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Martinez NG, Truong AQ, Nordeck CD, Agus D, Genberg BL, Buresh ME. "I want to stay here": Patient and staff perspectives on transitioning from a low-threshold buprenorphine program to clinic-based care. Drug Alcohol Depend 2024; 257:111130. [PMID: 38452408 DOI: 10.1016/j.drugalcdep.2024.111130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The Project Connections At Re-Entry (PCARE) Van is a low-threshold buprenorphine program operating outside the Baltimore City Detention Center. Like other low-threshold programs, PCARE seeks to engage a vulnerable population in care, stabilize patients, then transition patients to longer-term care; however, <10% of patients transition to clinic-based buprenorphine treatment. Our goal was to better understand these low transition rates and center patient perspectives in discussion of broader low-threshold program design. METHODS From December 2022 to June 2023, semi-structured interviews were conducted with 20 former and current PCARE patients and 6 staff members. We used deductive and inductive coding followed by thematic content analysis to identify themes around treatment experiences and care preferences. RESULTS There were strong preferences among current and former patients for continuing buprenorphine treatment at the PCARE Van. Several themes emerged from the data that explained patient preferences, including both advantages to continuing care at the van (preference for continuity, feeling respected by the program's structure and philosophy) and disadvantages to transitioning to a clinic (perceived harms associated with rigid or punitive care models). Staff noted limited program capacity, and patients expressed that if needed, they would transition to a clinic for altruistic reasons. Staff expressed varied perspectives on low-threshold care, emphasizing both larger systems factors, as well as beliefs about individual patient responsibility. CONCLUSIONS While many low-threshold care settings are designed as transitional bridge models, this research highlights patient preference for long-term care at low-threshold programs and supports efforts to adapt low-threshold models to be sustainable as longitudinal care.
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Affiliation(s)
- Noelle G Martinez
- Division of Addiction Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Building East Tower 2nd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Ashley Q Truong
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Courtney D Nordeck
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - Deborah Agus
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Behavioral Health Leadership Institute, 2601N. Howard Street, Baltimore, MD 21218, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Megan E Buresh
- Division of Addiction Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Building East Tower 2nd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA
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Spear SE, Salcedo P, Graves SM, Xie H. Is that a treatment program? Examining the physical landscape of opioid treatment programs in Los Angeles. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209256. [PMID: 38072382 DOI: 10.1016/j.josat.2023.209256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/24/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Little attention has been paid to the built environment of outpatient opioid treatment programs, despite the need to increase access to medications for opioid use disorder, particularly among people of color. The aims of this study were to rate the attractiveness of publicly-funded opioid treatment programs (OTPs) in Los Angeles County and explore whether less attractive OTPs are found in disadvantaged neighborhoods. METHODS We conducted observations of the exteriors of all OTPs located in specialty substance use disorder treatment clinics in Los Angeles County in 2021 (N = 44). We created an attractiveness index based on attractiveness of the building exteriors and the surrounding grounds, the presence of disorder such as garbage and graffiti, and the presence of bars on the windows. We tested whether less attractive facilities were more likely to be situated in disadvantaged neighborhoods with high concentrations of racial/ethnic minorities. RESULTS Most building exteriors were found to have an ordinary level of attractiveness or rated as unattractive. The grounds were largely unattractive. We found a significant negative association between attractiveness and neighborhood disadvantage. CONCLUSION This project was a preliminary study of the physical conditions of OTPs in Los Angeles. We found was that the physical conditions of OTPs in LA County were generally poor. Research has identified many individual and structural barriers to treatment for people with opioid use disorders. Future research should empirically test the association between the built environment of treatment clinics and access to treatment, particularly in communities of color.
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Affiliation(s)
- Suzanne E Spear
- Department of Health Sciences, California State University, Northridge, United States of America.
| | - Priscilla Salcedo
- Environmental Health and Safety Department, University of California Santa Barbara, United States of America
| | - Steven M Graves
- Department of Geography and Environmental Studies, California State University, Northridge, United States of America
| | - Hui Xie
- Department of Recreation and Tourism Management, California State University, Northridge, United States of America
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Rosansky JA, Albanese M, Phillips J, Schuman-Olivier Z. Unfilled prescriptions: Surveying patients' experiences with buprenorphine treatment in Massachusetts before and during the COVID-19 pandemic. Am J Addict 2023; 32:615-618. [PMID: 37543849 PMCID: PMC10841162 DOI: 10.1111/ajad.13460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/10/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We explored potential challenges to accessing office-based opioid treatment (OBOT) with buprenorphine during the COVID-19 pandemic. METHODS Using Facebook advertisements, we recruited a sample of N = 72 participants and conducted four repeated-measures analysis of variance comparing ratings of participants' abilities to access aspects of OBOT treatment. RESULTS Participants reported increased difficulty filling buprenorphine prescriptions during the pandemic than before, p = .011, partial η2 = 0.092, and this was correlated with past month opioid use, r = .236, p = .042. DISCUSSION, CONCLUSIONS, AND SCIENTIFIC SIGNIFICANCE This is the first investigation to report unfilled prescriptions during the pandemic and an association with opioid use. Unfilled prescriptions may contribute to relapse and partially explain increased overdose deaths during COVID-19.
