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Nahian A, McFadden LM. Changes in Substance Use Diagnoses in the Great Plains during the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:1630. [PMID: 39201189 PMCID: PMC11353988 DOI: 10.3390/healthcare12161630] [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: 06/18/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
As drug overdose mortality rises in the United States, healthcare visits present critical opportunities to mitigate this trend. This study examines changes in healthcare visits for substance use disorders (SUDs) and remission prior to and during the COVID-19 pandemic in the Great Plains, with a focus on identifying the characteristics of those served. Data were analyzed from 109,671 patient visits (mode = one visit per patient), encompassing diverse demographics, including sex, age, race, ethnicity, and geographic location. Visits analyzed included those for Alcohol Use Disorder (AUD), Opioid Use Disorder (OUD), or Stimulant Use Disorder (StUD) and those in remission of these disorders between March 2019 and March 2021. Patient demographic information and geographic factors, like rurality and Medicaid expansion status, were considered, and logistic regression was utilized. Visits were primarily by White (70.83%) and Native American (21.39%) patients, non-Hispanic (91.70%) patients, and males (54.16%). Various demographic, geographic, and temporal trends were observed. Findings indicated that males were more likely to receive an AUD diagnosis, while females were more likely to receive an OUD or StUD diagnosis. Metropolitan-residing patients were more likely to receive an AUD diagnosis, while non-metropolitan patients were more likely to receive an OUD diagnosis. Remission odds increased for StUD during the pandemic but decreased for AUD and OUD. These findings illuminate the demographic and geographic patterns of SUD-related healthcare visits, suggesting critical touchpoints for intervention. The results emphasize the urgent need for targeted healthcare strategies, especially in rural and underserved areas, to address persistent health disparities.
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Affiliation(s)
- Ahmed Nahian
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine at Seton Hill, Lynch Hall, 20 Seton Hill Dr, Greensburg, PA 15601, USA
| | - Lisa M. McFadden
- Division of Basic Biomedical Sciences, University of South Dakota, 414 E. Clarke St., Vermillion, SD 57069, USA
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Lewandowski ME, Delawalla CN, Butcher TJ, Oberlin BG. Changes in substance use, recovery, and quality of life during the initial phase of the COVID-19 pandemic. PLoS One 2024; 19:e0300848. [PMID: 38776315 PMCID: PMC11111065 DOI: 10.1371/journal.pone.0300848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/05/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted lives on a massive scale. While the pandemic appeared to worsen mental health outcomes broadly, its effects on alcohol/substance use and recovery are unclear. Many studies convolved the sociopolitical unrest beginning in May 2020 with the pandemic. We assessed pandemic-related changes in substance use, recovery involvement, and quality of life among US adults at two specified time periods that isolated pandemic effects from potentially confounding sociopolitical factors. OBJECTIVES We tested the following hypotheses: the pandemic and consequent policies (1) increased use of alcohol and illicit substances in active users; (2) increased use of alcohol/substances among people in early recovery; (3) reduced participation in recovery activities among those in early recovery, and that (4) use amount and use events correlated with impulsivity in both groups and that (5) substance use and abstinence correlated with resilience. METHODS We recruited 1,685 participants through Amazon's Mechanical Turk (MTurk). We assessed demographics, quality of life, alcohol/substance use, recovery activities, and measures of impulsivity and resilience at two time points, pre-pandemic and (early) during-pandemic. Only n = 45 (Active Users; males n = 32) and n = 34 (Recovery; males n = 20) passed data quality checks and were included in the primary analyses. RESULTS Among Active Users, weekly alcohol consumption and days spent using alcohol and illicit substances decreased during the pandemic. Resilience negatively correlated with pandemic-related substance use in early recovering participants. Significant reduction in the quality of life was coincident with a trend of lower recovery activity participation (31% decline) during the pandemic. CONCLUSIONS The reduced alcohol/substance use and participation in recovery activities might be expected from conditions that promote social isolation. The high prevalence of low-quality data from MTurk cautions for careful use of online data sourcing.
