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Zheng W, Cavrak M, Bowles H, Deng Y, Wen S, Gao S, Lander L, Berry J, Winstanley EL. 10-year retention of a comprehensive treatment model of buprenorphine for opioid use disorder. J Addict Dis 2024:1-8. [PMID: 38400724 PMCID: PMC11343915 DOI: 10.1080/10550887.2024.2315366] [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] [Indexed: 02/26/2024]
Abstract
BACKGROUND There has been extensive research demonstrating the effectiveness of medications for opioid use disorder (MOUD) but limited investigation into its long-term retention rate. OBJECTIVE Assess the long-term treatment retention of a buprenorphine-based MOUD clinic with additional stratifications by age and gender. METHODS This retrospective study analyzed 10-years of data from a MOUD clinic in West Virginia that served 3,255 unique patients during the study period (2009-2019). Retention was measured by summation of total treatment days with a new episode of care defined as re-initiating buprenorphine treatment after 60+ consecutive days of nonattendance. Kaplan-Meier survival analysis, with the log-rank test, was used to compare retention by gender and age. RESULTS The mean age was 38 (SD = 10.6) and 95% were non-Hispanic white. Irrespective of treatment episode, 56.8% of patients were retained ≥ 90 days, and the overall median time in treatment was 112 days. Considering only the first treatment episode, 48.4% of 3,255 patients were retained at least 90 days and the overall median was 77 days. Female patients had a ≥ 90 day retention rate of 52.2% for the first admission and 60.1% for multiple admissions, both significantly higher than those of male subjects (44.1% and 53.0%). Additionally, patients ≤ 24 years old had the lowest rate of treatment retention, while patients aged ≥ 35 had the highest. CONCLUSIONS This study adds to the limited data regarding long-term retention in MOUD. Our findings indicate gender and age were highly correlated with retention in MOUD treatment.
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Affiliation(s)
- Wanhong Zheng
- Department of Behavioral Medicine and Psychiatry, School of Medicine, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Megan Cavrak
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hannah Bowles
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Yongjia Deng
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Si Gao
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Laura Lander
- Department of Behavioral Medicine and Psychiatry, School of Medicine, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - James Berry
- Department of Behavioral Medicine and Psychiatry, School of Medicine, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
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Segel JE, Shearer RD, Jones AA, Khatri UG, Howell BA, Crowley DM, Sterner G, Vest N, Teixeira da Silva D, Winkelman TNA. Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants. Subst Use Misuse 2024; 59:558-566. [PMID: 38037904 PMCID: PMC10923074 DOI: 10.1080/10826084.2023.2287220] [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: 12/02/2023]
Abstract
BACKGROUND As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. METHODS A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. RESULTS There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. CONCLUSION Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.
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Affiliation(s)
- Joel E Segel
- Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
| | - Riley D Shearer
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Abenaa A Jones
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
| | - Utsha G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA
| | - D Max Crowley
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
- Evidence-to-Impact Collaborative, Penn State University, University Park, Pennsylvania, USA
| | - Glenn Sterner
- Consortium on Substance Use and Addiction, Penn State University, University Park, Pennsylvania, USA
- Department of Criminal Justice, Penn State Abington, Abington, Pennsylvania, USA
| | - Noel Vest
- Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tyler N A Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Health, Homelessness, and Criminal Justice Laboratory, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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Chapman SA, Fraimow-Wong L, Phoenix BJ, Tierney M, Spetz J. Perspectives on APRN prescribing of medications for opioid use disorder: Key barriers remain. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209215. [PMID: 37979946 PMCID: PMC11092094 DOI: 10.1016/j.josat.2023.209215] [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: 03/07/2023] [Revised: 06/22/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Deaths from drug overdoses are rising dramatically in the United States. Treatment for opioid use disorders may include behavioral treatments as well as medications for opioid use disorders (MOUD). Buprenorphine can be prescribed by physicians, nurse practitioners (NPs), other advanced practice registered nurses (APRNs), and physician assistants (PAs) and required a training and a federal waiver until recently. The number of NP MOUD prescribers grew steadily over the past decade, but research has identified state-level scope of practice regulations as a barrier to NP MOUD prescribing. This article explores the contributions of, and remaining barriers faced by NP and other APRN MOUD prescribers. We describe qualitative findings from a study of NPs and other key stakeholders involved in MOUD treatment in four states with two differing levels of regulatory structure. METHODS In this qualitative study, we conducted site visits and semi-structured interviews with NPs and other APRNs, physicians, clinic managers, and regulators in four states including New Mexico and West Virginia (full practice authority for NPs), and Ohio and Michigan (which require physician supervision). Interview notes were entered into a qualitative software package and coded and reviewed by two members of the research team. Data were grouped into key themes. RESULTS A total of 76 participants participated in individual or small group interviews in the four states. We found key themes and several subthemes that describe NP practice in MOUD. Participants described key contributions of NP engagement in MOUD, including increasing access, serving rural areas, the unique role of psychiatric NPs, and the value of the nursing model of care in working with people with substance use disorders (SUD). Participants also identified barriers including scope of practice regulations, other regulatory barriers, stigma, and lack of supportive services to address psychosocial needs. CONCLUSIONS The waiver requirements were eliminated at the end of 2022 in federal budget legislation. Other barriers for NP and other APRN prescribers remain and should be addressed in practice, and in state and federal regulations. Research needs to explore the impact of the waiver elimination on MOUD prescribing and access to services.
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Affiliation(s)
- Susan A Chapman
- University of California San Francisco School of Nursing, Department of Social and Behavioral Sciences, 490 Illinois Street, 12th Floor, San Francisco, CA 94143, United States of America.
| | - Leah Fraimow-Wong
- UCSF School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, United States of America.
| | - Bethany J Phoenix
- University of California San Francisco School of Nursing, Department of Community Health Systems, 2 Koret Way, 5th Floor, San Francisco, CA 94143-0608, United States of America.
| | - Matthew Tierney
- University of California San Francisco School of Nursing, Department of Community Health Systems, 2 Koret Way, 5th Floor, San Francisco, CA 94143-0608, United States of America.
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA 94158, United States of America.
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Driscoll DL, O'Donnell H, Patel M, Cattell-Gordon DC. Assessing and Addressing the Determinants of Appalachian Population Health: A Scoping Review. JOURNAL OF APPALACHIAN HEALTH 2023; 5:85-102. [PMID: 38784141 PMCID: PMC11110904 DOI: 10.13023/jah.0503.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Introduction Residents of Appalachia experience elevated rates of morbidity and mortality compared to national averages, and these disparities are associated with inequitable exposures to various determinants of population health. Social and environmental determinants of health are a useful lens through which to develop and evaluate programs to mitigate regional health disparities. Methods This 2023 scoping review was conducted of studies linking determinants of Appalachian health with leading causes of regional mortality and morbidity. The search strategy employed a keyword search that included geographic terms for the Appalachian Region and the primary adverse health outcomes in that region. Studies meeting the following inclusion criteria were reviewed: original article, published in the last five years, involving an Appalachian population, and includes a rigorous assessment of an association between a population health determinant and one or more leading causes of Appalachian morbidity and mortality. Results The search returned 221 research articles, including 30 interventional studies. The top three health outcomes included cancer (43.59%), diseases of despair (23.08%), and diabetes (12.82). Access to care (27.3%), rurality (18.9%), and education (14.8%) were the most common population health determinants identified. Interventional studies were categorized by program types: education, technology, partnerships, and multilevel interventions. Due to the heterogeneity of study types, the studies were combined using a narrative synthesis. Implications The results of this work can inform the development and evaluation of additional programs to promote Appalachian population health. Our study team will use these results to inform community-based discussions that develop strategic plans to mitigate health disparities in Central and Southcentral Appalachian Virginia.