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Affiliation(s)
- Joseph A. Rosansky
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge St, Cambridge, MA, 02139, United States
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St, Boston, MA, 02115, United States
| | - Mark Albanese
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge St, Cambridge, MA, 02139, United States
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St, Boston, MA, 02115, United States
- Physician Health Services, 860 Winter St, Waltham, MA, 02451, United States
| | - Joshua Phillips
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St, Boston, MA, 02115, United States
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge St, Cambridge, MA, 02139, United States
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St, Boston, MA, 02115, United States
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Magee T, Peters C, Jacobsen SM, Nees D, Dunford B, Ford AI, Vassar M. Inequities in the treatment of opioid use disorder: A scoping review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209082. [PMID: 37271346 DOI: 10.1016/j.josat.2023.209082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Given the lack of access to evidenced-based OUD treatment and the corresponding overdose crisis, researchers must evaluate and report health care inequities involving the treatment of OUD. Additionally, clinicians should be aware of these inequities in the treatment of patients. METHODS We carried out a scoping review of the literature regarding health inequities in treatment for OUD in July 2022. The study team retrieved articles published between 2016 and 2021 from MEDLINE and Ovid Embase. After authors received training, screening and data extraction were performed in masked, duplicate fashion. The team screened a total of 3673 titles and abstracts, followed by 172 articles for full-text review. The inequities that we examined were race/ethnicity, sex or gender, income, under-resourced/rural, occupational status, education level, and LGBTQ+. We used Stata 17.0 (StataCorp, LLC, College Station, TX) to summarize data and statistics of the studies within our sample. RESULTS A total of 44 studies evaluating inequities in OUD treatment met inclusion criteria. The most common inequity that studies examined was race/ethnicity (34/44 [77.27 %] studies), followed by under-resourced/rural (19/44 [43.18 %] studies), and sex or gender (18/44 [40.91 %] studies). LGBTQ+ (0/44 [0.0 %] studies) was not reported in the included studies. Our results indicate that many historically marginalized populations experience inequities related to access and outcomes in OUD treatment. The included studies in our scoping review occasionally demonstrated inconsistent findings. CONCLUSIONS Gaps exist within the literature on health inequities in treatment for OUD. The most examined inequities were race/ethnicity, under-resourced/rural and sex or gender, while studies did not examine LGBTQ+ status. Future research should aim to advance and supplement literature investigating health inequities in OUD treatment to ensure inclusive, patient-centered care.
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Affiliation(s)
- Trevor Magee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States.
| | - Caleb Peters
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Samuel M Jacobsen
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Danya Nees
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Bryan Dunford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
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De Aquino JP, Bahji A, Gómez O, Sofuoglu M. Alleviation of opioid withdrawal by cannabis and delta-9-tetrahydrocannabinol: A systematic review of observational and experimental human studies. Drug Alcohol Depend 2022; 241:109702. [PMID: 36434879 PMCID: PMC9772106 DOI: 10.1016/j.drugalcdep.2022.109702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/24/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND While six U.S. states have already officially authorized cannabinoids to substitute opioids and treat opioid use disorder, the therapeutic benefits of cannabinoids remain unclear, especially when weighted against their adverse effects. METHODS We conducted a systematic review of studies examining the association between opioid withdrawal and cannabis use or delta-9-tetrahydrocannabinol (THC) administration. We searched multiple databases from inception to July 30, 2022, and assessed study quality. RESULTS Eleven studies were identified, with a total of 5330 participants, of whom 64 % were male. Nine observational studies examined the association between cannabis use and opioid withdrawal. Two randomized, placebo-controlled clinical trials (RCTs) investigated the withdrawal-alleviating effects of dronabinol, a synthetic form of THC. Four observational studies found an association between cannabis use and the alleviation of opioid withdrawal; one reported exacerbation of opioid withdrawal symptoms; and four reported no association. RCTs reported that THC alleviated opioid withdrawal, albeit with dose-dependent increases in measures of abuse liability, dysphoria, and tachycardia. There was high heterogeneity in measurements of opioid withdrawal and the type and dose of opioid at baseline. CONCLUSIONS Although there is preliminary evidence that cannabis and its main psychoactive constituent, THC, may alleviate opioid withdrawal, these effects are likely to have a narrow therapeutic window. Further, the potential of cannabinoids to alleviate opioid withdrawal is determined by complex interactions between patient characteristics and pharmacological factors. Collectively, these findings have clinical, methodological, and mechanistic implications for treating opioid withdrawal during cannabinoid use, and for efforts to alleviate opioid withdrawal using non-opioid therapeutics.
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Affiliation(s)
- Joao P De Aquino
- Yale University School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue (151D), West Haven, CT 06516, USA; Clinical Neuroscience Research Unit (CNRU), Conneticut Mental Health Center, 34 Park St, 3rd Floor, New Haven, CT, 06519.
| | - Anees Bahji
- Cumming School of Medicine, University of Calgary, Department of Psychiatry, 2500 University Drive NW, Calgary, Alb., Canada
| | - Oscar Gómez
- Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Javeriana, 7th Street, 40-02, Bogotá, Colombia
| | - Mehmet Sofuoglu
- Yale University School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue (151D), West Haven, CT 06516, USA
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Evaluation of the Effectiveness of Buprenorphine-Naloxone on Opioid Overdose and Death among Insured Patients with Opioid Use Disorder in the United States. PHARMACOEPIDEMIOLOGY 2022; 1:101-112. [PMID: 36743423 PMCID: PMC9896393 DOI: 10.3390/pharma1030010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Opioid use disorder (OUD) is a chronic disease requiring long-term treatment and is associated with opioid overdose and increased risk of mortality. However, existing randomized clinical trials focused on short-term treatment engagement and detoxification rather than overdose or mortality risk due to limited follow-up time and ethical considerations. We used a hypothetical trial framework to conduct a retrospective cohort study to assess the effectiveness of time-varying buprenorphine-naloxone on opioid overdose and death. We identified 58,835 insured adult patients with OUD diagnosis in the US, 2010-2017. We fit a marginal structural model using inverse probability weighting methods to account for measured baseline and time-varying confounders, as well as selection bias due to possibly differential loss-to-follow-up. We found that receipt of buprenorphine-naloxone was associated with reduced risk of opioid overdose (hazard ratio (HR) = 0.66, 95% confidence interval (CI): 0.49, 0.91), death (HR = 0.24, 95% CI: 0.08, 0.75), and overdose or death (HR = 0.58, 95% CI: 0.40, 0.84). The E-value for death was 7.8, which was larger than the upper 95% CI of the association between each measured baseline variable and all-cause death, which implies that the unmeasured confounding itself may not explain away the estimated effect of treatment on the endpoint of all-cause mortality.