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Affiliation(s)
- Megayn E. Lewandowski
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Colette N. Delawalla
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
- Department of Psychological Science, Ball State University, Muncie, Indiana, United States of America
| | - Tarah J. Butcher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Brandon G. Oberlin
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
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Hughes PM, Easterly CW, Thomas KC, Shea CM, Domino ME. North Carolina Medicaid System Perspectives on Substance Use Disorder Treatment Policy Changes During the COVID-19 Pandemic. J Addict Med 2024; 18:e1-e7. [PMID: 38345239 PMCID: PMC10940189 DOI: 10.1097/adm.0000000000001272] [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: 03/14/2024]
Abstract
OBJECTIVE This study aimed to describe perspectives from stakeholders involved in the Medicaid system in North Carolina regarding substance use disorder (SUD) treatment policy changes during the coronavirus disease 2019 pandemic. METHODS We conducted semistructured interviews in early 2022 with state agency representatives, Medicaid managed care organizations, and Medicaid providers (n = 22) as well as 3 focus groups of Medicaid beneficiaries with SUD (n = 14). Interviews and focus groups focused on 4 topics: policies, meeting needs during COVID, demand for SUD services, and staffing. RESULTS Overall, policy changes, such as telehealth and take-home methadone, were considered beneficial, with participants displaying substantial support for both policies. Shifting demand for services, staffing shortages, and technology barriers presented significant challenges. Innovative benefits and services were used to adapt to these challenges, including the provision of digital devices and data plans to improve access to telehealth. CONCLUSIONS Perspectives from Medicaid stakeholders, including state organizations to beneficiaries, support the continuation of SUD policy changes that occurred. Staffing shortages remain a substantial barrier. Based on the participants' positive responses to the SUD policy changes made during the coronavirus disease 2019 pandemic, such as take-home methadone and telehealth initiation of buprenorphine, these changes should be continued. Additional steps are needed to ensure payment parity for telehealth services.
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Affiliation(s)
- Phillip M. Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy
- Division of Research, UNC Health Sciences at MAHEC, Asheville, NC
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caleb W. Easterly
- MD/PhD Program, UNC School of Medicine, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, UNC Chapel Hill
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christopher M. Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, UNC Chapel Hill
| | - Marisa Elena Domino
- Center for Health Information and Research (CHiR), College of Health Solutions, Arizona State University, Phoenix, AZ
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Sekeris A, Algahtani T, Aldabergenov D, Rock KL, Auwal F, Aldewaissan F, Williams BD, Kalk NJ, Copeland CS. Trends in deaths following drug use in England before, during, and after the COVID-19 lockdowns. Front Public Health 2023; 11:1232593. [PMID: 37841731 PMCID: PMC10570433 DOI: 10.3389/fpubh.2023.1232593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Aim This research aimed to describe how the characteristics of deaths following drug use changed during the COVID-19 pandemic in England, and how this can inform future strategy to support the health and social care of people who use drugs in future emergency scenarios. Method All deaths reported to the National Programme on Substance Abuse Deaths which occurred between January 2018 and December 2021 inclusive were extracted for analysis. Exponential smoothing models were constructed to determine any differences between forecasted vs. actual trends. Key results Following the first lockdown period in England there were significant increases in the proportion of people who died at home beyond the 95% confidence bounds of the exponential smoothing model and concurrent decreases in the proportion of people who died in hospital. Whilst the overall proportion of deaths attributable to opioids did not significantly deviate from the forecasted trend, there were significant increases in methadone-related deaths and decreases in heroin/morphine-related death beyond the 95% confidence bounds. The proportion of deaths concluded as suicide increased, as did those implicating antidepressant use. There were no changes in the proportion of deaths following use of other drug classes, alcohol use in combination with psychoactive drugs, or on decedent demographics (gender, age, and drug user status). A small number of deaths due to drug use had COVID-19 infection itself listed as a cause of death (n = 23). Conclusion For people who use drugs, the impact of the restrictions due to the COVID-19 pandemic was greater than that of infection from the virus itself. The health and social care strategy for these people needs to be pre-emptively adapted to mitigate against the specific risk factors for fatal drug overdose associated with future emergency scenarios.
