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Li W, Eisenberg M, Song M, Kennedy-Hendricks A, Saloner B. Medications for Opioid Use Disorder after Entering Residential Treatment: Evidence from Louisiana Medicaid. J Addict Med 2024:01271255-990000000-00366. [PMID: 39150076 DOI: 10.1097/adm.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Policies have attempted to increase the use of medication for opioid use disorder (MOUD) during an admission to a residential treatment program, but little is known about the association of residential admission with subsequent MOUD use. METHODS In a cohort study of Louisiana Medicaid beneficiaries age 18-64 with diagnosed opioid use disorder (OUD), weekly MOUD use and overdose for 20 weeks before and after an admission to residential treatment was analyzed using comparative interrupted time series regression. Participants with residential treatment admission between January 1, 2018, and December 31, 2020 (N = 12,222) were compared against a demographically similar group of people with OUD without residential treatment during the study period. RESULTS The samples with residential treatment were largely male (61.9%), White (47.2%), and aged 30 to 39 years (41.4%). At baseline, people admitted to residential treatment were much less likely to use MOUD than the comparison group (4.2% lower, CI: 3.8%, 4.5%, P < 0.01). After admission, use of any MOUD initially increased by 3.1% (P < 0.01) relative to the comparison group, which reverted to the counterfactual trend by 20 weeks. Post-admission MOUD use differed widely by medication. Overdose incidence was highest in the weeks right before admission, but otherwise, it did not change during the study period. CONCLUSIONS Admission to residential treatment for OUD was associated with a temporary increase in MOUD use. Policy initiatives should focus on both boosting use of MOUD during residential treatment and sustaining access to MOUD in outpatient care in the weeks following discharge.
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Affiliation(s)
- Wenshu Li
- From the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (WL, ME, MS, AK-H, BS); and Foundation Medicine, Cambridge, MA (WL)
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Burke KN, Krawczyk N, Li Y, Byrne L, Desai IK, Bandara S, Feder KA. Barriers and facilitators to use of buprenorphine in state-licensed specialty substance use treatment programs: A survey of program leadership. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209351. [PMID: 38499248 DOI: 10.1016/j.josat.2024.209351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD), including buprenorphine, reduce overdose risk and improve outcomes for individuals with opioid use disorder (OUD). However, historically, most non-opioid treatment program (non-OTP) specialty substance use treatment programs have not offered buprenorphine. Understanding barriers to offering buprenorphine in specialty substance use treatment settings is critical for expanding access to buprenorphine. This study aims to examine program-level attitudinal, financial, and regulatory factors that influence clients' access to buprenorphine in state-licensed non-OTP specialty substance use treatment programs. METHODS We surveyed leadership from state-licensed non-OTP specialty substance use treatment programs in New Jersey about organizational characteristics, including medications provided on- and off-site and percentage of OUD clients receiving any type of MOUD, and perceived attitudinal, financial, and regulatory barriers and facilitators to buprenorphine. The study estimated prevalence of barriers and compared high MOUD reach (n = 36, 35 %) and low MOUD reach (n = 66, 65 %) programs. RESULTS Most responding organizations offered at least one type of MOUD either on- or off-site (n = 80, 78 %). However, 71 % of organizations stated that fewer than a quarter of their clients with OUD use any type of MOUD. Endorsement of attitudinal, financial, and institutional barriers to buprenorphine were similar among high and low MOUD reach programs. The most frequently endorsed government actions suggested to increase use of buprenorphine were facilitating access to long-acting buprenorphine (n = 95, 96 %), education and stigma reduction for clients and families (n = 95, 95 %), and financial assistance to clients to pay for medications (n = 90, 90 %). CONCLUSIONS Although non-OTP specialty substance use programs often offer clients access to MOUD, including buprenorphine, most OUD clients do not actually receive MOUD. Buprenorphine uptake in these settings may require increased financial support for programs and clients, more robust education and training for providers, and efforts to reduce the stigma associated with medication among clients and their families.
