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Giraldo A, Shah P, Zerbo E, Nyaku AN. The role of recovery peer navigators in retention in outpatient buprenorphine treatment: a retrospective cohort study. Ann Med 2024; 56:2355566. [PMID: 38823420 PMCID: PMC11146239 DOI: 10.1080/07853890.2024.2355566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Racial and ethnic disparities are evident in the accessibility of treatment for opioid use disorder (OUD). Even when medications for OUD (MOUD) are accessible, racially and ethnically minoritized groups have higher attrition rates from treatment. Existing literature has primarily identified the specific racial and ethnic groups affected by these disparities, but has not thoroughly examined interventions to address this gap. Recovery peer navigators (RPNs) have been shown to improve access and overall retention on MOUD. PATIENTS AND METHODS In this retrospective cohort study, we evaluate the role of RPNs on patient retention in clinical care at an outpatient program in a racially and ethnically diverse urban community. Charts were reviewed of new patients seen from January 1, 2019 through December 31, 2019. Sociodemographic and clinical visit data, including which providers and services were utilized, were collected, and the primary outcome of interest was continuous retention in care. Bivariate analysis was done to test for statistically significant associations between variables by racial/ethnic group and continuous retention in care using Student's t-test or Pearson's chi-square test. Variables with p value ≤0.10 were included in a multivariable regression model. RESULTS A total of 131 new patients were included in the study. RPNs improved continuous retention in all-group analysis (27.6% pre-RPN compared to 80.2% post-RPN). Improvements in continuous retention were observed in all racial/ethnic subgroups but were statistically significant in the non-Hispanic Black (NHB) group (p < 0.001). Among NHB, increases in continuous retention were observed post-RPN in patients with male sex (p < 0.001), public health insurance (p < 0.001), additional substance use (p < 0.001), medical comorbidities (p < 0.001), psychiatric comorbidities (p = 0.001), and unstable housing (p = 0.005). Multivariate logistic regression demonstrated that patients who lacked insurance had lower odds of continuous retention compared to patients with public insurance (aOR = 0.17, 95% CI 0.039-0.70, p = 0.015). CONCLUSIONS RPNs can improve clinical retention for patients with OUD, particularly for individuals experiencing several sociodemographic and clinical factors that are typically correlated with discontinuation of care.
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Affiliation(s)
- Arley Giraldo
- Department of Psychiatry, NYU Grossman School of Medicine, NYC, NY, USA
| | - Payal Shah
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Erin Zerbo
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Independent Private Practice, Montclair, NJ, USA
| | - Amesika N. Nyaku
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Myers B, Regenauer KS, Johnson K, Brown I, Rose A, Ciya N, Ndamase S, Jacobs Y, Anvari M, Hines A, Dean D, Baskar R, Magidson J. A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa. RESEARCH SQUARE 2024:rs.3.rs-4566640. [PMID: 39070655 PMCID: PMC11275972 DOI: 10.21203/rs.3.rs-4566640/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Introduction In South Africa (SA), community-oriented primary care (COPC) teams work to re-engage out-of-care people with HIV (PWH) in treatment, many of whom have substance use (SU) concerns. SU stigma is high among these teams, limiting care engagement efforts. Integrating peer recovery coaches (PRCs) into COPC teams could shift SU stigma and improve patients' engagement in care. The PRC role does not exist in SA and represents a workforce innovation. To enhance acceptability, feasibility, and appropriateness for the local context, we engaged multiple stakeholder groups to co-design a PRC role for COPC team integration. Methods We used a five-step human-centered design process: (i) semi-structured interviews with healthcare worker (HCW, n = 25) and patient (n = 15) stakeholders to identify priorities for the role; (ii) development of an initial role overview; (iii) six ideation workshops with HCW (n = 12) and patient (n = 12) stakeholders to adapt this overview; (iv) refinement of the role prototype via four co-design workshops with HCW (n = 7) and patient (n = 9) stakeholders; and (v) consultation with HIV and SU service leaders to assess the acceptability and feasibility of integrating this prototype into COPC teams. Results Although all stakeholders viewed the PRC role as acceptable, patients and HCWs identified different priorities. Patients prioritized the care experience through sharing of lived experience and confidential SU support. HCWs prioritized clarification of the PRC role, working conditions, and processes to limit any impact on the COPC team. A personal history of SU, minimum 1 year in SU recovery, and strong community knowledge were considered role prerequisites by all stakeholders. Through the iterative process, stakeholders clarified their preferences for PRC session structure, location, and content and expanded proposed components of PRC training to include therapeutic and professional work practice competencies. Service leaders endorsed the prototype after the addition of PRC integration training for COPCs and PRC mentoring to address community and COPC dynamics. Conclusion Stakeholder engagement in an iterative HCD process has been integral to co-designing a PRC role that multiple stakeholder groups consider acceptable and that COPC teams are willing to implement. This offers a methodological framework for other teams designing SU workforce innovations.
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Affiliation(s)
| | | | - Kim Johnson
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Imani Brown
- Department of Psychology, University of Maryland
| | | | - Nonceba Ciya
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Sibabalwe Ndamase
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Yuche Jacobs
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | | | | | - Dwayne Dean
- Department of Psychology, University of Maryland
| | | | - Jessica Magidson
- Center for Substance Use, Addiction & Health Research, University of Maryland
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Casey SK, Howard S, Regan S, Romero A, Powell EA, Kehoe L, Kane MT, Wakeman SE. Linkage to Care Outcomes Following Treatment in A Low-Threshold Substance Use Disorder Bridge Clinic. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241261609. [PMID: 38912689 DOI: 10.1177/29767342241261609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Treatment for substance use disorders (SUD) remains low in the United States. To better meet needs of people who use alcohol and other drugs, low threshold bridge clinics which offer treatment without barrier and harm reduction services have gained prevalence. Bridge clinics work to surmount barriers to care by providing same day medication and treatment for SUD and eventually transitioning patients to community-based treatment providers. In this study, we examine SUD treatment outcomes among patients who transitioned out of a bridge clinic. METHODS This is a retrospective cohort study of posttreatment outcomes of patients seen at an urban medical center's bridge clinic between 2017 and 2022. The primary outcome was being in care anywhere at time of follow-up. We also examined the proportion of patients who completed each step of the cascade of care following transfer: connection to transfer clinic, completion of a clinic visit, retention in care, and medication use among those remaining in care at the transfer clinic. We examined the association of different bridge clinic services with still being in care anywhere and the association between successful transfer with being in care and taking medication at follow-up. RESULTS Of 209 eligible participants, 63 were surveyed. Sixty-five percent of participants identified as male, 74% as white, 12% as Hispanic, 6% as Black, and 16% were unhoused. Most participants (78%) reported being connected to SUD treatment from the Bridge Clinic, and 37% remained in care at the same facility at the time of survey. Eighty-four percent reported being in treatment anywhere and 68% reported taking medication for SUD at follow-up, with most participants reporting taking buprenorphine (46%). CONCLUSION Of those participants who transitioned out of a bridge clinic into community-based SUD care, 78% were successfully connected to ongoing care and 84% were still in care at follow-up.
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Affiliation(s)
- Sarah K Casey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney Howard
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Regan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alison Romero
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth A Powell
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Laura Kehoe
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Martha T Kane
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Randall MG, Horn BP, Crisanti AS. The Economic Effect of Peer Recovery Support Services: A Review of the Literature. Community Ment Health J 2024; 60:826-831. [PMID: 38019371 DOI: 10.1007/s10597-023-01212-z] [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: 06/27/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023]
Abstract
Peer Recovery Support Services (PRSS) have the potential to be an economically valuable intervention. To investigate this potential, we conducted a scoping review to summarize existing research on the economic impact of PRSS. We searched relevant electronic databases for peer-reviewed articles and grey literature between January 2000 and February 2023 that examined an economic outcome related to PRSS. Following a comprehensive search, screening, and full-text evaluation, eight articles were selected for review. The majority of the studies we identified focused on healthcare cost-avoidance. Some studies supported PRSS as a method of avoiding costly medical services, while others had mixed results. Our scoping review revealed limited studies addressing cost savings associated with PRSS and further research on the economic impact of PRSS is warranted.
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Affiliation(s)
| | - Brady P Horn
- Department of Economics and the Center on Alcoholism, Substance Use and Addictions (CASAA), University of New Mexico, Albuquerque, NM, USA
| | - Annette S Crisanti
- Department of Psychiatry and Behavioral Sciences Health, Sciences Center, University of New Mexico, Albuquerque, NM, USA
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Estrada MAG, Abraham AJ, Andrews CM, Grogan CM. Statewide efforts to address the opioid epidemic: Results from a national survey of single state agencies. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209309. [PMID: 38336265 PMCID: PMC11060908 DOI: 10.1016/j.josat.2024.209309] [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: 11/09/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Single State Agencies (SSAs) are at the forefront of efforts to address the nation's opioid epidemic, responsible for allocating billions of dollars in federal, state, and local funds to ensure service quality, promote best practices, and expand access to care. Federal expenditures to SSAs have more than tripled since the early years of the epidemic, yet, it is unclear what initiatives SSAs have undertaken to address the crisis and how they are financing these efforts. METHODS This study used data from an internet-based survey of SSAs, conducted by the University of Chicago Survey Lab from January to December 2021 (response rate of 94 %). The survey included a set of 14 items identifying statewide efforts to address the opioid epidemic and six funding sources. We calculated the percentage of SSAs that supported each statewide effort and the percentage of SSAs reporting use of each source of funding across the 14 statewide efforts. RESULTS Treatment of opioid-related overdose figured most prominently among statewide efforts, with all SSAs providing funding for naloxone distribution and all but one SSA supporting naloxone training. Recovery support services, Project ECHO, and Hub and Spoke models were supported by the vast majority of SSAs. Statewide efforts related to expanding access to medications for opioid use disorder (MOUD) received somewhat less support, with 45 % of SSAs supporting mobile methadone/MOUD clinics/programs and 70 % supporting buprenorphine in emergency departments. A relatively low proportion of SSAs (54 %) provided support for syringe services programs. State Opioid Response (SOR) funds were the most common funding source reported by SSAs (57 % of SSAs), followed by block grant funds (19 %) and other state funding (15 %). CONCLUSION Results highlight a range of SSA efforts to address the nation's opioid epidemic. Limited adoption of efforts to expand access to MOUD and harm reduction services may represent missed opportunities. The uncertainty over reauthorization of the SOR grant post-2025 also raises concerns over sustainability of funding for many of these statewide initiatives.
