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Austin EJ, Chen J, Soyer E, Idrisov B, Briggs ES, Moghimi Y, Saxon AJ, Fortney JC, Blanchard BE, Williams EC, Ratzliff AD, Ruiz MS, Koch U. Primary care team perspectives on approaches to engaging patients in treatment for opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209456. [PMID: 39067765 PMCID: PMC11347117 DOI: 10.1016/j.josat.2024.209456] [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: 12/20/2023] [Revised: 04/28/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Engagement is a critical component of successful treatment for opioid use disorder (OUD). However, rates of patient engagement in OUD treatment, especially in outpatient settings, are variable and often low. Little is known about the specific strategies members of primary care teams use to initiate and encourage ongoing participation in OUD treatment. In a national cohort of primary care clinics in the U.S., we explored the perspectives of primary care team members on the meaning of and approaches to OUD treatment engagement. METHODS We conducted semi-structured interviews with 35 providers from multidisciplinary primary care teams in an existing national cohort of 13 clinics across seven states. Teams were delivering OUD treatment via the Collaborative Care Model, a model that combines primary care providers (PCP), behavioral health care managers (BHCM) and consulting psychiatric providers (CPP) in a structured way to provide patient-centered, team-based, and measurement-based care. Interview participants included 14 PCPs, 13 BHCMs, and 8 CPPs. Interviews asked open-ended questions about provider experiences and practices that aided or hindered patient engagement in OUD treatment. Interview transcripts were double-coded by trained qualitative researchers and analyzed using a combination of deductive and inductive approaches to identify themes. RESULTS Two themes emerged that describe provider perspectives on the meaning of engagement: 1) qualifying engagement by the volume of contact with patients, and 2) the need for more multidimensional measures of engagement. Six themes emerged that characterized provider engagement practices: 1) creating an environment of disclosure, 2) normalizing OUD treatment, 3) offering gentle but persistent outreach, 4) providing human connection and encouragement, 5) tailoring treatment to patient needs, and 6) avoiding stigmatizing responses. Analysis identified multiple replicable strategies that providers used to support these engagement practices. CONCLUSIONS Providers consistently apply a range of strategies when trying to engage patients in OUD treatment. Specific engagement strategies used embodied compassion and pragmatism, hallmarks of patient-centered care. Further research is needed to understand the impact of scaling engagement approaches across all care settings.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America; Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., United States of America.
| | - Jessica Chen
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Elena Soyer
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Bulat Idrisov
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Elsa S Briggs
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Yavar Moghimi
- Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, The George Washington University, United States of America
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound, Seattle, WA, United States of America
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, United States of America; Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, United States of America
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, United States of America
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America; Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, United States of America
| | - Anna D Ratzliff
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, United States of America
| | - Monica S Ruiz
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C., United States of America
| | - Ulrich Koch
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., United States of America
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Goodwin S, Kirby KC, Raiff BR. Evolution of the substance use landscape: Implications for contingency management. J Appl Behav Anal 2024. [PMID: 39193870 DOI: 10.1002/jaba.2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024]
Abstract
Contingency management (CM), which involves the delivery of incentives upon meeting behavioral goals, has the potential to improve substance use treatment outcomes. The intervention allows for flexibility through numerous modifiable components including changes to incentive magnitude and schedule, target behavior, and intervention structure. Unfortunately, numerous changes in the substance use landscape have occurred in the past 10 to 15 years: Substances are more potent, overdose risk has increased, new substances and methods of use have been introduced, and substance classes are increasingly being intentionally and unintentionally mixed. These developments potentially undermine CM outcomes. We explored recent substance use changes due to legislative, regulatory, social, and economic factors for four substance classes: stimulants, opioids, tobacco, and cannabis. We discuss potential adjustments to the modifiable components of CM for future research in response to these changes. By continually adapting to the shifting substance use landscape, CM can maintain optimal efficacy.
