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Feeney ME, Law AC, Walkey AJ, Bosch NA. Variation in Use of Medications for Opioid Use Disorder in Critically Ill Patients Across the United States. Crit Care Med 2024; 52:e365-e375. [PMID: 38501933 PMCID: PMC11176030 DOI: 10.1097/ccm.0000000000006257] [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: 03/20/2024]
Abstract
OBJECTIVES To describe practice patterns surrounding the use of medications to treat opioid use disorder (MOUD) in critically ill patients. DESIGN Retrospective, multicenter, observational study using the Premier AI Healthcare Database. SETTING The study was conducted in U.S. ICUs. PATIENTS Adult (≥ 18 yr old) patients with a history of opioid use disorder (OUD) admitted to an ICU between 2016 and 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 108,189 ICU patients (658 hospitals) with a history of OUD, 20,508 patients (19.0%) received MOUD. Of patients receiving MOUD, 13,745 (67.0%) received methadone, 2,950 (14.4%) received buprenorphine, and 4,227 (20.6%) received buprenorphine/naloxone. MOUD use occurred in 37.9% of patients who received invasive mechanical ventilation. The median day of MOUD initiation was hospital day 2 (interquartile range [IQR] 1-3) and the median duration of MOUD use was 4 days (IQR 2-8). MOUD use per hospital was highly variable (median 16.0%; IQR 10-24; range, 0-70.0%); admitting hospital explained 8.9% of variation in MOUD use. A primary admitting diagnosis of unintentional poisoning (aOR 0.41; 95% CI, 0.38-0.45), presence of an additional substance use disorder (aOR 0.66; 95% CI, 0.64-0.68), and factors indicating greater severity of illness were associated with reduced odds of receiving MOUD in the ICU. CONCLUSIONS In a large multicenter, retrospective study, there was large variation in the use of MOUD among ICU patients with a history of OUD. These results inform future studies seeking to optimize the approach to MOUD use during critical illness.
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Affiliation(s)
| | - Anica C. Law
- Department of Medicine, The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine School of Medicine, Boston, MA
| | - Allan J. Walkey
- Department of Medicine, The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine School of Medicine, Boston, MA
| | - Nicholas A. Bosch
- Department of Medicine, The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine School of Medicine, Boston, MA
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O'Reilly LM, Schwartz K, Brown SA, Dir A, Gillenwater L, Adams Z, Zapolski T, Hulvershorn LA, Aalsma M. Attitudes toward and training in medications for opioid use disorders: a descriptive analysis among employees in the youth legal system and community mental health centers. Subst Abuse Treat Prev Policy 2024; 19:32. [PMID: 38907286 DOI: 10.1186/s13011-024-00614-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: 02/16/2024] [Accepted: 06/06/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth. METHODS Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training). RESULTS Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD. CONCLUSIONS These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.
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Affiliation(s)
- Lauren M O'Reilly
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Katherine Schwartz
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven A Brown
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, 401 W. 10th St, Indianapolis, IN, 46202, USA
| | - Allyson Dir
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Logan Gillenwater
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zachary Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tamika Zapolski
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew Aalsma
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Grist E, Cheetham A, Jackson J, Wood P, Lord S, Pricolo A, Armstrong F, Morgan K, Nguyen C, Tran T, Nielsen S. Clinical effectiveness of pharmacist administration of long-acting injectable buprenorphine: Findings from the EPIC-MATOD study. Drug Alcohol Rev 2024. [PMID: 38699894 DOI: 10.1111/dar.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Elizabeth Grist
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Melbourne, Australia
| | - Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Melbourne, Australia
| | - John Jackson
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Pene Wood
- College of Science, Health and Engineering, La Trobe University, Bendigo, Australia
- Wathaurong Aboriginal Health Service, Melbourne, Australia
- IPC Health, Melbourne, Australia
| | - Sarah Lord
- Pharmacotherapy Advocacy Meditation and Support Service, Melbourne, Australia
| | | | | | - Kirsty Morgan
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Melbourne, Australia
- Peninsula Health, Frankston, Australia
| | | | - Tom Tran
- Daffey's Pharmacy, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Melbourne, Australia
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Villamil VI, Underwood N, Cremer LJ, Rooks-Peck CR, Jiang X, Guy GP. Barriers to retention in medications for opioid use disorder treatment in real-world practice. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209310. [PMID: 38331319 PMCID: PMC11060890 DOI: 10.1016/j.josat.2024.209310] [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: 11/14/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Medications for Opioid Use Disorder (MOUD) are an effective method to treat persons with opioid use disorder (OUD). Longer treatment times are associated with better health outcomes, yet treatment retention rates remain low. This study aimed to assess patient characteristics and experiences associated with retention in treatment. METHODS Data were from an observational cohort study of OUD treatments. Among persons receiving buprenorphine or methadone, log-binomial regression models assessed the relationship between patient characteristics and experiences and three retention outcomes: retention in any OUD treatment, retention in the index treatment (OUD treatment being administered at the time when patients were screened for study eligibility), and 6-month retention in the index treatment. RESULTS Individuals being treated with methadone at the start of the study compared to those treated with buprenorphine were more likely to remain in their same index treatment at the 18-month follow-up (aPR = 1.35; 95 % CI = 1.11-1.65), and to have remained on their index treatment for 6-months or longer (aPR = 1.22; 95 % CI = 1.14-1.32), but were not significantly more likely to remain in any OUD treatment overall. Individuals residing five miles or less from treatment were more likely to have been retained in any OUD treatment (aPR = 1.06; 95 % CI = 1.00-1.12), to remain in their index treatment at the 18-month follow-up (aPR = 1.21; 95 % CI = 1.08-1.36), and to have remained in their index treatment for 6 months or more (aPR = 1.08; 95 % CI = 1.02-1.13). Individuals without health insurance were less likely to be retained in any OUD treatment (aPR = 0.86; 95 % CI = 0.78-0.95). CONCLUSION The prevalence of retention in any OUD treatment was higher for individuals residing five miles or less from treatment. These findings expand on previous studies that have shown distance to and location of treatment sites can impact treatment access and retention. Lack of health insurance was also associated with lower retention in any OUD treatment in this study. Given the high burden associated with overdose deaths, it is important to understand and address barriers to retention in treatment.
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Affiliation(s)
- Vanessa I Villamil
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States of America.