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Affiliation(s)
- Athanasios Sekeris
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Thikra Algahtani
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Daniyar Aldabergenov
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Kirsten L. Rock
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Fatima Auwal
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Farah Aldewaissan
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Bryn D. Williams
- Department of Anaesthetics, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Nicola J. Kalk
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Caroline S. Copeland
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
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Mondera F, Cammalleri V, Forestiero FM, Turatto F, Direnzo GFM, Napoli A, Pirelli F, Razafimpanana N, Rossi E, Baccolini V, Cinti L, Marzuillo C, Barra M, Antonelli G, Badiani A, Villari P. Adherence to SARS-CoV-2 Vaccination Recommendations among Patients with Substance Use Disorders: A Cross-Sectional Study in Rome, Italy. Vaccines (Basel) 2023; 11:1434. [PMID: 37766111 PMCID: PMC10538200 DOI: 10.3390/vaccines11091434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Adherence to vaccination recommendations is a challenge for national immunization programs. We quantified adherence to COVID-19 vaccination recommendations in people with substance use disorders (SUDs) attending an outpatient addiction center in Rome, Italy; we investigated the determinants of adherence, and also analyzed patient risk perception and compliance with preventive measures. A multivariable logistic regression model identified predictors of adherence to vaccination recommendations, with statistical validity tested by estimating adjusted odds ratios (aORs) and 95% confidence intervals (CIs). From December 2021 to January 2022, 200 SUD patients completed a questionnaire, 80% of whom reported being vaccinated against SARS-CoV-2 (minimum one dose). Negative predictors of vaccine uptake included being non-Italian (aOR: 0.36, 95% CI: 0.13-0.97), having coexisting comorbidities (aOR: 0.35, 95% CI: 0.13-0.95), and previous use of heroin (aOR: 0.24, 95% CI: 0.08-0.71). No difference was found for cocaine use, demographic characteristics, previous COVID-19 infection, methadone therapy, or compliance with preventive measures. Major reasons for non-adherence to vaccination recommendations were fear of side effects, insufficient recognition of the importance of vaccination, bureaucratic issues, and lack of trust in the authorities. Given their vulnerability, additional efforts are needed to facilitate access to vaccination for people with SUDs, and to limit disinformation around vaccines..
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Affiliation(s)
- Francesco Mondera
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Vincenzo Cammalleri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Francesca Maria Forestiero
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | | | - Anna Napoli
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (A.N.); (L.C.); (G.A.)
| | - Francesca Pirelli
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; (F.P.); (N.R.)
| | - Nirinalisera Razafimpanana
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; (F.P.); (N.R.)
| | - Ettore Rossi
- Villa Maraini Foundation, 00151 Rome, Italy; (G.F.M.D.); (E.R.); (M.B.); (A.B.)
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Lilia Cinti
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (A.N.); (L.C.); (G.A.)
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
| | - Massimo Barra
- Villa Maraini Foundation, 00151 Rome, Italy; (G.F.M.D.); (E.R.); (M.B.); (A.B.)
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (A.N.); (L.C.); (G.A.)
| | - Aldo Badiani
- Villa Maraini Foundation, 00151 Rome, Italy; (G.F.M.D.); (E.R.); (M.B.); (A.B.)
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy; (F.P.); (N.R.)
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (F.M.F.); (F.T.); (V.B.); (C.M.); (P.V.)
