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Castry M, Tin Y, Feder NM, Lewis N, Chatterjee A, Rudorf M, Samet JH, Beers D, Medley B, Gilbert L, Linas BP, Barocas JA. An economic analysis of the cost of mobile units for harm reduction, naloxone distribution, and medications for opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209517. [PMID: 39299504 DOI: 10.1016/j.josat.2024.209517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/10/2024] [Accepted: 09/08/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND & OBJECTIVE Mobile substance use treatment units are effective approaches to increase treatment access and reduce barriers to opioid use disorder (OUD) care. However, little is known about the economic costs of maintaining and operating these units. This study aimed to estimate the economic costs of starting and maintaining mobile units providing harm reduction, overdose education and naloxone distribution (OEND), and medication for opioid use disorder (MOUD). METHODS As part of the HEALing Communities Study, four communities in Massachusetts (Bourne/Sandwich, Brockton, Gloucester, Salem) implemented mobile units offering OEND and MOUD (buprenorphine and naltrexone only); each selected different services tailored to their community. All provided MOUD linkage via telehealth, but only one offered in-person MOUD prescribing on the unit. We retrospectively collected detailed resource utilization data from invoices to estimate the direct economic costs from August 2020 through June 2022. Cost components were categorized into start-up and operating costs. We calculated total economic cost over the study period and the average monthly operating cost. RESULTS Implementing a mobile unit offering OEND and MOUD required a one-time median start-up cost of $59,762 (range: $52,062-$113,671), with 80 % of those costs attributed to the vehicle purchase. The median monthly operating cost was $14,464. The largest cost category for all mobile units was personnel costs. The monthly ongoing costs varied by community settings and services: approximately $5000 for two urban communities offering OEND and MOUD linkage via telehealth (Gloucester, Salem), $28,000 for a rural community (Bourne/Sandwich), and $23,000 for an urban community also providing in-person MOUD prescribing on the unit (Brockton). CONCLUSION The economic costs of mobile substance use treatment and harm reduction units are substantial but vary by community settings and services offered. Our results provide valuable community-level economic data to stakeholders and policymakers considering establishing and/or expanding mobile units with OEND and MOUD services. Further exploration of cost-effectiveness and efficiency should be considered across different settings.
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Affiliation(s)
- Mathieu Castry
- Boston Medical Center, Section of Infectious Diseases, United States of America
| | - Yjuliana Tin
- University of Colorado School of Medicine, Divisions of General Internal Medicine and Infectious Diseases, United States of America
| | - Noah M Feder
- University of Pittsburgh School of Medicine, United States of America
| | - Nikki Lewis
- Boston Medical Center, Section of General Internal Medicine, United States of America
| | - Avik Chatterjee
- Boston Medical Center, Section of General Internal Medicine, United States of America; Boston University Chobanian and Avedisian School of Medicine, United States of America
| | - Maria Rudorf
- Boston Medical Center, Section of General Internal Medicine, United States of America
| | - Jeffrey H Samet
- Boston Medical Center, Section of General Internal Medicine, United States of America; Boston University Chobanian and Avedisian School of Medicine, United States of America
| | - Donna Beers
- Boston Medical Center, Section of General Internal Medicine, United States of America
| | - Bethany Medley
- Columbia University School of Social Work, Social Intervention Group, United States of America
| | - Louisa Gilbert
- Columbia University School of Social Work, Social Intervention Group, United States of America
| | - Benjamin P Linas
- Boston Medical Center, Section of Infectious Diseases, United States of America; Boston University Chobanian and Avedisian School of Medicine, United States of America
| | - Joshua A Barocas
- University of Colorado School of Medicine, Divisions of General Internal Medicine and Infectious Diseases, United States of America.