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Nielsen S, Tse WC, Larance B. Opioid agonist treatment for people who are dependent on pharmaceutical opioids. Cochrane Database Syst Rev 2022; 9:CD011117. [PMID: 36063082 PMCID: PMC9443668 DOI: 10.1002/14651858.cd011117.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are ongoing concerns regarding pharmaceutical opioid-related harms, including overdose and dependence, with an associated increase in treatment demand. People dependent on pharmaceutical opioids appear to differ in important ways from people who use heroin, yet most opioid agonist treatment research has been conducted in people who use heroin. OBJECTIVES: To assess the effects of maintenance opioid agonist pharmacotherapy for the treatment of pharmaceutical opioid dependence. SEARCH METHODS We updated our searches of the following databases to January 2022: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, MEDLINE, four other databases, and two trial registers. We checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs with adults and adolescents examining maintenance opioid agonist treatments that made the following two comparisons. 1. Full opioid agonists (methadone, morphine, oxycodone, levo-alpha-acetylmethadol (LAAM), or codeine) versus different full opioid agonists or partial opioid agonists (buprenorphine) for maintenance treatment. 2. Full or partial opioid agonist maintenance versus non-opioid agonist treatments (detoxification, opioid antagonist, or psychological treatment without opioid agonist treatment). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. MAIN RESULTS We identified eight RCTs that met inclusion criteria (709 participants). We found four studies that compared methadone and buprenorphine maintenance treatment, and four studies that compared buprenorphine maintenance to either buprenorphine taper (in addition to psychological treatment) or a non-opioid maintenance treatment comparison. We found low-certainty evidence from three studies of a difference between methadone and buprenorphine in favour of methadone on self-reported opioid use at end of treatment (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.28 to 0.86; 165 participants), and low-certainty evidence from four studies finding a difference in favour of methadone for retention in treatment (RR 1.21, 95% CI 1.02 to 1.43; 379 participants). We found low-certainty evidence from three studies showing no difference between methadone and buprenorphine on substance use measured with urine drug screens at end of treatment (RR 0.81, 95% CI 0.57 to 1.17; 206 participants), and moderate-certainty evidence from one study of no difference in days of self-reported opioid use (mean difference 1.41 days, 95% CI 3.37 lower to 0.55 days higher; 129 participants). There was low-certainty evidence from three studies of no difference between methadone and buprenorphine on adverse events (RR 1.13, 95% CI 0.66 to 1.93; 206 participants). We found low-certainty evidence from four studies favouring maintenance buprenorphine treatment over non-opioid treatments in terms of fewer opioid positive urine drug tests at end of treatment (RR 0.66, 95% CI 0.52 to 0.84; 270 participants), and very low-certainty evidence from four studies finding no difference on self-reported opioid use in the past 30 days at end of treatment (RR 0.63, 95% CI 0.39 to 1.01; 276 participants). There was low-certainty evidence from three studies of no difference in the number of days of unsanctioned opioid use (standardised mean difference (SMD) -0.19, 95% CI -0.47 to 0.09; 205 participants). There was moderate-certainty evidence from four studies favouring buprenorphine maintenance over non-opioid treatments on retention in treatment (RR 3.02, 95% CI 1.73 to 5.27; 333 participants). There was moderate-certainty evidence from three studies of no difference in adverse effects between buprenorphine maintenance and non-opioid treatments (RR 0.50, 95% CI 0.07 to 3.48; 252 participants). The main weaknesses in the quality of the data was the use of open-label study designs, and difference in follow-up rates between treatment arms. AUTHORS' CONCLUSIONS There is very low- to moderate-certainty evidence supporting the use of maintenance agonist pharmacotherapy for pharmaceutical opioid dependence. Methadone or buprenorphine did not differ on some outcomes, although on the outcomes of retention and self-reported substance use some results favoured methadone. Maintenance treatment with buprenorphine appears more effective than non-opioid treatments. Due to the overall very low- to moderate-certainty evidence and small sample sizes, there is the possibility that the further research may change these findings.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, Australia
| | - Wai Chung Tse
- Monash Addiction Research Centre, Monash University, Frankston, Australia
- School of Medicine, Monash University, Melbourne, Australia
| | - Briony Larance
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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CLIFTON JOHNM, BELCHER ANNABELLEM, GREENBLATT AAROND, WELSH CHRISTOPHERM, COLE THOMASO, DAVIS ALANK. Psilocybin use patterns and perception of risk among a cohort of Black individuals with Opioid Use Disorder. JOURNAL OF PSYCHEDELIC STUDIES 2022; 6:80-87. [PMID: 36686617 PMCID: PMC9850635 DOI: 10.1556/2054.2022.00214] [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] [Indexed: 01/26/2023]
Abstract
Background and aims There is growing evidence that psilocybin, a serotonergic psychedelic substance, may be useful in the treatment of substance use disorders. However, there is a lack of data on the beliefs and attitudes towards psilocybin amongst Black individuals diagnosed with Opioid Use Disorder (OUD). This study characterized psilocybin use patterns and perception of risk amongst a cohort of Black individuals diagnosed with OUD. Methods Using a convenience sampling approach, patients were recruited from an urban methadone treatment program and paid five dollars to complete an anonymous phone-based survey. Results Twenty-eight patients participated (mean age 53.8; N = 28; 35.7% female). Most (N = 23; 82.1%) had "heard of" psilocybin mushrooms before taking the survey, but only five (N = 5; 17.8%) had ever used them. More than 80% perceived a risk or were "unsure" of the risk for sixteen of the seventeen items queried about psilocybin. Approximately half (N = 15; 53.6%) were willing to try therapy incorporating psilocybin and half (N = 14; 50%) said they would be more likely to try if it were FDA approved for OUD. Most (N = 18; 64.3%) preferred to stay on methadone treatment alone, 32.1% (N = 9) wanted to try treatment with both psilocybin and methadone, and only one participant opted for psilocybin treatment without methadone. Conclusion Many Black individuals with Opioid Use Disorder perceive psilocybin as dangerous and may be hesitant to try psilocybin treatment. Culturally informed treatment models, educational interventions and community outreach programs should be developed to increase racial/ethnic minority representation in psilocybin research and treatment.