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Affiliation(s)
- Kathryn N Burke
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America.
| | - Noa Krawczyk
- New York University Grossman School of Medicine, 550 1(st) Ave, New York, NY 10016, United States of America
| | - Yuzhong Li
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, United States of America
| | - Lauren Byrne
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
| | - Isha K Desai
- George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW #2, Washington, DC 20037, United States of America
| | - Sachini Bandara
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
| | - Kenneth A Feder
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
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Ramdin C, Zembrzuska M, Zembrzuski K, Nelson L. Layperson knowledge on naloxone and medications for opioid use disorder in an urban population: a cross sectional survey study. J Addict Dis 2024:1-9. [PMID: 38764149 DOI: 10.1080/10550887.2024.2353431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND AND OBJECTIVES There has been little research in an urban population regarding knowledge of harm reduction measures and treatment options. The objective of our study was to evaluate knowledge and perceptions of harm reduction measures and types of treatment available for opioid use disorder among patients and family in an urban emergency department (ED) waiting room. METHODS We conducted a single center, cross-sectional survey study that occurred between September 2021 and August 2022. A convenience sample of patients and family members that were above 18 and English speaking were recruited by research assistants. Participants were assessed on knowledge and preferences around drug treatment options and harm reduction. Data were summarized using descriptive statistics and compared using the Freeman-Halton/Kruskall-Wallis/Mann-Whitney U tests. p-Values were reported at the 0.05 significance level. RESULTS We collected 200 responses. Of these, 104 people had a connection to someone with a substance use disorder (SUD) and 50 had an SUD. Of those who had a connection to someone with SUD, 63 had heard of naloxone (60.6%, CI: [50.5, 69.9]). Fewer than 60% of respondents in each group had heard of Medications for Opioid Use Disorder (MOUD) (p = 0.46) and fewer than 50% thought that among people who use drugs that they knew would be interested in receiving treatment (p = 0.10). DISCUSSION AND CONCLUSIONS Our study found that among people who came to an urban emergency department, there was a lack of awareness of harm reduction and MOUD. Interventions should be put into place to educate on the importance of MOUD and harm reduction.
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Affiliation(s)
- Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Krzysztof Zembrzuski
- School of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Callen EF, Clay T, Lutgen C, Robertson E, Staton EW, Filippi MK. Quantifying diagnosis and treatment practices of opioid use disorder in primary care practices using chart review data. J Addict Dis 2024:1-8. [PMID: 38605500 DOI: 10.1080/10550887.2024.2327728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices. METHODS American Academy of Family Physicians (AAFP) offered a monthly online educational series to seven U.S. practices. Practices were asked to complete up to 50 chart reviews for visits during two periods: February-April, 2019, and February-April, 2022. Each chart had to have an ICD-10 diagnosis of opioid misuse, opioid dependence, or opioid use. Chart reviews consisted of 14 questions derived from an American Academy of Addiction Psychiatry (AAAP) Performance in Practice activity, and then, scored based on practices' responses. Descriptive statistics and binary logistic and multinomial regressions were used. RESULTS Both periods had 173 chart reviews (total: 346) from the six practices. Most chart reviews were for patients with a diagnosis of opioid dependence (2019: 90.2%; 2022: 83.2%). Three questions for assessing OUD treatment behaviors had high levels of documentation across both time periods (>85%): other drug use, treatment readiness, and treatment discussion. DISCUSSION Results show a gap in the treatment of patients with OUD in primary care across several clinical practice recommendations. CONCLUSIONS Expanding OUD treatment integration to primary care remains the most promising effort to combat the opioid crisis.
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Affiliation(s)
- Elisabeth F Callen
- American Academy of Family Physicians National Research Network, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Tarin Clay
- American Academy of Family Physicians National Research Network, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Cory Lutgen
- American Academy of Family Physicians National Research Network, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Elise Robertson
- American Academy of Family Physicians National Research Network, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Elizabeth W Staton
- DARTNet Institute, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa K Filippi
- American Academy of Family Physicians National Research Network, Leawood, KS, USA
- Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC, USA
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Speight C. What the X? Understanding changes in buprenorphine prescribing regulation. J Am Assoc Nurse Pract 2024; 36:147-150. [PMID: 37646580 DOI: 10.1097/jxx.0000000000000942] [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: 09/01/2023]
Abstract
ABSTRACT Opioid use disorder remains an epidemic in the United States. Buprenorphine is a Food and Drug Administration-approved medication for opioid use disorder that is associated with decreased opioid-related mortality and morbidity. Until recently, providers had to have a specialized wavier, a Drug Enforcement Agency (DEA) X, to prescribe buprenorphine for opioid use disorder. The 2023 Consolidated Appropriations Act, signed into law by President Biden, removed X waiver requirements and implements new training requirements for all new and renewing DEA registrants. This brief report outlines the history of buprenorphine prescribing regulation, reviews the recent regulatory changes and their implications for nurse practitioner buprenorphine prescribing, and concludes by considering the importance of promoting buprenorphine access.