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Affiliation(s)
| | | | | | - David C Cattell-Gordon
- Center for Telehealth at the University of Virginia (retired); ThreadEx Consulting LLC (current)
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5
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Herczyk JM, Zullig KJ, Davis SM, Mallow J, Hobbs GR, Davidov DM, Lander LR, Theeke L. Association of Loneliness and Mindfulness in Substance Use Treatment Retention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6571. [PMID: 37623157 PMCID: PMC10454177 DOI: 10.3390/ijerph20166571] [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: 06/30/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Elevated mental illness prevalence complicates efforts designed to address the opioid crisis in Appalachia. The recovery community acknowledges that loneliness impacts mood and engagement in care factors; however, the predictive relationship between loneliness and retention in medication-assisted outpatient treatment programs has not been explored. Our objectives were to identify associations between mental health factors and retention in treatment and elucidate treatment retention odds. Data were collected from eighty participants (n = 57 retained, n = 23 not retained) of a mindfulness-based relapse prevention (MBRP) intervention for individuals receiving medication for opioid use disorder (MOUD) in Appalachia. Loneliness, depression, and anxiety did not differ between the retained and not retained, nor did they predict not being retained; however, mindfulness was significantly lower among those not retained in treatment compared to those retained (OR = 0.956, 95% CI (0.912-1.00), and p < 0.05). Preliminary findings provide evidence for mindfulness training integration as part of effective treatment, with aims to further elucidate the effectiveness of mindfulness therapies on symptom reduction in co-occurring mental health disorders, loneliness, and MOUD treatment retention.
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Affiliation(s)
- Johnathan M. Herczyk
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Keith J. Zullig
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Stephen M. Davis
- Department of Health Policy, Management and Leadership, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Jennifer Mallow
- School of Nursing, West Virginia University, Morgantown, WV 26506, USA
| | - Gerald R. Hobbs
- Department of Statistics, West Virginia University, Morgantown, WV 26506, USA
| | - Danielle M. Davidov
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Laura R. Lander
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neurosciences Institute, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Laurie Theeke
- School of Nursing, The George Washington University, Washington, DC 20052, USA
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Claypool AL, DiGennaro C, Russell WA, Yildirim MF, Zhang AF, Reid Z, Stringfellow EJ, Bearnot B, Schackman BR, Humphreys K, Jalali MS. Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids. JAMA HEALTH FORUM 2023; 4:e231080. [PMID: 37204803 PMCID: PMC10199347 DOI: 10.1001/jamahealthforum.2023.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/26/2023] [Indexed: 05/20/2023] Open
Abstract
Importance Buprenorphine is an effective and cost-effective medication to treat opioid use disorder (OUD), but is not readily available to many people with OUD in the US. The current cost-effectiveness literature does not consider interventions that concurrently increase buprenorphine initiation, duration, and capacity. Objective To conduct a cost-effectiveness analysis and compare interventions associated with increased buprenorphine treatment initiation, duration, and capacity. Design and Setting This study modeled the effects of 5 interventions individually and in combination using SOURCE, a recent system dynamics model of prescription opioid and illicit opioid use, treatment, and remission, calibrated to US data from 1999 to 2020. The analysis was run during a 12-year time horizon from 2021 to 2032, with lifetime follow-up. A probabilistic sensitivity analysis on intervention effectiveness and costs was conducted. Analyses were performed from April 2021 through March 2023. Modeled participants included people with opioid misuse and OUD in the US. Interventions Interventions included emergency department buprenorphine initiation, contingency management, psychotherapy, telehealth, and expansion of hub-and-spoke narcotic treatment programs, individually and in combination. Main Outcomes and Measures Total national opioid overdose deaths, quality-adjusted life years (QALYs) gained, and costs from the societal and health care perspective. Results Projections showed that contingency management expansion would avert 3530 opioid overdose deaths over 12 years, more than any other single-intervention strategy. Interventions that increased buprenorphine treatment duration initially were associated with an increased number of opioid overdose deaths in the absence of expanded treatment capacity. With an incremental cost- effectiveness ratio of $19 381 per QALY gained (2021 USD), the strategy that expanded contingency management, hub-and-spoke training, emergency department initiation, and telehealth was the preferred strategy for any willingness-to-pay threshold from $20 000 to $200 000/QALY gained, as it was associated with increased treatment duration and capacity simultaneously. Conclusion and Relevance This modeling analysis simulated the effects of implementing several intervention strategies across the buprenorphine cascade of care and found that strategies that were concurrently associated with increased buprenorphine treatment initiation, duration, and capacity were cost-effective.
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Affiliation(s)
- Anneke L. Claypool
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Catherine DiGennaro
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - W. Alton Russell
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Melike F. Yildirim
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Alan F. Zhang
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Zuri Reid
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Erin J. Stringfellow
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Benjamin Bearnot
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, Palo Alto, California
| | - Mohammad S. Jalali
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
- MIT Sloan School of Management, Cambridge, Massachusetts
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Baus AD, Carter M, Boyd J, McMullen E, Bennett T, Persily A, Davidov DM, Lilly C. A Better Life: Factors that Help and Hinder Entry and Retention in MAT from the Perspective of People in Recovery. JOURNAL OF APPALACHIAN HEALTH 2023; 5:72-94. [PMID: 38023116 PMCID: PMC10629892 DOI: 10.13023/jah.0501.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction Opioid addiction and opioid-related overdoses and deaths are serious public health problems nationally and in West Virginia, in particular. Medication-assisted treatment (MAT) is an effective yet underutilized treatment for opioid use disorder (OUD). Purpose Research examining factors that help individuals succeed in MAT has been conducted from provider and program perspectives, but little research has been conducted from the perspective of those in recovery. Methods This study, co-developed with individuals in recovery, took place in West Virginia-based MAT programs using an exploratory sequential mixed methods approach. The survey was open February through August 2021. Data were analyzed late 2021 through mid 2022. Results Respondents experienced many barriers to MAT entry and retention, including community bias / stigma, lack of affordable programming, and lack of transportation. Respondents sought MAT primarily for personal reasons, such as being tired of being sick, and tired of having to look for drugs every day. As one respondent shared, " I wanted to better my life, to get it under control." Implications Programs and policies should make it easy for individuals to enter treatment when ready, through affordable and accessible treatment options, reduced barriers to medications, focused outreach and education, individualized care, and reduced stigmatization.