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Affiliation(s)
- Miguel Antonio G Estrada
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens, GA, USA.
| | - Amanda J Abraham
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens, GA, USA
| | - Christina M Andrews
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Colleen M Grogan
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
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Incze MA, Kelley AT, James H, Nolan S, Stofko A, Fordham C, Gordon AJ. Post-hospitalization Care Transition Strategies for Patients with Substance Use Disorders: A Narrative Review and Taxonomy. J Gen Intern Med 2024; 39:837-846. [PMID: 38413539 PMCID: PMC11043281 DOI: 10.1007/s11606-024-08670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
Hospitalizations represent important opportunities to engage individuals with substance use disorders (SUD) in treatment. For those who engage with SUD treatment in the hospital setting, tailored supports during post-discharge transitions to longitudinal care settings may improve care linkages, retention, and treatment outcomes. We updated a recent systematic review search on post-hospitalization SUD care transitions through a structured review of published literature from January 2020 through June 2023. We then added novel sources including a gray literature search and key informant interviews to develop a taxonomy of post-hospitalization care transition models for patients with SUD. Our updated literature search generated 956 abstracts not included in the original systematic review. We selected and reviewed 89 full-text articles, which yielded six new references added to 26 relevant articles from the original review. Our search of five gray literature sources yielded four additional references. Using a thematic analysis approach, we extracted themes from semi-structured interviews with 10 key informants. From these results, we constructed a taxonomy consisting of 10 unique SUD care transition models in three overarching domains (inpatient-focused, transitional, outpatient-focused). These models include (1) training and protocol implementation; (2) screening, brief intervention, and referral to treatment; (3) hospital-based interdisciplinary consult team; (4) continuity-enhanced interdisciplinary consult team; (5) peer navigation; (6) transitional care management; (7) outpatient in-reach; (8) post-discharge outreach; (9) incentivizing follow-up; and (10) bridge clinic. For each model, we describe design, scope, approach, and implementation strategies. Our taxonomy highlights emerging models of post-hospitalization care transitions for patients with SUD. An established taxonomy provides a framework for future research, implementation efforts, and policy in this understudied, but critically important, aspect of SUD care.
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Affiliation(s)
- Michael A Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA.
| | - A Taylor Kelley
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Patient-Aligned Care Team, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Hannah James
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Stofko
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA
| | - Cole Fordham
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA
| | - Adam J Gordon
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Patient-Aligned Care Team, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Treitler P, Crystal S, Cantor J, Chakravarty S, Kline A, Morton C, Powell KG, Borys S, Cooperman NA. Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose. JAMA Netw Open 2024; 7:e243614. [PMID: 38526490 PMCID: PMC10964115 DOI: 10.1001/jamanetworkopen.2024.3614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Importance Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking. Objective To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization. Design, Setting, and Participants This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023. Exposure Hospital OORP implementation. Main Outcomes and Measures The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access. Results A total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities. Conclusions and Relevance In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.
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Affiliation(s)
- Peter Treitler
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Boston University School of Social Work, Boston, Massachusetts
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Joel Cantor
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Sujoy Chakravarty
- Department of Health Sciences, Rutgers University, Camden, New Jersey
| | - Anna Kline
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Cory Morton
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Kristen Gilmore Powell
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Suzanne Borys
- Division of Mental Health and Addiction Services, New Jersey Department of Human Services, Trenton
| | - Nina A. Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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Hayes BT, Li P, Nienaltow T, Torres-Lockhart K, Khalid L, Fox AD. Low-dose buprenorphine initiation and treatment continuation among hospitalized patients with opioid dependence: A retrospective cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209261. [PMID: 38103838 PMCID: PMC10947892 DOI: 10.1016/j.josat.2023.209261] [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: 05/11/2023] [Revised: 09/20/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Buprenorphine is an effective treatment for both opioid use disorder (OUD) and chronic pain, but buprenorphine's pharmacology complicates treatment initiation for some patients. Low-dose buprenorphine initiation is a novel strategy that may reduce precipitated withdrawal. Few studies describe what patient populations benefit most from low-dose initiations and the clinical parameters that impact treatment continuation. This study aimed to 1) describe experiences with low-dose buprenorphine initiation, including both successes and failures among hospitalized patients in an urban underserved community; 2) identify patient- and treatment-related characteristics associated with unsuccessful initiation and treatment discontinuation; and 3) assess buprenorphine treatment continuation after discharge. METHODS This is a retrospective cohort study with opioid-dependent (meaning OUD or receiving long-term opioid therapy for chronic pain) patients who underwent low-dose buprenorphine initiation during hospital admission from October 2021 through April 2022. The primary outcome was successful completion of low-dose initiation. Bivariate analysis identified patient- and treatment-related factors associated with unsuccessful initiation. Secondary outcomes were buprenorphine treatment discontinuation at post-discharge follow-up, 30- and 90-days. RESULTS Of 28 patients who underwent low-dose buprenorphine initiation, 68 % successfully completed initiation. Unsuccessful initiation was associated with receipt of methadone during admission and higher morphine milligram equivalents (MME) of supplemental opioids. Of 22 patients with OUD, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 46 %, 36 %, and 36 %. Of 6 patients with chronic pain, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 100 %, 100 %, and 83 %. CONCLUSION Low-dose buprenorphine initiation can be successful in opioid-dependent hospitalized patients. Patients taking methadone or requiring higher MME of supplemental opioids may have more difficulty with the low-dose buprenorphine initiation approach, but these findings should be replicated in larger studies. This study suggests patient- and treatment-related factors that clinicians could consider when determining the optimal treatment strategy for patients wishing to transition to buprenorphine.
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Affiliation(s)
| | - Phoebe Li
- Montefiore Medical Center, United States of America
| | | | | | - Laila Khalid
- Montefiore Medical Center, United States of America
| | - Aaron D Fox
- Montefiore Medical Center, United States of America
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Moffitt T, Fallin-Bennett A, Fanucchi L, Walsh SL, Cook C, Oller D, Ross A, Gallivan M, Lauckner J, Byard J, Wheeler-Crum P, Lofwall MR. The development of a recovery coaching training curriculum to facilitate linkage to and increase retention on medications for opioid use disorder. Front Public Health 2024; 12:1334850. [PMID: 38425462 PMCID: PMC10903364 DOI: 10.3389/fpubh.2024.1334850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Medication treatment for opioid use disorder (MOUD) decreases opioid overdose risk and is the standard of care for persons with opioid use disorder (OUD). Recovery coach (RC)-led programs and associated training curriculums to improve outcomes around MOUD are limited. We describe our comprehensive training curriculum including instruction and pedagogy for novel RC-led MOUD linkage and retention programs and report on its feasibility. Methods–pedagogy and training development The Kentucky HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) created the Linkage and Retention RC Programs with a local recovery community organization, Voices of Hope-Lexington. RCs worked to reduce participant barriers to entering or continuing MOUD, destigmatize and educate on MOUD and harm reduction (e.g., safe injection practices), increase recovery capital, and provide opioid overdose education with naloxone distribution (OEND). An extensive hybrid (in-person and online, both synchronous and asynchronous), inclusive learning-focused curriculum to support the programs (e.g., motivational interviewing sessions, role plays, MOUD competency assessment, etc.,) was created to ensure RCs developed the necessary skills and could demonstrate competency before deployment in the field. The curriculum, pedagogy, learning environment, and numbers of RCs trained and community venues receiving a trained RC are reported, along with interviews from three RCs about the training program experience. Results The curriculum provides approximately 150 h of training to RCs. From December 2020 to February 2023, 93 RCs and 16 supervisors completed the training program; two were unable to pass a final competency check. RCs were deployed at 45 agencies in eight Kentucky HCS counties. Most agencies (72%) sustained RC services after the study period ended through other funding sources. RCs interviewed reported that the training helped them better explain and dispel myths around MOUD. Conclusion Our novel training and MOUD programs met a current unmet need for the RC workforce and for community agencies. We were able to train and deploy RCs successfully in these new programs aimed at saving lives through improving MOUD linkage and retention. This paper addresses a need to enhance the training requirements around MOUD for peer support specialists.