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Fentem A, Riordan R, Doroshenko C, Li X, Kasson E, Banks D, Winograd RP, Cavazos-Rehg P. Impact of the COVID-19 pandemic on burnout and perceived workplace quality among addiction treatment providers. Addict Sci Clin Pract 2023; 18:5. [PMID: 36670445 PMCID: PMC9854021 DOI: 10.1186/s13722-023-00361-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study examines the impact of the COVID-19 pandemic on work satisfaction, work-related stress, and perceived work quality among substance use treatment providers to better understand challenges faced among this group during the pandemic. METHODS Participants of this study were 91 addiction treatment providers (e.g., therapists, physicians, community support specialists, administrative staff) recruited from various treatment facilities (e.g., inpatient and outpatient settings). Mixed method analyses were conducted to assess self-reported burnout, sources of work-related stress, and perceived work quality during the pandemic. Responses from providers reporting COVID-19 related decreases in work quality were compared to responses from providers who reported their quality of work had increased or remained the same. RESULTS Results demonstrated half of providers (51%) reported their quality of work had decreased. This perceived decrease in quality of work was associated with higher levels of emotional exhaustion (M = 17.41 vs. M = 12.48, p = 0.002), workplace stress (M = 42.80 vs. M = 30.84, p = 0.001), as well as decreased enjoyment of work (83% vs. 51%, p = 0.001) and decreased personal accomplishment (M = 20.64 vs. M = 23.05 p = 0.001). Qualitative investigations further illustrated that increased hours, changes in work schedules, work-life balance challenges, difficulties with client communication, and increased client needs were contributing factors increasing stress/burnout and decreasing perceived work quality. CONCLUSIONS Addiction treatment providers experience high levels of burnout and workplace stress. Additionally, many individuals perceived a decrease in their quality of work during the COVID-19 pandemic. Addiction treatment facility administration should address these challenges to support the well-being of clinical staff and the clients they serve both during and after the COVID-19 pandemic.
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Affiliation(s)
- Andrea Fentem
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Raven Riordan
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Christine Doroshenko
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Xiao Li
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Erin Kasson
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Devin Banks
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121 USA
| | - Rachel P. Winograd
- grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri St. Louis, 43 Benton Court, St. Louis, MO 63121 USA
| | - Patricia Cavazos-Rehg
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
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Meshberg-Cohen S, Farook M, Gross G, Levina V, DeViva J. Treatment utilization and modality preference among veterans receiving outpatient substance use disorder treatment during a pandemic. Am J Addict 2023; 32:32-39. [PMID: 36286598 DOI: 10.1111/ajad.13347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/23/2022] [Accepted: 09/24/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study examines substance use disorder (SUD) treatment utilization patterns in response to a pandemic. METHOD Retrospective electronic medical record data were collected during three time periods (N = 390): "Pre-COVID-19" (12/02/2019-03/14/2020), "COVID-19" (03/15/2020-06/30/2020), and COVID-19 "Re-entry" (7/01/2020-10/01/2020). Number of visits in each time period, SUD diagnosis, treatment modality (video, telephone, none), demographic, and clinical variables were examined. One-way analyses of variance (ANOVA) and chi-square analyses tested the relationships between treatment modality, demographics, clinical variables, and psychiatric emergency room (PER) visits. Binary logistic regressions examined the effect of treatment modality on PER use during COVID-19 and Re-entry, controlling for alcohol, opioid, and cocaine use disorders, age, and past-year (pre-COVID-19) PER use. RESULTS Treatment modality was associated with SUD (alcohol, cocaine, opioids), age, and PER visits. Veterans who primarily attended telephone appointments were more likely to require PER services compared to those attending video appointments. In the full model, alcohol use disorder (AUD), past-year PER visits, and treatment modality (telephone visits) continued to be significantly associated with COVID-19 PER use, while past-year PER visits correlated with Re-entry PER use. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE During COVID-19, veterans whose main treatment modality was telephone were more likely to require PER services than veterans who were seen by video, even after controlling for age, AUD, opioid use disorder, and past-year PER visits. This study is the first to have examined SUD treatment modality utilization patterns in response to COVID-19. Findings suggest that treatment modality during the initial phase of COVID-19 correlated with PER presentation.