| | - Natasha Underwood
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States of America
| | - Laura J Cremer
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States of America
| | - Cherie R Rooks-Peck
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States of America
| | - Xinyi Jiang
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States of America
| | - Gery P Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States of America
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Riggs KR, Kertesz SG. Illuminating the Consequentialist Logic of Harm Reduction After Overdose Through a Hypothetical Randomized Trial. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:45-48. [PMID: 38635430 PMCID: PMC11034905 DOI: 10.1080/15265161.2024.2327277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Kevin R. Riggs
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, Alabama, United States
- Birmingham VA Medical Center, Birmingham, Alabama, United States
| | - Stefan G. Kertesz
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, Alabama, United States
- Birmingham VA Medical Center, Birmingham, Alabama, United States
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Riser E, Kennedy AG, Holterman LA, Brooklyn J, Maruti S, Sobel HG. Preparing Medical Students to Care for Patients with Opioid Use Disorder: Buprenorphine Waiver Training in Undergraduate Medical Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01968-w. [PMID: 38684575 DOI: 10.1007/s40596-024-01968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Elly Riser
- The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Amanda G Kennedy
- The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Leigh Ann Holterman
- The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
| | - John Brooklyn
- The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Sanchit Maruti
- The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Halle G Sobel
- The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
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Endo Y, Sasaki K, Munir MM, Woldesenbet S, Tsilimigras DI, Katayama E, Yang J, Limkemann A, Schenk A, Washburn K, Pawlik TM. Effect of the opioid crisis on the liver transplantation donor pool: A national analysis. Clin Transplant 2024; 38:e15290. [PMID: 38545890 DOI: 10.1111/ctr.15290] [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] [Received: 11/22/2023] [Revised: 01/22/2024] [Accepted: 03/03/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Over the last decade there has been a surge in overdose deaths due to the opioid crisis. We sought to characterize the temporal change in overdose donor (OD) use in liver transplantation (LT), as well as associated post-LT outcomes, relative to the COVID-19 era. METHODS LT candidates and donors listed between January 2016 and September 2022 were identified from the Scientific Registry of Transplant Recipients database. Trends in LT donors and changes related to OD were assessed pre- versus post-COVID-19 (February 2020). RESULTS Between 2016 and 2022, most counties in the United States experienced an increase in overdose-related deaths (n = 1284, 92.3%) with many counties (n = 458, 32.9%) having more than a doubling in drug overdose deaths. Concurrently, there was an 11.2% increase in overall donors, including a 41.7% increase in the number of donors who died from drug overdose. In pre-COVID-19 overdose was the 4th top mechanism of donor death, while in the post-COVID-19 era, overdose was the 2nd most common cause of donor death. OD was younger (OD: 35 yrs, IQR 29-43 vs. non-OD: 43 yrs, IQR 31-56), had lower body mass index (≥35 kg/cm2, OD: 31.2% vs. non-OD: 33.5%), and was more likely to be HCV+ (OD: 28.9% vs. non-OD: 5.4%) with lower total bilirubin (≥1.1 mg/dL, OD: 12.9% vs. non-OD: 20.1%) (all p < .001). Receipt of an OD was not associated with worse graft survival (HR .94, 95% CI .88-1.01, p = .09). CONCLUSIONS Opioid deaths markedly increased following the COVID-19 pandemic, substantially altering the LT donor pool in the United States.
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Affiliation(s)
- Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Kazunari Sasaki
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jason Yang
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Ashley Limkemann
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Austin Schenk
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Kenneth Washburn
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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MacLean RR, Ankawi B, Driscoll MA, Gordon MA, Frankforter TL, Nich C, Szollosy SK, Loya JM, Brito L, Ribeiro MIP, Edmond SN, Becker WC, Martino S, Sofuoglu M, Heapy AA. Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment. JMIR Res Protoc 2024; 13:e54342. [PMID: 38506917 PMCID: PMC10993119 DOI: 10.2196/54342] [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: 11/08/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap. OBJECTIVE This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD. METHODS Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes. RESULTS The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025. CONCLUSIONS Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54342.
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Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Brett Ankawi
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Mary A Driscoll
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Melissa A Gordon
- School of Medicine, Yale University, New Haven, CT, United States
| | | | - Charla Nich
- School of Medicine, Yale University, New Haven, CT, United States
| | - Sara K Szollosy
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jennifer M Loya
- School of Medicine, Yale University, New Haven, CT, United States
| | - Larissa Brito
- School of Medicine, Yale University, New Haven, CT, United States
| | | | - Sara N Edmond
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - William C Becker
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Alicia A Heapy
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
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Han BH, Orozco MA, Miyoshi M, Doland H, Moore AA, Jones KF. Experiences of Aging with Opioid Use Disorder and Comorbidity in Opioid Treatment Programs: A Qualitative Analysis. J Gen Intern Med 2024:10.1007/s11606-024-08676-z. [PMID: 38436883 DOI: 10.1007/s11606-024-08676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The number of older adults entering opioid treatment programs (OTPs) to treat opioid use disorder (OUD) is increasing. However, the lived experiences of aging in OTPs have not been examined. OBJECTIVE To explore the aging experience with OUD and barriers to medical care for older adults who receive care in OTPs. DESIGN From November 2021 to July 2022, we conducted 1-to-1, semi-structured qualitative interviews in English and Spanish, audio-recorded, transcribed, systematically coded, and analyzed to identify key themes regarding the challenges of aging with OUD and managing chronic diseases. PARTICIPANTS Thirty-six adults aged ≥ 55 enrolled in OTPs in San Diego, California. APPROACH A descriptive qualitative approach was used. Major themes and subthemes were identified through thematic analysis until thematic saturation was reached. KEY RESULTS All participants were on methadone and had a mean age of 63.4 (SD 5.1) years; 11 (30.6%) identified as female, 14 (39%) as Hispanic/Latino, and 11 (36%) as Black, with a mean duration of methadone treatment of 5.6 years. Chronic diseases were common, with 21 (58.3%) reporting hypertension, 9 (25%) reporting untreated hepatitis C, and 32 (88.9%) having ≥ 2 chronic diseases. Three major themes emerged: (1) avoidance of medical care due to multiple intersectional stigmas, including those related to drug use, substance use disorder (SUD) treatment, ageism, and housing insecurity; (2) increasing isolation with aging and loss of family and peer groups; (3) the urgent need for integrating medical and aging-focused care with OUD treatment in the setting of increasing health and functional challenges. CONCLUSIONS Older adults with OUD reported increasing social isolation and declining health while experiencing multilevel stigma and discrimination. The US healthcare system must transform to deliver age-friendly care that integrates evidence-based geriatric models of care incorporated with substance use disorder treatment and addresses the intersectional stigma this population has experienced in healthcare settings.
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Affiliation(s)
- Benjamin H Han
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Mirella A Orozco
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Mari Miyoshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Heidi Doland
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alison A Moore
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Katie Fitzgerald Jones
- New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Jamaica Plain, MA, USA
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Gallardo KR, Wilkerson JM, Stewart HLN, Zoschke IN, Fredriksen Isaacs C, McCurdy SA. "Being here is saving my life": Resident experiences of living in recovery residences for people taking medication for an opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209242. [PMID: 38061632 DOI: 10.1016/j.josat.2023.209242] [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: 04/07/2023] [Revised: 08/11/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) are an effective treatment for addressing opioid use disorder. Despite MOUD's demonstrated effectiveness, MOUD-related stigma is prevalent throughout many recovery communities and subsequently limits persons taking MOUD access to recovery supports, including recovery housing. While recovery residences that serve people taking MOUD could be a critical recovery support, they are limited in number and understudied. METHODS We conducted in-depth interviews with 47 residents in medication-assisted recovery (MAR) living in 11 Texas-based recovery residences serving people taking MOUD to characterize residents' experiences and understand the impact that these homes had on their recovery. RESULTS We found that many participants could not previously access recovery housing and other recovery supports due to MOUD-related stigma, thus recovery homes that supported people in MAR were considered a groundbreaking opportunity. Recovery residences provided participants with a space in which they did not feel judged for taking MOUD, which facilitated participants' connections with their fellow housemates. Subsequently, participants no longer had to hide their MAR pathway and could be transparent about taking MOUD among their recovery residence community. Last, recovery homes provided a supportive environment in which participants' internalized MOUD-related stigma could evolve into acceptance of their MAR pathway. CONCLUSIONS Recovery residences that serve people in MAR provide a supportive, safe, nonjudgmental recovery environment in which residents develop relationships with other peers taking MOUD, share openly about their MAR, and are empowered to embrace their recovery pathway. These findings highlight the need for more recovery residences that are supportive of people taking MOUD as part of their recovery.