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Ganapathi L, Srikrishnan AK, McFall AM, Gunaratne MP, Kumar MS, Lucas GM, Mehta SH, Solomon SS. Expanding single-venue services to better engage young people who inject drugs: insights from India. Harm Reduct J 2024; 21:170. [PMID: 39272091 PMCID: PMC11401385 DOI: 10.1186/s12954-024-01084-w] [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: 08/08/2023] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Over the last decade, India has had an alarming rise in injection of opioids across several cities. Although scale-up of public sector services for people who inject drugs (PWID) in India has occurred over decades, accessibility has been diminished by fragmented services across physical locations. To circumvent this barrier, and in alignment with the World Health Organization's guidelines to provide comprehensive care to key populations, Integrated Care Centers (ICCs) were established across 8 Indian cities as a public-private service delivery model for providing free single-venue services to PWID. ICCs have been very successful in expanding service availability and convenience for PWID generally. However, few studies from low- and middle-income countries (LMIC) have evaluated how well young PWID (defined as those ≤ 29 years of age) engage with single-venue service models like ICCs or specific services provided in such models. Young PWID are an important subpopulation in India, as they bear a disproportionate burden of new HIV infections because of greater risk and evidence of lower receipt of HIV testing and harm reduction services compared to older PWID. In this comment, we offer insights specific to young PWID drawn from multiple quantitative and qualitative studies examining the reach and effectiveness of ICCs, which may provide generalizable insights into limitations of services for young PWID more broadly in India and globally. FINDINGS Our studies suggest that while ICCs have expanded service availability, particularly in cities with emerging injection drug use epidemics, population-level reach to foster initial engagement among young PWID can be optimized. Additionally, young PWID who do engage with ICCs experience gaps in substance use treatment receipt and retention, and experience barriers to receipt of ICC services that are distinct from those experienced by older PWID. Notably, HIV incidence among ICC clients is concentrated in young PWID. Finally, ICCs were not intended to reach adolescent PWID, and new services are needed for this subpopulation. CONCLUSIONS In addition to co-locating services, iterative optimization of models such as ICCs should incorporate youth-specific differentiated interventions and be accompanied by policy changes that are critical to improving the reach and effectiveness of harm reduction and HIV services among young PWID in India.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Pediatric Global Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Division of Pediatric Infectious Diseases, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Aylur K Srikrishnan
- Y.R. Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, Tamil Nadu, 600010, India
| | - Allison M McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Mihili P Gunaratne
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Muniratnam Suresh Kumar
- Y.R. Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, Tamil Nadu, 600010, India
- Psymed Hospital, 49 Harrington Road, Chetpet, Chennai, Tamil Nadu, 600031, India
| | - Gregory M Lucas
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Shruti H Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
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Davis MT, Tschampl C, Hodgkin D, Regis C, Taveras E, Plant B, Reilly B, Horgan C. Mobile clinics for opioid use disorders: What they do and how they do it. A qualitative analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209428. [PMID: 38879017 DOI: 10.1016/j.josat.2024.209428] [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: 01/26/2024] [Revised: 04/10/2024] [Accepted: 06/04/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION People with substance use disorders (SUD) face many barriers to receiving evidence-based treatments including access to and cost of treatment. People who use drugs face stigma that limits access to traditional office-based clinics. With the goal of reducing morbidity and mortality, mobile clinics reduce many of these barriers by providing harm reduction and on-demand low-threshold medical care. METHODS In 2020 Massachusetts Department of Public Health (DPH) Mobile Addiction Services Program expanded a program called Community Care in Reach building on its success in reducing barriers to care and increasing patient encounters. In the current evaluation we conducted site visits to the four new mobile clinics and conducted one individual semi-structured provider interview at each of the four clinics. In addition, we supported a monthly learning collaborative of staff in four agencies involved with this initiative. The current evaluation used the RE-AIM framework to analyze the implementation of the mobile clinics. RESULTS Clinicians described many challenges and opportunities. The typical patient is unhoused, having a substance use disorder, and disconnected from traditional pathways to care. Clinicians are able to initiate people on buprenorphine largely due to the trust they establish with patients. Referral networks are facilitated by established community linkages. The philosophy of care is patient-centered. Mobile clinics provide a wide range of healthcare services including harm reduction, although finding a location to park and relations with police can be challenging. The workflow is uneven due to the model that is built on unscheduled visits. CONCLUSION This study provides insight into how mobile clinics address the gaps in care for persons with OUD and fatal opioid overdoses. Harm reduction services are a critical intervention and financial sustainability of mobile clinics has to be tested.
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Affiliation(s)
- Margot Trotter Davis
- Heller School for Social Policy and Management, Brandeis University, United States of America.
| | - Cynthia Tschampl
- Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Dominic Hodgkin
- Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Craig Regis
- Kraft Center for Community Health at Massachusetts General Brigham Hospital, United States of America
| | - Elsie Taveras
- Kraft Center for Community Health at Massachusetts General Brigham Hospital, United States of America
| | - Ben Plant
- Massachusetts Department of Public Health, United States of America
| | - Brittni Reilly
- Massachusetts Department of Public Health, United States of America
| | - Constance Horgan
- Heller School for Social Policy and Management, Brandeis University, United States of America
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Bailey A, DaCunha A, Napoleon SC, Kang AW, Kemo M, Martin RA. Provision of medications to treat opioid use disorder via a mobile health unit: A scoping review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209431. [PMID: 38852822 PMCID: PMC11300152 DOI: 10.1016/j.josat.2024.209431] [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: 01/08/2024] [Revised: 05/10/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Mobile health units (MHUs) provide a variety of low-barrier services to populations that face systemic barriers to healthcare access. However, MHUs are not a common delivery method for medications to treat opioid use disorder (MOUD), and, of these, there is no consensus regarding MHU targeted objectives and outcomes. This scoping review seeks to summarize the state of the literature examining the delivery of MOUD by MHUs in the United States. METHODS A search of PubMed, PsycInfo, and CINAHL on February 21, 2023, found 223 articles. Two authors completed title and abstract and full text reviews and extracted data relevant to intervention and study design, program objectives, and study outcomes. Ten articles fit the study's inclusion criteria (nine total interventions). RESULTS Of the 10 studies, six were cohort designs, three were cross-sectional (one with qualitative interviews), and one study conducted qualitative interviews only. Most studies were located in the Northeastern United States. MHU interventions primarily aimed to provide MOUD and to retain populations in treatment. Two interventions aimed to engage patients and then transfer them to fixed-site MOUD providers. Across four interventions that provided buprenorphine, 1- and 3-month retention rates varied from 31.6 % to 72.3 % and 26.2 % to 58.5 %, respectively. Qualitative interviews found that MOUD delivery from the MHU was characterized by less stigma/judgment and greater privacy compared to fixed-site, and it was flexible and low-barrier. MHUs were reportedly underutilized by the target populations, suggesting a lack of awareness from community members with opioid use disorder. CONCLUSIONS MHUs that deliver MOUD are both under-provided and -utilized. Future research should continue to assess MOUD provision from MHUs with an emphasis on robust study design, application to other formulations of MOUD, and evaluation of outcomes such as participant satisfaction and key informant perceived challenges. REGISTRATION Submitted to Open Science Framework (OSF) Repository on February 6, 2023.