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Affiliation(s)
- JOHN M. CLIFTON
- University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author. 2828 Old Hickory Blvd. Nashville, TN 37221. Tel.: +615-414-6997.
| | | | | | | | - THOMAS O. COLE
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - ALAN K. DAVIS
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH 43210, USA,Department of Psychiatry, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA,Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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Mitchell P, Samsel S, Curtin KM, Price A, Turner D, Tramp R, Hudnall M, Parton J, Lewis D. Geographic disparities in access to Medication for Opioid Use Disorder across US census tracts based on treatment utilization behavior. Soc Sci Med 2022; 302:114992. [PMID: 35512612 DOI: 10.1016/j.socscimed.2022.114992] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Drug overdose is the leading cause of accidental death in the U.S. with deaths from opioid overdose occurring at a higher rate in rural areas. The gaps in the provision of healthcare services have been exacerbated by the opioid crisis leaving vulnerable populations without access to preventative care and education, harm reduction, both chronic and acute treatment of the symptoms of opioid use disorder (OUD), and long-term psychological support for those with OUD and their families. There has been a call in the literature -and a federal mandate-for increased access to opioid treatment facilities, but to date this access has not been operationalized using best practices in geography. Medication for Opioid Use Disorder (MOUD) with FDA-approved methadone or buprenorphine has been shown to increase treatment retention, reduce opioid use and associated health and societal harms, and reduce opioid related overdose, and as such is considered the most effective treatment for OUD. The objective of this study is to examine U.S. adults' spatial access to MOUD - specifically locations of certified Opioid Treatment Programs (OTPs) and DATA-waived Buprenorphine providers. A gravity-based variant of the enhanced two-step floating catchment area model is employed, where friction of distance is based on previously published willingness to travel distances for patients visiting OTPs, to assess how opioid agonist treatment accessibility varies across the nation. Findings suggest that there are extensive 'treatment deserts' where there is little to no physical access to MOUD, especially in rural areas. The significance of this work lies in the incorporation of treatment utilization behavior in the access metric, and the continued confirmation of gaps in access to OUD services despite federal efforts to improve accessibility.
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Affiliation(s)
- Penelope Mitchell
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA.
| | - Steven Samsel
- Institute of Data & Analytics, University of Alabama, Tuscaloosa, AL, USA
| | - Kevin M Curtin
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Ashleigh Price
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Daniel Turner
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Ryan Tramp
- Institute of Data & Analytics, University of Alabama, Tuscaloosa, AL, USA
| | - Matthew Hudnall
- Department of Information Systems, Operations Management, and Statistics, University of Alabama, Tuscaloosa, AL, USA
| | - Jason Parton
- Department of Information Systems, Operations Management, and Statistics, University of Alabama, Tuscaloosa, AL, USA
| | - Dwight Lewis
- Department of Management, University of Alabama, Tuscaloosa, AL, USA
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Sun T, Aroke H, Kogut S, Katenka N, Bratberg J, Buchanan A. Early buprenorphine-naloxone initiation for opioid use disorder reduces opioid overdose, emergency room visits and healthcare cost compare to late initiation. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 48:217-225. [PMID: 34780312 DOI: 10.1080/00952990.2021.1981358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although the effectiveness of buprenorphine-naloxone (BUP-NX) has been established, real-world evidence on the benefits of early treatment initiation is limited. OBJECTIVE To evaluate the association between early BUP-NX initiation and health-related outcomes among insured adults with opioid use disorder (OUD). METHODS We conducted a cross-sectional analysis using the Optum's de-identified Clinformatics® Data Mart Database from 2010 to 2018. Patients who initiated BUP-NX within 30 days of OUD diagnosis were classified as early initiators. Patients who initiated BUP-NX later, but within the one-year follow-up, were defined as late initiators. Outcomes included opioid overdose, opioid overdose-related emergency department (ED) visits, and all-cause healthcare cost during the year after OUD diagnosis. We employed generalized linear models to compare outcomes between early and late initiators, adjusting for baseline covariates and accounting for missing information for covariates using multiple imputation. RESULTS A total of 8,388 patients with OUD were identified; mean age was 39.9 years; 36% were female; and 67.6% were early initiators. Early initiators had an estimated 42% lower rate of opioid overdose (adjusted rate ratio (aRR) = 0.58; 95% confidence interval (CI): 0.52, 0.64); 51% lower rate of opioid overdose-related ED visits (aRR = 0.49; 95% CI: 0.44, 0.55); and 31% lower total healthcare cost (adjusted cost ratio = 0.69; 95% CI: 0.66, 0.72), compared to late initiators. CONCLUSION Compared to late BUP-NX initiation, early initiation was associated with a lower risk of opioid overdose and opioid overdose-related ED visits, and reduced total healthcare cost among insured adult patients with OUD.