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Affiliation(s)
- Adam D Baus
- West Virginia University School of Public Health; West Virginia Alliance for Creative Health Solutions, Inc.,
| | - Martha Carter
- West Virginia Alliance for Creative Health Solutions, Inc
| | - Jennifer Boyd
- New River Health Association; West Virginia Alliance for Creative Health Solutions, Inc
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8
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Dai Z, Limen GN, Abate MA, Kraner JC, Mock AR, Smith GS. Characterization of Unintentional Deaths Among Buprenorphine Users. J Stud Alcohol Drugs 2023; 84:171-179. [PMID: 36799687 PMCID: PMC9948141 DOI: 10.15288/jsad.22-00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Medications used to treat opioid use disorder (OUD) reduce drug overdose risk. Buprenorphine is often the preferred treatment for OUD because of its high safety profile. Given expanding buprenorphine use, this study sought to examine buprenorphine-involved deaths (BIDs) and compare them with other drug-related deaths. METHOD West Virginia drug-related deaths from 2005 to early 2020 were identified. Study data included decedent demographics, toxicology, autopsy findings, and medical and prescription histories. Characteristics of BIDs compared with other drug-related deaths were statistically analyzed. RESULTS Among 11,764 drug-related deaths, only 564 (4.8%) involved buprenorphine. Buprenorphine alone was present in 32 deaths, of which 20 were considered the direct cause of death (0.2% of all drug-related deaths). Significantly more BIDs involved five or more drugs (23%) compared with other opioid deaths (14.9%). Co-intoxicants found most frequently in BIDs were benzodiazepines (47.3%), methamphetamine (27.1%), and fentanyl (22.9%). Cardiovascular and pulmonary comorbidities were identified in 43% and 21% of BIDs, respectively. Of the 564 BIDs, a current buprenorphine prescription was present in 132 deaths (23.4%). CONCLUSIONS Despite increasing buprenorphine use, BIDs comprised less than 5% of overall West Virginia drug-related deaths. Seldom was it the only drug found, and most decedents did not have current prescriptions for buprenorphine. Although buprenorphine is effective, with a wide safety margin, clinicians and patients should be aware that buprenorphine can be involved in overdose deaths, especially when buprenorphine is taken in combination with drugs such as benzodiazepines, methamphetamine, or fentanyl, and in persons with underlying cardiovascular or pulmonary comorbidities.
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Affiliation(s)
- Zheng Dai
- West Virginia University Health Affairs Institute, Morgantown, West Virginia
| | - George N. Limen
- West Virginia University School of Pharmacy, Morgantown, West Virginia
| | - Marie A. Abate
- West Virginia University School of Pharmacy, Morgantown, West Virginia
| | - James C. Kraner
- West Virginia Office of the Chief Medical Examiner, Charleston, West Virginia
| | - Allen R. Mock
- West Virginia Office of the Chief Medical Examiner, Charleston, West Virginia
| | - Gordon S. Smith
- West Virginia University School of Public Health, Morgantown, West Virginia
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9
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Winstanley EL, Thacker EP, Choo LY, Lander LR, Berry JH, Tofighi B. Patient-reported problems filling buprenorphine prescriptions and motivations for illicit use. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100091. [PMID: 36844166 PMCID: PMC9949336 DOI: 10.1016/j.dadr.2022.100091] [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: 06/11/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Background While barriers to accessing buprenorphine (BUP) therapy have been well described, little is known about pharmacy-related barriers. The objective of this study was to estimate the prevalence of patient-reported problems filling BUP prescriptions and determine whether these problems were associated with illicit use of BUP. The secondary objectives included identifying motivations for illicit BUP use and the prevalence of naloxone acquisition among patients prescribed BUP. Methods Between July 2019 and March 2020, 139 participants receiving treatment for an opioid use disorder (OUD) at two sites within a rurally-located health system, completed an anonymous 33-item survey. A multivariable model was used to assess the association between pharmacy-related problems filling BUP prescriptions and illicit substance use. Results More than a third of participants reported having problems filling their BUP prescription (34.1%, n = 47) with the most commonly reported problems being insufficient pharmacy stock of BUP (37.8%, n = 17), pharmacist refusal to dispense BUP (37.8%, n = 17), and insurance problems (34.0%, n = 16). Of those who reported illicit BUP use (41.5%, n = 56), the most common motivations were to avoid/ease withdrawal symptoms (n = 39), prevent/reduce cravings (n = 39), maintain abstinence (n = 30), and treat pain (n = 19). In the multivariable model, participants who reported a pharmacy-related problems were significantly more likely to use illicitly obtained BUP (OR=8.93, 95% CI: 3.12, 25.52, p < 0.0001). Conclusion Efforts to improve BUP access have primarily focused on increasing the number of clinicians waivered to prescribe; however, challenges persist with BUP dispensing and coordinated efforts may be needed to systematically reduce pharmacy-related barriers.
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Affiliation(s)
- Erin L. Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States,Department of Neuroscience, West Virginia University, Morgantown, WV, United States,Corresponding author at: Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.
| | - Emily P. Thacker
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Lyn Yuen Choo
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, United States
| | - Laura R. Lander
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States,Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States,Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | - Babak Tofighi
- Department of Population Health, New York University School of Medicine, United States
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Marcovitz DE, Pettapiece-Phillips M, Kast KA, White K, Himelhoch H, Audet C. Implementation of a Hub-and-Spoke Partnership for Opioid Use Disorder Treatment in a Medicaid Nonexpansion State. Psychiatr Serv 2022; 73:819-822. [PMID: 34875847 DOI: 10.1176/appi.ps.202100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hub-and-spoke (H&S) partnerships for managing opioid use disorder vary by U.S. state. This column provides the first description of the development of an H&S partnership in Tennessee, a Medicaid nonexpansion state. Medicaid expansion allows states to fund evidence-based substance use disorder treatment and community-based psychosocial interventions. In an H&S model in a Medicaid nonexpansion context, federal grant support must fund not only treatment itself but also the creation and maintenance of parallel billing and documentation processes for various partners, reducing the funds available for patient care.
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Affiliation(s)
- David E Marcovitz
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Mariah Pettapiece-Phillips
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Kristopher A Kast
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Katie White
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Heather Himelhoch
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Carolyn Audet
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee (Marcovitz, Pettapiece-Phillips, Kast, White, Audet); Department of Surgery and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Himelhoch). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
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Carpenter D, Lambert KV, Harless JC, Wilson CG, Davis SA, Zule WA, Ostrach B. North Carolina Community Pharmacists’ Buprenorphine Dispensing Practices and Attitudes. J Am Pharm Assoc (2003) 2022; 62:1606-1614. [DOI: 10.1016/j.japh.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
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Delaney SR, Tacker DH, Snozek CLH. The North American opioid epidemic: opportunities and challenges for clinical laboratories. Crit Rev Clin Lab Sci 2022; 59:309-331. [PMID: 35166639 DOI: 10.1080/10408363.2022.2037122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since 1999, the opioid epidemic in North America has resulted in over 1 million deaths, and it continues to escalate despite numerous efforts in various arenas to combat the upward trend. Clinical laboratories provide drug testing to support practices such as emergency medicine, substance use disorder treatment, and pain management; increasingly, these laboratories are collaborating in novel partnerships including drug-checking services (DCS) and multidisciplinary treatment teams. This review examines drug testing related to management of licit and illicit opioid use, new technologies and test strategies employed by clinical laboratories, barriers hindering laboratory response to the opioid epidemic, and areas for improvement and standardization within drug testing. Literature search terms included combinations of "opioid," "opiate," "fentanyl," "laboratory," "epidemic," "crisis," "mass spectrometry," "immunoassay," "drug screen," "drug test," "guidelines," plus review of PubMed "similar articles" and references within publications. While immunoassay (IA) and point-of-care (POC) test options for synthetic opioids are increasingly available, mass spectrometry (MS) platforms offer the greatest flexibility and sensitivity for detecting novel, potent opioids. Previously reserved as a second-tier application in most drug test algorithms, MS assays are gaining a larger role in initial screening for specific patients and DCS. However, there are substantial differences among laboratories in terms of updating test menus, algorithms, and technologies to meet changing clinical needs. While some clinical laboratories lack the resources and expertise to implement MS, many are also slow to adopt available IA and POC tests for newer opioids such as fentanyl. MS-based testing also presents challenges, including gaps in available guidance for assay validation and ongoing performance assessment that contribute to a dramatic lack of standardization among laboratories. We identify opportunities for improvement in laboratory operations, reporting, and interpretation of drug test results, including laboratorian and provider education and laboratory-focused guidelines. We also highlight the need for collaboration with providers, assay and instrument manufacturers, and national organizations to increase the effectiveness of clinical laboratory and provider efforts in preventing morbidity and mortality associated with opioid use and misuse.