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Affiliation(s)
- Shelby Goodwin
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
| | | | - Bethany R Raiff
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
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Epland C, Pals H, Hayden J. Buprenorphine Enhanced Taper Tolerability Evaluation Report (BETTER): A Case Series. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241242242. [PMID: 38591225 DOI: 10.1177/29767342241242242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Discontinuing sublingual buprenorphine (SL-BUP) has been identified by some patients as a potential outcome of success for opioid use disorder treatment. The process of tapering SL-BUP can be lengthy as unpleasant opioid withdrawal symptoms limit the pace of dose adjustments. Uncontrolled withdrawal symptoms pose a risk for return to illicit opioid use and more patient-centered options for tapering SL-BUP are needed. Previous case reports have identified using extended-release subcutaneous buprenorphine (ER-BUP) to minimize withdrawal symptoms as the dose self-decreases very gradually. Ideal dosing strategies, appropriate patient characteristics, and duration of buprenorphine release with the ER-BUP injection are not well described. PATIENT CASES We present 8 cases where a single 100 mg ER-BUP injection was administered to patients experiencing intolerable withdrawal symptoms during SL-BUP taper. Patients were taking between 2 and 6 mg SL-BUP daily prior to injection. Three patients experienced mild adverse effects the day after receiving injection, all of which were taking lower SL-BUP doses (2-3 mg). In the 12 months following injection, 3 patients experienced mild, but tolerable withdrawal symptoms at variable intervals. Two patients returned to taking SL-BUP and no patients returned to illicit opioid use. Buprenorphine urine toxicology showed elimination of buprenorphine occurred after 24 weeks. DISCUSSION Findings from these cases support current evidence-based guidance that ER-BUP tapering is better tolerated than traditional SL-BUP tapering. These patient cases and pharmacokinetic modeling of ER-BUP suggest that a target preinjection dose of 2 to 6 mg SL-BUP will minimize the risk of more severe adverse effects or withdrawal symptoms. Patients and providers should ensure that remission is well-established before initiating SL-BUP taper. A shared decision-making approach can help support patient autonomy and understanding safety risks of discontinuing SL-BUP. Future prospective studies with larger populations could further refine dosing strategies with various SL-BUP preinjection doses and newer ER-BUP formulations.
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Affiliation(s)
- Claudia Epland
- Minneapolis Veterans Affairs Hospital, Minneapolis, MN, USA
| | - Haley Pals
- Tomah Veterans Affairs Medical Center, Tomah, WI, USA
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Saraiya TC, Jones AC, Lopez-Castro T, Hood CO, Flores J, Badour CL. Trauma-related shame predicts daily non-medical prescription opioid use among individuals with PTSD symptoms. J Psychiatr Res 2024; 171:171-176. [PMID: 38290235 PMCID: PMC10922897 DOI: 10.1016/j.jpsychires.2024.01.041] [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: 06/13/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
Non-medical prescription opioid use (NMPOU) is the use of opioids without a prescription or in a way different from how they were prescribed and is the fourth most common type of drug use in the United States. Separate research has shown that trauma-related shame is linked to posttraumatic stress disorder (PTSD) and, respectively, opioid use. However, no study to date has empirically examined the association between trauma-related shame and NMPOU among individuals with PTSD symptoms. Forty adults with clinical or subclinical PTSD who reported engaging in NMPOU at least one day in the prior month before the study completed 28 days of daily surveys. Trauma-related shame was measured at baseline. NMPOU and underlying motives to engage in NMPOU were assessed once daily via a smartphone app. Twenty-four participants (60 %) reported NMPOU over the 28-day period. After controlling for PTSD symptoms and covariates, mixed models showed that higher trauma-related shame significantly predicted higher risk of daily NMPOU (B = 0.06, SE = 0.03, t = 2.14, p=.03). After controlling for false discovery rates, trauma-related shame also significantly predicted NMPOU due to the following motives (p's < 0.031): to manage depression/sadness, to manage anxiety, to manage other stress/worry, and to get high. Among individuals with PTSD, higher baseline trauma-related shame prospectively and positively predicted greater NMPOU over a four-week daily monitoring period. Findings suggest a need to attend to trauma-related shame and its impact on subsequent motivations to engage in NMPOU. Future research should examine how treatments may effectively target trauma-related shame to reduce NMPOU and more severe PTSD symptoms.