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Affiliation(s)
- Kathryn R Gallardo
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America.
| | - J Michael Wilkerson
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Hannah L N Stewart
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - I Niles Zoschke
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Cameron Fredriksen Isaacs
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Sheryl A McCurdy
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
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Fuller DB, Gryczynski J, Schwartz RP, Halsted C, Mitchell SG, Whitter M. State guidance and system changes related to COVID-19: Impact on opioid treatment programs. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209214. [PMID: 38042301 PMCID: PMC10947927 DOI: 10.1016/j.josat.2023.209214] [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: 01/26/2023] [Revised: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION In the United States, methadone treatment may only be provided through opioid treatment programs (OTPs), which operate under a complex system of federal and state regulations. During the pandemic, federal regulators relaxed several longstanding restrictions for OTPs by permitting expanded eligibility for take-home medication and allowing counseling and medication management through telehealth. The purpose of this study was to assess the guidance provided by states regarding the revised guidelines and efforts to protect staff and patients in response to the pandemic. METHODS Between September and October of 2020, The National Association of State Alcohol and Drug Abuse Directors (NASADAD) and Friends Research Institute, fielded a web-based qualitative survey of state opioid treatment authorities (SOTAs) across the United States, the District of Columbia, and Puerto Rico. The study conducted the survey prior to the availability of the COVID vaccines. It queried 42 SOTAs concerning state guidance provided to OTPs on treatment operations and practices for existing patients and new admissions; actions to protect staff and patients; changes in treatment need and operational capacity; and administrative practices regarding treatment. This study examines the responses of 42 SOTAs (65 %) who completed the survey. RESULTS Using content analysis, responses to the survey indicate that most states provided guidance to OTPs in response to the revised federal regulations and the need to protect staff and patients. All respondents reported that their states permitted increased number of take-homes doses for existing patients (100 %) and most reported doing so for new admissions (69 %; N=29). Ninety-eight percent (98 %; N=41) reported permitting remote counseling for existing patients and 90 % (N=38) permitting this for new admissions. SOTAs reported providing guidance on staff safety, operational procedures, oversight, and reforming billing practices to align with new models of service delivery. CONCLUSIONS SOTAs generally reported that federal guidance increased patient access, engagement, and retention. Increased take-home flexibilities were viewed as important for expanding access and continuity of treatment, with the majority of SOTAs stating that the revised treatment practices (e.g., expansion of telehealth, flexible medication dispensing practices) were beneficial. These regulatory flexibilities, many believe, promoted the continuation of treatment and successful patient outcomes during the pandemic.
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Affiliation(s)
- Douglas B Fuller
- National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America.
| | - Jan Gryczynski
- Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America.
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America.
| | - Caroline Halsted
- National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America.
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, #103, Baltimore, MD 21201, United States of America.
| | - Melanie Whitter
- National Association of State Alcohol & Drug Abuse Directors, Inc., 1919 Pennsylvania Avenue, NW, Suite M-250, Washington, DC 20006, United States of America.
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del Pozo B, Reichert J, Martins K, Taylor B. Police Use of Discretion in Encounters with People with Opioid Use Disorder: a Study of Illinois Police Officers. JOURNAL OF POLICE AND CRIMINAL PSYCHOLOGY 2024; 39:141-156. [PMID: 38617402 PMCID: PMC11008765 DOI: 10.1007/s11896-023-09628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 04/16/2024]
Abstract
Police frequently encounter people with opioid use disorder (OUD), having a profound effect on their risk environment and health outcomes. Officers retain significant discretionary authority in their response to these encounters. To explore the factors that underlie these decisions, we surveyed a sample of Illinois police officers. We administered an online survey to Illinois police departments using a random sampling strategy, stratified by agency size and the rurality of their service areas. Our final sample was 248 police officers from 27 departments. We surveyed officers' beliefs about (1) influences and control over their decision making; (2) the approval of other actors in making referrals to treatment for addiction, and (3) the potential impacts of medication-assisted treatment (MAT). We analyzed the survey data using descriptive statistics and regression analyses. Most officers were highly influenced by the expectations of their supervisors when responding to subjects who appeared to have an OUD, and about half would take direction from addiction treatment providers. Police in urban departments perceived greater support for MAT and were more likely to believe MAT could reduce the need for future arrests. Our findings suggest ways police officers can be influenced to make discretionary decisions that improve the health outcomes of their encounters with people with OUD: (1) Supervisors should serve as champions to promote referrals to treatment for substance use disorders; (2) collaboration between law enforcement and community addiction treatment providers should be strengthened, and (3) MAT should be supported and expanded in rural areas.
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Affiliation(s)
- Brandon del Pozo
- The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, USA
| | - Jessica Reichert
- Center for Justice Research and Evaluation, Illinois Criminal Justice Information Authority, Chicago, USA
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Qian G, Humphreys K, Goldhaber-Fiebert JD, Brandeau ML. Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis. Drug Alcohol Depend 2024; 256:111112. [PMID: 38335797 PMCID: PMC10940194 DOI: 10.1016/j.drugalcdep.2024.111112] [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: 08/12/2023] [Revised: 01/12/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
AIM To assess the effectiveness and cost-effectiveness of buprenorphine and methadone treatment in the U.S. if exemptions expanding coverage for substance use disorder services via telehealth and allowing opioid treatment programs to supply a greater number of take-home doses of medications for opioid use disorder (OUD) continue (Notice of Proposed Rule Making, NPRM). DESIGN SETTING AND PARTICIPANTS Model-based analysis of buprenorphine and methadone treatment for a cohort of 100,000 individuals with OUD, varying treatment retention and overdose risk among individuals receiving and not receiving methadone treatment compared to the status quo (no NPRM). INTERVENTION Buprenorphine and methadone treatment under NPRM. MEASUREMENTS Fatal and nonfatal overdoses and deaths over five years, discounted lifetime per person QALYs and costs. FINDINGS For buprenorphine treatment under the status quo, 1.21 QALYs are gained at a cost of $19,200/QALY gained compared to no treatment; with 20% higher treatment retention, 1.28 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment, and the strategy dominates the status quo. For methadone treatment under the status quo, 1.11 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment. In all scenarios, methadone provision cost less than $20,000/QALY gained compared to no treatment, and less than $50,000/QALY gained compared to status quo methadone treatment. CONCLUSIONS Buprenorphine and methadone OUD treatment under NPRM are likely to be effective and cost-effective. Increases in overdose risk with take-home methadone would reduce health benefits. Clinical and technological strategies could mitigate this risk.