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Affiliation(s)
- Amelia Bailey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Alyssa DaCunha
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Siena C Napoleon
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Augustine W Kang
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA; Stanford University School of Medicine, Stanford, CA, USA
| | - Madeleine Kemo
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Rosemarie A Martin
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Lowenstein M, Popova E, Jalloh A, Mazzella S, Botcheos D, Bertocchi J, Westfahl S, Garcia KP, Truchil R, Chertok J. The Mobile Overdose Response Program: A mobile, low-threshold opioid use disorder treatment model in Philadelphia. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209429. [PMID: 38857828 DOI: 10.1016/j.josat.2024.209429] [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: 12/31/2023] [Revised: 04/04/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Low-threshold substance use treatment programs may help overcome barriers for marginalized individuals. The aims of this study were to 1) describe participant characteristics and treatment outcomes for a multi-site, Philadelphia-based mobile program providing street-based buprenorphine initiation, stabilization, and referral to ongoing care and 2) examine associations between patient characteristics and successful linkage. METHODS We conducted a retrospective cohort study of patients receiving buprenorphine through Prevention Point Philadelphia's mobile overdose response program from 9/2020-12/2021. We abstracted electronic medical record data, including patient characteristics, mobile program treatment, and care linkage. We used descriptive statistics to characterize the sample and assessed the association between patient characteristics and successful care linkage using multi-variable logistic regression. RESULTS Two hundred thirty-seven patients initiated buprenorphine in the program across six sites. Mean age was 46. Participants were majority men (67 %); 59 % identified as Black, 33 % identified as White, and 15 % reported Hispanic ethnicity. Most were publicly insured (74 %) and 30 % were unstably housed. Basedline engagement in primary care (32 %), psychiatric treatment (5 %), and counseling (2 %) were low. Most participants reported heroin or fentanyl use at intake (87 %), with high rates of IV drug use (37 %)., and co-occurring substance use and prior buprenorphine treatment experience were common.. 86 % completed ≥1 mobile follow-up visit, and 69 % completed ≥4 mobile program visits. 51 % of patients attended at least one visit at an outside site, and 30 % had ≥2 visits for buprenorphine prescriptions at an outside site. 35 % of the referrals were internal, meaning they went to University-based practices staffed by the mobile unit physicians. In a multivariable logistic regression model, internal referral was associated with significantly increased odds of effective care linkage (aOR 2.47, 95 % CI 1.20-5.09). CONCLUSIONS Targeted community outreach with low-threshold substance use care facilitated treatment access among marginalized individuals. Participants showed high levels of engagement with the mobile program, but rates of outside care linkage, while comparable to retention in other low-threshold models, were lower. The only predictor of effective care linkage was referral to brick-and-mortar clinics staffed by mobile unit physicians. These findings support the importance of outreach beyond traditional health care settings to engage high-risk patients with OUD.
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Affiliation(s)
- Margaret Lowenstein
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Ellena Popova
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Aminata Jalloh
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Rachael Truchil
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Judy Chertok
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Heidari O, Meyer D, Lowensen K, Patil A, O'Conor KJ, LaRicci J, Hunt D, Bocek AP, Cargill V, Farley JE. Colocating Syringe Services, COVID-19 Vaccination, And Infectious Disease Testing: Baltimore's Experience. Health Aff (Millwood) 2024; 43:883-891. [PMID: 38830163 DOI: 10.1377/hlthaff.2024.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
People who inject drugs face many challenges that contribute to poor health outcomes, including drug overdose, HIV, and hepatitis C infections. These conditions require high-quality prevention and treatment services. Syringe services programs are evidence-based harm reduction programs, and they have established track records with people who inject drugs, earning them deep trust within this population. In Baltimore, Maryland, although many syringe support services were limited during the COVID-19 pandemic, the health department's syringe services programs remained operational, allowing for the continuation of harm reduction services, including naloxone distribution. This evaluation describes a collaborative effort to colocate infectious disease testing and COVID-19 vaccination with a syringe services program. Our evaluation demonstrated that colocation of important services with trusted community partners can facilitate engagement and is essential for service uptake. Maintaining adequate and consistent funding for these services is central to program success. Colocation of other services within syringe services programs, such as medications for opioid use disorder, wound care, and infectious disease treatment, would further expand health care access for people who inject drugs.