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Affiliation(s)
- Tianyu Sun
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Hilary Aroke
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Stephen Kogut
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Natallia Katenka
- Department of Computer Science and Statistics, College of Art and Science, University of Rhode Island, Kingston, Rhode Island, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Ashley Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
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Nalven T, Spillane NS, Schick MR, Weyandt LL. Diversity inclusion in United States opioid pharmacological treatment trials: A systematic review. Exp Clin Psychopharmacol 2021; 29:524-538. [PMID: 34242040 PMCID: PMC8511246 DOI: 10.1037/pha0000510] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pharmacological treatments for opioid use disorders (OUDs) may have mixed efficacy across diverse groups, i.e., sex/gender, race/ethnicity, and socioeconomic status (SES). The present systematic review aims to examine how diverse groups have been included in U.S. randomized clinical trials examining pharmacological treatments (i.e., methadone, buprenorphine, or naltrexone) for OUDs. PubMed was systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The initial search yielded 567 articles. After exclusion of ineligible articles, 50 remained for the present review. Of the included articles, 14.0% (n = 7) reported both full (i.e., accounting for all participants) sex/gender and race/ethnicity information; only two of those articles also included information about any SES indicators. Moreover, only 22.0% (n = 11) reported full sex/gender information, and 42.0% (n = 21) reported full racial/ethnic information. Furthermore, only 10.0% (n = 5) reported that their lack of subgroup analyses or diverse samples was a limitation to their studies. Particularly underrepresented were American Indian/Alaska Native (AI/AN), Asian, Native Hawaiian/Other Pacific Islander (NH/OPI), and multiracial individuals. These results also varied by medication type; Black individuals were underrepresented in buprenorphine randomized controlled trials (RCTs) but were well represented in RCTs for methadone and/or naltrexone. In conclusion, it is critical that all people receive efficacious pharmacological care for OUDs given the ongoing opioid epidemic. Findings from the present review, however, support that participants from diverse or marginalized backgrounds are underrepresented in treatment trials, despite being at increased risk for disparities related to OUDs. Suggestions for future research are advanced. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Tessa Nalven
- Department of Psychology, University of Rhode Island
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12
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Steele VR, Maxwell AM. Treating cocaine and opioid use disorder with transcranial magnetic stimulation: A path forward. Pharmacol Biochem Behav 2021; 209:173240. [PMID: 34298030 PMCID: PMC8445657 DOI: 10.1016/j.pbb.2021.173240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022]
Abstract
Developing new, effective treatments for substance use disorders (SUDs), especially cocaine and opioid use disorders (CUD and OUD), are of immense importance. These are chronic, relapsing brain diseases characterized by dysregulated circuits manifesting from neuroplastic change brought on by repeated exposure to substances of abuse. A potential treatment is therapeutically inducing neuroplastic change in targeted dysregulated circuits. One such intervention, repetitive transcranial magnetic stimulation (rTMS) has gained traction over the past two decades as a method of noninvasively stimulating cortical structures in order to induce subcortical neuroplastic change. By doing so, rTMS ameliorates symptoms that are consequent of dysregulations in disease-related circuits, such as craving, and reduces drug use. Although rTMS has been successfully applied as a treatment for other clinical disorders, progress toward treatment applications for SUDs has been stymied by what we dub "known unknowns". These are fundamental lines of research within the rTMS-SUD field that have yet to be systematically understood which could help to optimize TMS as an intervention for SUDs. Because progress in treatment for CUD and OUD is imperative given the widespread severity of OUD and the lack of treatment for CUD, it is necessary to critically reflect on the ways in which rTMS research for these disorders can most effectively move forward to help patients. We articulate six "known unknowns" and outline a direction of research to address each. Briefly, the "known unknowns" in the field are: 1) Cortical target selection, 2) subcortical circuit engagement, 3) optimizing rTMS sequences, 4) rTMS as an adjuvant to existing interventions, 5) manipulating brain state, and 6) selecting outcome measures. We also outline research design approaches to address these "known unknowns" in the rTMS-SUDs field. Unification of efforts across research laboratories is necessary to develop empirically validated treatments that will benefit patients in a timely fashion.
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Affiliation(s)
- Vaughn R Steele
- Yale University, School of Medicine, Department of Psychiatry, New Haven CT, USA.
| | - Andrea M Maxwell
- Medical Scientist Training Program, University of Minnesota, Minneapolis MN, USA
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Herring AA, Vosooghi AA, Luftig J, Anderson ES, Zhao X, Dziura J, Hawk KF, McCormack RP, Saxon A, D’Onofrio G. High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder. JAMA Netw Open 2021; 4:e2117128. [PMID: 34264326 PMCID: PMC8283555 DOI: 10.1001/jamanetworkopen.2021.17128] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022] Open
Abstract
Importance Emergency departments (EDs) sporadically use a high-dose buprenorphine induction strategy for the treatment of opioid use disorder (OUD) in response to the increasing potency of the illicit opioid drug supply and commonly encountered delays in access to follow-up care. Objective To examine the safety and tolerability of high-dose (>12 mg) buprenorphine induction for patients with OUD presenting to an ED. Design, Setting, and Participants In this case series of ED encounters, data were manually abstracted from electronic health records for all ED patients with OUD treated with buprenorphine at a single, urban, safety-net hospital in Oakland, California, for the calendar year 2018. Data analysis was performed from April 2020 to March 2021. Interventions ED physicians and advanced practice practitioners were trained on a high-dose sublingual buprenorphine induction protocol, which was then clinically implemented. Main Outcomes and Measures Vital signs; use of supplemental oxygen; the presence of precipitated withdrawal, sedation, and respiratory depression; adverse events; length of stay; and hospitalization during and 24 hours after the ED visit were reported according to total sublingual buprenorphine dose (range, 2 to >28 mg). Results Among a total of 391 unique patients (median [interquartile range] age, 36 [29-48] years), representing 579 encounters, 267 (68.3%) were male and 170 were (43.5%) Black. Homelessness (88 patients [22.5%]) and psychiatric disorders (161 patients [41.2%]) were common. A high dose of sublingual buprenorphine (>12 mg) was administered by 54 unique clinicians during 366 (63.2%) encounters, including 138 doses (23.8%) greater than or equal to 28 mg. No cases of respiratory depression or sedation were reported. All 5 (0.8%) cases of precipitated withdrawal had no association with dose; 4 cases occurred after doses of 8 mg of buprenorphine. Three serious adverse events unrelated to buprenorphine were identified. Nausea or vomiting was rare (2%-6% of cases). The median (interquartile range) length of stay was 2.4 (1.6-3.75) hours. Conclusions and Relevance These findings suggest that high-dose buprenorphine induction, adopted by multiple clinicians in a single-site urban ED, was safe and well tolerated in patients with untreated OUD. Further prospective investigations conducted in multiple sites would enhance these findings.