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Affiliation(s)
- Tanya C Saraiya
- Center for Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Alyssa C Jones
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Southeast Mental Illness Research, Education, and Clinical Centers, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | | | - Caitlyn O Hood
- Department of Psychiatry, University of Kentucky, Lexington, KY, USA
| | - Jessica Flores
- South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Christal L Badour
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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Koltenyuk V, Mrad I, Choe I, Ayoub MI, Kumaraswami S, Xu JL. Multimodal Acute Pain Management in the Parturient with Opioid Use Disorder: A Review. J Pain Res 2024; 17:797-813. [PMID: 38476879 PMCID: PMC10928917 DOI: 10.2147/jpr.s434010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/08/2024] [Indexed: 03/14/2024] Open
Abstract
The opioid epidemic in the United States has led to an increasing number of pregnant patients with opioid use disorder (OUD) presenting to obstetric units. Caring for this complex patient population requires an interdisciplinary approach involving obstetricians, anesthesiologists, addiction medicine physicians, psychiatrists, and social workers. The management of acute pain in the parturient with OUD can be challenging due to several factors, including respiratory depression, opioid tolerance, and opioid-induced hyperalgesia. Patients with a history of OUD can present in one of three categories: 1) those with untreated OUD; 2) those who are currently abstinent from opioids; 3) those being treated with medications to prevent withdrawal. A patient-centered, multimodal approach is essential for optimal peripartum pain relief and prevention of adverse maternal and neonatal outcomes. Medications for opioid use disorder (MOUD), previously referred to as medication-assisted therapy (MAT), include opioids like methadone, buprenorphine, and naltrexone. These are prescribed for pregnant patients with OUD, but appropriate dosing and administration of these medications are critical to avoid withdrawal in the mother. Non-opioid analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used in a stepwise approach, and regional techniques like neuraxial anesthesia and truncal blocks offer opioid-sparing options. Other medications like ketamine, clonidine, dexmedetomidine, nitrous oxide, and gabapentinoids show promise for pain management but require further research. Overall, a comprehensive pain management strategy is essential to ensure the well-being of both the mother and the fetus in pregnant patients with OUD.
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Affiliation(s)
| | - Ismat Mrad
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY, USA
| | - Ian Choe
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Mohamad Ibrahim Ayoub
- Department of Anesthesiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sangeeta Kumaraswami
- Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, NY, USA
| | - Jeff L Xu
- Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, NY, USA
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Skogseth EM, Brant K, Harrison E, Apsley HB, Crowley M, Schwartz RP, Jones AA. Women and Treatment for Opioid Use Disorder: Contributors to Treatment Success From the Perspectives of Women in Recovery, Women With Past Attempts in Drug Treatment, and Health and Criminal Justice Professionals. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:11782218231222339. [PMID: 38433748 PMCID: PMC10906498 DOI: 10.1177/11782218231222339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 03/05/2024]
Abstract
Introduction The disproportionate incidence of opioid use disorder (OUD) and the alarming increases in opioid-related overdose deaths among women highlight a clear need for the expansion of effective harm reduction and treatment practices. Research supports medications for opioid use disorders (MOUD) as an effective intervention; however, with low rates of utilization of such, there is a need to identify factors that facilitate MOUD treatment uptake and retention for women. Thus, the current study examines contributors to treatment success through the triangulation of perspectives from affected women as well as health and criminal justice professionals. Methods Interviews (N = 42) were conducted from May to July 2022 with women in recovery who previously used or currently use MOUD (N = 10), women who currently use opioids who terminated a MOUD program previously (N = 10), SUD treatment professionals (N = 12), and criminal justice professionals who work with women who use opioids (N = 10). Interviews for all participants centered around their backgrounds, perceived barriers and facilitators to MOUD treatment, and issues specific to women in treatment for substance use disorder. We used a thematic qualitative data analysis process to analyze transcripts. Results Participants highlighted contributors to treatment success from 3 domains: (1) internal processes (including promoting self-efficacy and setting realistic goals), (2) access to resources (including material resources, such as food and shelter, educational resources and social support), and (3) treatment structure (such as treatment type and protocol). Conclusion Internal processes, access to resources, and treatment structure contribute to MOUD treatment success for women with OUD. Structured support where experiences are shared, and realistic goals are set, may promote feelings of acceptance and empowerment, thereby bolstering chances of treatment success. Additionally, the court system can promote evidence-based and trauma-informed substance use treatment and provide accessible educational resources related to substance use to extend these benefits to more women.