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Affiliation(s)
- Sarah Meshberg-Cohen
- Psychology Service/Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Minnah Farook
- Psychology Service/Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Georgina Gross
- Psychology Service/Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Victoria Levina
- Psychology Service/Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jason DeViva
- Psychology Service/Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Greenwald MK, Ghosh S, Winston JR. A randomized, sham-controlled, quintuple-blinded trial to evaluate the NET device as an alternative to medication for promoting opioid abstinence. Contemp Clin Trials Commun 2022; 30:101018. [PMID: 36303593 PMCID: PMC9593273 DOI: 10.1016/j.conctc.2022.101018] [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: 05/02/2022] [Revised: 09/04/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is an unmet need for non-medication approaches to illicit opioid discontinuation and relapse prevention. The NET (NeuroElectric Therapy) Device is a non-invasive, battery-operated, portable, re-useable device designed to deliver bilateral transcranial transcutaneous alternating current electrical stimulation, and is intended to treat opioid use disorder (OUD) without medication. The device is a CE-marked Class IIa, non-significant risk, investigational medical device. Objective This prospective trial (NRC021) tests the hypothesis that the NET Device provides safe and effective neurostimulation treatment for persons with OUD who express a desire to be opioid abstinent without medications for opioid use disorder (MOUD). Methods NRC021 is a randomized, parallel-group, sham-controlled, quintuple-blinded, single-site study. Persons with OUD entering a residential treatment facility for opioid detoxification are assigned to active or sham treatment (n = 50/group). Group assignment is stratified on presence of any current non-opioid substance use disorder and by sex. The biostatistician maintains the blinding so that the study sponsor, principal investigator, research assistants, treatment staff, and participants remain blinded. Following discharge from the inpatient facility, participants are assessed once weekly over 12 weeks for substance use (using timeline followback interview and video assessment of observed oral fluid sample provision and testing). The primary efficacy endpoint is each participant's overall percentage of weekly abstinence from illicit opioid use without use of MOUD. The secondary efficacy endpoint is each participant's percentage of non-opioid drug-free weeks. Safety outcomes are also measured. Conclusion NRC021 is designed to assess the efficacy of a novel non-medication treatment for OUD. Clinical trial registration ClinicalTrials.gov with the identifier NCT04916600.
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Affiliation(s)
- Mark K. Greenwald
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA,Corresponding author. Department of Psychiatry and Behavioral Neurosciences, Tolan Park Medical Building, 3901 Chrysler Service Drive, Suite 2A, Detroit, MI, 48201, USA.
| | - Samiran Ghosh
- Department of Biostatistics and Data Science, University of Texas School of Public Health, Houston, TX, USA
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Eaves ER, Trotter RT, Marquez B, Negron K, Doerry E, Mensah D, Compton-Gore KA, Lanzetta SA, Kruithoff K, Dykman K, Baldwin JA. Possibilities and constraints of rapid online ethnography: Lessons from a rapid assessment of COVID-19 policy for people who use drugs. FRONTIERS IN SOCIOLOGY 2022; 7:959642. [PMID: 36072500 PMCID: PMC9441939 DOI: 10.3389/fsoc.2022.959642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
During the COVID-19 Pandemic, health care provision changed rapidly and funding became available to assess pandemic-related policy change. Research activities, however, were limited to contactless, online delivery. It was clear early on that some elements of online rapid ethnography were feasible and effective, while others would not approach traditional ethnographic depth. We conducted an online Rapid Assessment, Response, and Evaluation (RARE) project from August 2020 to September 2021 to understand how COVID-19 policy impacted people who use drugs. Our interdisciplinary research team conducted online ethnographic interviews and focus groups with 45 providers and community stakeholders, and 19 clients from rural and urban areas throughout Arizona. In addition, 26 webinars, online trainings, and virtual conferences focused on opioid policy and medication for opioid use disorders (MOUD) were opportunities to observe conversations among providers and program representatives about how best to implement policy changes, how to reach people in recovery, and what aspects of the changes should carry forward into better all-around opioid services in the future. Our RARE project was successful in collecting a range of providers' perspectives on both rural and urban implementation of take-home MOUDs as well as a wide view of national conversations, but client perspectives were limited to those who were not impacted by the policies and continued to attend in-person daily clinic visits. We describe challenges to online rapid ethnography and how online research may have allowed for an in-depth, but incomplete picture of how policy changes during COVID-19 policy affected people with opioid use disorders.
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Affiliation(s)
- Emery R. Eaves
- Department of Anthropology, Northern Arizona University, Flagstaff, AZ, United States
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Robert T. Trotter
- Department of Anthropology, Northern Arizona University, Flagstaff, AZ, United States
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Bonnie Marquez
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Kayla Negron
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Eck Doerry
- School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, United States
| | - David Mensah
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Kate A. Compton-Gore
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Shana A. Lanzetta
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Kathryn Kruithoff
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Kaitlyn Dykman
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Julie A. Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, United States
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