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Affiliation(s)
- Sarah R Delaney
- Department of Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Danyel H Tacker
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Christine L H Snozek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA
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Haggerty T, Khodaverdi M, Dekeseredy P, Wood N, Hendricks B, Peklinsky J, Sedney CL. Assessing the impact of social distancing measures implemented during COVID-19 pandemic on medications for opioid use disorder in West Virginia. J Subst Abuse Treat 2021; 136:108687. [PMID: 34903397 PMCID: PMC8651495 DOI: 10.1016/j.jsat.2021.108687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022]
Abstract
Introduction This study evaluates if social distancing measures instituted during the novel coronavirus SARS-CoV-2 (COVID-19) pandemic were associated with a reduction in Medication for Opioid Use Disorder (MOUD) prescribing in West Virginia. The COVID-19 pandemic necessitated the quick implementation of public health interventions such as social distancing. This led to the use of telemedicine in the clinical setting however implementing telemedicine involves system level and infrastructure level changes within a healthcare environment. This could cause a barrier to MOUD delivery as it is often provided concomitantly with other face to face substance use and mental health services. The purpose of this study is to determine whether social distancing was associated with a reduction in MOUD prescribing in West Virginia, with the goal of adding to the knowledge of how COVID-19 and COVID-19-related mitigation strategies have impacted patients with OUD. Methods Prescription monitoring data were requested from the West Virginia Board of Pharmacy. We applied interrupted time series modeling to investigate MOUD prescribing practices before and after social distancing took effect. Gabapentin prescriptions were utilized as a control for comparison. Results Our study assessed state-wide buprenorphine and Suboxone prescriptions as compared to a control medication and found an increase in dosage of both medications and an increase in number of buprenorphine prescriptions, but a small decrease in buprenorphine/naloxone prescription number related to the dates of implementation of social distancing. Taken together, overall this indicates an increase in prescription number of MOUD prescriptions as well as an increase in dosage. Conclusion This study suggests that social distancing measures were associated with an increase in both the number of MOUD prescriptions and the number of doses in each prescription. Significant alterations to MOUD delivery in the clinical setting were implemented in a short timeframe with the COVID-19 pandemic. Understanding the implementation of clinical measures to accommodate social distancing measures may provide benefit to transformation of future delivery of MOUD.
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Affiliation(s)
- Treah Haggerty
- West Virginia University School of Medicine, Morgantown, WV 26506, United States of America.
| | - Maryam Khodaverdi
- West Virginia Clinical and Translational Science Institute, Morgantown, WV 26506, United States of America
| | - Patricia Dekeseredy
- West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - Nathan Wood
- West Virginia Board of Pharmacy, 2310 Kanawha Blvd, Charleston, WV 25311, United States of America
| | - Brian Hendricks
- West Virginia University School of Public Health, Department of Epidemiology, Morgantown, WV 26506, United States of America
| | - Jason Peklinsky
- West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - Cara L Sedney
- West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
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Hawkins EJ, Malte CA, Gordon AJ, Williams EC, Hagedorn HJ, Drexler K, Blanchard BE, Burden JL, Knoeppel J, Danner AN, Lott A, Liberto JG, Saxon AJ. Accessibility to Medication for Opioid Use Disorder After Interventions to Improve Prescribing Among Nonaddiction Clinics in the US Veterans Health Care System. JAMA Netw Open 2021; 4:e2137238. [PMID: 34870679 PMCID: PMC8649831 DOI: 10.1001/jamanetworkopen.2021.37238] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE With increasing rates of opioid use disorder (OUD) and overdose deaths in the US, increased access to medications for OUD (MOUD) is paramount. Rigorous effectiveness evaluations of large-scale implementation initiatives using quasi-experimental designs are needed to inform expansion efforts. OBJECTIVE To evaluate a US Department of Veterans Affairs (VA) initiative to increase MOUD use in nonaddiction clinics. DESIGN, SETTING, AND PARTICIPANTS This quality improvement initiative used interrupted time series design to compare trends in MOUD receipt. Primary care, pain, and mental health clinics in the VA health care system (n = 35) located at 18 intervention facilities and nonintervention comparison clinics (n = 35) were matched on preimplementation MOUD prescribing trends, clinic size, and facility complexity. The cohort of patients with OUD who received care in intervention or comparison clinics in the year after September 1, 2018, were evaluated. The preimplementation period extended from September 1, 2017, through August 31, 2018, and the postimplementation period from September 1, 2018, through August 31, 2019. EXPOSURES The multifaceted implementation intervention included education, external facilitation, and quarterly reports. MAIN OUTCOMES AND MEASURES The main outcomes were the proportion of patients receiving MOUD and the number of patients per clinician prescribing MOUD. Segmented logistic regression evaluated monthly proportions of MOUD receipt 1 year before and after initiative launch, adjusting for demographic and clinical covariates. Poisson regression models examined yearly changes in clinician prescribing over the same time frame. RESULTS Overall, 7488 patients were seen in intervention clinics (mean [SD] age, 53.3 [14.2] years; 6858 [91.6%] male; 1476 [19.7%] Black, 417 [5.6%] Hispanic; 5162 [68.9%] White; 239 [3.2%] other race [including American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and multiple races]; and 194 [2.6%] unknown) and 7558 in comparison clinics (mean [SD] age, 53.4 [14.0] years; 6943 [91.9%] male; 1463 [19.4%] Black; 405 [5.4%] Hispanic; 5196 [68.9%] White; 244 [3.2%] other race; 250 [3.3%] unknown). During the preimplementation year, the proportion of patients receiving MOUD in intervention clinics increased monthly by 5.0% (adjusted odds ratio [AOR], 1.05; 95% CI, 1.03-1.07). Accounting for this preimplementation trend, the proportion of patients receiving MOUD increased monthly by an additional 2.3% (AOR, 1.02; 95% CI, 1.00-1.04) during the implementation year. Comparison clinics increased by 2.6% monthly before implementation (AOR, 1.03; 95% CI, 1.01-1.04), with no changes detected after implementation. Although preimplementation-year trends in monthly MOUD receipt were similar in intervention and comparison clinics, greater increases were seen in intervention clinics after implementation (AOR, 1.04; 95% CI, 1.01-1.08). Patients treated with MOUD per clinician in intervention clinics saw greater increases from before to after implementation compared with comparison clinics (incidence rate ratio, 1.50; 95% CI, 1.28-1.77). CONCLUSIONS AND RELEVANCE A multifaceted implementation initiative in nonaddiction clinics was associated with increased MOUD prescribing. Findings suggest that engagement of clinicians in general clinical settings may increase MOUD access.