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Affiliation(s)
- Gary Qian
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
| | - Keith Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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Javorski MJ, Rosinski BF, Shah S, Thompson MA, Streem D, Gordon SM, Insler S, Houghtaling PL, Griffin B, Blackstone EH, Unai S, Svensson LG, Pettersson GB, Elgharably H. Infective Endocarditis in Patients Addicted to Injected Opioid Drugs. J Am Coll Cardiol 2024; 83:811-823. [PMID: 38383096 DOI: 10.1016/j.jacc.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Persons who inject drugs and require surgery for infective endocarditis have 2 potentially lethal diseases. Current postoperative rehabilitation efforts seem ineffective in preventing loss to follow-up, injection drug use relapse (relapse), and death. OBJECTIVES The purpose of this study was to characterize drug use, psychosocial issues, surgical outcome, and postoperative addiction management, as well as loss to follow-up, relapse, and mortality and their risk factors. METHODS From January 2010 to June 2020, 227 persons who inject drugs, age 36 ± 9.9 years, underwent surgery for infective endocarditis at a quaternary hospital having special interest in developing addiction management programs. Postsurgery loss to follow-up, relapse, and death were assessed as competing risks and risk factors identified parametrically and by machine learning. CIs are 68% (±1 SE). RESULTS Heroin was the most self-reported drug injected (n = 183 [81%]). Psychosocial issues included homelessness (n = 56 [25%]), justice system involvement (n = 150 [66%]), depression (n = 118 [52%]), anxiety (n = 104 [46%]), and post-traumatic stress disorder (n = 33 [15%]). Four (1.8%) died in-hospital. Medication for opioid use disorder prescribed at discharge increased from 0% in 2010 to 100% in 2020. At 1 and 5 years, conditional probabilities of loss to follow-up were 16% (68% CI: 13%-22%) and 59% (68% CI: 44%-65%), relapse 32% (68% CI: 28%-34%) and 79% (68% CI: 74%-83%), and mortality 21% (68% CI: 18%-23%) and 68% (68% CI: 62%-72%). Younger age, heroin use, and lower education level were predictors of relapse. CONCLUSIONS Infective endocarditis surgery can be performed with low mortality in persons who inject drugs, but addiction is far more lethal. Risk of loss to follow-up and relapse require more effective addiction strategies without which this major loss to society will continue.
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Affiliation(s)
- Michael J Javorski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brad F Rosinski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shawn Shah
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew A Thompson
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - David Streem
- Department of Psychiatry, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven Insler
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Penny L Houghtaling
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
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Bjørnestad ED, Vederhus JK, Clausen T. Change in self-reported somatic symptoms among patients in opioid maintenance treatment from baseline to 1-year follow-up. BMC Psychiatry 2024; 24:149. [PMID: 38383345 PMCID: PMC10882792 DOI: 10.1186/s12888-024-05590-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND High somatic comorbidity is common among patients in treatment for opioid use disorder (OUD). The present study aims to investigate changes in self-reported somatic health conditions and somatic symptoms among patients entering opioid maintenance treatment (OMT) programs. METHODS We used data from the Norwegian Cohort of Patients in OMT and Other Drug Treatment (NorComt) study. Of 283 patients who entered OMT, 176 were included for analysis at a 1-year follow-up. Participants provided self-reported data during structured interviews on somatic conditions, somatic symptoms, substance use severity measures, and mental distress. A multivariable linear regression analysis identified factors associated with changes in the burden of somatic symptoms. RESULTS Patients entering OMT reported a high prevalence of somatic conditions at the beginning of treatment, with 3 of 5 patients reporting at least one. The most prevalent condition was hepatitis C, followed by asthma and high blood pressure. Patients reported experiencing a high number of somatic symptoms. The intensity of these symptoms varied across a wide spectrum, with oral health complaints and reduced memory perceived as the most problematic. Overall, for the entire sample, there was no significant change in somatic symptoms from baseline to 1 year. Further analysis indicated that those who reported a higher burden of somatic symptoms at baseline had the greatest improvement at the 1-year follow-up. A higher number of somatic conditions and higher mental distress at baseline was associated with improvements in somatic symptoms burden at follow-up. CONCLUSIONS Patients in OMT report a range of somatic conditions and somatic symptoms. Given the wide range of symptoms reported by patients in OMT, including some at high intensity levels, healthcare providers should take into consideration the somatic healthcare needs of individuals in OMT populations. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).
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Affiliation(s)
- Endre Dahlen Bjørnestad
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway.
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway.
| | - John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital HF, Po. box 416, Kristiansand, Norway
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway
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Martínez-Cuevas FL, Cruz SL, González-Espinosa C. Methadone Requires the Co-Activation of μ-Opioid and Toll-Like-4 Receptors to Produce Extracellular DNA Traps in Bone-Marrow-Derived Mast Cells. Int J Mol Sci 2024; 25:2137. [PMID: 38396814 PMCID: PMC10889600 DOI: 10.3390/ijms25042137] [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: 01/19/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Methadone is an effective and long-lasting analgesic drug that is also used in medication-assisted treatment for people with opioid use disorders. Although there is evidence that methadone activates μ-opioid and Toll-like-4 receptors (TLR-4s), its effects on distinct immune cells, including mast cells (MCs), are not well characterized. MCs express μ-opioid and Toll-like receptors (TLRs) and constitute an important cell lineage involved in allergy and effective innate immunity responses. In the present study, murine bone-marrow-derived mast cells (BMMCs) were treated with methadone to evaluate cell viability by flow cytometry, cell morphology with immunofluorescence and scanning electron microscopy, reactive oxygen species (ROS) production, and intracellular calcium concentration ([Ca2+]i) increase. We found that exposure of BMMCs to 0.5 mM or 1 mM methadone rapidly induced cell death by forming extracellular DNA traps (ETosis). Methadone-induced cell death depended on ROS formation and [Ca2+]i. Using pharmacological approaches and TLR4-defective BMMC cultures, we found that µ-opioid receptors were necessary for both methadone-induced ROS production and intracellular calcium increase. Remarkably, TLR4 receptors were also involved in methadone-induced ROS production as it did not occur in BMMCs obtained from TLR4-deficient mice. Finally, confocal microscopy images showed a significant co-localization of μ-opioid and TLR4 receptors that increased after methadone treatment. Our results suggest that methadone produces MCETosis by a mechanism requiring a novel crosstalk pathway between μ-opioid and TLR4 receptors.
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Affiliation(s)
- Frida L. Martínez-Cuevas
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav, IPN), Unidad Sede Sur, Calzada de los Tenorios No. 235, Col. Rinconada de las Hadas, México City CP 14330, Mexico;
| | - Silvia L. Cruz
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav, IPN), Unidad Sede Sur, Calzada de los Tenorios No. 235, Col. Rinconada de las Hadas, México City CP 14330, Mexico;
| | - Claudia González-Espinosa
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav, IPN), Unidad Sede Sur, Calzada de los Tenorios No. 235, Col. Rinconada de las Hadas, México City CP 14330, Mexico;
- Centro de Investigación Sobre el Envejecimiento, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav, IPN), Unidad Sede Sur, Calzada de los Tenorios, No. 235, Col. Rinconada de las Hadas, México City CP 14330, Mexico
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Nyaku AN, Zerbo EA, Chen C, Milano N, Johnston B, Chadwick R, Marcello S, Baston K, Haroz R, Crystal S. A survey of barriers and facilitators to the adoption of buprenorphine prescribing after implementation of a New Jersey-wide incentivized DATA-2000 waiver training program. BMC Health Serv Res 2024; 24:179. [PMID: 38331802 PMCID: PMC10851589 DOI: 10.1186/s12913-024-10648-2] [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: 11/03/2023] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Opioid-involved overdose deaths continue to rise in the US, despite availability of highly effective treatments for opioid use disorder (OUD), in part due to the insufficient number of treatment providers. Barriers include the need for providers to gain expertise and confidence in providing MOUD to their patients who need these treatments. To mitigate this barrier, New Jersey sponsored a buprenorphine training program with financial incentives for participation, which met the then existing requirement for the DATA-2000 waiver. In a 2019 follow-up survey, participants reported on barriers and facilitators to subsequent buprenorphine prescribing. METHODS Participants in the training program completed a 10-min electronic survey distributed via email. The survey addressed demographics, practice characteristics, current buprenorphine prescribing, and barriers and facilitators to adoption and/or scale up of buprenorphine prescribing. RESULTS Of the 440 attendees with a valid email address, 91 individuals completed the survey for a response rate of 20.6%. Of the 91 respondents, 89 were eligible prescribers and included in the final analysis. Respondents were predominantly female (n = 55, 59.6%) and physicians (n = 55, 61.8%); representing a broad range of specialties and practice sites. 65 (73%) of respondents completed the training and DEA-registration, but only 31 (34.8%) were actively prescribing buprenorphine. The most frequently cited barriers to buprenorphine prescribing were lack of access to support services such as specialists in addiction, behavioral health services, and psychiatry. The most frequently reported potential facilitators were integrated systems with direct access to addiction specialists and psychosocial services, easier referral to behavioral health services, more institutional support, and improved guidance on clinical practice standards for OUD treatment. CONCLUSION More than half (52.3%) of those who completed incentivized training and DEA registration failed to actively prescribe buprenorphine. Results highlight provider perceptions of inadequate availability of support for the complex needs of patients with OUD and suggest that broader adoption of buprenorphine prescribing will require scaling up support to clinicians, including increased availability of specialized addiction and mental health services.