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Affiliation(s)
- Omeid Heidari
- Omeid Heidari , University of Washington, Seattle, Washington
| | - Diane Meyer
- Diane Meyer, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Derrick Hunt
- Derrick Hunt, Baltimore City Health Department, Baltimore, Maryland
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Anderson ES, Frazee BW. The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department. Emerg Med Clin North Am 2024; 42:391-413. [PMID: 38641396 DOI: 10.1016/j.emc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients.
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Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA; Division of Addiction Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
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Rennert L, Howard KA, Kickham CM, Gezer F, Coleman A, Roth P, Boswell K, Gimbel RW, Litwin AH. Implementation of a mobile health clinic framework for Hepatitis C virus screening and treatment: a descriptive study. LANCET REGIONAL HEALTH. AMERICAS 2024; 29:100648. [PMID: 38124995 PMCID: PMC10733089 DOI: 10.1016/j.lana.2023.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Background Although treatment for Hepatitis C Virus (HCV) is effective, individuals face access barriers. The utility of mobile health clinics (MHC), effective mechanisms for providing healthcare to underserved populations, is understudied for HCV-related interventions. We aimed to describe implementation of, and factors associated with, screening and treatment via MHCs. Methods Clemson Rural Health implemented a novel MHC program to reach and treat populations at-risk for HCV with a focus on care for uninsured individuals. We examined HCV screening and treatment initiation/completion indicators between May 2021 and January 2023. Findings Among 607 individuals screened across 31 locations, 94 (15.5%) tested positive via antibody and viral load testing. Treatment initiation and completion rates were 49.6% and 86.0%, respectively. Among those screened, the majority were male (57.5%), White (61.3%; Black/Hispanic: 28.2%/7.7%), and without personal vehicle as primary transportation mode (54.4%). Injection drug use (IDU) was 27.2% and uninsured rate was 42.8%. Compared to HCV-negative, those infected included more individuals aged 30-44 (52.1% vs. 36.4%, p = 0.023), male (70.2% vs. 55.2%, p = 0.009), White (78.5% vs. 60.2%, p < 0.0001), without personal vehicle (58.5% vs. 43.5%, p = 0.028), IDU (83.7% vs. 21.0%, p < 0.0001), and uninsured (61.2% vs. 48.8%, p = 0.050). Uninsured rates were higher among those initiating compared to not initiating treatment (74.5% vs. 45.3%, p = 0.004). Interpretation The MHC framework successfully reaching its target population: at-risk individuals with access barriers to healthcare. The high HCV screening and treatment initiation/completion rates demonstrate the utility of MHCs as effective and acceptable intervention settings among historically difficult-to-treat populations. Funding Gilead Sciences, Inc., and SC Center for Rural and Primary Healthcare.
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Affiliation(s)
- Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | - Kerry A. Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | | | - Fatih Gezer
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | | | - Prerana Roth
- Prisma Health-Upstate, Greenville, SC, USA
- Clemson University School of Health Research, Clemson University, Clemson, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | | | - Ronald W. Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Clemson Rural Health, Clemson University, Clemson, SC, USA
| | - Alain H. Litwin
- Prisma Health-Upstate, Greenville, SC, USA
- Clemson University School of Health Research, Clemson University, Clemson, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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Altwies EE, Zinsli KA, Chwastiak L, Tsui JI, Bhatraju EP, Ramchandani MS, Golden MR, Dombrowski JC. Substance Use and Mental Health Comorbidities and Receipt of Specialty Care Among Patients Enrolled in a Low-Barrier HIV Clinic. AIDS Behav 2023; 27:3952-3960. [PMID: 37351687 PMCID: PMC11022825 DOI: 10.1007/s10461-023-04110-3] [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] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Abstract
Low-barrier care is one model of a differentiated service delivery approach for people with HIV (PWH) who are not engaged in conventionally-organized HIV care. Although psychiatric and substance use disorders are common among patients in low-barrier clinics, approaches to behavioral health service delivery within this context have not been well-described. We conducted a descriptive analysis using retrospective review of medical records to evaluate substance use and psychiatric comorbidities and receipt of behavioral health services among patients in the Max Clinic in Seattle, Washington. Among 227 patients enrolled from 2015 to mid-2020, most had a history of hazardous substance use (85%), a psychiatric diagnosis (69%) or unstable housing (69%) documented in the medical record. Less than half of patients referred for depression treatment (33%) or for opioid use disorder treatment (40%) completed even one specialty care visit. More effective approaches are needed to engage patients in behavioral health services within the context of low-barrier HIV care.
