Medically treated opioid overdoses among New Jersey Medicaid beneficiaries: Rapid growth and complex comorbidity amid growing fentanyl penetration

Returning home during the pandemic: a thematic analysis describing experiences of people with substance use disorders released early from New Jersey prisons during COVID-19

BACKGROUND & AIMS

The COVID-19 pandemic created intersecting health risks for incarcerated people with a history of substance use disorder (SUD). To reduce exposure to COVID-19 in prison, several US states enacted decarceration legislation. New Jersey enacted the Public Health Emergency Credit Act (PHECA), granting early release to thousands of incarcerated persons meeting eligibility criteria. This study undertook to explore how large scale decarceration during the pandemic impacted the reentry process for released individuals with SUDs.

METHODS

Twenty seven participants involved in PHECA releases - 21 persons released from NJ carceral facilities with past/present SUDs (14 with opioid use disorder, 7 with other SUDs) and 6 reentry service providers acting as key informants - completed phone interviews on PHECA experiences from February-June 2021. Cross-case thematic analysis of transcripts identified common themes and divergent perspectives.

RESULTS

Respondents described challenges consistent with long-documented reentry difficulties including housing and food insecurity, difficulty accessing community services, insufficient employment opportunities, and limited access to transportation. Challenges that were pertinent to mass release during a pandemic included limited access to communication technology and community providers and community providers exceeding enrollment capacity. Despite reentry difficulties, respondents identified many areas where prisons and reentry service providers adapted to meet novel challenges presented by mass decarceration during the COVID-19 pandemic. Facilitators made available by prison and reentry provider staff included providing released persons with cell phones, transportation assistance at transit hubs, prescription support for medications for opioid use disorder, and pre-release assistance with ID and benefits through NJ's Joint Comprehensive Assessment Plan.

CONCLUSIONS

Formerly incarcerated people with SUDs experienced reentry challenges during PHECA releases similar to those that occur during ordinary circumstances. Despite barriers faced during typical releases and novel challenges unique to mass release during a pandemic, providers made adaptations to support released persons' successful reentry. Recommendations are made based on areas of need identified in interviews, including reentry service provision facilitating housing and food security, employment, medical services, technology fluency, and transportation. In anticipation of future large scale releases, providers will benefit from planning ahead and adapting to address temporary increases in resource demands.

Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities

Objectives

Identify rates and correlates of comorbid affective and substance use disorders among an understudied population, Medicaid/Medicare beneficiaries receiving care at an opioid treatment program serving patients from small urban and rural areas. Examine whether past-year non-medical opioid use status differentiates comorbidity status.

Methods

A cross-sectional, venue-based design was used to recruit a convenience sample of patients treated with methadone for opioid use disorder. Measures were assessed across three domains: (1) demographic characteristics, (2) opioid use characteristics, and (3) comorbid disorders. Brief validated screeners categorized probable comorbid disorders. Bivariate analyses examined correlates of comorbid disorders and determined variable selection for multivariable analyses.

Results

In this sample (N = 210; mean age = 38.5 years; female = 62.2%; Non-Hispanic White race/ethnicity = 86.1%), comorbid disorders were common. Rates were as follows: current anxiety (48.1%), depression (41.1%), and PTSD (33.7%), and past-year stimulant (27.6%), marijuana (19.0%), alcohol (14.9%), and sedative (7.6%). In bivariate analyses, past-year non-medical opioid use and a greater accumulation of opioid use consequences were associated with most disorders. When including demographic and opioid use characteristics in multivariable analyses, past-year non-medical opioid use was associated with anxiety, PTSD, stimulant use disorder, and sedative use disorder.

Conclusions

Few studies have investigated comorbid disorders among this understudied population. This analysis highlights a high burden, especially for affective disorders. Our findings demonstrate that routine, ongoing assessment of non-medical opioid use may be a promising and feasible strategy to detect patients needing integrated care. Future research should investigate whether changes to assessment protocols at opioid treatment programs in small urban and rural settings facilitate care coordination.

Longitudinal analysis of the prevalence and correlates of heavy episodic drinking and self-reported opioid use among a national cohort of patients with HIV

BACKGROUND

Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use.

METHODS

We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use. We used multinomial logistic regression to estimate odds of reporting concomitant HED and self-reported opioid use.

RESULTS

Among 3702 PWH, 1458 (39.4%) reported HED during the study period and 350 (9.5%) reported opioid use. In the multinomial model, compared to reporting neither HED nor opioid use, lifetime housing instability (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.01 to 2.35), Veterans Aging Cohort Study Index 2.0 (a measure of disease severity; aOR 1.14, 95% CI 1.02 to 1.28), depressive symptoms (aOR 2.27, 95% CI 1.42 to 3.62), past-year cigarette smoking (aOR 3.06, 95% CI 1.53 to 6.14), cannabis use (aOR 1.69, 95% CI 1.09 to 2.62), and cocaine/stimulant use (aOR 11.54, 95% CI 7.40 to 17.99) were independently associated with greater odds of concomitant HED and self-reported opioid use. Compared to having attended no college, having some college or more (aOR 0.39, 95% CI 0.26 to 0.59) was associated with lower odds of concomitant HED and self-reported opioid use.

CONCLUSIONS

Among PWH, concomitant HED and self-reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater illness severity. Efforts to minimize opioid-related risk should address high-risk drinking as a modifiable risk factor for harm among these groups.

Opioid overdose survivors: Medications for opioid use disorder and risk of repeat overdose in Medicaid patients

BACKGROUND

Patients with medically-treated opioid overdose are at high risk for subsequent adverse outcomes, including repeat overdose. Understanding factors associated with repeat overdose can aid in optimizing post-overdose interventions.

METHODS

We conducted a longitudinal, retrospective cohort study using NJ Medicaid data from 2014 to 2019. Medicaid beneficiaries aged 12-64 with an index opioid overdose from 2015 to 2018 were followed for one year for subsequent overdose. Exposures included patient demographics; co-occurring medical, mental health, and substance use disorders; service and medication use in the 180 days preceding the index overdose; and MOUD following index overdose.

RESULTS

Of 4898 individuals meeting inclusion criteria, 19.6% had repeat opioid overdoses within one year. Index overdoses involving heroin/synthetic opioids were associated with higher repeat overdose risk than those involving prescription/other opioids only (HR = 1.44, 95% CI = 1.22-1.71). Risk was higher for males and those with baseline opioid use disorder diagnosis or ED visits. Only 21.7% received MOUD at any point in the year following overdose. MOUD was associated with a large decrease in repeat overdose risk among those with index overdose involving heroin/synthetic opioids (HR = 0.30, 95% CI = 0.20-0.46). Among those receiving MOUD at any point in follow-up, 10.5% (112/1065) experienced repeat overdose versus 22.1% (848/3833) for those without MOUD.

CONCLUSIONS

Repeat overdose was common among individuals with medically-treated opioid overdose. Risk factors for repeat overdose varied by type of opioid involved in index overdose, with differential implications for intervention. MOUD following index opioid overdose involving heroin/synthetic opioids was associated with reduced repeat overdose risk.