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Affiliation(s)
- Andrew A. Herring
- Department of Emergency Medicine, Highland Hospital—Alameda Health System, Oakland, California
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Aidan A. Vosooghi
- Department of Emergency Medicine, Highland Hospital—Alameda Health System, Oakland, California
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Joshua Luftig
- Department of Emergency Medicine, Highland Hospital—Alameda Health System, Oakland, California
| | - Erik S. Anderson
- Department of Emergency Medicine, Highland Hospital—Alameda Health System, Oakland, California
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Xiwen Zhao
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - James Dziura
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kathryn F. Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ryan P. McCormack
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
| | - Andrew Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology Yale School of Public Health, New Haven, Connecticut
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Disparities in Access to Medications for Opioid Use Disorder in the Veterans Health Administration. J Addict Med 2021; 15:143-149. [PMID: 32826617 DOI: 10.1097/adm.0000000000000719] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES A variety of patients - including women, older, racial/ethnic minority, rural, homeless, and justice-involved patients - are vulnerable to experiencing poor healthcare access and quality, such as lower quality substance use disorder treatment, than other populations. The current study examined receipt of medications for opioid use disorder by vulnerable populations within Veterans Health Administration (VHA) facilities to determine whether there are patient and facility factors that are associated with disparities in care. METHODS Using national VHA clinical/administrative data from Fiscal Year 2017, we calculated receipt of medications for opioid use disorder using the American Society for Addiction Medicine quality measure specifications. A mixed-effects logistic regression model tested whether patient vulnerability (ie, women, older age, racial/ethnic minority, rural residence, homeless, and justice-involved) and facility (eg, regional location, availability of a methadone clinic) characteristics were associated with medication receipt. RESULTS Among the 53,568 veterans at VHA facilities diagnosed with opioid use disorder in Fiscal Year 2017, vulnerable populations - including women, older, Black, rural, homeless, and justice-involved veterans - had lower odds of receiving medications for opioid use disorder than their nonvulnerable counterparts. Veterans had higher odds of receiving medications at facilities with a higher proportion of patients with opioid use disorder, but lower odds of receiving medications at facilities in the Southern region compared to the Northeast region of the United States. CONCLUSIONS Quality improvement efforts targeted at vulnerable populations are needed at the VHA to ensure these groups receive the same quality of substance use disorder treatment as other veterans.
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Samples H, Williams AR, Crystal S, Olfson M. Impact Of Long-Term Buprenorphine Treatment On Adverse Health Care Outcomes In Medicaid. Health Aff (Millwood) 2021; 39:747-755. [PMID: 32364847 DOI: 10.1377/hlthaff.2019.01085] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The optimal, or even minimum, duration of medication treatment for opioid use disorder (OUD) needed to improve long-term outcomes has not been established empirically. As a result, health plans set potentially restrictive treatment standards to guide benefits and payment. To address this gap, we used a National Quality Forum measure for OUD medication treatment duration (180 days) to examine the impact of longer treatment on health care outcomes within a key population of Medicaid enrollees. Compared to buprenorphine discontinuation around the National Quality Forum benchmark (six to nine months), longer treatment (at least fifteen months) was associated with relative reductions in the risk of having all-cause inpatient (-52 percent) and emergency department (-26 percent) use, opioid-related hospital use (-128 percent), overdose events (-173 percent), and opioid prescriptions (-120 percent) and in the rate of prescription opioid use (-124 percent). We argue that these clinical benefits provide a rationale for policies that increase access to longer-term buprenorphine treatment, including lengthening the standards for minimum treatment duration.
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Affiliation(s)
- Hillary Samples
- Hillary Samples ( h. samples@columbia. edu ) is a postdoctoral research fellow in the Department of Epidemiology, Columbia University Mailman School of Public Health, in New York City
| | - Arthur Robin Williams
- Arthur Robin Williams is an assistant professor in the Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, in New York City
| | - Stephen Crystal
- Stephen Crystal is the Board of Governors Professor in the Institute for Health, Health Care Policy, and Aging Research, Rutgers University, in New Brunswick, New Jersey
| | - Mark Olfson
- Mark Olfson is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law in the Department of Psychiatry, Vagelos College of Physicians and Surgeons, and a professor of epidemiology in the Mailman School of Public Health, both at Columbia University; and a research psychiatrist at the New York State Psychiatric Institute, in New York City
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Evans EA, Harrington C, Roose R, Lemere S, Buchanan D. Perceived Benefits and Harms of Involuntary Civil Commitment for Opioid Use Disorder. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:718-734. [PMID: 33404337 DOI: 10.1177/1073110520979382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Involuntary civil commitment (ICC) to treatment for opioid use disorder (OUD) prevents imminent overdose, but also restricts autonomy and raises other ethical concerns. Using the Kass Public Health Ethics Framework, we identified ICC benefits and harms. Benefits include: protection of vulnerable, underserved patients; reduced legal consequences; resources for families; and "on-demand" treatment access. Harms include: stigmatizing and punitive experiences; heightened family conflict and social isolation; eroded patient self-determination; limited or no provision of OUD medications; and long-term overdose risk. To use ICC ethically, it should be recognized as comprising vulnerable patients worthy of added protections; be a last resort option; utilize consensual, humanizing processes; provide medications and other evidence-based-treatment; integrate with existing healthcare systems; and demonstrate effective outcomes before diffusion. ICC to OUD treatment carries significant potential harms that, if unaddressed, may outweigh its benefits. Findings can inform innovations for ensuring that ICC is used in an ethically responsible way.