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Affiliation(s)
- Emma M Skogseth
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Kristina Brant
- Department of Agricultural Economics, Society, and Education, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, PA, USA
| | - Eric Harrison
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Hannah B Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Max Crowley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | | - Abenaa A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, PA, USA
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Adams A, Blawatt S, Magel T, MacDonald S, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review. Subst Abuse Treat Prev Policy 2023; 18:56. [PMID: 37777766 PMCID: PMC10543348 DOI: 10.1186/s13011-023-00564-9] [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] [Received: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic review to explore the impact of these changes on program effectiveness and client experiences in OAT. METHODS The protocol for this review was registered in PROSPERO (CRD42022352310). From Aug.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, Cochrane Register of Controlled Trials, and the grey literature. We included studies reporting quantitative measures of retention in treatment, illicit substance use, overdose, client health, quality of life, or treatment satisfaction or using qualitative methods to examine client experiences with take-home doses during the pandemic. We critically appraised studies using the Mixed Methods Appraisal Tool. We synthesized quantitative data using vote-counting by direction of effect and presented the results in harvest plots. Qualitative data were analyzed using thematic synthesis. We used a convergent segregated approach to integrate quantitative and qualitative findings. RESULTS Forty studies were included. Most were from North America (23/40) or the United Kingdom (9/40). The quantitative synthesis was limited by potential for confounding, but suggested an association between take-home doses and increased retention in treatment. There was no evidence of an association between take-home doses and illicit substance use or overdose. Qualitative findings indicated that take-home doses reduced clients' exposure to unregulated substances and stigma and minimized work/treatment conflicts. Though some clients reported challenges with managing their medication, the dominant narrative was one of appreciation, reduced anxiety, and a renewed sense of agency and identity. The integrated analysis suggested reduced treatment burden as an explanation for improved retention and revealed variation in individual relationships between take-home doses and illicit substance use. We identified a critical gap in quantitative measures of patient-important outcomes. CONCLUSION The relaxation of restrictions on take-home doses was associated with improved client experience and retention in OAT. We found no evidence of an association with illicit substance use or overdose, despite the expansion of take-home doses to previously ineligible groups. Including patient-important outcome measures in policy, program development, and treatment planning is essential to ensuring that decisions around take-home doses accurately reflect their value to clients.