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Affiliation(s)
- Trevor Moffitt
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Amanda Fallin-Bennett
- College of Nursing, University of Kentucky, Lexington, KY, United States
- Voices of Hope, Lexington, KY, United States
| | - Laura Fanucchi
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Sharon L. Walsh
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Christopher Cook
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Devin Oller
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Anna Ross
- Voices of Hope, Lexington, KY, United States
| | - Molly Gallivan
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - John Lauckner
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Jeremy Byard
- Arthur Street Hotel, Louisville, KY, United States
| | | | - Michelle R. Lofwall
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
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Nordeck CD, Sharma A, Terplan M, Dusek K, Gilliams E, Gryczynski J. Opioid Use Disorder Treatment Linkage at Strategic Touchpoints Using Buprenorphine (OUTLAST-B): Rationale, Design, and Evolution of a Randomized Controlled Trial. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2023; 8:e230010. [PMID: 38456042 PMCID: PMC10919199 DOI: 10.20900/jpbs.20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background Despite the effectiveness and growing availability of treatment for opioid use disorder (OUD) with buprenorphine, many people with OUD do not access treatment services. This article describes the rationale, methodological design, evolution, and progress of an ongoing clinical trial of treatment linkage strategies for people with untreated OUD. Methods The study, titled Opioid Use Disorder Treatment Linkage at Strategic Touchpoints using Buprenorphine (OUTLAST-B), uses "strategic touchpoints", initially sexual health clinics and subsequently broadened to other service venues and participant social networks, for recruitment and screening. Adults with untreated OUD (target N = 360) are randomized to one of the three arms: Usual Care (UC, enhanced with overdose education and naloxone distribution), Patient Navigation (PN), or Patient Navigation with an immediate short-term bridge prescription for buprenorphine (PN + BUP). In the PN and PN + BUP arms, the Patient Navigator works with participants for 2 months to facilitate treatment entry and early retention, resolve barriers (e.g., ID cards, transportation), and provide motivational support. Results The primary outcome is OUD treatment entry within 30 days of enrollment. Participants are assessed at baseline and followed at 3- and 6-months post-enrollment on measures of healthcare utilization, substance use, and general functioning. Challenges and recruitment adaptations pursuant to the COVID-19 pandemic are discussed. Conclusions This study could provide insights on how to reach people with untreated OUD and link them to care through non-traditional routes. Trial Registration The study is registered at ClinicalTrials.gov (NCT04991974).
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Affiliation(s)
| | - Anjalee Sharma
- Friends Research Institute, Baltimore, MD 21201, USA
- Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | | | - Kristi Dusek
- Friends Research Institute, Baltimore, MD 21201, USA
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11
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Kirk MR, Dawkins AD, Wei X, Ajumobi O, Lee LC, Oman R, Woodard S, Wagner KD. What makes a peer? Characteristics of certified peer recovery support specialists in an emergency department-based intervention. PLoS One 2023; 18:e0289920. [PMID: 38060503 PMCID: PMC10703250 DOI: 10.1371/journal.pone.0289920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/28/2023] [Indexed: 12/18/2023] Open
Abstract
Providing brief interventions by certified peer recovery support specialists (CPRSS) in the emergency department (ED) following a drug related visit is a promising method of service engagement and has garnered national attention. This study examines CPRSS's perceptions of the qualities that enable them to deliver interventions in the ED. We conducted qualitative interviews with 14 CPRSSs working in EDs. Interview topics included how the participants became involved with CPRSS work, experiences working in the ED, how the ED differs from other settings, and what interactions with patients look like. Interviews were digitally recorded, transcribed, and analyzed for emerging categories. Three categories were identified relating to CPRSS work: (1) how they approach peer work, (2) inherent qualities required to do the work, regardless of the setting, and (3) context-specific skills required to do the work in the ED. When describing their approach to this work, participants talked about CPRSS work as their life calling and their passion. Participants also identified certain qualities that all CPRSS workers possess, regardless of the setting, including the ability to build rapport, strong listening skills, and a shared lived experience. Lastly, participants identified how specific hard and soft skills help them to navigate organizational and structural challenges in the ED. The unique conditions of the ED and the required qualities of a CPRSS should be considered when implementing an ED-based intervention.
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Affiliation(s)
- Mia R. Kirk
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Ashley D. Dawkins
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Xing Wei
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Olufemi Ajumobi
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Lisa C. Lee
- Roots to Wings Consulting, LLC, Reno, Nevada, United States of America
| | - Roy Oman
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Stephanie Woodard
- Division of Public and Behavioral Health, Bureau of Behavioral Health, Wellness and Prevention, State of Nevada, Carson City, Nevada, United States of America
| | - Karla D. Wagner
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
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12
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Singla DR, Savel KA, Magidson JF, Vigod SN, Dennis CL. The Role of Peer Providers to Scale Up Psychological Treatments for Perinatal Populations Worldwide. Curr Psychiatry Rep 2023; 25:735-740. [PMID: 37819490 DOI: 10.1007/s11920-023-01459-z] [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] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Psychological treatments remain largely inaccessible to perinatal populations despite their robust effectiveness. This gap is partly due to the limited number of available treatment providers. In this review, we critically evaluate recent literature on task-sharing to peer providers and propose future directions. RECENT FINDINGS There is a growing evidence base demonstrating that peer providers can effectively deliver psychological treatments for perinatal populations, as well as engage in processes critical to quality assurance, such as measurement-based peer supervision. Findings have also highlighted some benefits of peers over licensed healthcare providers, such as enhanced collaborative relationships, reduced stigma, provision of social comparisons, and increased accessibility. Peer providers may be one solution to improve access to psychological treatments for perinatal populations. However, there is a need to address clinical, professional, and health-system level barriers to effectively leverage this cadre of treatment providers.
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Affiliation(s)
- Daisy R Singla
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Katarina A Savel
- Department of Psychiatry, Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Jessica F Magidson
- Center for Substance Use, Addiction & Health Research, University of Maryland, College Park, MD, USA
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lawerence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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13
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Felton JW, Kleinman MB, Doran K, Satinsky EN, Tralka H, Dean D, Brown CJS, Anvari MS, Bradley VD, Magidson JF. Peer Activate: A Feasibility Trial of a Peer-Delivered Intervention to Decrease Disparities in Substance Use, Depression, and Linkage to Substance Use Treatment. J Psychosoc Nurs Ment Health Serv 2023; 61:23-31. [PMID: 37256749 DOI: 10.3928/02793695-20230523-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although effective evidence-based interventions (EBIs) exist, racial/ethnic minority individuals with lower income are less likely to have access to these interventions and may experience greater stigma in the health care system, resulting in disproportionate rates of morbidity and mortality. Peer recovery specialists (PRSs) may be uniquely suited to address barriers faced by those from impoverished areas; however, peers have not traditionally been trained in implementing EBIs. The current open-label trial (N = 8) was performed to evaluate implementation and preliminary effectiveness of an adapted EBI supporting recovery, linkage to treatment, and reduced depression. Results suggest the intervention was feasible, acceptable, and appropriate for linking individuals from a community setting to substance use treatment and could be delivered with fidelity by a peer interventionist. Participants who completed the intervention demonstrated clinically reliable decreases in substance use and depressive symptoms. Findings provide initial support for PRS dissemination of EBIs to increase linkage to care and support recovery in traditionally underserved populations. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 23-31.].
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14
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Cance JD, Adams ET, D'Amico EJ, Palimaru A, Fernandes CSF, Fiellin LE, Bonar EE, Walton MA, Komro KA, Knight D, Knight K, Rao V, Youn S, Saavedra L, Ridenour TA, Deeds B. Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:30-39. [PMID: 37261635 PMCID: PMC10689575 DOI: 10.1007/s11121-023-01545-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.
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Affiliation(s)
- J D Cance
- RTI International, Research Triangle Park, Durham, NC, USA.
| | - E T Adams
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | | | | | - L E Fiellin
- Yale University School of Medicine, New Haven, CT, USA
| | - E E Bonar
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - M A Walton
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - K A Komro
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - D Knight
- Texas Christian University, Fort Worth, TX, USA
| | - K Knight
- Texas Christian University, Fort Worth, TX, USA
| | - V Rao
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S Youn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L Saavedra
- RTI International, Research Triangle Park, Durham, NC, USA
| | - T A Ridenour
- RTI International, Research Triangle Park, Durham, NC, USA
| | - B Deeds
- National Institute on Drug Abuse, MD, Bethesda, USA
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15
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Pless V, McClure J, Davis M, Farfalla J, Onufrey Y, Humm K, Ranade R, Terzian M. Reducing Overdose Through Policy Interventions: ASTHO's Recommendations for State and Territorial Health Officials and Agencies. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:748-752. [PMID: 37478096 DOI: 10.1097/phh.0000000000001799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Victoria Pless
- Association of State and Territorial Health Officials, Arlington, Virginia
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16
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Suzuki J, Martin B, Loguidice F, Smelson D, Liebschutz JM, Schnipper JL, Weiss RD. A Peer Recovery Coach Intervention for Hospitalized Patients with Opioid Use Disorder: A Pilot Randomized Controlled Trial. J Addict Med 2023; 17:604-607. [PMID: 37788617 PMCID: PMC10544697 DOI: 10.1097/adm.0000000000001162] [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] [Indexed: 04/01/2023]
Abstract
OBJECTIVES Patients with opioid use disorder (OUD) are increasingly being hospitalized for acute medical illnesses. Despite initiation of medications for OUD (MOUDs), many discontinue treatment after discharge. To evaluate whether a psychosocial intervention can improve MOUD retention after hospitalization, we conducted a pilot randomized controlled trial of a peer recovery coach intervention. METHODS An existing peer recovery coach intervention was adapted for this trial. Hospitalized adults with OUD receiving MOUD treatment were randomized to receive either a recovery coach intervention or treatment-as-usual. For those in the intervention arm, the coach guided the participant to complete a relapse prevention plan, maintained contact throughout the 6-month follow-up period, encouraged MOUD continuation, and helped to identify community resources. Those receiving treatment-as-usual were discharged with a referral to outpatient treatment. Primary outcome was retention in MOUD treatment at 6 months. Secondary outcomes were the proportion of participants readmitted to the hospital and the number of days until treatment discontinuation and to hospital readmission. RESULTS Twenty-five individuals who provided consent and randomized to the recovery coach intervention (n = 13) or treatment-as-usual (n = 12) were included in the analysis. No significant differences were found in the proportion of participants retained in MOUD treatment at 6 months (38.5% vs 41.7%, P = 0.87), proportion of participants readmitted at 6 months (46.2% vs 41.2%, P = 0.82), or the time to treatment discontinuation (log-rank P = 0.92) or readmission (log-rank P = 0.85). CONCLUSIONS This pilot trial failed to demonstrate that a recovery coach intervention improved MOUD treatment retention compared with treatment-as-usual among hospitalized individuals with OUD.