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Affiliation(s)
- Eden E Altwies
- School of Medicine, University of Washington, Seattle, WA, USA.
| | - Kaitlin A Zinsli
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
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Stewart RE, Christian HP, Cardamone NC, Abrams C, Drob C, Mandell DS, Metzger D, Lowenstein M. Mobile service delivery in response to the opioid epidemic in Philadelphia. Addict Sci Clin Pract 2023; 18:71. [PMID: 38031174 PMCID: PMC10687974 DOI: 10.1186/s13722-023-00427-5] [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: 05/02/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The harms of opioid use disorder (OUD) and HIV infection disproportionately impact marginalized populations, especially people experiencing homelessness and people who inject drugs (PWID). Mobile OUD service delivery models are emerging to increase access and reduce barriers to OUD care. While there is growing interest in these models, there is limited research about the services they provide, how they operate, and what barriers they face. We characterize the capacity, barriers, and sustainment of mobile OUD care services in a large city with a high incidence of OUD and HIV. METHODS From May to August 2022, we conducted semi-structured interviews with leadership from all seven mobile OUD care units (MOCU) providing a medication for OUD or other substance use disorder services in Philadelphia. We surveyed leaders about their unit's services, staffing, operating location, funding sources, and linkages to care. Leaders were asked to describe their clinical approach, treatment process, and the barriers and facilitators to their operations. Interview recordings were coded using rapid qualitative analysis. RESULTS MOCUs are run by small, multidisciplinary teams, typically composed of a clinician, one or two case managers, and a peer recovery specialist or outreach worker. MOCUs provide a range of services, including medications for OUD, wound care, medical services, case management, and screening for infectious diseases. No units provide methadone, but all units provide naloxone, six write prescriptions for buprenorphine, and one unit dispenses buprenorphine. The most frequently reported barriers include practical challenges of working on a MOCU (e.g. lack of space, safety), lack of community support, and patients with substantial medical and psychosocial needs. Interviewees reported concerns about funding and specifically as it relates to providing their staff with adequate pay. The most frequently reported facilitators include positive relationships with the community, collaboration with other entities (e.g. local nonprofits, the police department, universities), and having non-clinical staff (e.g. outreach workers, peer recovery specialists) on the unit. CONCLUSIONS MOCUs provide life-saving services and engage marginalized individuals with OUD. These findings highlight the challenges and complexities of caring for PWID and demonstrate a need to strengthen collaborations between MOCU providers and the treatment system. Policymakers should consider programmatic funding for permanent mobile OUD care services.
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Affiliation(s)
- Rebecca E Stewart
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Hanna P Christian
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | - Caroline Drob
- The Health Federation of Philadelphia, Philadelphia, PA, USA
| | - David S Mandell
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Metzger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Margaret Lowenstein
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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11
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Miles J, Treitler P, Lloyd J, Samples H, Mahone A, Hermida R, Gupta S, Duncan A, Baaklini V, Simon KI, Crystal S. Racial And Ethnic Disparities In Buprenorphine Receipt Among Medicare Beneficiaries, 2015-19. Health Aff (Millwood) 2023; 42:1431-1438. [PMID: 37782874 PMCID: PMC10910625 DOI: 10.1377/hlthaff.2023.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
We examined Medicare Part D claims from the period 2015-19 to identify state and national racial and ethnic disparities in buprenorphine receipt among Medicare disability beneficiaries with diagnosed opioid use disorder or opioid overdose. Racial and ethnic disparities in buprenorphine use remained persistently high during the study period, especially for Black beneficiaries, suggesting the need for targeted interventions and policies.