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Affiliation(s)
- Elizabeth A Evans
- Elizabeth A. Evans, Ph.D., M.A., is an Associate Professor of public health at the University of Massachusetts Amherst. She received her B.A. from the University of California San Diego, her M.A. from Indiana University, Bloomington, and her Ph.D. from the University of California Los Angeles Fielding School of Public Health. Dr. Evans researches how health care systems and public policies can better promote health and wellness particularly among individuals at risk for opioid and substance use disorders, mental illness, and infectious diseases. Calla Harrington, M.P.H., M.S.W., L.C.S.W., is a Research Fellow in the Department of Health Policy and Promotion at the University of Massachusetts Amherst. Calla received her M.P.H. in Epidemiology from UMass Amherst, her clinical M.S.W. from Boston University, M.A., and her B.S.W. from Eastern University in St. Davids, PA. Robert Roose, M.D., M.P.H., F.A.S.A.M., is the Chief Medical Officer for Mercy Medical Center and affiliates. Dr. Roose received his M.D. and M.P.H. from the George Washington University School of Medicine and Health Sciences in Washington, DC. He received his B.S. from the University of Illinois at Urbana-Champaign, IL. He serves on the Quality Improvement Council of the American Society of Addiction Medicine and is a key contributor to opioid task forces in Massachusetts. Susan Lemere, M.S.W., L.I.C.S.W., received her M.S.W. from Smith College in Northampton, MA, a M.F.A. from Pine Manor College in Brookline, MA, and a B.A. at UMass Amherst. Currently, she is pursuing her Ph.D. in public health at UMass Amherst. David Buchanan, Dr.P.H., Professor Emeritus at UMass Amherst, received his B.A., his M.P.H., and his Dr.PH., from University of California Berkeley. He is a prominent expert in public health ethics
| | - Calla Harrington
- Elizabeth A. Evans, Ph.D., M.A., is an Associate Professor of public health at the University of Massachusetts Amherst. She received her B.A. from the University of California San Diego, her M.A. from Indiana University, Bloomington, and her Ph.D. from the University of California Los Angeles Fielding School of Public Health. Dr. Evans researches how health care systems and public policies can better promote health and wellness particularly among individuals at risk for opioid and substance use disorders, mental illness, and infectious diseases. Calla Harrington, M.P.H., M.S.W., L.C.S.W., is a Research Fellow in the Department of Health Policy and Promotion at the University of Massachusetts Amherst. Calla received her M.P.H. in Epidemiology from UMass Amherst, her clinical M.S.W. from Boston University, M.A., and her B.S.W. from Eastern University in St. Davids, PA. Robert Roose, M.D., M.P.H., F.A.S.A.M., is the Chief Medical Officer for Mercy Medical Center and affiliates. Dr. Roose received his M.D. and M.P.H. from the George Washington University School of Medicine and Health Sciences in Washington, DC. He received his B.S. from the University of Illinois at Urbana-Champaign, IL. He serves on the Quality Improvement Council of the American Society of Addiction Medicine and is a key contributor to opioid task forces in Massachusetts. Susan Lemere, M.S.W., L.I.C.S.W., received her M.S.W. from Smith College in Northampton, MA, a M.F.A. from Pine Manor College in Brookline, MA, and a B.A. at UMass Amherst. Currently, she is pursuing her Ph.D. in public health at UMass Amherst. David Buchanan, Dr.P.H., Professor Emeritus at UMass Amherst, received his B.A., his M.P.H., and his Dr.PH., from University of California Berkeley. He is a prominent expert in public health ethics
| | - Robert Roose
- Elizabeth A. Evans, Ph.D., M.A., is an Associate Professor of public health at the University of Massachusetts Amherst. She received her B.A. from the University of California San Diego, her M.A. from Indiana University, Bloomington, and her Ph.D. from the University of California Los Angeles Fielding School of Public Health. Dr. Evans researches how health care systems and public policies can better promote health and wellness particularly among individuals at risk for opioid and substance use disorders, mental illness, and infectious diseases. Calla Harrington, M.P.H., M.S.W., L.C.S.W., is a Research Fellow in the Department of Health Policy and Promotion at the University of Massachusetts Amherst. Calla received her M.P.H. in Epidemiology from UMass Amherst, her clinical M.S.W. from Boston University, M.A., and her B.S.W. from Eastern University in St. Davids, PA. Robert Roose, M.D., M.P.H., F.A.S.A.M., is the Chief Medical Officer for Mercy Medical Center and affiliates. Dr. Roose received his M.D. and M.P.H. from the George Washington University School of Medicine and Health Sciences in Washington, DC. He received his B.S. from the University of Illinois at Urbana-Champaign, IL. He serves on the Quality Improvement Council of the American Society of Addiction Medicine and is a key contributor to opioid task forces in Massachusetts. Susan Lemere, M.S.W., L.I.C.S.W., received her M.S.W. from Smith College in Northampton, MA, a M.F.A. from Pine Manor College in Brookline, MA, and a B.A. at UMass Amherst. Currently, she is pursuing her Ph.D. in public health at UMass Amherst. David Buchanan, Dr.P.H., Professor Emeritus at UMass Amherst, received his B.A., his M.P.H., and his Dr.PH., from University of California Berkeley. He is a prominent expert in public health ethics
| | - Susan Lemere