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women’s Hospital, Boston MA
- Harvard Medical School, Boston MA
| | - Bianca Martin
- Department of Psychiatry, Brigham and Women’s Hospital, Boston MA
| | - Frank Loguidice
- Department of Psychiatry, Brigham and Women’s Hospital, Boston MA
| | - David Smelson
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA
| | - Jane M. Liebschutz
- Division of General Internal Medicine, University of Pittsburgh, UPMC, Pittsburgh, PA
| | - Jeffrey L. Schnipper
- Harvard Medical School, Boston MA
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston MA
| | - Roger D. Weiss
- Harvard Medical School, Boston MA
- McLean Hospital, Belmont MA 02478
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17
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Strickland JC, Acuff SF. Role of social context in addiction etiology and recovery. Pharmacol Biochem Behav 2023; 229:173603. [PMID: 37487953 PMCID: PMC10528354 DOI: 10.1016/j.pbb.2023.173603] [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: 03/30/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023]
Abstract
While social context has long been considered central to substance use disorder prevention and treatment and many drug-taking events occur in social settings, experimental research on social context has historically been limited. Recent years have seen an emergence of concerted preclinical and human laboratory research documenting the direct impact of social context on substance use, delineating behavioral and neurobiological mechanisms underlying social influence's role. We review this emerging preclinical and human laboratory literature from a theoretical lens that considers distinct stages of the addiction process including drug initiation/acquisition, escalation, and recovery. A key conclusion of existing research is that the impact of the social environment is critically moderated by the drug-taking behavior and drug use history of a social peer. Specifically, while drug-free social contexts can reduce the likelihood of drug use initiation and act as a competitive non-drug alternative preventing escalation, drug-using peers can equally facilitate initiation and escalation through peer modeling as a contingent reward of use. Likewise, social context may facilitate recovery or serve as a barrier that increases the chances of a return to regular use. We conclude by discussing evidence-based treatments and recovery support services that explicitly target social mechanisms or that have identified social context as a mechanism of change within treatment. Ultimately, new areas for research including the expansion of drug classes studied and novel human laboratory designs are needed to further translate emerging findings into clinical practice.
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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 21224, USA.
| | - Samuel F Acuff
- Department of Psychology, The University of Memphis, 202 Psychology Building, Memphis, TN 38152, USA; Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 152 Merrimac St, Boston MA, 02135 USA
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18
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Martin AK, Perryman T, Bernstein JA, Taylor JL, Cruz R, Muroff J, Samet JH, Assoumou SA. Peer recovery coaching for comprehensive HIV, hepatitis C, and opioid use disorder management: The CHORUS pilot study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100156. [PMID: 37113387 PMCID: PMC10126838 DOI: 10.1016/j.dadr.2023.100156] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023]
Abstract
Introduction Amidst a surge in HIV and hepatitis C virus (HCV) infections in persons who use drugs, medications that effectively prevent HIV and treat opioid use disorder and HCV remain underutilized. Methods We developed a 6-month peer recovery coaching intervention (brief motivational interviewing followed by weekly virtual or in-person coaching) and collected data on uptake of medications for opioid use disorder (MOUD), HIV pre-exposure prophylaxis (PrEP), and HCV treatment. The primary outcomes were intervention acceptability and feasibility. Results At a Boston substance use disorder bridge clinic, we enrolled 31 HIV-negative patients who used opioids. Participants reported high intervention satisfaction at 6 months (95% "satisfied" or "very satisfied"). At study completion, 48% of the participants were on MOUD, 43% who met CDC guidelines were on PrEP, and 22% with HCV were engaged with treatment. Conclusions A peer recovery coaching intervention is feasible and acceptable, with positive preliminary findings regarding MOUD, PrEP and HCV treatment uptake.
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Affiliation(s)
- Anna K. Martin
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Tyshaun Perryman
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Judith A. Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Jessica L. Taylor
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States
| | - Ricardo Cruz
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Jordana Muroff
- Boston University School of Social Work, Boston, MA, United States
| | - Jeffrey H. Samet
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Sabrina A. Assoumou
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States
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19
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Jakubowski A, Singh-Tan S, Torres-Lockhart K, Nahvi S, Stein M, Fox AD, Lu T. Hospital-based clinicians lack knowledge and comfort in initiating medications for opioid use disorder: opportunities for training innovation. Addict Sci Clin Pract 2023; 18:31. [PMID: 37198707 PMCID: PMC10193697 DOI: 10.1186/s13722-023-00386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Hospital-based clinicians infrequently initiate medications for opioid use disorder (MOUD) for hospitalized patients. Our objective was to understand hospital-based clinicians' knowledge, comfort, attitudes, and motivations regarding MOUD initiation to target quality improvement initiatives. METHODS General medicine attending physicians and physician assistants at an academic medical center completed questionnaires eliciting barriers to MOUD initiation, including knowledge, comfort, attitudes and motivations regarding MOUD. We explored whether clinicians who had initiated MOUD in the prior 12 months differed in knowledge, comfort, attitudes, and motivations from those who had not. RESULTS One-hundred forty-three clinicians completed the survey with 55% reporting having initiated MOUD for a hospitalized patient during the prior 12 months. Common barriers to MOUD initiation were: (1) Not enough experience (86%); (2) Not enough training (82%); (3) Need for more addiction specialist support (76%). Overall, knowledge of and comfort with MOUD was low, but motivation to address OUD was high. Compared to MOUD non-initiators, a greater proportion of MOUD initiators answered knowledge questions correctly, agreed or strongly agreed that they wanted to treat OUD (86% vs. 68%, p = 0.009), and agreed or strongly agreed that treatment of OUD with medication was more effective than without medication (90% vs. 75%, p = 0.022). CONCLUSIONS Hospital-based clinicians had favorable attitudes toward MOUD and are motivated to initiate MOUD, but they lacked knowledge of and comfort with MOUD initiation. To increase MOUD initiation for hospitalized patients, clinicians will need additional training and specialist support.
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Affiliation(s)
- Andrea Jakubowski
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
| | - Sumeet Singh-Tan
- Department of Medicine, Hospital Division, Albert Einstein College of Medicine/Montefiore Medical Center, 111 E. 210 St, Bronx, NY 10467 USA
| | - Kristine Torres-Lockhart
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
| | - Shadi Nahvi
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
| | - Melissa Stein
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
| | - Aaron D. Fox
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
| | - Tiffany Lu
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
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20
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Streck JM, Regan S, Werner M, Glynn A, Villanti AC, Park ER, Wakeman SE, Evins AE, Rigotti NA. Preliminary feasibility of integrating tobacco treatment into SUD peer recovery coaching: a mixed-methods study of peer recovery coaches. Addict Sci Clin Pract 2023; 18:25. [PMID: 37122035 PMCID: PMC10148997 DOI: 10.1186/s13722-023-00380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Individuals with substance use disorder (SUD) have high prevalence of cigarette smoking and difficulty quitting. Peer recovery coaches (PRCs; individuals with lived SUD experience) facilitate SUD behavior change in recoverees but it is unknown if/how they address tobacco treatment in SUD recovery coaching. We assessed PRC's tobacco-related practices and attitudes about tobacco treatment in SUD recovery. METHODS The Tobacco use In Peer-recovery Study (TIPS) was a cross-sectional mixed-methods pilot survey (January-March 2022) of the 26 PRCs employed by a Massachusetts-based healthcare system's 12 SUD treatment clinics/programs. PRCs completed a quantitative survey (n = 23/26; 88%) and a telephone-based qualitative interview (n = 20/26; 77%). RESULTS One-third of PRCs reported current smoking, 50% reported former smoking, and 18% never smoked. Among PRCs, 61% reported accompanying recoverees outdoors to smoke, 26% smoked with recoverees, 17% had provided cigarettes to recoverees, 32% used smoking to help build peer-relationships, and 74% rated smoking as socially acceptable in SUD treatment. PRCs reported regularly talking to recoverees about tobacco treatment (65%), believed they should have a role in helping recoverees quit smoking (52%), and were interested in tobacco treatment training (65%). A majority of both nonsmoking and current smoking PRCs (73% vs. 57%) regularly talked to recoverees about quitting smoking. CONCLUSION PRCs' attitudes about integrating tobacco treatment into SUD recovery coaching were generally positive and PRCs reported they could have a role in helping recoverees with tobacco treatment. Barriers to integrating tobacco treatment into SUD recovery include use of cigarettes as a peer-recovery tool and high prevalence and social acceptability of smoking in SUD recovery.
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Affiliation(s)
- Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
- Harvard Medical School, Harvard University, Boston, MA, USA.
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA.
| | - Susan Regan
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Michael Werner
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Alexia Glynn
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Sarah E Wakeman
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nancy A Rigotti
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
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21
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Kleinman MB, Anvari MS, Bradley VD, Felton JW, Belcher AM, Seitz-Brown CJ, Greenblatt AD, Dean D, Bennett M, Magidson JF. "Sometimes you have to take the person and show them how": adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention. Subst Abuse Treat Prev Policy 2023; 18:15. [PMID: 36879304 PMCID: PMC9990281 DOI: 10.1186/s13011-023-00524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Despite efficacy of medication for opioid use disorder, low-income, ethno-racial minoritized populations often experience poor opioid use disorder treatment outcomes. Peer recovery specialists, individuals with lived experience of substance use and recovery, are well-positioned to engage hard-to-reach patients in treatment for opioid use disorder. Traditionally, peer recovery specialists have focused on bridging to care rather than delivering interventions. This study builds on research in other low-resource contexts that has explored peer delivery of evidence-based interventions, such as behavioral activation, to expand access to care. METHODS We sought feedback on the feasibility and acceptability of a peer recovery specialist-delivered behavioral activation intervention supporting retention in methadone treatment by increasing positive reinforcement. We recruited patients and staff at a community-based methadone treatment center and peer recovery specialist working across Baltimore City, Maryland, USA. Semi-structured interviews and focus groups inquired about the feasibility and acceptability of behavioral activation, recommendations for adaptation, and acceptability of working with a peer alongside methadone treatment. RESULTS Participants (N = 32) shared that peer recovery specialist-delivered behavioral activation could be feasible and acceptable with adaptations. They described common challenges associated with unstructured time, for which behavioral activation could be particularly relevant. Participants provided examples of how a peer-delivered intervention could fit well in the context of methadone treatment, emphasizing the importance of flexibility and specific peer qualities. CONCLUSIONS Improving medication for opioid use disorder outcomes is a national priority that must be met with cost-effective, sustainable strategies to support individuals in treatment. Findings will guide adaptation of a peer recovery specialist-delivered behavioral activation intervention to improve methadone treatment retention for underserved, ethno-racial minoritized individuals living with opioid use disorder.