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Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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Mahone A, Enich M, Treitler P, Lloyd J, Crystal S. Opioid use disorder treatment and the role of New Jersey Medicaid policy changes: perspectives of office-based buprenorphine providers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:606-617. [PMID: 37506336 PMCID: PMC10826857 DOI: 10.1080/00952990.2023.2234075] [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: 02/09/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Background: In the US, seventy percent of drug-related deaths are attributed to opioids. In response to the ongoing opioid crisis, New Jersey's (NJ) Medicaid program implemented the MATrx model to increase treatment access for Medicaid participants with opioid use disorder (OUD). The model's goals include increasing the number of office-based treatment providers, enhancing Medicaid reimbursement for certain treatment services, and elimination of prior authorizations for OUD medications.Objectives: To explore office-based addiction treatment providers' experiences delivering care in the context of statewide policy changes and their perspectives on treatment access changes and remaining barriers.Methods: This qualitative study used purposive sampling to recruit office-based New Jersey medications for opioid use disorder (MOUD) providers . Twenty-two providers (11 females, 11 males) discussed treatment experiences since the policy changes in 2019, including evaluations of the current state of OUD care in New Jersey and perceived outcomes of the MATrx model policy changes.Results: Providers reported the MOUD climate in NJ improved as Medicaid implemented policies intended to reduce barriers to care and increase treatment access. Elimination of prior authorizations was noted as important, as it reduced provider burden and allowed greater focus on care delivery. However, barriers remained, including stigma, pharmacy supply issues, and difficulty obtaining injectable or non-generic medication formulations.Conclusion: NJ policies may have improved access to care for Medicaid beneficiaries by reducing barriers to care and supporting providers in prescribing MOUD. Yet, stigma and lack of psychosocial supports still need to be addressed to further improve access and care quality.
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Affiliation(s)
- Anais Mahone
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901
- School of Social Work, Rutgers, the State University of New Jersey, 120 Albany St. New Brunswick, NJ 08901
| | - Michael Enich
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901
- School of Social Work, Rutgers, the State University of New Jersey, 120 Albany St. New Brunswick, NJ 08901
| | - Peter Treitler
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901
- School of Social Work, Rutgers, the State University of New Jersey, 120 Albany St. New Brunswick, NJ 08901
| | - James Lloyd
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901
- School of Social Work, Rutgers, the State University of New Jersey, 120 Albany St. New Brunswick, NJ 08901
- School of Public Health, Rutgers, the State University of New Jersey, 683 Hoes Lane West. Piscataway, NJ 08854
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Magel T, Matzinger E, Blawatt S, Harrison S, MacDonald S, Amara S, Metcalfe R, Bansback N, Byres D, Schechter M, Oviedo-Joekes E. How injectable opioid agonist treatment (iOAT) care could be improved? service providers and stakeholders’ perspectives. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2176287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Tianna Magel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Elizabeth Matzinger
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Sarah Blawatt
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Sherif Amara
- SafePoint Supervised Consumption Site, Fraser Health Authority, Surrey, Canada
| | - Rebecca Metcalfe
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - David Byres
- Provincial Health Services Authority, Vancouver, Canada
| | - Martin Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
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Reed MK, Smith KR, Ciocco F, Hass RW, Cox AL, Kelly EL, Weinstein LC. Sorting through life: evaluating patient-important measures of success in a medication for opioid use disorder (MOUD) treatment program. Subst Abuse Treat Prev Policy 2023; 18:4. [PMID: 36641478 PMCID: PMC9839958 DOI: 10.1186/s13011-022-00510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/22/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) is the gold standard treatment for opioid use disorder. Traditionally, "success" in MOUD treatment is measured in terms of program retention, adherence to MOUD, and abstinence from opioid and other drug use. While clinically meaningful, these metrics may overlook other aspects of the lives of people with opioid use disorder (OUD) and surprisingly do not reflect the diagnostic criteria for OUD. METHODS Authors identified items for a pilesorting task to identify participant-driven measures of MOUD treatment success through semi-structured interviews. Interviews were transcribed verbatim and coded in Nvivo using directed and conventional content analysis to identify measures related to treatment success and quality of life goals. Participants of a low-threshold MOUD program were recruited and asked to rank identified measures in order of importance to their own lives. Multidimensional scaling (MDS) compared the similarity of items while non-metric MDS in R specified a two-dimensional solution. Descriptive statistics of participant demographics were generated in SPSS. RESULTS Sixteen semi-structured interviews were conducted between June and August 2020 in Philadelphia, PA, USA, and 23 measures were identified for a pilesorting activity. These were combined with 6 traditional measures for a total list of 29 items. Data from 28 people were included in pilesorting analysis. Participants identified a combination of traditional and stakeholder-defined recovery goals as highly important, however, we identified discrepancies between the most frequent and highest ranked items within the importance categories. Measures of success for participants in MOUD programs were complex, multi-dimensional, and varied by the individual. However, some key domains such as emotional well-being, decreased drug use, and attendance to basic functioning may have universal importance. The following clusters of importance were identified: emotional well-being, decreased drug use, and human functioning. CONCLUSIONS Outcomes from this research have practical applications for those working to provide services in MOUD programs. Programs can use aspects of these domains to both provide patient-centered care and to evaluate success. Specifics from the pilesorting results may also inform approaches to collaborative goal setting during treatment.