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Affiliation(s)
- Eric J. Hawkins
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Carol A. Malte
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - Adam J. Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences Center, Health Services Research & Development, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Emily C. Williams
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Hildi J. Hagedorn
- Center for Care Delivery & Outcomes Research, Health Services Research & Development, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Psychiatry, University of Minnesota, Minneapolis
| | - Karen Drexler
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Brittany E. Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jennifer L. Burden
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC
| | - Jennifer Knoeppel
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC
| | - Anissa N. Danner
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - Aline Lott
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - Joseph G. Liberto
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Andrew J. Saxon
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
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Zullig KJ, Lander LR, Tuscano M, Garland M, Hobbs GR, Faulkenberry L. Testing Mindfulness-Based Relapse Prevention with Medications for Opioid Use Disorder Among Adults in Outpatient Therapy: a Quasi-experimental Study. Mindfulness (N Y) 2021; 12:3036-3046. [PMID: 34659584 PMCID: PMC8504564 DOI: 10.1007/s12671-021-01763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to explore the effectiveness of mindfulness-based relapse prevention (MBRP) with individuals receiving medication for opioid use disorder (MOUD) in a naturalistic, open-ended outpatient group treatment setting. METHODS Eighty participants (mean age 36.3) who had at least 90 consecutive days substance free self-selected into treatment (MBRP, n = 35) or comparison groups (treatment as usual, TAU, n = 45). Outcomes tracked included treatment retention and relapse, and self-reported craving, anxiety, depression, and mindfulness at baseline, 12 weeks, 24 weeks, and 36 weeks post-recruitment. MBRP group participants attended biweekly 60-min sessions for 24 weeks. A linear mixed model analysis of variance determined the significance of the MBRP intervention on changes in craving, anxiety, depression, and mindfulness. RESULTS No significant differences in sex, education level, insurance status, relationship status, or employment status were detected at baseline between groups. The 36-week retention (74%, MBRP/MOUD; 71%, TAU/MOUD) and relapse rates (43%, MBRP/MOUD; 47%, TAU/MOUD) were similar for the groups. There were only four relapses on opioids. Significant reductions (p < .05) were observed in the MBRP/MOUD group for craving, anxiety, and depression in addition to significant increases in mindfulness compared to those in TAU/MOUD. CONCLUSIONS Although state and federal resources are available to expand MOUD, no standard of behavioral therapy has been established as most complimentary to MOUD. The current study results suggest MBRP can be implemented as an outpatient therapy for individuals in MOUD.
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Affiliation(s)
- Keith J. Zullig
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV USA
| | - Laura R. Lander
- Department of Behavioral Medicine and Psychiatry and Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, USA
| | - Meghan Tuscano
- West Virginia University Research Corporation, Morgantown, USA
| | - Megan Garland
- Department of Occupational and Environmental Health Sciences, West Virginia University School of Public Health, Morgantown, USA
| | - Gerry R. Hobbs
- Department of Statistics, West Virginia University, Morgantown, USA
| | - Laurel Faulkenberry
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, USA
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16
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Hodgkin D, Horgan C, Bart G. Financial sustainability of payment models for office-based opioid treatment in outpatient clinics. Addict Sci Clin Pract 2021; 16:45. [PMID: 34225785 PMCID: PMC8256208 DOI: 10.1186/s13722-021-00253-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/22/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Office-Based Opioid Treatment (OBOT) is a delivery model which seeks to make medications for opioid use disorder (MOUD), particularly buprenorphine, widely available in general medical clinics and offices. Despite evidence supporting its effectiveness and cost-effectiveness, uptake of the OBOT model has been relatively slow. One important barrier to faster diffusion of OBOT may be the financial challenges facing clinics that could adopt it. METHODS We review key features and variants of the OBOT model, then discuss different approaches that have been used to fund it, and the findings from previous economic analyses of OBOT's impact on organizational finances. We conclude by discussing the implications of these analyses for the financial sustainability of the OBOT delivery model. RESULTS Like other novel services, OBOT poses challenges for providers due to its reliance on services which are 'non-billable' in a fee-for-service environment. A variety of approaches exist for covering the non-billable costs, but which approaches are feasible depends on local payer policies. The scale of the challenges varies with clinic size, organizational affiliations and the policies of the state where the clinic operates. Small clinics in a purely fee-for-service environment may be particularly challenged in pursuing OBOT, given the need to fund a dedicated staff and extra administrative work. The current pandemic may pose both opportunities and challenges for the sustainability of OBOT, with expanded access to telemedicine, but also uncertainty about the durability of the expansion. CONCLUSION The reimbursement environment for OBOT delivery varies widely around the US, and is evolving as Medicare (and possibly other payers) introduce alternative payment approaches. Clinics considering adoption of OBOT are well advised to thoroughly investigate these issues as they make their decision. In addition, payers will need to rethink how they pay for OBOT to make it sustainable.
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Affiliation(s)
- Dominic Hodgkin
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, United States.
| | - Constance Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, United States
| | - Gavin Bart
- Department of Medicine, University of Minnesota Medical School and Division of Addiction Medicine, Hennepin Healthcare, Minneapolis, United States
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17
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Varon ML, Baker E, Byers E, Cirolia L, Bogler O, Bouchonville M, Schmeler K, Hariprasad R, Pramesh CS, Arora S. Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:25-38. [PMID: 34292501 DOI: 10.1007/s13187-021-02031-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
Solving health problems requires not only the development of new medical knowledge but also its dissemination, particularly to underserved communities. The barriers to effective dissemination also contribute to the disparities in cancer care experienced most everywhere. This concern is particularly acute in low and middle-income countries which already bear a disproportionate burden of cancer, a situation that is projected to worsen. Project ECHO (Extension for Community Healthcare Outcomes) is a knowledge dissemination platform that can increase workforce capacity across many fields, including cancer care by scaling best practices. Here we describe how Project ECHO works and illustrate this with existing programs that span the cancer care continuum and the globe. The examples provided combined with the explanation of how to build effective Project ECHO communities provide an accessible guide on how this education strategy can be integrated into existing work to help respond to the challenge of cancer.
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Affiliation(s)
| | - Ellen Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Byers
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Lucca Cirolia
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Oliver Bogler
- Center for Cancer Training, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Bouchonville
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Roopa Hariprasad
- Division of Clinical Oncology, National Institute of Cancer Prevention and Research, New Delhi, India
| | | | - Sanjeev Arora
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
- UNM School of Medicine, Albuquerque, NM, USA.