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Affiliation(s)
- Mary B Kleinman
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA.
| | - Morgan S Anvari
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Valerie D Bradley
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Julia W Felton
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Annabelle M Belcher
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Aaron D Greenblatt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dwayne Dean
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
| | - Melanie Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland at College Park, College Park, Maryland, USA
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22
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Goldfarb SS, Graves K, Geletko K, Hansen MD, Kinsell H, Harman J. Racial and Ethnic Differences in Emergency Department Wait Times for Patients with Substance Use Disorder. J Emerg Med 2023; 64:481-487. [PMID: 36997432 DOI: 10.1016/j.jemermed.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Substance use-related morbidity and mortality rates are at an all-time high in the United States, yet there remains significant stigma and discrimination in emergency medicine about patients with this condition. OBJECTIVES The purpose of this study was to determine whether there are racial and ethnic differences in emergency department (ED) wait times among patients with substance use disorder. METHODS The study uses pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016 to 2018. The dependent variable is length of time the patient with a diagnosis of substance use disorder waited in the ED before being admitted for care. The independent variable is patient race and ethnicity. Adjusted analyses were conducted using a generalized linear model. RESULTS There were a total of 3995 reported ED events among patients reporting a substance use disorder in the NHAMCS sample between 2016 and 2018. After adjusting for covariates, Black patients with substance use disorder were significantly more likely to wait longer in the ED (35% longer) than White patients with substance use disorder (p < 0.01). CONCLUSIONS The findings showed that Black patients with substance use disorder are waiting 35% longer, on average, than White patients with the same condition. This is concerning, given that emergency medicine is a critical frontline of care, and often the only source of care, for these patients. Furthermore, longer wait times can increase the likelihood of leaving the ED without being seen. Programs and policies should address potential stigma and discrimination among providers, and EDs should consider adding people with lived experiences to the staff to serve as peer recovery specialists and bridge the gap for care.
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Affiliation(s)
- Samantha Sittig Goldfarb
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Katelyn Graves
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Karen Geletko
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Megan Deichen Hansen
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Heidi Kinsell
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Jeff Harman
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
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23
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Evaluation of post-discharge engagement for emergency department patients with opioid use history who received telehealth recovery coaching services. Subst Abuse Treat Prev Policy 2023; 18:9. [PMID: 36774507 PMCID: PMC9922103 DOI: 10.1186/s13011-023-00523-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/09/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND In recent years, emergency departments (EDs) across the nation have implemented peer recovery coach (PRC) services to support patients who use opioids. The majority of such interventions discussed in the literature follow an in-person modality where PRCs engage patients directly at the ED bedside. However, the use of telehealth services in EDs is becoming more popular. These services connect PRCs with ED patients in real-time via secure communications technology, and very little is known about the service- and clinical-based outcomes with which they are associated. The current study sought to assess factors associated with successful post-discharge follow-up of patients with a history of opioid use who received PRC telehealth services while in the ED. METHOD Data come from records for 917 patients who engaged with a telehealth PRC one or more times (1208 total engagements) at 1 of 13 EDs within the same health system. A multilevel Poisson regression model was used to assess the degree to which variables predicted successful post-discharge follow-up, defined as the number of times a PRC successfully spoke with the patient each month after ED discharge. RESULTS At least one follow-up was successfully completed by a PRC for 23% of enrolled patients. Significant predictors of successful follow-up included patient employment at baseline (Incidence Rate Ratio [IRR]: 2.8, CI: 2.05-3.9), living in a rural area (IRR: 1.8, CI: 1.04-3.2), PRC provision of referrals (IRR: 1.7, CI: 1.2-2.2), number of ED encounters in the previous 365 days (IRR: 0.99, CI: 0.98-0.99), and duration of the initial PRC telehealth interaction (IRR: 0.87, CI: 0.85-0.88). CONCLUSION Given that relationship development is a key tool in the PRC profession, understanding successful follow-up associated with telehealth engagement has unique importance. The results have potential utility for planning and implementing peer telehealth services in EDs and other locations, which is needed for the development of the PRC profession and the likely expansion of peer telehealth services.
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24
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Byrne KA, Mericle AA, Litwin AH. Development and initial findings from the Peer Recovery Coach (PRC) checklist: a new tool to assess the nature of peer recovery coaching service delivery. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:159-169. [PMID: 36745742 DOI: 10.1080/00952990.2022.2164504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Peer recovery coaching is recovery support service for Substance Use Disorder (SUD) that emphasizes shared lived experience and social support. Though a promising intervention for SUD, differences in the roles, responsibilities, and operationalization of peer recovery coaching across studies make objective implementation and evaluation of this service a challenge.Objective: This study sought to develop a tool to better guide and operationalize peer recovery coaching service delivery. This study describes the initial development, acceptability, feasibility, and validity of this tool: The PRC Checklist.Methods: The PRC Checklist was conceptualized and operationalized by drawing from social support theory and recovery capital research. The PRC Checklist was utilized by PRCs in a pilot randomized controlled trial to demonstrate feasibility and acceptability. To further validate the PRC Checklist, recovery coaches (N = 16; 56% female) were recruited to complete a survey about their responsibilities and their perspectives on the content and potential utility of the PRC Checklist.Results: The PRC checklist used in the pilot study delineates personalized from generalized support and tracks 25 specific activities across three domains of support (i.e. socioemotional, informational, and instrumental). PRCs in the pilot study were able to use the PRC Checklist in all in-person initial baseline encounters and 96.4% of follow-up encounters. Qualitative information collected during project meetings was generally positive but also identified potential limitations to its use. All PRCs surveyed reported that they agreed that the PRC Checklist was helpful, encompassed the services they provided, represented a good idea, provided meaningful information, and would be easy to use. All five of the most common activities PRCs engaged in were reflected in the PRC Checklist.Conclusion: Capturing both personal and generalized support provided by PRCs, this work suggests that the PRC Checklist captures key activities engaged in and is a helpful tool for use in healthcare settings.
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Affiliation(s)
| | - Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
| | - Alain H Litwin
- Department of Addiction Medicine, Prisma Health - Upstate, Greenville, SC, USA
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25
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James H, Morgan J, Ti L, Nolan S. Transitions in care between hospital and community settings for individuals with a substance use disorder: A systematic review. Drug Alcohol Depend 2023; 243:109763. [PMID: 36634575 DOI: 10.1016/j.drugalcdep.2023.109763] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Individuals with a substance use disorder (SUD) have high rates of hospital service utilization including emergency department (ED) presentations and hospital admissions. Acute care settings offer a critical opportunity to engage individuals in addiction care and improve health outcomes especially given that the period of transition from hospital to community is challenging. This review summarizes literature on interventions for optimizing transitions in care from hospital to community for individuals with a SUD. METHODS The literature search focused on key terms associated with transitions in care and SUD. The search was conducted on three databases: MEDLINE, CINAHL, and PsychInfo. Eligible studies evaluated interventions acting prior to or during transitions in care from hospital to community and reported post-discharge engagement in specialized addiction care and/or return to hospital and were published since 2010. RESULTS Title and abstract screening were conducted for 2337 records. Overall, 31 studies met inclusion criteria, including 7 randomized controlled trials and 24 quasi-experimental designs which focused on opioid use (n = 8), alcohol use (n = 5), or polysubstance use (n = 18). Interventions included pharmacotherapy initiation (n = 7), addiction consult services (n = 9), protocol implementation (n = 3), screening, brief intervention, and referral to treatment (n = 2), patient navigation (n = 4), case management (n = 1), and recovery coaching (n = 3). CONCLUSIONS Both pharmacologic and psychosocial interventions implemented around transitions from acute to community care settings can improve engagement in care and reduce hospital readmission and ED presentations. Future research should focus on long-term health and social outcomes to improve quality of care for individuals with a SUD.
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Affiliation(s)
- Hannah James
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V6H 0A5, Canada
| | - Jeffrey Morgan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6Z 1Z3, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V6H 0A5, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V6H 0A5, Canada.
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26
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Slater TM, Rodney T, Finnell DS. Promoting the integration of peer support specialists into the healthcare team. Nursing 2023; 53:50-55. [PMID: 36700816 DOI: 10.1097/01.nurse.0000903972.32588.ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ABSTRACT The 21st Century Cures Act to address the opioid crisis spurred the expansion of the peer support specialist (PSS) workforce. Nurses are in key positions to promote the successful integration of the PSS into the healthcare team. This article describes the role of the PSS, including key functions that overlap with those of nurses and ways they can help mitigate stigma, which remains a significant barrier to patients' access to treatment.