- Elizabeth A. Evans, Ph.D., M.A., is an Associate Professor of public health at the University of Massachusetts Amherst. She received her B.A. from the University of California San Diego, her M.A. from Indiana University, Bloomington, and her Ph.D. from the University of California Los Angeles Fielding School of Public Health. Dr. Evans researches how health care systems and public policies can better promote health and wellness particularly among individuals at risk for opioid and substance use disorders, mental illness, and infectious diseases. Calla Harrington, M.P.H., M.S.W., L.C.S.W., is a Research Fellow in the Department of Health Policy and Promotion at the University of Massachusetts Amherst. Calla received her M.P.H. in Epidemiology from UMass Amherst, her clinical M.S.W. from Boston University, M.A., and her B.S.W. from Eastern University in St. Davids, PA. Robert Roose, M.D., M.P.H., F.A.S.A.M., is the Chief Medical Officer for Mercy Medical Center and affiliates. Dr. Roose received his M.D. and M.P.H. from the George Washington University School of Medicine and Health Sciences in Washington, DC. He received his B.S. from the University of Illinois at Urbana-Champaign, IL. He serves on the Quality Improvement Council of the American Society of Addiction Medicine and is a key contributor to opioid task forces in Massachusetts. Susan Lemere, M.S.W., L.I.C.S.W., received her M.S.W. from Smith College in Northampton, MA, a M.F.A. from Pine Manor College in Brookline, MA, and a B.A. at UMass Amherst. Currently, she is pursuing her Ph.D. in public health at UMass Amherst. David Buchanan, Dr.P.H., Professor Emeritus at UMass Amherst, received his B.A., his M.P.H., and his Dr.PH., from University of California Berkeley. He is a prominent expert in public health ethics
| | - David Buchanan
- Elizabeth A. Evans, Ph.D., M.A., is an Associate Professor of public health at the University of Massachusetts Amherst. She received her B.A. from the University of California San Diego, her M.A. from Indiana University, Bloomington, and her Ph.D. from the University of California Los Angeles Fielding School of Public Health. Dr. Evans researches how health care systems and public policies can better promote health and wellness particularly among individuals at risk for opioid and substance use disorders, mental illness, and infectious diseases. Calla Harrington, M.P.H., M.S.W., L.C.S.W., is a Research Fellow in the Department of Health Policy and Promotion at the University of Massachusetts Amherst. Calla received her M.P.H. in Epidemiology from UMass Amherst, her clinical M.S.W. from Boston University, M.A., and her B.S.W. from Eastern University in St. Davids, PA. Robert Roose, M.D., M.P.H., F.A.S.A.M., is the Chief Medical Officer for Mercy Medical Center and affiliates. Dr. Roose received his M.D. and M.P.H. from the George Washington University School of Medicine and Health Sciences in Washington, DC. He received his B.S. from the University of Illinois at Urbana-Champaign, IL. He serves on the Quality Improvement Council of the American Society of Addiction Medicine and is a key contributor to opioid task forces in Massachusetts. Susan Lemere, M.S.W., L.I.C.S.W., received her M.S.W. from Smith College in Northampton, MA, a M.F.A. from Pine Manor College in Brookline, MA, and a B.A. at UMass Amherst. Currently, she is pursuing her Ph.D. in public health at UMass Amherst. David Buchanan, Dr.P.H., Professor Emeritus at UMass Amherst, received his B.A., his M.P.H., and his Dr.PH., from University of California Berkeley. He is a prominent expert in public health ethics
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Unger JB, Molina GB, Baron MF. Opioid knowledge and perceptions among Hispanic/Latino residents in Los Angeles. Subst Abus 2020; 42:603-609. [PMID: 32814003 DOI: 10.1080/08897077.2020.1806185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most research and health education efforts to address the opioid crisis have focused on white populations. However, opioid use, opioid use disorder, and opioid overdose deaths also have increased among Hispanics. Methods: This study conducted four focus groups in a Hispanic community in Southern California (N = 45) to assess opioid-related knowledge, perceptions, and preventive behaviors among Hispanic residents. Focus group questions assessed medication storage, disposal, and sharing; opioid-related knowledge; how to recognize a drug problem; perceptions of the extent of the opioid use problem in the community; and sources of help for drug problems. Results: Qualitative analysis revealed that most participants were aware of the potential dangers of opioids and the importance of keeping them out of the reach of children. However, participants reported stockpiling, sharing, and borrowing prescription medications for financial reasons. They perceived marijuana use as a larger problem in the community than opioids. They were familiar with the behavioral indicators of opioid addiction, but they were unaware of the availability of naloxone to reverse overdoses. They were ambivalent about searching for information about opioids and treatment options because they lacked self-efficacy to find accurate information on the internet. Conclusions: Findings identify some knowledge gaps about opioids among Hispanics and suggest opportunities for culturally accessible health education to provide Hispanics with information about opioid use disorder, overdose reversal, and treatment options.
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Affiliation(s)
- Jennifer B Unger
- Keck School of Medicine and School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Gregory B Molina
- Keck School of Medicine and School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Melvin F Baron
- Keck School of Medicine and School of Pharmacy, University of Southern California, Los Angeles, CA, USA
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