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18
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Strickland JC, Huhn AS, Bergeria CL, Strain EC, Dunn KE. Provider Continuity in the Prescribing of Buprenorphine/Naloxone Within Medicare Part D. J Addict Med 2021; 15:325-333. [PMID: 33156180 DOI: 10.1097/adm.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Efforts to improve buprenorphine access for opioid use disorder have focused on increasing the number of waivered providers. However, it is unknown how efforts to increase initial prescribing result in a sustained pool of prescribers. We examine the prevalence of year-to-year provider-level buprenorphine prescribing, and provider- and state-level factors associated with provider continuity. METHODS Providers prescribing buprenorphine/naloxone within the Medicare Part D claims database were evaluated from 2013 to 2017 with prescriber continuity measured as prescriptions made in consecutive years from the same provider (N = 14,222 unique providers; 6670 in 2013). RESULTS The number of providers prescribing buprenorphine/naloxone within Medicare Part D increased from 2013 to 2017. The majority of providers prescribed buprenorphine/naloxone to 10 or fewer beneficiaries. Approximately 84% of providers prescribing buprenorphine/naloxone in 1 year prescribed it in the following year. Continuous prescribing from 2013 to 2017 was 59.4%, which was 86% the rate of a comparator chronic health medication (ie, lisinopril). Survival analyses indicated that female providers (adjusted hazard ratios [AHR] = 1.30, P < 0.001) and clinical neuroscience specialties such as psychiatry (AHR = 1.21, P < 0.001) exhibited greater discontinuation rates, whereas those with higher buprenorphine/naloxone beneficiary loads (AHR = 0.50, P < 0.001) and in states with a greater increase in overdose mortality rates (AHR = 0.88, P < 0.05) showed lower discontinuation rates. CONCLUSIONS These data support evidence that providers who begin prescribing buprenorphine continue prescribing, although short of maximum capacity. Efforts to help providers become waivered, understand the impact of overdose fatalities in their area, and prescribe to multiple patients are likely to generate an enduring positive contribution to the number of treated patients.
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Affiliation(s)
- Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD
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19
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Hooker SA, Sherman MD, Lonergan-Cullum M, Sattler A, Liese BS, Justesen K, Nissly T, Levy R. Mental Health and Psychosocial Needs of Patients Being Treated for Opioid Use Disorder in a Primary Care Residency Clinic. J Prim Care Community Health 2021; 11:2150132720932017. [PMID: 32507067 PMCID: PMC7278330 DOI: 10.1177/2150132720932017] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose: Primary care is an ideal setting to deliver efficacious treatments for opioid use disorder (OUD). Primary care providers need to be aware of other concerns patients with OUD might have in order to provide comprehensive care. This study describes the prevalence of mental health, comorbid substance use, and psychosocial concerns of patients seeking treatment for OUD in primary care and their relation to 6-month treatment retention. Methods: Patients (N = 100; M age = 34.9 years (SD = 10.8), 74% white, 46% female) with OUD who were starting treatment with buprenorphine at an academic family medicine residency clinic completed surveys of mental health concerns (depression, anxiety, trauma), psychosocial needs (food insecurity, income, transportation, employment), and demographic variables. Chart reviews were conducted to gather information on comorbid substance use, mental health diagnoses, and 6-month treatment retention. Results: Mental health symptoms were highly prevalent in this sample (44% screened positive for anxiety, 31% for depression, and 52% for posttraumatic stress disorder). Three-quarters reported use of illicit substances other than opioids. Many patients also had significant psychosocial concerns, including unemployment (54%), low income (75%), food insecurity (51%), and lacking reliable transportation (64%). Two-thirds (67%) of the sample were retained at 6 months; patients who previously used intravenous opioids were more likely to discontinue treatment (P = .003). Conclusions: Many patients receiving treatment for OUD have significant mental health problems, comorbid substance use, and psychosocial concerns; interestingly, none of these factors predicted treatment retention at 6 months. Primary care clinics would benefit from having appropriate resources, interventions, and referrals for these comorbid issues in order to enhance overall patient well-being and promote recovery.
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Affiliation(s)
- Stephanie A Hooker
- University of Minnesota, Minneapolis, MN, USA.,HealthPartners Institute, Minneapolis, MN, USA
| | | | | | | | | | | | | | - Robert Levy
- University of Minnesota, Minneapolis, MN, USA
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20
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Sheppard AB, Young JC, Davis SM, Moran GE. Perceived Ability to Treat Opioid Use Disorder in West Virginia. JOURNAL OF APPALACHIAN HEALTH 2021; 3:32-42. [PMID: 35769171 PMCID: PMC9192106 DOI: 10.13023/jah.0302.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Medication-assisted treatment (MAT) is an evidence-based therapy for opioid use disorder (OUD) that has not been fully implemented in rural areas due to patient, provider, and logistical barriers. Limited information is available on provider perceptions of barriers to MAT in rural Central Appalachia which has very high rates of OUD compared to the rest the United States. PURPOSE Determine perceived barriers for potential prescribers to using MAT, including buprenorphine, as part of treatment for OUD in West Virginia. METHODS A 30-question, anonymous survey was sent to physicians, physician assistants and advanced practice registered nurses using an online link. Link was distributed through the WV Medicaid provider list, professional association and institutional contact lists, and social media. Comparisons were made by provider waivered or non-waivered status. RESULTS Overall, 84% of waivered providers (n = 77) and only 8% of non-waivered providers (n = 341) indicated ever prescribing a form of MAT for OUD; 73% percent of waivered providers were currently prescribing MAT and accepting new patients with OUD. Only 4% of non-waivered providers were currently prescribing MAT and 21% were currently accepting new patients with OUD. Lack of available mental health and psychosocial support services and concerns about diversion or misuse of medication were the top perceived barriers to implementing MAT programs. IMPLICATIONS Implementing strategies to improve access to behavioral health care including telehealth and apps, provider training and addressing stigma around OUD treatment were identified as priorities that would help increase providers' willingness to prescribe medications for OUD treatment.
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Affiliation(s)
| | - Jonathan C Young
- West Virginia University Health Sciences Center Office of Health Affairs
| | - Steve M Davis
- Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health
| | - Garrett E Moran
- Professor, Health Policy, Management, and Leadership, West Virginia University School of Public Health
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21
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Hooker SA, Lonergan-Cullum M, Levy R, Nissly T, Sherman MD. Longitudinal assessment of mental health and well-being in patients being treated with medications for opioid use disorder in primary care. Addict Behav Rep 2021; 13:100348. [PMID: 33997252 PMCID: PMC8105616 DOI: 10.1016/j.abrep.2021.100348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 01/07/2023] Open
Abstract
Opioid use disorder (OUD) continues to be a significant problem in the United States, contributing to overdose and death. Recent efforts to expand access to treatment of OUD in primary care have increased the availability of medications for OUD (MOUDs). However, OUD is often accompanied by poor mental health and well-being, and it is not known if treatment with MOUDs alone is associated with improved psychological well-being. This study's purpose was to examine changes in mental health and well-being in the first 6 months of treatment with MOUDs in a family medicine residency clinic. Patients (N = 126; M age = 34.6 years, SD = 10.6; 54.8% male; 71.4% white) completed validated screeners of mental health and well-being (depression, anxiety, anger, loneliness, perceived stress, meaning in life, and life satisfaction) at baseline (induction visit for buprenorphine), 1-month, and 6-months. Results indicated that the mental health and well-being indices did not significantly change over the first 6 months of treatment on MOUDs. There were initial decreases in depression and anxiety at 1-month; however, both increased and were equivalent to baseline levels at 6-months. These results suggest that MOUD treatment alone does not significantly impact mental health or well-being in patients with OUD. Additional treatments or supports are clearly needed to address the comorbid mental health and well-being challenges in this population, as these factors can be both antecedents and consequences of substance misuse.