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Affiliation(s)
- Tammy M Slater
- At Johns Hopkins School of Nursing in Baltimore, Md., Tammy Slater is an assistant professor and the Adult-Gerontology Acute Care Nurse Practitioner Track Coordinator, Tamar Rodney is an assistant professor and the Advanced Practice Psychiatric Mental Track Coordinator, and Deborah S. Finnell is a Professor Emerita
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27
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Bailey A, Harrington C, Evans EA. A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes. HEALTH & JUSTICE 2023; 11:3. [PMID: 36707446 PMCID: PMC9883127 DOI: 10.1186/s40352-022-00201-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND An emergent intervention to address the opioid epidemic is the use of multidisciplinary outreach teams which connect an individual in the community to healthcare resources after the experience of an opioid overdose. While these interventions are receiving federal funding, less is known empirically to inform future interventions. Understanding the process and outcomes of these interventions is advisable due to the novel partnerships of public health and law enforcement agencies who sometimes hold divergent goals. The objective of the present review was to describe program structure and evaluated outcomes of community-based post-overdose interventions. RESULTS A search of PubMed, PsycInfo, and Web of Science yielded 5 peer-reviewed articles that detail the implementation and outcomes of interventions delivered in the United States published from 2001 to July 2021. Most interventions used a multidisciplinary outreach team and referenced first responder data to contact individuals who recently experienced an overdose at their residence. Services offered often included referral to substance use treatment, recovery coaches, and social services. Method of outreach, evaluation measures, and outcomes varied. From the available literature, facilitators of program engagement included communication, information sharing, and leadership buy-in among multidisciplinary partners. CONCLUSIONS Future studies could benefit from exploration of service provision in rural areas, for family affected by overdose, and for minoritized populations. Community-based post-overdose interventions utilizing a law enforcement partnership are emergent with promising yet limited examples in empirical literature.
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Affiliation(s)
- Amelia Bailey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02912 USA
| | - Calla Harrington
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
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28
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Comanici KH, Nichols MA, Scott C, Conklin M, Ott CA, Arnett S, Karwa R. Understanding the role of community pharmacies in current medication for opioid use disorder care practices. J Am Pharm Assoc (2003) 2023; 63:261-268.e2. [PMID: 36209034 DOI: 10.1016/j.japh.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many barriers for patient access to medications for opioid use disorder (MOUD) exist in current care practices. Previous literature has evaluated subsets of pharmacists, patients, and prescribers; however, few have collectively evaluated the perspectives of all 3 groups. OBJECTIVE The objective of the study was to identify barriers, facilitators, and opportunities for improvement in Indiana community pharmacy MOUD care practices from the perspectives of peer recovery coaches, community pharmacists, and prescribers to optimize patient care. METHODS Individual semistructured interviews were conducted with each participant. Interviews explored stakeholders' perspectives on their current role in MOUD care practices and how current pharmacy practices could be improved. Data were analyzed using preconceived deductive and iterative inductive codes. The first author analyzed all transcripts, of which 3 were also analyzed separately by the last author to confirm consistent utilization of codes. All transcripts were coded once, followed by a second coding to ensure inductive codes were thoroughly applied. RESULTS Ten peer recovery coaches, 10 pharmacists, and 6 prescribers were included. Interviews identified barriers, facilitators, and opportunities for improvement in current MOUD care practices. Stigma was a major barrier identified by all groups. Other barriers identified included limited patient engagement at pharmacies and lack of access to patient-specific health information in community pharmacy settings. Pharmacists also identified additional barriers including Drug Enforcement Administration regulations and difficulties balancing patient care with external factors like insurance and legal policies. Positive prescriber/pharmacist relationships were identified as a facilitator of care. Opportunities for improvement included having community MOUD resource information available at pharmacies, further education on MOUD for pharmacists, and increased collaboration between pharmacists and prescribers. CONCLUSION Many barriers exist in current MOUD care practices. Additional pharmacist MOUD education and intentional collaboration between pharmacists, peer recovery coaches, and prescribers would facilitate better care and leverage the accessibility of pharmacists within their communities.
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29
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Burns M, Tang L, Chang CCH, Kim JY, Ahrens K, Allen L, Cunningham P, Gordon AJ, Jarlenski MP, Lanier P, Mauk R, McDuffie MJ, Mohamoud S, Talbert J, Zivin K, Donohue J. Duration of medication treatment for opioid-use disorder and risk of overdose among Medicaid enrollees in 11 states: a retrospective cohort study. Addiction 2022; 117:3079-3088. [PMID: 35652681 PMCID: PMC10683938 DOI: 10.1111/add.15959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Medication for opioid use disorder (MOUD) reduces harms associated with opioid use disorder (OUD), including risk of overdose. Understanding how variation in MOUD duration influences overdose risk is important as health-care payers increasingly remove barriers to treatment continuation (e.g. prior authorization). This study measured the association between MOUD continuation, relative to discontinuation, and opioid-related overdose among Medicaid beneficiaries. DESIGN Retrospective cohort study using landmark survival analysis. We estimated the association between treatment continuation and overdose risk at 5 points after the index, or first, MOUD claim. Censoring events included death and disenrollment. SETTING AND PARTICIPANTS Medicaid programs in 11 US states: Delaware, Kentucky, Maryland, Maine, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia and Wisconsin. A total of 293 180 Medicaid beneficiaries aged 18-64 years with a diagnosis of OUD and had a first MOUD claim between 2016 and 2017. MEASUREMENTS MOUD formulations included methadone, buprenorphine and naltrexone. We measured medically treated opioid-related overdose within claims within 12 months of the index MOUD claim. FINDINGS Results were consistent across states. In pooled results, 5.1% of beneficiaries had an overdose, and 67% discontinued MOUD before an overdose or censoring event within 12 months. Beneficiaries who continued MOUD beyond 60 days had a lower relative overdose hazard ratio (HR) compared with those who discontinued by day 60 [HR = 0.39; 95% confidence interval (CI) = 0.36-0.42; P < 0.0001]. MOUD continuation was associated with lower overdose risk at 120 days (HR = 0.34; 95% CI = 0.31-0.37; P < 0.0001), 180 days (HR = 0.31; 95% CI = 0.29-0.34; P < 0.0001), 240 days (HR = 0.29; 95% CI = 0.26-0.31; P < 0.0001) and 300 days (HR = 0.28; 95% CI = 0.24-0.32; P < 0.0001). The hazard of overdose was 10% lower with each additional 60 days of MOUD (95% CI = 0.88-0.92; P < 0.0001). CONCLUSIONS Continuation of medication for opioid use disorder (MOUD) in US Medicaid beneficiaries was associated with a substantial reduction in overdose risk up to 12 months after the first claim for MOUD.
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Affiliation(s)
- Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Lu Tang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Chung-Chou H. Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Joo Yeon Kim
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Katherine Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, ME
| | - Lindsay Allen
- Health Policy, Management, and Leadership Department, School of Public Health, West Virginia University, Morgantown, WV
| | - Peter Cunningham
- Health Behavior and Policy Department, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Adam J. Gordon
- Department of Medicine and Department of Psychiatry, School of Medicine, University of Utah, Salt Lake City, UT
| | - Marian P. Jarlenski
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Paul Lanier
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rachel Mauk
- Government Resource Center, Ohio Colleges of Medicine, The Ohio State University, Columbus, OH
| | - Mary Joan McDuffie
- Center for Community Research & Service, Biden School of Public Policy and Administration, University of Delaware, Newark, DE
| | - Shamis Mohamoud
- The Hilltop Institute, University of Maryland Baltimore County, Baltimore, MD
| | - Jeffery Talbert
- Division of Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, KY
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Julie Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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30
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Jack HE, Denisiuk ED, Collins BA, Stephens D, Blalock KL, Klein JW, Bhatraju EP, Merrill JO, Hallgren KA, Tsui JI. Peer providers and linkage with buprenorphine care after hospitalization: A retrospective cohort study. Subst Abus 2022; 43:1308-1316. [PMID: 35896006 PMCID: PMC9586121 DOI: 10.1080/08897077.2022.2095078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background: People with opioid use disorder (OUD) are increasingly started on buprenorphine in the hospital, yet many patients do not attend outpatient buprenorphine care after discharge. Peer providers, people in recovery themselves, are a growing part of addiction care. We examine whether patients who received a low-intensity, peer-delivered intervention during hospitalization had a greater rate of linking with outpatient buprenorphine care relative to those not seen by a peer. Methods: This was a retrospective cohort study of adults with OUD who were started on buprenorphine during hospitalization. The primary outcome was receipt of a buprenorphine prescription within 30 days of discharge. Secondary outcomes included attendance at a follow-up visit with a buprenorphine provider within 30 days and hospital readmission within 90 days. Modified Poisson regression analyses tested for differences in the rate ratios (RR) of each binary outcome for patients who were versus were not seen by a peer provider. Peer notes in the electronic health record were reviewed to characterize peer activities. Results: 111 patients met the study inclusion criteria, 31.5% of whom saw a peer provider. 55.0% received a buprenorphine prescription within 30 days of hospital discharge. Patients with versus without peer provider encounters did not significantly differ in the rates of receiving a buprenorphine prescription (RR = 1.06, 95% CI: 0.74-1.51), hospital readmission (RR = 1.45, 95% CI: 0.80-2.64), or attendance at a buprenorphine follow-up visit (RR = 1.03, 95% CI: 0.68-1.57). Peers most often listened to or shared experiences with patients (68.6% of encounters) and helped facilitate medical care (60.0% of encounters). Conclusions: There were no differences in multiple measures of buprenorphine follow-up between patients who received this low-intensity peer intervention and those who did not. There is need to investigate what elements of peer provider programs contribute to patient outcomes and what outcomes should be assessed when evaluating peer programs.