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Affiliation(s)
- Chandra Speight
- Department of Advanced Nursing Practice and Education, College of Nursing, East Carolina University, Greenville, North Carolina
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Hoang BL, Sledge D. The association between medication for opioid use disorder and employment outcomes in the U.S.: The relevance of race and ethnicity. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100081. [PMID: 36846575 PMCID: PMC9948818 DOI: 10.1016/j.dadr.2022.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022]
Abstract
•White admissions given MOUD were less likely to become unemployed at discharge.•Blacks and Hispanics given MOUD were more likely to remain unemployed at discharge.•Racial disparities associated with MOUD have notable implications for policy.
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Affiliation(s)
- Bai Linh Hoang
- Department of Political Science, The University of Texas at Arlington, 701 S. Nedderman Drive, Arlington, TX 76019, United States
| | - Daniel Sledge
- Department of Political Science, The University of Texas at Arlington, 701 S. Nedderman Drive, Arlington, TX 76019, United States
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Kim SJ, Medina M, Chang J. Healthcare Utilization of Patients with Opioid Use Disorder in US Hospitals from 2016 to 2019: Focusing on Racial and Regional Variances. Clin Drug Investig 2022; 42:853-863. [PMID: 36001256 PMCID: PMC9399995 DOI: 10.1007/s40261-022-01192-0] [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] [Accepted: 08/07/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a lack of US population-based research on healthcare utilization differences caused by opioid misuse. OBJECTIVE The aim of this study was to explore disparities in healthcare utilization by type of opioid use disorder, race, region, and other patient factors for a more targeted prevention and treatment program. METHODS The National Inpatient Sample of the United States was used to identify patients with opioid use disorder (n = 101,231, weighted n = 506,155) from 2016 to 2019. Type of opioid use disorder was defined as opioid dependence/unspecified use, adverse effects of opioids, opioid misuse, and opioid poisoning (also known as overdose). We examined the sample characteristics and the association between type of disorder, racial and regional variables, and healthcare utilization, measured by hospital charges and length of stay. The multivariate survey linear regression model was used. RESULTS Among 506,155 patients, most were categorized as opioid dependence/unspecified use (56.3%) and opioid poisoning (42.7%). The number of opioid use disorder patients during the study decreased; however, overall total charges and length of stay continuously increased. Survey linear results showed that opioid poisoning, adverse effects, and abuse were associated with higher hospital charges than opioid dependence; however, length of stay was significantly lower for these groups. White patients compared with minorities, and West, Northeast, and South regions were associated with higher hospital charges and length of stay. CONCLUSION Significant differences in healthcare utilization exist between type of disorder, race, and region. Such findings illustrate that tailored treatment regimens are required to bridge the gaps in care and combat the opioid crisis. Minorities with opioid use disorder utilize healthcare the least, possibly because of affordability, and need culturally sensitive and financially feasible treatment options.
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Affiliation(s)
- Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea.,Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea.,Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA.
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What is the prevalence of and trend in opioid use disorder in the United States from 2010 to 2019? Using multiplier approaches to estimate prevalence for an unknown population size. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100052. [PMID: 35783994 PMCID: PMC9248998 DOI: 10.1016/j.dadr.2022.100052] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Opioid-related overdose deaths have increased since 2010 in the U.S., but information on trends in opioid use disorder (OUD) prevalence is limited due to unreliable data. Multiplier methods are a classical epidemiological technique to estimate prevalence when direct estimation is infeasible or unreliable. We used two different multiplier approaches to estimate OUD prevalence from 2010 to 2019. First, we estimated OUD in National Survey on Drug Use and Health (NSDUH), and based on existing capture-recapture studies, multiplied prevalence by 4.5x. Second, we estimated the probability of drug poisoning death among people with OUD (Meta-analysis indicates 0.52/100,000), and divided the number of drug poisoning deaths in the US by this probability. Estimates were weighted to account for increase in drug-related mortality in recent years due to fentanyl. Estimated OUD prevalence was lowest when estimated in NSDUH with no multiplier, and highest when estimated from vital statistics data without adjustment. Consistent findings emerged with two methods: NSDUH data with multiplier correction, and vital statistics data with multiplier and adjustment. From these two methods, OUD prevalence increased from 2010 to 2014; then stabilized and slightly declined annually (survey data with multiplier, highest prevalence of 4.0% in 2015; death data with a multiplier and correction, highest prevalence of 2.35% in 2016). The number of US adolescent and adult individuals with OUD in 2019 was estimated between 6.7-7.6 million. When multipliers and corrections are used, OUD may have stabilized or slightly declined after 2015. Nevertheless, it remains highly prevalent, affecting 6-7 million US adolescents and adults.
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