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Affiliation(s)
- Stephanie A Hooker
- HealthPartners Institute, Research Division, 8170 E 33 Ave, Mail Stop 21112R, Minneapolis, MN 55440, United States.,University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware St SE, 6-240 Phillips-Wangensteen Building, Minneapolis, MN 55455, United States
| | - Mary Lonergan-Cullum
- University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware St SE, 6-240 Phillips-Wangensteen Building, Minneapolis, MN 55455, United States
| | - Robert Levy
- University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware St SE, 6-240 Phillips-Wangensteen Building, Minneapolis, MN 55455, United States
| | - Tanner Nissly
- University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware St SE, 6-240 Phillips-Wangensteen Building, Minneapolis, MN 55455, United States
| | - Michelle D Sherman
- University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware St SE, 6-240 Phillips-Wangensteen Building, Minneapolis, MN 55455, United States
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22
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Transporting to treatment: Evaluating the effectiveness of a mobile engagement unit. J Subst Abuse Treat 2021; 129:108377. [PMID: 34080548 DOI: 10.1016/j.jsat.2021.108377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Substance use treatment providers have increasingly developed novel engagement and low-threshold treatment services (such as mobile treatment units) to meet the needs of people with opioid use disorder (OUD). Use of these service models has outpaced the research on their effectiveness. The current study examines the effectiveness of a mobile engagement unit in connecting individuals with OUD to a treatment program. METHODS This retrospective cohort study included 468 Medicaid-enrolled individuals served through a managed care behavioral health system. Analyses used administrative data from 2018 to 2019 to compare the characteristics and service use of individuals transported to an intake appointment by a mobile engagement unit with individuals who arrived through typical referral routes such as walk-in, other providers, and court order. The authors employed a difference-in-differences analysis to adjust for prior service history. The outcomes of interest were any utilization of substance use treatment services. RESULTS The groups were virtually identical in age and gender, prior to matching, except for race where there was a lower proportion of Black individuals (17% versus 44%) and lower pre-service utilization of outpatient and methadone services by the mobile group. Following intake, mobile participants used significantly more outpatient substance use treatment services (23 percentage point relative increase) and methadone maintenance (32 percentage point relative increase) than the comparison group. CONCLUSIONS The results of this study suggest that mobile engagement units designed to identify and serve individuals with OUD in the community hold promise for reaching underserved high-risk populations and reduce barriers to treatment entry and recovery.
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23
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Kaski S, Marshalek P, Herschler J, Wen S, Zheng W. Sublingual Buprenorphine/Naloxone and Multi-Modal Management for High-Risk Chronic Pain Patients. J Clin Med 2021; 10:jcm10050973. [PMID: 33801173 PMCID: PMC7957677 DOI: 10.3390/jcm10050973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
Patients with chronic pain managed with opioid medications are at high risk for opioid overuse or misuse. West Virginia University (WVU) established a High-Risk Pain Clinic to use sublingual buprenorphine/naloxone (bup/nal) plus a multimodal approach to help chronic pain patients with history of Substance Use Disorder (SUD) or aberrant drug-related behavior. The objective of this study was to report overall retention rates and indicators of efficacy in pain control from approximately six years of High-Risk Pain Clinic data. A retrospective chart review was conducted for a total of 78 patients who enrolled in the High-Risk Pain Clinic between 2014 and 2020. Data gathered include psychiatric diagnoses, prescribed medications, pain score, buprenorphine/naloxone dosing, time in clinic, and reason for dismissal. A linear mixed effects model was used to assess the pain score from the Defense and Veterans Pain Rating Scale (DVPRS) and daily bup/nal dose across time. The overall retention of the High-Risk Pain Clinic was 41%. The mean pain score demonstrated a significant downward trend across treatment time (p < 0.001), while the opposite trend was seen with buprenorphine dose (p < 0.001). With the benefit of six years of observation, this study supports buprenorphine/naloxone as a safe and efficacious component of comprehensive chronic pain treatment in patients with SUD or high-risk of opioid overuse or misuse.
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Affiliation(s)
- Shane Kaski
- MS4, West Virginia University School of Medicine, Morgantown, WV 26506, USA;
| | - Patrick Marshalek
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV 26506, USA; (P.M.); (J.H.)
| | - Jeremy Herschler
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV 26506, USA; (P.M.); (J.H.)
| | - Sijin Wen
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, WV 26506, USA;
| | - Wanhong Zheng
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV 26506, USA; (P.M.); (J.H.)
- Correspondence:
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24
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Sattler AF, Hooker SA, Levy R, Sherman MD. Psychosocial Needs of Parents Engaged in Treatment for Opioid Use Disorder. Subst Use Misuse 2021; 56:2202-2213. [PMID: 34590964 DOI: 10.1080/10826084.2021.1981386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Little research has examined the needs of parents with opioid use disorder (OUD) who are receiving medications for OUD (MOUDs), which is striking given growing rates of OUD among parents. Objective: The current study expands the literature by examining psychiatric, psychosocial, and parenting-related functioning, as well as 12-month MOUD treatment retention among parents versus non-parents participating in a buprenorphine program at an academic family medicine residency clinic. Methods: Patients (N = 144; 61 parents) completed measures of psychiatric and psychosocial functioning at the first MOUD visit; parents also completed measures of parental functioning. Results: Parents endorsed less anxiety and loneliness, as well as greater social connection, life satisfaction, and life meaning. Parents were also older, more likely to be female, of a race other than white, married, employed, and had higher incomes. Although parents endorsed high levels of parental self-agency and strong bonds with children, many also reported elevated parental shame. Among parents, higher levels of shame were also associated with higher depression, anxiety, anger, stress, and loneliness. Over 25% of parents reported that a child lived with friends/relatives over 3 months, and 11% noted a child having been removed from the home by child protective services. Finally, parents were more likely to be retained in treatment at 12 months, although this finding was non-significant after controlling for covariates. Conclusions/Importance: These findings illustrate the needs experienced by parents engaged in MOUD treatment, which may prove valuable in informing policy, program development, and treatment approaches for parents with OUD.