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Affiliation(s)
- Helen E. Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Eric D. Denisiuk
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Brett A. Collins
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Dan Stephens
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kendra L. Blalock
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jared W. Klein
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elenore P. Bhatraju
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joseph O. Merrill
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Judith I. Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
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31
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Magidson JF, Rose AL, Regenauer KS, Brooke-Sumner C, Anvari MS, Jack HE, Johnson K, Belus JM, Joska J, Bassett IV, Sibeko G, Myers B. "It's all about asking from those who have walked the path": Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa. Addict Sci Clin Pract 2022; 17:52. [PMID: 36131304 PMCID: PMC9490994 DOI: 10.1186/s13722-022-00330-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers-individuals with lived experience of SUD-may be a promising solution for addressing SUD stigma, while also improving engagement in HIV care. We evaluated the perceived acceptability of integrating a peer role into community-based HIV care teams as a strategy to address SUD stigma at multiple levels and improve patient engagement in HIV care. METHODS Patients and stakeholders (N = 40) were recruited from publicly-funded HIV and SUD organizations in Cape Town, South Africa. We conducted a quantitative assessment of stigma among stakeholders using an adapted Social Distance Scale (SDS) and patient perceptions of working with a peer, as well as semi-structured interviews focused on experiences of SUD stigma, acceptability of a peer model integrated into community-based HIV care, and potential peer roles. RESULTS On the SDS, 75% of stakeholders had high stigma towards a patient with SUD, yet 90% had low stigma when in recovery for at least 2 years. All patients endorsed feeling comfortable talking to someone in recovery and wanting them on their HIV care team. Three main themes emerged from the qualitative data: (1) patient-reported experiences of enacted SUD and HIV stigmas were common and impacted HIV care engagement; (2) both patients and stakeholders considered a peer model highly acceptable for integration into HIV care to support engagement and address SUD stigma; and (3) patients and stakeholders identified both individual-level and systems-level roles for peers, how peers could work alongside other providers to improve patient care, and key characteristics that peers would need to be successful in these roles. CONCLUSIONS Findings from this formative work point to the promise of a peer model for reducing SUD stigma among patients and HCWs within community-based HIV care teams in SA.
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Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA.
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Kristen S Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Morgan S Anvari
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Jennifer M Belus
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ingrid V Bassett
- Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Goodman Sibeko
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa. .,HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. .,Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Building 408, GPO Box U1987, Perth, WA, 6845, Australia.
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Vakili J, Sizemore L, Rebeiro PF, Tyndall B, Talley P, Whaley K, Brantley M. Assessment of Tennessee's county-level vulnerability to hepatitis C virus and HIV outbreaks using socioeconomic, healthcare, and substance use indicators. PLoS One 2022; 17:e0270891. [PMID: 35925969 PMCID: PMC9352017 DOI: 10.1371/journal.pone.0270891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV), hepatitis C virus (HCV), and injection drug use are syndemic in the central Appalachian states. In Tennessee (TN), declines in HIV among persons who inject drugs (PWID) stalled, and HCV infection rates increased significantly from 2013-2017. To better target strategies to address the syndemic, county-level socioeconomic, opioid use, access to healthcare, and health factors were modeled to identify indicators predictive of vulnerability to an HIV/HCV outbreak among PWID in TN. METHODS Newly reported chronic HCV cases among persons aged 13-39 years in 2016-2017 were used as a proxy for county-level HIV/HCV vulnerability among TN's 95 counties. Seventy-five publicly available county-level measures from 2016-2017 were collected and reduced through multiple dimension reduction techniques. Negative binomial regression identified indicators associated with HCV which were used to calculate county-level vulnerability to a local HIV/HCV outbreak. RESULTS Thirteen county-level indicators were identified as strongly predictive of HIV/HCV vulnerability with the statistically significant indicators being percentage of the population aged 20-44 years, per capita income, teen birth rate, percentage of clients in TDMHSAS-funded opioid treatment and recovery, syphilis case rate, and percentage of homes with at least one vehicle. Based on the 13 indicators, we identified the distribution of vulnerability to an HIV/HCV outbreak among TN's counties. Eleven high vulnerability counties were identified, with the preponderance located in east and middle TN. CONCLUSION This analysis identified the county-level factors most associated with vulnerability to an HIV/HCV outbreak among PWID in TN. These results, alongside routine surveillance, will guide targeted prevention and linkage to care efforts for the most vulnerable communities.
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Affiliation(s)
- Jessica Vakili
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Lindsey Sizemore
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Peter F. Rebeiro
- Vanderbilt University School of Medicine, Departments of Medicine and Biostatistics, Nashville, TN, United States of America
| | - Ben Tyndall
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Pamela Talley
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Kristyn Whaley
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Meredith Brantley
- Tennessee Department of Health, Nashville, TN, United States of America
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Rationale, design, and methodology of a randomized pilot trial of an integrated intervention combining computerized behavioral therapy and recovery coaching for people with opioid use disorder: The OVERCOME study. Contemp Clin Trials Commun 2022; 28:100918. [PMID: 35573387 PMCID: PMC9097607 DOI: 10.1016/j.conctc.2022.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/25/2022] [Accepted: 04/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Opioid use disorder (OUD) has led to a staggering death toll in terms of drug-related overdoses. Despite the demonstrated benefits and effectiveness of buprenorphine, retention is suboptimal, and patients typically present with high rates of ongoing polysubstance use during treatment. A pilot trial provided preliminary support for the efficacy of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to buprenorphine in reducing substance use. Recovery coaching services provided by individuals with substance use experience and successful recovery have also shown to positively influence recovery outcomes for people with OUD by increasing buprenorphine initiation and reducing opioid use. Methods The OVERCOME study is a randomized clinical trial (RCT) aimed to tests an integrated intervention combining CBT4CBT and Recovery Coaching relative to treatment-as-usual (TAU) among individuals with OUD on buprenorphine. The primary outcome measure is the percentage of samples with any drug tested as positive at each research visit conducted during treatment (visits 1 to 8). Secondary outcomes include the percentage of samples with any drug tested as positive at 1- and 3- month follow-up and retention to buprenorphine at 3- month follow-up. Results We describe the rationale, design, and methodology of the OVERCOME Study. Conclusion This trial will provide evidence of the efficacy of an integrated intervention combining CBT4CBT and Recovery Coaching for reducing substance use and increasing buprenorphine adherence which has the potential to reduce mortality among people with OUD.
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Abstract
Opioid Use Disorder Diagnosis and ManagementThe last 20 years have seen a staggering increase in opioid-related morbidity and mortality. Although the consequences of untreated OUDs are significant, OUD is a treatable illness. This article reviews the epidemiology of OUD and its complications, screening, diagnosis, treatment, and harm reduction interventions.
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Affiliation(s)
- Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
- Department of Quality, Patient Experience, and Equity, Mass General Brigham, Boston
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Cascade of care for office-based buprenorphine treatment in Bronx community clinics. J Subst Abuse Treat 2022; 139:108778. [DOI: 10.1016/j.jsat.2022.108778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/01/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022]
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Nielsen S, Lubman DI. Time to address addiction treatment inequality in hospital settings. Lancet Public Health 2022; 7:e6-e7. [DOI: 10.1016/s2468-2667(21)00260-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
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Low-threshold Buprenorphine Treatment in a Syringe Services Program: Program Description and Outcomes. J Addict Med 2022; 16:447-453. [PMID: 34775441 PMCID: PMC9095762 DOI: 10.1097/adm.0000000000000934] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Low-threshold buprenorphine treatment aims to reduce barriers to evidence-based opioid use disorder treatment. We aimed to describe the treatment philosophy, practices, and outcomes of a low-threshold syringe services program (SSP)-based buprenorphine program developed through an SSP-academic medical center partnership. METHODS We included all SSP participants who received 1 or more buprenorphine prescription from Feb 5, 2019 to October 9, 2020. We collected data on patient characteristics, substance use, buprenorphine prescriptions, and urine drug tests (UDTs). We evaluated buprenorphine treatment retention using prescription data and buprenorphine adherence using UDTs. We used 2 retention definitions: (1) percentage of patients with buprenorphine prescriptions at 30, 90, and 180 days; and (2) total percentage of days "covered" with buprenorphine prescriptions through 180 days. RESULTS One-hundred and eighteen patients received 1 or more buprenorphine prescriptions. Patients were largely middle-aged (mean age 44, standard deviation 11), male (68%), Hispanic (31%) or Non-Hispanic Black (32%), with heroin (90%) and crack/cocaine (62%) use, and injection drug use (59%). Retention was 62%, 43%, and 31% at 30, 90, and 180 days, respectively. The median percentage of days covered with buprenorphine prescriptions through 180 days was 43% (interquartile range 8%-92%). Of the 82 patients who completed 2 or more UDTs, the median percentage of buprenorphine-positive UDTs was 71% (interquartile range 40%-100%). CONCLUSIONS In an SSP-based low-threshold buprenorphine treatment program, approximately one-third of patients continued buprenorphine treatment for 180 days or more, and buprenorphine adherence was high. SSPs can be a pathway to buprenorphine treatment for patients at high risk for opioid-related harms.
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Abstract
Opioid use disorder (OUD) is a treatable chronic disorder with episodes of remission and recurrence characterized by loss of control of opioid use, compulsive use, and continued use despite harms. If untreated, OUD is associated with significant morbidity and mortality. Buprenorphine and methadone reduce fatal and nonfatal opioid overdose and infectious complications of OUD and are the first-line treatment options. Physicians have an important role to play in diagnosing OUD and its comorbidities, offering evidence-based treatment, and delivering overdose prevention and other harm reduction services to people who continue to use opioids. Interdisciplinary office-based addiction treatment programs support high-quality OUD care.