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Affiliation(s)
- Megan K. Reed
- grid.265008.90000 0001 2166 5843Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Curtis Building, Suite 704, PA 19107 Philadelphia, USA ,grid.265008.90000 0001 2166 5843Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA ,grid.265008.90000 0001 2166 5843Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA USA
| | - Kelsey R. Smith
- grid.265008.90000 0001 2166 5843Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - Francesca Ciocco
- grid.265008.90000 0001 2166 5843Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - Richard W. Hass
- grid.265008.90000 0001 2166 5843Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA USA ,grid.265008.90000 0001 2166 5843Jefferson Center for Interprofessional Practice and Education, Thomas Jefferson University, Philadelphia, PA USA
| | - Avery Lin Cox
- grid.265008.90000 0001 2166 5843Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - Erin L. Kelly
- grid.265008.90000 0001 2166 5843Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - Lara C. Weinstein
- grid.265008.90000 0001 2166 5843Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
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11
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Wyse JJ, Lovejoy TI, Gordon AJ, Mackey K, Herreid-O'Neill A, Morasco BJ. "I'm Clean and Sober, But Not Necessarily Free": Perceptions of Buprenorphine Among Patients in Long-Term Treatment. Subst Abus 2023; 44:41-50. [PMID: 37226910 PMCID: PMC11132627 DOI: 10.1177/08897077231165625] [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: 05/26/2023]
Abstract
BACKGROUND Patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved clinical outcomes. Despite this, patients often express desires to discontinue treatment and some view taper as treatment success. Little is known about the beliefs and medication perspectives of patients engaged in long-term buprenorphine treatment that may underlie motivations to discontinue. METHODS This study was conducted at the VA Portland Health Care System (2019-2020). Qualitative interviews were conducted with participants prescribed buprenorphine for ≥2 years. Coding and analysis were guided by directed qualitative content analysis. RESULTS Fourteen patients engaged in office-based buprenorphine treatment completed interviews. While patients expressed strong enthusiasm for buprenorphine as a medication, the majority expressed the desire to discontinue, including patients actively tapering. Motivations to discontinue fell into 4 categories. First, patients were troubled by perceived side effects of the medication, including effects on sleep, emotion, and memory. Second, patients expressed unhappiness with being "dependent" on buprenorphine, framed in opposition to personal strength/independence. Third, patients expressed stigmatized beliefs about buprenorphine, describing it as "illicit," and associated with past drug use. Finally, patients expressed fears about buprenorphine unknowns, including potential long-term health effects and interactions with medications required for surgery. CONCLUSIONS Despite recognizing benefits, many patients engaged in long-term buprenorphine treatment express a desire to discontinue. Findings from this study may help clinicians anticipate patient concerns and can be used to inform shared decision-making conversations regarding buprenorphine treatment duration.