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Affiliation(s)
- Jennifer Miles
- Jennifer Miles , Rutgers University, New Brunswick, New Jersey
| | | | | | | | | | | | - Sumedha Gupta
- Sumedha Gupta, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | | | | | - Kosali I Simon
- Kosali I. Simon, Indiana University, Bloomington, Indiana
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12
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Tay Wee Teck J, Butner JL, Baldacchino A. Understanding the use of telemedicine across different opioid use disorder treatment models: A scoping review. J Telemed Telecare 2023:1357633X231195607. [PMID: 37661829 DOI: 10.1177/1357633x231195607] [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: 09/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. METHODS The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. RESULTS A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. CONCLUSIONS Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
- Forward Leeds and Humankind Charity, Durham, UK
| | - Jenna L Butner
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alex Baldacchino
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, UK
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13
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Incze MA, Sehgal SL, Hansen A, Garcia L, Stolebarger L. Evaluation of a Primary Care-Based Multidisciplinary Transition Clinic for Patients Newly Initiated on Buprenorphine in the Emergency Department. Subst Abus 2023; 44:220-225. [PMID: 37675904 DOI: 10.1177/08897077231188592] [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: 09/08/2023]
Abstract
BACKGROUND Care transitions represent vulnerable events for patients newly initiating medications for opioid use disorder (MOUD). Multidisciplinary primary care-based transition clinics may improve care linkage and retention in MOUD treatment. Additionally, these interventions may help primary care clinicians (PCPs) overcome barriers to adopting MOUD into practice. In this evaluation, we assessed the impact of a primary care-based transition clinic for patients newly initiating buprenorphine for opioid use disorder (OUD) in the emergency department. METHODS We conducted a retrospective program evaluation within a single academic health system involving adults who newly initiated buprenorphine for OUD through an emergency department-based program and were referred to follow up in either a dedicated multidisciplinary primary care-based transition clinic (SPARC) vs referral to usual primary care (UPC). We performed descriptive analyses comparing patient demographics, referral volume, linkage to care, treatment retention, and markers of high-quality care between the 2 groups. A log-rank test was used to determine the difference in probabilities of retention between SPARC and UPC over 6 months. RESULTS Over 12 months, the number of referrals to SPARC was greater than to UPC (N = 64 vs N = 26). About 58% of patients referred to SPARC attended an initial visit vs 38% referred to UPC. Treatment retention was consistently greater in SPARC than UPC (1 m: 90% vs 60%; 3 m: 76% vs 40%; 6 m: 60% vs 30%). Markers of care quality including naloxone provision (100% vs 80%) and infectious screening (81% vs 40%) were greater in SPARC clinic. SPARC was associated with a statistically significant increased probability of retention in treatment as compared to UPC (P < .01). CONCLUSIONS In this observational evaluation, a primary care-based multidisciplinary transition clinic for patients initiating buprenorphine MOUD was associated with expanded access to longitudinal OUD treatment and superior linkage to care, retention in care, and quality of care compared to referral to usual primary care. Further research using a more rigorous research design is required to further evaluate these findings.
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Affiliation(s)
- Michael A Incze
- Division of General Internal Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sonia L Sehgal
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Annika Hansen
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Luke Garcia
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Laura Stolebarger
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA
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14
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Jakubowski A, Fowler S, Fox AD. Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature. Addict Sci Clin Pract 2023; 18:40. [PMID: 37301953 PMCID: PMC10256972 DOI: 10.1186/s13722-023-00394-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Syringe services programs (SSPs) provide a spectrum of health services to people who use drugs, with many providing referral and linkage to substance use disorder (SUD) treatment, and some offering co-located treatment with medications for opioid use disorder (MOUD). The objective of this study was to review the evidence for SSPs as an entry point for SUD treatment with particular attention to co-located (onsite) MOUD. METHODS We performed a scoping review of the literature on SUD treatment for SSP participants. Our initial query in PubMed led to title and abstract screening of 3587 articles, followed by full text review of 173, leading to a final total of 51 relevant articles. Most articles fell into four categories: (1) description of SSP participants' SUD treatment utilization; (2) interventions to link SSP participants to SUD treatment; (3) post-linkage SUD treatment outcomes; (4) onsite MOUD at SSPs. RESULTS SSP participation is associated with entering SUD treatment. Barriers to treatment entry for SSP participants include: use of stimulants, lack of health insurance, residing far from treatment programs, lack of available appointments, and work or childcare responsibilities. A small number of clinical trials demonstrate that two interventions (motivational enhancement therapy with financial incentives and strength-based case management) are effective for linking SSP participants to MOUD or any SUD treatment. SSP participants who initiate MOUD reduce their substance use, risk behaviors, and have moderate retention in treatment. An increasing number of SSPs across the United States offer onsite buprenorphine treatment, and a number of single-site studies demonstrate that patients who initiate buprenorphine treatment at SSPs reduce opioid use, risk behaviors, and have similar retention in treatment to patients in office-based treatment programs. CONCLUSIONS SSPs can successfully refer participants to SUD treatment and deliver onsite buprenorphine treatment. Future studies should explore strategies to optimize the implementation of onsite buprenorphine. Because linkage rates were suboptimal for methadone, offering onsite methadone treatment at SSPs may be an appealing solution, but would require changes in federal regulations. In tandem with continuing to develop onsite treatment capacity, funding should support evidence-based linkage interventions and increasing accessibility, availability, affordability and acceptability of SUD treatment programs.