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Affiliation(s)
- Amesika N Nyaku
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB I689, Newark, NJ, 07103, USA.
| | - Erin A Zerbo
- Private Practice, Montclair, NJ, 07042, USA
- Department of Psychiatry, Rutgers New Jersey Medical School, 183 South Orange Ave, BHSB F-Level, Newark, NJ, 07103, USA
| | - Clement Chen
- Department of Psychiatry, Rutgers New Jersey Medical School, 183 South Orange Ave, BHSB F-Level, Newark, NJ, 07103, USA
| | - Nicole Milano
- Mental Health Association in New Jersey, 673 Morris Avenue, Suite 100, Springfield, NJ, 07781, USA
| | - Barbara Johnston
- Mental Health Association in New Jersey, 673 Morris Avenue, Suite 100, Springfield, NJ, 07781, USA
| | - Randall Chadwick
- Rutgers University Behavioral Health Care, 151 Centennial Avenue, Suite 1140, Piscataway, NJ, 08854, USA
| | - Stephanie Marcello
- Rutgers University Behavioral Health Care, 151 Centennial Avenue, Suite 1140, Piscataway, NJ, 08854, USA
| | - Kaitlan Baston
- Department of Internal Medicine, Cooper Medical School of Rowan University, Three Cooper Plaza, Camden, NJ, 08103, USA
| | - Rachel Haroz
- Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - 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, USA
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Kaufman MJ, Meloni EG, Qrareya AN, Paronis CA, Bogin V. Effects of inhaled low-concentration xenon gas on naltrexone-precipitated withdrawal symptoms in morphine-dependent mice. Drug Alcohol Depend 2024; 255:110967. [PMID: 38150894 PMCID: PMC10841182 DOI: 10.1016/j.drugalcdep.2023.110967] [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: 08/16/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Opioid withdrawal symptoms (OWS) are highly aversive and prompt unprescribed opioid use, which increases morbidity, mortality, and, among individuals being treated for opioid use disorder (OUD), recurrence. OWS are driven by sympathetic nervous system (SNS) hyperactivity that occurs when blood opioid levels wane. We tested whether brief inhalation of xenon gas, which inhibits SNS activity and is used clinically for anesthesia and diagnostic imaging, attenuates naltrexone-precipitated withdrawal-like signs in morphine-dependent mice. METHODS Adult CD-1 mice were implanted with morphine sulfate-loaded (60 mg/ml) minipumps and maintained for 6 days to establish morphine dependence. On day 7, mice were given subcutaneous naltrexone (0.3 mg/kg) and placed in a sealed exposure chamber containing either 21% oxygen/balance nitrogen (controls) or 21% oxygen/added xenon peaking at 30%/balance nitrogen. After 10 minutes, mice were transferred to observation chambers and videorecorded for 45 minutes. Videos were scored in a blind manner for morphine withdrawal behaviors. Data were analyzed using 2-way ANOVAs testing for treatment and sex effects. RESULTS AND CONCLUSIONS Xenon-exposed mice exhibited fewer jumps (P = 0.010) and jumping suppression was detectible within the first 10-minute video segment, but no sex differences were detected. Brief inhalation of low concentration xenon rapidly and substantially attenuated naltrexone-precipitated jumping in morphine-dependent mice, suggesting that it can inhibit OWS. If xenon effects translate to humans with OUD, xenon inhalation may be effective for reducing OWS, unprescribed opioid use, and for easing OUD treatment initiation, which could help lower excess morbidity and mortality associated with OUD.
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Affiliation(s)
- Marc J Kaufman
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA.
| | - Edward G Meloni
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Alaa N Qrareya
- University of Mississippi School of Pharmacy, Faser Hall Room 331, University, MS 38677, USA
| | - Carol A Paronis
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Vlad Bogin
- Nobilis Therapeutics, Inc., US Bancorp Tower, 111 S.W. Fifth Avenue, Suite 3150, Portland, OR 97204, USA
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Chapman SA, Fraimow-Wong L, Phoenix BJ, Tierney M, Spetz J. Perspectives on APRN prescribing of medications for opioid use disorder: Key barriers remain. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209215. [PMID: 37979946 PMCID: PMC11092094 DOI: 10.1016/j.josat.2023.209215] [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: 03/07/2023] [Revised: 06/22/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Deaths from drug overdoses are rising dramatically in the United States. Treatment for opioid use disorders may include behavioral treatments as well as medications for opioid use disorders (MOUD). Buprenorphine can be prescribed by physicians, nurse practitioners (NPs), other advanced practice registered nurses (APRNs), and physician assistants (PAs) and required a training and a federal waiver until recently. The number of NP MOUD prescribers grew steadily over the past decade, but research has identified state-level scope of practice regulations as a barrier to NP MOUD prescribing. This article explores the contributions of, and remaining barriers faced by NP and other APRN MOUD prescribers. We describe qualitative findings from a study of NPs and other key stakeholders involved in MOUD treatment in four states with two differing levels of regulatory structure. METHODS In this qualitative study, we conducted site visits and semi-structured interviews with NPs and other APRNs, physicians, clinic managers, and regulators in four states including New Mexico and West Virginia (full practice authority for NPs), and Ohio and Michigan (which require physician supervision). Interview notes were entered into a qualitative software package and coded and reviewed by two members of the research team. Data were grouped into key themes. RESULTS A total of 76 participants participated in individual or small group interviews in the four states. We found key themes and several subthemes that describe NP practice in MOUD. Participants described key contributions of NP engagement in MOUD, including increasing access, serving rural areas, the unique role of psychiatric NPs, and the value of the nursing model of care in working with people with substance use disorders (SUD). Participants also identified barriers including scope of practice regulations, other regulatory barriers, stigma, and lack of supportive services to address psychosocial needs. CONCLUSIONS The waiver requirements were eliminated at the end of 2022 in federal budget legislation. Other barriers for NP and other APRN prescribers remain and should be addressed in practice, and in state and federal regulations. Research needs to explore the impact of the waiver elimination on MOUD prescribing and access to services.