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Epidemiology & Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katherine Mackey
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Anders Herreid-O'Neill
- Oregon Rural Practice Network (ORPRN), Oregon Health & Science University, Portland, OR, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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12
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Kelley AT, Incze MA. The need for a more inclusive and objective approach in developing a core outcomes set for opioid use disorder. Addiction 2023; 118:194-195. [PMID: 36148639 DOI: 10.1111/add.16054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Alan Taylor Kelley
- Vulnerable Veteran Innovative Patient Aligned Care Team (VIP) Initiative, Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael A Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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13
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Magel J, Hartman P, Fritz JM, Koch NN, Dostal H, Vollmer N, Ferguson NL, Tapken J, Cohee K, Cochran G, Gordon AJ. Patients' Perceptions of Physical Therapists Addressing Opioid Misuse. Subst Abus 2023; 44:32-40. [PMID: 37226908 DOI: 10.1177/08897077231165072] [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: 05/26/2023]
Abstract
INTRODUCTION In the US, rising numbers of patients who misuse illicit or prescribed opioids provides opportunities for physical therapists (PTs) to be engaged in their care. Prior to this engagement, it is necessary to understand the perceptions of patients who access physical therapy services about their PTs playing such a role. This project examined patients' perceptions of PTs addressing opioid misuse. METHODS We surveyed patients, newly encountering outpatient physical therapy services in a large University-based healthcare setting, via anonymous, web-based survey. Within the survey, questions were rated on a Likert scale (1 = completely disagree to 7 = completely agree) and we evaluated responses of patients who were prescribed opioids versus those who were not. RESULTS Among 839 respondents, the highest mean score was 6.2 (SD = 1.5) for "It is OK for physical therapists to refer their patients with prescription opioid misuse to a specialist to address the opioid misuse." The lowest mean score was 5.6 (SD = 1.9) for "It is OK for physical therapists to ask their patient why they are misusing prescription opioids." Compared to those with no prescription opioid exposure while attending physical therapy, patients with prescription opioid exposure had lower agreement that it was OK for the physical therapist to refer their patients with opioid misuse to a specialist (β = -.33, 95% CI = -0.63 to -0.03). CONCLUSIONS Patients attending outpatient physical therapy seem to support PTs addressing opioid misuse and there are differences in support based on whether the patients had exposure to opioids.
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Affiliation(s)
- John Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Paul Hartman
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Nicholas N Koch
- University of Utah Health, University of Utah, Salt Lake City, UT, USA
| | - Hannah Dostal
- University of Utah Health, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jennifer Tapken
- Direct Performance Physical Therapy, Virginia Beach, VA, USA
| | - Kim Cohee
- University of Utah Health, University of Utah, Salt Lake City, UT, USA
| | - Gerald Cochran
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA) and Greater Intermountain Node (GIN) of the NIDA Clinical Trials Network, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA) and Greater Intermountain Node (GIN) of the NIDA Clinical Trials Network, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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14
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Palis H, Xavier C, Dobrer S, Desai R, Sedgemore KO, Scow M, Lock K, Gan W, Slaunwhite A. Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study. BMC Public Health 2022; 22:2084. [PMCID: PMC9664696 DOI: 10.1186/s12889-022-14506-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Stimulant use has been rising among people with opioid use disorder in recent years in North America, alongside a parallel rise in illicit drug toxicity (overdose) deaths. This study aimed to examine the association between stimulant use and overdose mortality.
Methods
Data from a universal health insurance client roster were used to identify a 20% random general population sample (aged ≥12) in British Columbia, Canada between January 1 2015 and December 31 2018 (N = 1,089,682). Provincial health records were used to identify people who used opioids and/or stimulants. Fatal overdose observed during follow-up (January 12,015- December 312,018) was retrieved from Vital Statistics Death Registry and BC Coroners Service Data. Potential confounders including age, sex, health region, comorbidities and prescribed medications were retrieved from the provincial client roster and health records.
Results
We identified 7460 people who used stimulants and or opioids. During follow-up there were 272 fatal overdose events. People who used both opioids and stimulants had more than twice the hazard of fatal overdose (HR: 2.02, 95% CI: 1.47-2.78, p < 0.001) compared to people who used opioids only. The hazard of death increased over time among people who used both opioids and stimulants.
Conclusions
There is an urgent need to prioritize the service needs of people who use stimulants to reduce overdose mortality in British Columbia. Findings have relevance more broadly in other North American settings, where similar trends in opioid and stimulant polysubstance use have been observed.
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