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Affiliation(s)
- Adam F Sattler
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
| | - Stephanie A Hooker
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA.,HealthPartners Institute, Bloomington, Minnesota, USA
| | - Robert Levy
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
| | - Michelle D Sherman
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
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25
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Snell-Rood C, Willging C, Showalter D, Peters H, Pollini RA. System-level factors shaping the implementation of “hub and spoke” systems to expand MOUD in rural areas. Subst Abus 2020; 42:716-725. [DOI: 10.1080/08897077.2020.1846149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Claire Snell-Rood
- University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - David Showalter
- Department of Sociology, University of California Berkeley, Berkeley, California, USA
| | - Hannah Peters
- University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Robin A. Pollini
- West Virginia University School of Public Health, Morgantown, West Virginia, USA
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26
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Rapid Transition of Individual and Group-based Behavioral Outpatient Visits to Telepsychiatry in Response to COVID-19. J Addict Med 2020; 15:263-265. [DOI: 10.1097/adm.0000000000000748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Winstanley EL. The Bell Tolls for Thee & Thine: Compassion Fatigue & the Overdose Epidemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102796. [PMID: 32499119 DOI: 10.1016/j.drugpo.2020.102796] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 01/10/2023]
Abstract
Non-fatal and fatal overdoses are traumatic events that have been increasing over the past 20 years and disproportionately impacting rural communities in the United States. The human suffering caused by the opioid epidemic is rarely described in the empirical literature. The purpose of this article is to 1) define individual- and community-level overdose-related compassion fatigue (OCF), 2) review measurement of compassion fatigue (CF) and interventions to reduce CF, 3) discuss strategies that may reduce OCF and 4) briefly discuss policy implications. OCF is distress resulting from knowledge of or exposure to overdose-related harms, which at the community-level may prohibit collaboration and adaptive agency to effectively respond. When OCF occurs at a community-level, it could have negative consequences by eroding support for evidence-based services and fueling stigma-driven policies that blame people who use drugs. Empathy underlies both OCF and vicarious resilience by allowing one to understand the suffering caused by overdose deaths and to witness the joy of addiction recovery. Using the risk environment framework, OCF at the micro- and macro-levels of the social environment, may increase rural communities' vulnerability to harm by emphasizing individual responsibility for reducing overdoses rather than community-level infrastructure and resource management. Additional research is needed to develop a measure of OCF and to confirm whether OCF is associated with increased stigma and decreased support for harm reduction in rural areas.
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Affiliation(s)
- Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV.
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28
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Lander LR, Zheng W, Hustead JD, Mahoney JJ, Berry JH, Marshalek P, Winstanley EL. Long-term treatment retention in West Virginia's comprehensive opioid addiction treatment (COAT) program. J Neurol Sci 2020; 411:116712. [PMID: 32058182 PMCID: PMC7409552 DOI: 10.1016/j.jns.2020.116712] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The United States continues to experience an opioid epidemic of unprecedented proportions despite FDA approval of life saving medications, such as buprenorphine. This paper describes a novel group-based buprenorphine treatment model and summarizes patient characteristics and treatment retention. This model, known as the Comprehensive Opioid Addiction Treatment (COAT) program, was developed in West Virginia, the epicenter of the opioid epidemic. METHODS Data on 454 patients actively enrolled in the COAT program were extracted from an administrative clinical data set and electronic medical records and analyzed using descriptive and quantitative analysis to determine long-term retention in treatment using frequencies and means. RESULTS The characteristics of the 454 patients are as follows: average age of 39, 53% female, predominantly white (94%) and Medicaid was the primary insurance provider (68%). Analysis of retention showed 37.8% of patents were retained less than one year and 14.7% were retained 10 or more years. Initiating treatment at a younger age was associated with long-term retention. CONCLUSION Opioid use disorder is a chronic relapsing disease and treatment models that retain patients long-term have the greatest benefit. The COAT model has been successful in retaining patients long-term in a rural setting where barriers to treatment are many.
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Affiliation(s)
- Laura R Lander
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States.
| | - Wanhong Zheng
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Jeremy D Hustead
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James J Mahoney
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James H Berry
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Patrick Marshalek
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Erin L Winstanley
- West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, West Virginia, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
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29
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Lister JJ, Ellis JD, Yoon M. Opioid prescribing and opioid-overdose deaths in Michigan: Urban-rural comparisons and changes across 2013-2017. Addict Behav Rep 2019; 11:100234. [PMID: 32467830 PMCID: PMC7244930 DOI: 10.1016/j.abrep.2019.100234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 01/17/2023] Open
Abstract
Examined opioid prescribing and opioid-overdose death rates in Michigan counties. Conducted urban-rural county comparisons and tested for changes across 2013–2017. Higher rates of overdose deaths in urban, and higher rates of prescribing in rural. Opioid-overdose death rates rose in both urban and rural counties across 2013–2017. Opioid prescribing rates did not change in urban or rural counties across 2013–2017.
Background Opioid-overdose deaths and opioid prescriptions have increased substantially within the past decade, leading to examinations of urban-rural differences for these opioid-related outcomes, and whether annual trends differ by urban-rural status. Most investigations have examined differences using national data, whereas few studies have identified patterns in hard-hit regions. Therefore, we examined urban-rural differences for opioid-related outcomes in Michigan, a state with overdose death and prescribing rates above the national average. Methods This study used county-level public data on opioid prescribing and opioid-overdose death rates in Michigan. Bivariate and joinpoint regression analyses tested for annual differences and annual changes in opioid-related outcomes across 2013–2017. Rural Urban Continuum Codes classified urban-rural county status. Results Bivariate analyses demonstrated that urban counties had consistently higher opioid-overdose death rates than rural, whereas rural counties had consistently higher opioid prescribing rates than urban. Joinpoint regression (2013–2017) revealed opioid-overdose death rates increased in urban (Annual Percent Change = 25.0%, p = .001) and rural counties (Annual Percent Change = 21.7%, p = .002), though no changes for opioid prescribing rates were observed among urban or rural counties. Conclusions Our study highlights nuanced urban-rural patterns in Michigan, a hard-hit state, compared to trends in national data. Both urban and rural counties experienced rising rates of opioid-overdose deaths, and rural counties experienced higher opioid prescribing rates than urban. Though urban counties experienced higher opioid-overdose death rates than rural, the rise in both county types was similar. Future research directions, implications for public health, and healthcare policy recommendations are discussed.
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Affiliation(s)
- Jamey J Lister
- Rutgers, The State University of New Jersey, School of Social Work, USA.,Wayne State University, School of Medicine, Department of Psychiatry and Behavioral Neurosciences, USA
| | - Jennifer D Ellis
- Wayne State University, School of Medicine, Department of Psychiatry and Behavioral Neurosciences, USA.,Wayne State University, Department of Psychology, USA
| | - Miyoung Yoon
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
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30
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Watson DP, Andraka-Christou B, Clarke T, Wiegandt J. Introduction to the special issue on innovative interventions and approaches to expand medication assisted treatment: Seizing research opportunities made available by the opioid STR program. J Subst Abuse Treat 2019; 108:1-3. [PMID: 31668689 DOI: 10.1016/j.jsat.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The 21st Century Cures Act is the most significant piece of U.S. legislation aimed at tackling the opioid epidemic to date. This special issue comprises papers reflecting medication-assisted treatment (MAT)-related research made possible through the Cures Act-authorized State Targeted Response (STR) grant mechanism. Work related to both STR evaluation and original research conducted within the context of STR activities are included in the issue, with topics including community assessments of MAT-related needs, MAT access and linkage, criminal justice-oriented MAT implementation, and adjunctive MAT supports and treatments. All of the research represented this issue is early-stage, with results reflecting data collected primarily within the first of STR's two year funding cycle. While such formative work does have inherent limitations, the gravity of the opioid epidemic requires rapid assessment and dissemination of results to inform the public health response in a manner that will have a timely and meaningful impact.
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Affiliation(s)
- Dennis P Watson
- Center for Dissemination and Implementation Research, Department of Medicine, University of Illinois College of Medicine at Chicago, 818 S. Wolcott Ave., Chicago, IL 60612, United States of America.
| | - Barbara Andraka-Christou
- Department of Health Management and Informatics, University of Central Florida, 4000 Central Florida Boulevard, Orlando, FL 32816, United States of America.
| | - Thomas Clarke
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20866, United States of America.
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