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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
| | - Sabrina Fowler
- Present Address: Ascension St. John Hospital, 22101 Moross Road, Detroit, MI 48236 USA
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 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
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15
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Tschampl CA, Regis C, Johnson NE, Davis MT, Hodgkin D, Brolin MF, Do E, Horgan CM, Green TC, Reilly B, Duska M, Taveras EM. Protocol for the implementation of a statewide mobile addiction program. J Comp Eff Res 2023; 12:e220117. [PMID: 36988165 PMCID: PMC10402748 DOI: 10.57264/cer-2022-0117] [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: 06/27/2022] [Accepted: 02/13/2023] [Indexed: 03/30/2023] Open
Abstract
With overdose deaths increasing, improving access to harm reduction and low barrier substance use disorder treatment is more important than ever. The Community Care in Reach® model uses a mobile unit to bring both harm reduction and clinical care for addiction to people experiencing barriers to office-based care. These mobile units provide many resources and services to people who use drugs, including safer consumption supplies, naloxone, medication for substance use disorder treatment, and a wide range of primary and preventative care. This protocol outlines the evaluation plan for the Community in Care® model in MA, USA. Using the RE-AIM framework, this evaluation will assess how mobile services engage new and underserved communities in addiction services and primary and preventative care.
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Affiliation(s)
- Cynthia A Tschampl
- Institute on Healthcare Systems, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02453, USA
| | - Craig Regis
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nafissa E Johnson
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Margot Trotter Davis
- Institute for Behavioral Health, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02453, USA
| | - Dominic Hodgkin
- Institute for Behavioral Health, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02453, USA
| | - Mary F Brolin
- Institute for Behavioral Health, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02453, USA
| | - Elizabeth Do
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Constance M Horgan
- Institute for Behavioral Health, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02453, USA
| | - Traci C Green
- Institute for Behavioral Health, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02453, USA
| | - Brittni Reilly
- Bureau of Substance Addiction Services, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - MaryKate Duska
- Bureau of Substance Addiction Services, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Elsie M Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA 02114, USA
- Mass General Brigham, Somerville, MA 02145, USA
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16
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Carlberg-Racich S, Sherrod D, Swope K, Brown D, Afshar M, Salisbury-Afshar E. Perceptions and Experiences With Evidence-based Treatments Among People Who Use Opioids. J Addict Med 2023; 17:169-173. [PMID: 36084213 PMCID: PMC9992442 DOI: 10.1097/adm.0000000000001064] [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: 11/26/2022]
Abstract
OBJECTIVES Even where treatment is available, people who use drugs (PWUD) may not seek help. Few published studies examine beliefs, experiences, and perceptions of evidence-based treatment among PWUD who are not actively engaged in care. This study aimed to explore the experiences of PWUD in considering or accessing treatment and gauge receptiveness to low-threshold treatment models. METHODS A purposeful sample of participants actively using opioids and with previous interest in or experience with treatment was recruited from a harm reduction program in Chicago. Semistructured interviews were conducted to explore key phenomena while allowing for unanticipated themes. The instrument included questions about historical drug use, treatment experience, and perceptions of how to improve treatment access and services. Private interviews were audio recorded, transcribed, and double coded by 2 analysts. Queries of coded data were analyzed using issue-focused analysis to identify themes. RESULTS The sample (N = 40) approximated groups at highest risk of fatal overdose in Chicago, with more than 80% between the ages of 45 to 64 years, 65% African American, and 62% male identified. The majority had prior treatment experience, although all resumed use after completing or leaving treatment. The most prevalent barriers to treatment included structural barriers related to social determinants, lack of readiness for abstinence, burdensome intake procedures, and regulatory/programmatic requirements. Most participants expressed interest in low-threshold treatment. CONCLUSIONS Existing treatment barriers may be addressed by shifting to lower-threshold intake processes and/or outreach-based delivery of opioid agonist treatment. Engaging PWUD in efforts to create lower-threshold treatment programs is necessary to ensure that needs are met.
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Affiliation(s)
- Suzanne Carlberg-Racich
- From the Master of Public Health Program, DePaul University, Chicago, IL (SC-R); Sinai Urban Health Institute, Chicago, IL (DS); Loyola University School of Medicine, Maywood, IL (KS, DB); Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (MA); Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (ES-A)
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17
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Grieb SM, Harris R, Rosecrans A, Zook K, Sherman SG, Greenbaum A, Lucas GM, Page KR. Awareness, perception and utilization of a mobile health clinic by people who use drugs. Ann Med 2022; 54:138-149. [PMID: 36799361 PMCID: PMC8741230 DOI: 10.1080/07853890.2021.2022188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION People who use drugs (PWUD) face a multitude of barriers to accessing healthcare and other services. Mobile health clinics (MHC) are an innovative, cost-effective health care delivery approach that increases healthcare access to vulnerable populations and medically underserved areas. There is limited understanding, however, of how PWUD perceive and experience MHCs. METHODS Semi-structured interviews were conducted with 31 PWUD - 16 who had received care (clients) on an MHC (The Spot) and 15 who had not (non-clients) - to explore their perceptions and utilization of an MHC partnered with a mobile syringe services program in Baltimore, Maryland. Data analysis of the text was conducted using an iterative thematic constant comparison process informed by grounded theory. RESULTS Clients and non-clients, once aware of the MHC, had positive perceptions of The Spot and its benefits for their individual health as well as for the wellbeing of their community. These sentiments among clients were largely driven by access to low-barrier buprenorphine and service delivery without stigma around drug use. However, lack of general awareness of the spot and specific service offering were barriers to its use among non-clients. DISCUSSION MHCs provide an important opportunity to engage PWUD in healthcare and to expand buprenorphine use; however, even with accessibility near where PWUD access injection equipment, barriers to its use remain. Peer dissemination may be able to facilitate program information sharing and recruitment.KEY MESSAGESPeople who use drugs perceive a mobile health clinic in their neighbourhood as a benefit to their communities and themselves by improving access to healthcare services, providing access to low-threshold buprenorphine dispensation, and offering services without drug use stigma.People who use drugs learned about a mobile health clinic in their neighbourhood largely through word-of-mouth. As a result, people received limited information about the mobile health clinic services creating a barrier to its use.