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Affiliation(s)
- Susan A Chapman
- University of California San Francisco School of Nursing, Department of Social and Behavioral Sciences, 490 Illinois Street, 12th Floor, San Francisco, CA 94143, United States of America.
| | - Leah Fraimow-Wong
- UCSF School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, United States of America.
| | - Bethany J Phoenix
- University of California San Francisco School of Nursing, Department of Community Health Systems, 2 Koret Way, 5th Floor, San Francisco, CA 94143-0608, United States of America.
| | - Matthew Tierney
- University of California San Francisco School of Nursing, Department of Community Health Systems, 2 Koret Way, 5th Floor, San Francisco, CA 94143-0608, United States of America.
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA 94158, United States of America.
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Harris M, Scott J, Hope V, Busza J, Sweeney S, Preston A, Southwell M, Eastwood N, Vuckovic C, McGaff C, Yoon I, Wilkins L, Ram S, Lord C, Bonnet P, Furlong P, Simpson N, Slater H, Platt L. Safe inhalation pipe provision (SIPP): protocol for a mixed-method evaluation of an intervention to improve health outcomes and service engagement among people who use crack cocaine in England. Harm Reduct J 2024; 21:19. [PMID: 38263202 PMCID: PMC10804795 DOI: 10.1186/s12954-024-00938-7] [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: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Over 180,000 people use crack cocaine in England, yet provision of smoking equipment to support safer crack use is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, leading to pipe sharing and injuries from use of unsafe materials. This increases risk of viral infection and respiratory harm among a marginalised underserved population. International evaluations suggest crack pipe supply leads to sustained reductions in pipe sharing and use of homemade equipment; increased health risk awareness; improved service access; reduction in injecting and crack-related health problems. In this paper, we introduce the protocol for the NIHR-funded SIPP (Safe inhalation pipe provision) project and discuss implications for impact. METHODS The SIPP study will develop, implement and evaluate a crack smoking equipment and training intervention to be distributed through peer networks and specialist drug services in England. Study components comprise: (1) peer-network capacity building and co-production; (2) a pre- and post-intervention survey at intervention and non-equivalent control sites; (3) a mixed-method process evaluation; and (4) an economic evaluation. Participant eligibility criteria are use of crack within the past 28 days, with a survey sample of ~ 740 for each impact evaluation survey point and ~ 40 for qualitative process evaluation interviews. Our primary outcome measure is pipe sharing within the past 28 days, with secondary outcomes pertaining to use of homemade pipes, service engagement, injecting practice and acute health harms. ANTICIPATED IMPACT SIPP aims to reduce crack use risk practices and associated health harms; including through increasing crack harm reduction awareness among service providers and peers. Implementation has only been possible with local police approvals. Our goal is to generate an evidence base to inform review of the legislation prohibiting crack pipe supply in the UK. This holds potential to transform harm reduction service provision and engagement nationally. CONCLUSION People who smoke crack cocaine in England currently have little reason to engage with harm reduction and drug services. Little is known about this growing population. This study will provide insight into population characteristics, unmet need and the case for legislative reform. TRIAL REGISTRATION ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454.
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Affiliation(s)
- Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jenny Scott
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - Vivian Hope
- Public Health Institute/School of Public and Allied Health, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Joanna Busza
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sedona Sweeney
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Andrew Preston
- Exchange Supplies, 1 Great Western Industrial Centre, Dorchester, Dorset, DT1 1, UK
| | | | | | - Cedomir Vuckovic
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Caitlynne McGaff
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Ian Yoon
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Louise Wilkins
- The Health Shop, 12 Broad Street, Nottingham, NG1 3AL, UK
| | - Shoba Ram
- The Maples, Verona House, 53 Filwood Rd, Bristol, BS16 3RX, UK
| | - Catherine Lord
- Bristol Drugs Project, 11 Brunswick Square, St Paul's, Bristol, BS2 8PE, UK
| | - Philippe Bonnet
- The Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK
| | - Peter Furlong
- Change Grow Live, 34 Albion Place, Leeds, LS1 6JH, UK
| | | | - Holly Slater
- POW Nottingham, 16 Independent Street, Nottingham, NG7 3LN, UK
| | - Lucy Platt
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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21
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Laks J, Alford DP. Treatment of opioid use disorder in patients with liver disease. Clin Liver Dis (Hoboken) 2024; 23:e0207. [PMID: 38831768 PMCID: PMC11146471 DOI: 10.1097/cld.0000000000000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/15/2024] [Indexed: 06/05/2024] Open
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22
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Schwarz T, Anzenberger J, Busch M, Gmel G, Kraus L, Krausz M, Labhart F, Meyer M, Schaub MP, Westenberg JN, Uhl A. Opioid agonist treatment in transition: A cross-country comparison between Austria, Germany and Switzerland. Drug Alcohol Depend 2024; 254:111036. [PMID: 38091902 DOI: 10.1016/j.drugalcdep.2023.111036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND AIMS OAT is a well developed and successful treatment strategy for opioid dependent patients in Europe. It has significantly contributed to the fight against the HIV and HCV pandemics, leading to an increased life expectancy in this population. Building on the OAT experiences in Austria, Germany, and Switzerland and their models of care, the objective of this study is to analyse experiences and changes in patient structures to identify necessary adaptations for the system of care. METHODS We analysed national register-based data from patients receiving OAT during the period spanning from 2010 to 2020 in Austria, Germany (cases), and Switzerland. We examined and compared OAT policies and practice at national levels through a review of literature and publicly available policy documents. RESULTS Across these three countries, the life expectancy of OAT patients increased substantially. The mean age increased from 33.0 in 2010 to 39.1 in 2020 in Austria, from 35.6 years to 41.5 years in Germany (cases), and from 39.6 to 47.1 in Switzerland, respectively. In all three countries, the percentage of patients/cases aged 60 years and older increased more than tenfold between 2010 and 2020. CONCLUSIONS Integrated support models, reliable care structures, internationally comparable high treatment coverage, flexible prescribing practices, and a wide range of available OAT medications are successful strategies. The experiences in these countries indicate that it is possible to address the complex and chronic nature of opioid dependence and its concurrent mental and physical health challenges, resulting in an increasing life expectancy of OAT patients.