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Affiliation(s)
- Jessica L Taylor
- Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, and Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
| | - Jeffrey H Samet
- Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, and Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
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Gormley MA, Pericot-Valverde I, Diaz L, Coleman A, Lancaster J, Ortiz E, Moschella P, Heo M, Litwin AH. Effectiveness of peer recovery support services on stages of the opioid use disorder treatment cascade: A systematic review. Drug Alcohol Depend 2021; 229:109123. [PMID: 34700201 DOI: 10.1016/j.drugalcdep.2021.109123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peer recovery support services (PRSS) have been increasingly incorporated during the recovery process for opioid use disorder (OUD), yet little is known about the effects of PRSS on clinical outcomes of individuals who misuse opioids. This study systematically synthesized existing literature reporting the effectiveness of PRSS interventions on stages of the OUD treatment cascade. METHODS A search conducted on five databases identified studies from database inception to January 26th 2021 that evaluated the effects of PRSS on PRSS engagement, medication for OUD (MOUD) initiation, MOUD retention, opioid and non-opioid misuse, and remission. Characteristics of PRSS interventions, study design, and clinical outcomes were extracted. Methodological quality was assessed with the quality assessment tool for quantitative studies by the Effective Public Health Practice Project. RESULTS Of 123 titles, 22 were subjected to full-text review and 12 ultimately met inclusion criteria. Only two studies were randomized control trials, half compared the outcomes of PRSS participants to those of a counterfactual group. Most PRSS were unstandardized and broadly described, involving linkage to treatment (91.7%) or follow-up support (91.7%). MOUD initiation was reported the most often (66.7%), followed by PRSS engagement (33.3%) and opioid use (25.0%). No studies reported findings for MOUD retention or remission. Findings for available outcomes were inconsistent and difficult to compare due to the heterogeneity of PRSS interventions and methodological limitations. CONCLUSION Effectiveness of PRSS interventions on stages of the OUD treatment cascade remain inconclusive. Additional research is necessary before supporting the implementation of PRSS on a broad scale.
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Affiliation(s)
- Mirinda Ann Gormley
- Clemson University College of Behavioral, Social, and Health Science, Department of Public Health Sciences, 503 Edwards Hall, Clemson SC, 29631, USA; Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA.
| | - Irene Pericot-Valverde
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Clemson University School of Health Research, 605 Grove Road Suite 301, Clemson, SC, 29605, USA
| | - Liam Diaz
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Greenville County Behavioral Health AmeriCorps VISTA Program, 130 Industrial Dr. Suite B, Greenville, SC, 29607, USA
| | - Ashley Coleman
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Jonathan Lancaster
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Clemson University College of Behavioral, Social, and Health Science, Department of Psychology, 418 Brackett Hall, Clemson SC, 29634, USA
| | - Erik Ortiz
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Phillip Moschella
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; Prisma Health Department of Emergency Medicine, 701 Grove Rd., Greenville, SC, 29605, USA; University of South Carolina School of Medicine Greenville, Department of Medicine, 701 Grove road, Greenville, SC, 29605, USA
| | - Moonseong Heo
- Clemson University College of Behavioral, Social, and Health Science, Department of Public Health Sciences, 503 Edwards Hall, Clemson SC, 29631, USA; Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA
| | - Alain H Litwin
- Prisma Health Addiction Research Center, 605 Grove Rd. Suite 205, Greenville, SC, 29605, USA; University of South Carolina School of Medicine Greenville, Department of Medicine, 701 Grove road, Greenville, SC, 29605, USA; Clemson University School of Health Research, 605 Grove Road Suite 301, Clemson, SC, 29605, USA; Prisma Health Department of Internal Medicine, 876 W Faris Rd., Greenville, SC, 29605, USA
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Anvari MS, Seitz-Brown CJ, Spencer J, Mulheron M, Abdelwahab S, Borba CPC, Magidson JF, Felton JW. "How can I hug someone now [over the phone]?": Impacts of COVID-19 on peer recovery specialists and clients in substance use treatment. J Subst Abuse Treat 2021; 131:108649. [PMID: 34716038 PMCID: PMC8548675 DOI: 10.1016/j.jsat.2021.108649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
Introduction The COVID-19 pandemic has disproportionately affected underserved, low-income, ethnoracial minority communities, as well as those with substance use disorders (SUDs). The workforce of peer recovery specialists (PRSs), individuals with lived substance use and recovery experience, has rapidly expanded in response to a shortage of access to substance use treatment, particularly for those from underserved communities. As PRSs are likely serving individuals disproportionately affected by the pandemic, it is important to understand how COVID-19 has affected the PRS role and the individuals with SUD who they are supporting. Method This study aimed to examine: (1) the impact of COVID-19 on the PRS role and experience, (2) the impact of COVID-19 on clients in or seeking SUD treatment, (3) facilitators for clients engaging in treatment and adapting to new changes, and (4) sustainability of new treatment methods post-pandemic. Results Findings suggest that PRSs have had to adapt their role and responsibilities to meet changing client needs; however, PRS strengths, such as their shared experience and expertise navigating treatment barriers, make them uniquely suited to assist clients during the pandemic. The study identified various barriers and facilitators to clients seeking treatment or living with SUD, such as the loss of interpersonal connection. PRSs also identified some drawbacks to utilizing telehealth, but identified this as a potentially sustainable approach to delivering care after the pandemic. Conclusion Future research could explore how challenges to fulfilling the PRS role, as well as adaptations to overcome these challenges, have changed over time.
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Affiliation(s)
- Morgan S Anvari
- Department of Psychology, University of Maryland, College Park, United States of America.
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Jessie Spencer
- Division of Public Health, Michigan State University, United States of America
| | - Megan Mulheron
- Division of Public Health, Michigan State University, United States of America
| | - Sara Abdelwahab
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Christina P C Borba
- Department of Psychiatry, Boston University School of Medicine, United States of America
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Julia W Felton
- Division of Public Health, Michigan State University, United States of America
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Satinsky EN, Kleinman MB, Tralka HM, Jack HE, Myers B, Magidson JF. Peer-delivered services for substance use in low- and middle-income countries: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103252. [PMID: 33892281 DOI: 10.1016/j.drugpo.2021.103252] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/02/2021] [Accepted: 03/29/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Addressing the burden of disease associated with substance use is a global priority, yet access to treatment is limited, particularly in low- and middle-income countries (LMICs). Peers, individuals with lived experience of substance use, may play an important role in expanding access to treatment, supporting outcomes, and reducing stigma. While peer-delivered services for substance use have been scaling up in high-income countries (HICs), less is known about their application in LMICs. This systematic review synthesizes the evidence of peer-delivered services for substance use in LMICs. METHODS PsycINFO, Embase, Global Health, PubMed, and six region-specific databases were searched, and articles that described peer-delivered services for substance use and related outcomes in LMICs were included. Risk of bias was evaluated using tools appropriate for each study design. To provide a more stringent evaluation of structured interventions, a subset of articles was analyzed using the Cochrane Effective Practice and Organization of Care (EPOC) framework. RESULTS The search yielded 6540 articles. These were narrowed down to 34 included articles. Articles spanned four continents, included quantitative and qualitative methodologies, and primarily targeted infectious disease risk behaviors. Ten articles were included in the EPOC sub-analysis. In the context of high risk of bias, some of these articles demonstrated positive impacts of the peer-delivered services, including reductions in risk behaviors and increases in infectious disease knowledge scores, while many others showed no significant difference in outcomes between peer intervention and control groups. CONCLUSIONS Peer-delivered services may be feasible for addressing substance use and reducing infectious disease risk behaviors in LMICs, where there are severe human resource shortages. Globally, peers' lived experience is valuable for engaging patients in substance use treatment and harm reduction services. Further research is needed to better characterize and quantify outcomes for peer-delivered services for substance use in LMICs.
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Affiliation(s)
- Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Psychology, University of Maryland, College Park, MD, USA.
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Hannah M Tralka
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E Jack
- Department of Medicine, University of Washington, Seattle, WA, USA; Centre for Global Mental Health, King's College London, London, UK
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South Africa Medical Research Council, Cape Town, South Africa; Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Harris RA, Mandell DS, Kampman KM, Bao Y, Campbell K, Cidav Z, Coviello DM, French R, Livesey C, Lowenstein M, Lynch KG, McKay JR, Oslin DW, Wolk CB, Bogner HR. Collaborative care in the treatment of opioid use disorder and mental health conditions in primary care: A clinical study protocol. Contemp Clin Trials 2021; 103:106325. [PMID: 33631356 PMCID: PMC8117118 DOI: 10.1016/j.cct.2021.106325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND People with opioid use disorder (OUD) often have a co-occurring psychiatric disorder, which elevates the risk of morbidity and mortality. Promising evidence supports the use of collaborative care for treating people with OUD in primary care. Whether collaborative care interventions that treat both OUD and psychiatric disorders will result in better outcomes is presently unknown. METHODS The Whole Health Study is a 3-arm randomized controlled trial designed to test collaborative care treatment for OUD and the psychiatric disorders that commonly accompany OUD. Approximately 1200 primary care patients aged ≥18 years with OUD and depression, anxiety, or PTSD will be randomized to one of three conditions: (1) Augmented Usual Care, which consists of a primary care physician (PCP) waivered to prescribe buprenorphine and an addiction psychiatrist to consult on medication-assisted treatment; (2) Collaborative Care, which consists of a waivered PCP, a mental health care manager trained in psychosocial treatments for OUD and psychiatric disorders, and an addiction psychiatrist who provides consultation for OUD and mental health; or (3) Collaborative Care Plus, which consists of all the elements of the Collaborative Care arm plus a Certified Recovery Specialist to help with treatment engagement and retention. Primary outcomes are six-month rates of opioid use and six-month rates of remission of co-occurring psychiatric disorders. DISCUSSION The Whole Health Study will investigate whether collaborative care models that address OUD and co-occurring depression, anxiety, or PTSD will result in better patient outcomes. The results will inform clinical care delivery during the current opioid crisis. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov registration: NCT04245423.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kyle M Kampman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, USA
| | - Kristen Campbell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Donna M Coviello
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rachel French
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cecilia Livesey
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Margaret Lowenstein
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kevin G Lynch
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - David W Oslin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Courtney Benjamin Wolk
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
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