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Affiliation(s)
- Suzanne M Grieb
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Harris
- Baltimore City Health Department, Baltimore, MD, USA
| | - Amanda Rosecrans
- Baltimore City Health Department, Baltimore, MD, USA.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Zook
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen R Page
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Holmes LM, Rishworth A, King BH. Disparities in opioid overdose survival and naloxone administration in Pennsylvania. Drug Alcohol Depend 2022; 238:109555. [PMID: 35810621 DOI: 10.1016/j.drugalcdep.2022.109555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pennsylvania has one of the highest opioid overdose rates in the US; however, since 2018 approximately 80% of people who experienced an opioid overdose in the state survived. More attention has been paid to opioid overdose mortality despite notable individual and geographic differences in overdose survival. Naloxone is an essential tool in increasing chances of survival after opioid overdose, but its availability and the rate at which it is administered differs by county in Pennsylvania and nationally. METHODS We use 2018-2020 Pennsylvania Overdose Information Network data on opioid incidents and where they occurred, combined with 2015-2019 American Community Survey data, to evaluate opioid overdose survival and naloxone administration by county over a three-year period. RESULTS Individuals who received at least one dose of naloxone following overdose had 11 times greater odds of survival. White, middle-aged men were least likely to survive opioid overdose. Both survival and naloxone administration rates differed by county with lower rates in less populated counties. CONCLUSION Expanding naloxone distribution and administration and ensuring proper education about standing orders for naloxone administration are important tools for addressing opioid overdose mortality.
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Affiliation(s)
- Louisa M Holmes
- The Pennsylvania State University, Department of Geography, University Park, PA 16802, USA.
| | - Andrea Rishworth
- University of Toronto Mississauga, Department of Geography, Geomatics and Environment, Mississauga, ON L5L 1C6, Canada
| | - Brian H King
- The Pennsylvania State University, Department of Geography, University Park, PA 16802, USA
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Harris R, Rosecrans A, Zoltick M, Willman C, Saxton R, Cotterell M, Bell J, Blackwell I, Page KR. Utilizing telemedicine during COVID-19 pandemic for a low-threshold, street-based buprenorphine program. Drug Alcohol Depend 2022; 230:109187. [PMID: 34890927 PMCID: PMC8619879 DOI: 10.1016/j.drugalcdep.2021.109187] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Changes in federal policy during the COVID-19 pandemic allowing for the use of telemedicine to treat opioid use disorder (OUD) have facilitated innovative strategies to engage and retain people in treatment. Since 2018, the Baltimore City Health Department has operated a mobile street medicine program called Healthcare on The Spot (The Spot) that provides treatment for OUD and infectious diseases. This study describes the transition of The Spot's buprenorphine service to telemedicine during the COVID-19 pandemic and one year treatment retention. METHODS Patients actively engaged in care at the time of transition to telemedicine and patients newly engaged in buprenorphine services through telemedicine were included in this descriptive analysis and assessed at one year for retention. RESULTS From March 16, 2020 to March 15, 2021, The Spot provided voice-only buprenorphine treatment services to 150 patients, 70.7% (n = 106) male and 80.0% (n = 120) Black; 131 were patients who transitioned from in person services and 19 were newly engaged via telemedicine. 80.7% (n = 121) of patients remained engaged in treatment at one year, 16.0% (n = 24) were lost to follow-up, and 3.3% (n = 5) were deceased. Patients newly engaged via telemedicine were more likely to be female and white than those retained from in person services. CONCLUSION The Spot's transition of patients from a street medicine program to telemedicine during the COVID-19 pandemic has implications for future practice. Increased flexibility of service delivery, extended prescription length, and decreased UDT likely contributed to high retention rates and should inform the future structure of low-threshold buprenorphine programs.
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Affiliation(s)
- Robert Harris
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Baltimore City Health Department, Baltimore, MD, USA.
| | - Amanda Rosecrans
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Meredith Zoltick
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Catherine Willman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Ronald Saxton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Margaret Cotterell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Joy Bell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Ingrid Blackwell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
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