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Affiliation(s)
- Tanja Schwarz
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria; Doctoral Programme Meduni Vienna, Medical University of Vienna, Spitalgasse 23, Vienna 1090, Austria.
| | - Judith Anzenberger
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria
| | - Martin Busch
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria
| | - Gerhard Gmel
- Addiction Switzerland, Lausanne, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Mental Health and Addiction Research, Munich, Germany; Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Krausz
- University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Florian Labhart
- Psychiatric University Clinic Basel, University of Basel, Basel, Switzerland
| | - Maximilian Meyer
- Psychiatric University Clinic Basel, University of Basel, Basel, Switzerland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland
| | - Jean N Westenberg
- Addiction Switzerland, Lausanne, Switzerland; University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Alfred Uhl
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria; Sigmund Freud University Vienna, Vienna, Austria
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Bolshakova M, González JL, Thompson T, Schneberk T, Sussman S, Unger JB, Bluthenthal RN. A qualitative analysis of internal medicine residents' experience with substance use disorder education and training: a pilot study. J Addict Dis 2024; 42:63-70. [PMID: 36330994 DOI: 10.1080/10550887.2022.2139580] [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: 11/06/2022]
Abstract
BACKGROUND Lack of education and training on caring for patients with substance use disorder (SUD) is common among healthcare providers, often resulting in clinicians feeling unprepared to treat patients with SUD. OBJECTIVES This study explored resident physicians' experiences with SUD education throughout medical school and residency and qualitatively evaluated whether a SUD initiative improved resident's knowledge and efficacy of treating various SUDs. METHODS We implemented a brief (seven hours total) educational initiative focused on treating SUDs virtually over the course of an academic year for residents enrolled in the University of Southern California Internal Medicine Residency program. Semi-structured interviews were conducted with residents after completion of the initiative. A thematic analysis was conducted to identify common themes that emerged from the qualitative data. RESULTS Every resident noted receiving insufficient training for the treatment of SUDs prior to the initiative. The initiative was viewed favorably, and participants particularly appreciated having an introduction to prescribing medication for the treatment of SUD such as buprenorphine. Despite the perceived success of the initiative in increasing awareness of treatment modalities for SUD, residents expressed a lack of comfort in handling SUD cases and desired additional practical lectures and application of knowledge through increased experiential training. CONCLUSIONS SUD education and training appears to be a useful constituent of resident training and should be included in the standard curriculum and rotations. Residency programs should consider including formal education, hands-on practice, and providing adequate resources for residents to develop their capabilities to care for patients with SUD.
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Affiliation(s)
- Maria Bolshakova
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - José Luis González
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- LAC + USC Medical Center, Los Angeles, CA, USA
| | - Tiana Thompson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Vekaria V, Patra BG, Xi W, Murphy SM, Avery J, Olfson M, Pathak J. Association of opioid or other substance use disorders with health care use among patients with suicidal symptoms. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209177. [PMID: 37820869 PMCID: PMC10841388 DOI: 10.1016/j.josat.2023.209177] [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: 01/08/2023] [Revised: 06/23/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Prior literature establishes noteworthy relationships between suicidal symptoms and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, engagement with health care services among this vulnerable population remains underinvestigated. This study sought to examine patterns of health care use, identify risk factors in seeking treatment, and assess associations between outpatient service use and emergency department (ED) visits. METHODS Using electronic health records (EHRs) derived from five health systems across New York City, the study selected 7881 adults with suicidal symptoms (including suicidal ideation, suicide attempt, or self-harm) and SUDs between 2010 and 2019. To examine the association between SUDs (including OUD) and all-cause service use (outpatient, inpatient, and ED), we performed quasi-Poisson regressions adjusted for age, gender, and chronic disease burden, and we estimated the relative risks (RR) of associated factors. Next, the study evaluated cause-specific utilization within each resource category (SUD-related, suicide-related, and other-psychiatric) and compared them using Mann-Whitney U tests. Finally, we used adjusted quasi-Poisson regression models to analyze the association between outpatient and ED utilization among different risk groups. RESULTS Among patients with suicidal symptoms and SUD diagnoses, relative to other SUDs, a diagnosis of OUD was associated with higher all-cause outpatient visits (RR: 1.22), ED visits (RR: 1.54), and inpatient hospitalizations (RR: 1.67) (ps < 0.001). Men had a lower risk of having outpatient visits (RR: 0.80) and inpatient hospitalizations (RR: 0.90), and older age protected against ED visits (RR range: 0.59-0.69) (ps < 0.001). OUD was associated with increased SUD-related encounters across all settings, and increased suicide-related ED visits and inpatient hospitalizations (p < 0.001). Individuals with more mental health outpatient visits were less likely to have suicide-related ED visits (RR: 0.86, p < 0.01), however this association was not found among younger and male patients with OUD. Although few OUD patients received medications for OUD (MOUD) treatment (9.9 %), methadone composed the majority of MOUD prescriptions (77.7 %), of which over 70 % were prescribed during an ED encounter. CONCLUSIONS This study reinforces the importance of tailoring SUD and suicide risk interventions to different age groups and types of SUDs, and highlights missed opportunities for deploying screening and prevention resources among the male and OUD populations. Redressing underutilization of MOUD remains a priority to reduce acute health outcomes among younger patients with OUD.
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Affiliation(s)
- Veer Vekaria
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Braja G Patra
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Wenna Xi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Jonathan Avery
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States of America
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, NY, United States of America
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America; Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States of America.
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Nordeck CD, Sharma A, Terplan M, Dusek K, Gilliams E, Gryczynski J. Opioid Use Disorder Treatment Linkage at Strategic Touchpoints Using Buprenorphine (OUTLAST-B): Rationale, Design, and Evolution of a Randomized Controlled Trial. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2023; 8:e230010. [PMID: 38456042 PMCID: PMC10919199 DOI: 10.20900/jpbs.20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background Despite the effectiveness and growing availability of treatment for opioid use disorder (OUD) with buprenorphine, many people with OUD do not access treatment services. This article describes the rationale, methodological design, evolution, and progress of an ongoing clinical trial of treatment linkage strategies for people with untreated OUD. Methods The study, titled Opioid Use Disorder Treatment Linkage at Strategic Touchpoints using Buprenorphine (OUTLAST-B), uses "strategic touchpoints", initially sexual health clinics and subsequently broadened to other service venues and participant social networks, for recruitment and screening. Adults with untreated OUD (target N = 360) are randomized to one of the three arms: Usual Care (UC, enhanced with overdose education and naloxone distribution), Patient Navigation (PN), or Patient Navigation with an immediate short-term bridge prescription for buprenorphine (PN + BUP). In the PN and PN + BUP arms, the Patient Navigator works with participants for 2 months to facilitate treatment entry and early retention, resolve barriers (e.g., ID cards, transportation), and provide motivational support. Results The primary outcome is OUD treatment entry within 30 days of enrollment. Participants are assessed at baseline and followed at 3- and 6-months post-enrollment on measures of healthcare utilization, substance use, and general functioning. Challenges and recruitment adaptations pursuant to the COVID-19 pandemic are discussed. Conclusions This study could provide insights on how to reach people with untreated OUD and link them to care through non-traditional routes. Trial Registration The study is registered at ClinicalTrials.gov (NCT04991974).
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Affiliation(s)
| | - Anjalee Sharma
- Friends Research Institute, Baltimore, MD 21201, USA
- Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | | | - Kristi Dusek
- Friends Research Institute, Baltimore, MD 21201, USA
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Soto C, Miller K, Moerner L, Nguyen V, Ramos GG. Implementation of medication for opioid use disorder treatment in Indian health clinics in California: A qualitative evaluation. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209115. [PMID: 37399928 DOI: 10.1016/j.josat.2023.209115] [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: 10/12/2022] [Revised: 04/22/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION American Indians and Alaska Native (AIAN) populations are disproportionately affected by opioid misuse. Medication for opioid use disorder (MOUD) is essential to decrease overdose events and overdose deaths. AIAN communities can benefit from MOUD programs that are housed within primary care clinics to improve treatment accessibility. This study aimed to gather information on the needs, barriers, and successes related to implementing MOUD programs in Indian health clinics (IHCs) offering primary care. METHODS The study used the Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) evaluation framework to structure key informant interviews with clinic staff who received technical assistance for MOUD program implementation. The study incorporated RE-AIM dimensions into a semi-structured interview guide. We developed the coding approach for analyzing interview data using Braun and Clarke's (2006) reflexive thematic analysis in qualitative research. RESULTS Eleven clinics participated in the study. The research team conducted twenty-nine interviews with clinic staff. We found that inadequate education about MOUD, scant resources, and limited availability of AIAN providers adversely impacted reach. Challenges with integrating medical and behavioral care, patient-level barriers (e.g., rural conditions, geographical dispersion), and limited workforce capacity impacted MOUD effectiveness. Stigma at the clinic level was detrimental to MOUD adoption. Implementation was challenging due to a limited number of waivered providers, and the need for technical assistance and MOUD policies and procedures. Staff turnover and restricted physical infrastructure negatively influenced MOUD maintenance. CONCLUSIONS Clinical infrastructure should be strengthened. The integration of culture into clinic services must be embraced by staff to support MOUD adoption. Increased representation from AIAN clinical staff is needed to appropriately represent the population being served. Stigma at various levels must be addressed, and the multiple barriers that AIAN communities face must be considered in understanding MOUD program implementation and outcomes.
