2019; 55:377-386. [PMID: 31608746 PMCID: PMC7002277 DOI: 10.1080/10826084.2019.1673420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Illicit, nonmedical use of opioid agonist medications such as methadone is an ongoing concern. Yet, few studies have examined nonmedical use of methadone by people who inject drugs (PWID). Objectives: This study describes the prevalence of nonmedical methadone use in a community sample of PWID and examines factors associated with recent use of nonmedical methadone. Methods: A cross-sectional sample of PWID (N = 777) was recruited using targeted sampling and interviewed in California (2011-2013). Descriptive, bivariate, and multivariate logistic regression analyses were used to determine characteristics associated with nonmedical methadone use in the last 30 days. To determine if nonmedical methadone use was associated with overdose in the last 6 months, a separate multivariate analysis was conducted. Results: Among PWID sampled, 21% reported nonmedical methadone use in the last 30 days. In multivariate logistic regression analysis, nonmedical methadone use was associated with recent methadone maintenance treatment (adjusted odds ratio [AOR] = 2.86; 95% confidence interval [CI] = 1.90, 4.30), recent nonmedical buprenorphine use (AOR = 3.12; 95% CI = 1.31, 7.47), higher injection frequency (referent <30 injections; 30-89 injections AOR = 1.89; 95% CI = 1.19, 3.02; 90-plus injections AOR = 2.43; 95% CI = 1.53, 3.87), schizophrenia diagnosis (AOR = 2.36; 95% CI = 1.36, 4.10), recent non-injection opioid prescription use (AOR = 2.97; 95% CI = 1.99, 4.43), and recent injection opioid prescription misuse (AOR = 2.13; 95% CI = 1.27, 3.59). Nonmedical methadone use was found not to be associated with nonfatal overdose (AOR = 0.77; 95% CI = 0.38, 1.56). Conclusion: Nonmedical methadone use identifies a vulnerable subpopulation among PWID, is not associated with elevated nonfatal overdose risk, and evidences a need to expand methadone treatment availability.
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Affiliation(s)
- Johnathan Zhao
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
| | - Alex H. Kral
- RTI International, 351 California Street, Suite 500, San Francisco, CA 94104
| | - Lynn D. Wenger
- RTI International, 351 California Street, Suite 500, San Francisco, CA 94104
| | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd floor, Los Angeles, CA 90033
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26
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Soyka M, Pogarell O. Neue Slow-release-Buprenorphinformulierungen zur Optimierung der Opioidsubstitution. DER NERVENARZT 2019; 90:932-937. [DOI: 10.1007/s00115-019-0783-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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27
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Parida S, Carroll KM, Petrakis IL, Sofuoglu M. Buprenorphine treatment for opioid use disorder: recent progress. Expert Rev Clin Pharmacol 2019; 12:791-803. [PMID: 31232604 DOI: 10.1080/17512433.2019.1635454] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Suprit Parida
- VA Connecticut Healthcare System, VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- School of Medicine, Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Kathleen M. Carroll
- School of Medicine, Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Ismene L. Petrakis
- VA Connecticut Healthcare System, VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- School of Medicine, Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- School of Medicine, Department of Psychiatry, Yale University, New Haven, CT, USA
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28
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Tompkins CNE, Neale J, Strang J. Opioid users' willingness to receive prolonged-release buprenorphine depot injections for opioid use disorder. J Subst Abuse Treat 2019; 104:64-71. [PMID: 31370986 DOI: 10.1016/j.jsat.2019.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 12/18/2022]
Abstract
AIMS Prolonged-release implantable and depot injection formulations of buprenorphine are very recent developments in the treatment of opioid use disorder. Such formulations remove the need for daily dosing and provide patients with sustained concentrations of buprenorphine over a period of weeks or months. We explored opioid users' personal willingness to receive prolonged-release buprenorphine depot injections and factors influencing their interest. METHODS The study took place in London during 2018, before depot buprenorphine was licensed for use in Europe. Thirty-six face-to-face, semi-structured qualitative interviews were conducted with people who were: i) using heroin daily and not receiving any treatment for opioid use (n = 12); or ii) prescribed daily oral buprenorphine (n = 12); or iii) prescribed daily oral methadone (n = 12). Participants were asked about their willingness to receive depot buprenorphine and were encouraged to discuss factors that might alter their opinions. Interview data were analysed following the stages of Iterative Categorization. FINDINGS Participants expressed a high level of willingness to receive depot buprenorphine. Their views were influenced both positively and negatively by six key features of depot buprenorphine: i) reduced contact with pharmacies and drug treatment services; ii) impact on illicit drug use and recovery; iii) the perceived effectiveness of depot buprenorphine; iv) the duration and dosage of depot buprenorphine injections; v) clinical administration of the depot buprenorphine injection; and vi) potential for side effects associated with the depot buprenorphine injection. CONCLUSIONS Willingness to receive a given medication is complex, individual and changeable. Opioid users seem likely to welcome greater choice and flexibility in respect of opioid agonist medications and appear more likely to accept and adhere to depot buprenorphine if it enables them to reduce their illicit drug use and facilitates their recovery. Research is now needed to assess whether patients' reported willingness to receive depot buprenorphine translates into actual uptake and adherence.
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Affiliation(s)
- Charlotte N E Tompkins
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, 4 Windsor Walk, King's College London, London SE5 8AF, United Kingdom.
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, 4 Windsor Walk, King's College London, London SE5 8AF, United Kingdom; South London & Maudsley (SLaM) NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8BB, United Kingdom; Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, 4 Windsor Walk, King's College London, London SE5 8AF, United Kingdom; South London & Maudsley (SLaM) NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8BB, United Kingdom
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Abstract
It is important for nurses not working in the area of addictions to be informed of the diagnosis and treatment of opioid use disorder so that they may serve as a resource, educate others, and influence and refer individuals to seek treatment on the basis of best evidence. In this article, we provide an overview of the postscreening diagnosis and treatment of opioid use disorders with an emphasis on medication-assisted treatment, starting with the definition of substance use disorder, tolerance, dependence, and addiction.
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