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Affiliation(s)
- Claradina Soto
- University of Southern California, 1845 N Soto St., Los Angeles, CA 90032, USA.
| | - Kimberly Miller
- University of Southern California, 1845 N Soto St., Los Angeles, CA 90032, USA
| | - Lou Moerner
- University of Southern California, 1845 N Soto St., Los Angeles, CA 90032, USA
| | - VyVy Nguyen
- University of Southern California, 1845 N Soto St., Los Angeles, CA 90032, USA
| | - Guadalupe G Ramos
- University of Southern California, 1845 N Soto St., Los Angeles, CA 90032, USA
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Stevens A, Hendrie N, Bacon M, Parrott S, Monaghan M, Williams E, Lewer D, Moore A, Berlin J, Cunliffe J, Quinton P. Evaluating police drug diversion in England: protocol for a realist evaluation. HEALTH & JUSTICE 2023; 11:46. [PMID: 37968494 PMCID: PMC10652635 DOI: 10.1186/s40352-023-00249-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023]
Abstract
There is increasing international interest in the use of police drug diversion schemes that offer people suspected of minor drug-related offences an educative or therapeutic intervention as an alternative to criminalisation. While there have been randomised trials of some such schemes for their effects on reducing offending, with generally positive results, less is known about the health outcomes, and what works, for whom, in what circumstances and why. This protocol reports on a realist evaluation of police drug diversion in England that has been coproduced by a team of academic, policing, health, and service user partners. The overall study design combines a qualitative assessment of the implementation, contexts, mechanisms, moderators and outcomes of schemes in Durham, Thames Valley and the West Midlands with a quantitative, quasi-experimental analysis of administrative data on the effects of being exposed to the presence of police drug diversion on reoffending and health outcomes. These will be supplemented with analysis of the cost-consequences of the evaluated schemes, an analysis of the equity of their implementation and effects, and a realist synthesis of the various findings from these different methods.
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Affiliation(s)
| | | | | | | | | | | | - Dan Lewer
- Bradford Institute for Health Research, Bradford, UK
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Rutrick D, Learned SM, Boyett B, Hassman D, Shinde S, Zhao Y. 18-Month efficacy and safety analysis of monthly subcutaneous buprenorphine injection for opioid use disorder: Integrated analysis of phase 3 studies. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209155. [PMID: 37657559 DOI: 10.1016/j.josat.2023.209155] [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: 12/14/2022] [Revised: 02/27/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Few studies investigate the natural history of patients on long-term treatment for opioid use disorder (OUD). We evaluated the long-term efficacy, safety, and tolerability experience of monthly extended-release buprenorphine (BUP-XR) in participants seeking treatment for OUD, via integrated analysis of phase 3 studies. METHODS Study 1 was a 24-week randomized, double-blind, placebo-controlled trial of participants receiving monthly injections of BUP-XR (300 mg × 2, 100 mg × 4 [n = 203] or 300 mg × 6 [n = 201]) or placebo (n = 100). Study 2 was a 48-week, open-label trial enrolling 257 participants who completed study 1 and 412 de novo participants, to receive 6 and 12 BUP-XR injections, respectively. Study 3 was a 24-week, open-label extension enrolling 208 participants who completed study 2 for 6 additional injections. We assessed opioid abstinence as the proportion of urine opioid negative participants by visit and the percentage of each participant's negative opioid assessments during the first 6 months. RESULTS In total, 916 participants were treated with BUP-XR or placebo. By the end of 18 months, 92.7 % of the de novo cohort and 81.8 % of the study 1 cohort were urine negative for opioids. Among early nonresponders (percentage of abstinence ≤20 %), 73.1 % were urine negative after 18 months. The longer treatment period was well tolerated, with no new safety concerns, and a low incidence of opioid withdrawal signs and symptoms, and hepatic disorder. CONCLUSIONS Extending BUP-XR treatment beyond 6 months sustained improvement in opioid abstinence and was well tolerated, supporting clinical benefit up to 18 months. TRIAL REGISTRATION NCT02357901 (study 1); NCT02510014 (study 2); NCT02896296 (study 3).
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Affiliation(s)
- Daniel Rutrick
- Adams Clinical, 521 Mt. Auburn St., Watertown, MA 02472, USA
| | - Susan M Learned
- Indivior, Inc., 10710 Midlothian Tpke, North Chesterfield, VA 23235, USA
| | - Brent Boyett
- North Mississippi Medical Center Neuroscience Institute, 830 South Gloster Street, Tupelo, MS 38801, USA
| | - David Hassman
- Hassman Research Institute, 30 Lake Center Dr., Marlton, NJ, 08053, USA
| | - Sunita Shinde
- Indivior, Inc., 10710 Midlothian Tpke, North Chesterfield, VA 23235, USA
| | - Yue Zhao
- Indivior, Inc., 10710 Midlothian Tpke, North Chesterfield, VA 23235, USA.
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Stringfellow EJ, Lim TY, Dong H, Zhang Z, Jalali MS. The association between longitudinal trends in receipt of buprenorphine for opioid use disorder and buprenorphine-waivered providers in the United States. Addiction 2023; 118:2215-2219. [PMID: 37434347 DOI: 10.1111/add.16291] [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: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Abstract
AIMS, DESIGN AND SETTING We sought to describe longitudinal trends in buprenorphine receipt and buprenorphine-waivered providers in the United States from 2003 to 2021 and measure whether the relationship between the two differed after capacity-building strategies were enacted nationally in 2017. This was a retrospective study of two separate cohorts covering the years 2003-21, testing whether the association between two trends in these cohorts changed comparing 2003 to 2016 and from 2017 to 2021, among buprenorphine providers in the United States, regardless of treatment setting. Patients receiving dispensed buprenorphine at retail pharmacies. PARTICIPANTS All providers who have obtained a waiver to prescribe buprenorphine in the United States, and an estimate of the annual number of patients who had buprenorphine for opioid use disorder (OUD) dispensed to them at a retail pharmacy. MEASUREMENTS We synthesized and summarized data from multiple sources to assess the cumulative number of buprenorphine-waivered providers over time. We used national-level prescription data from IQVIA to estimate annual buprenorphine receipt for OUD. FINDINGS From 2003 to 2021, the number of buprenorphine-waivered providers in the United States increased from fewer than 5000 in the first 2 years of Food and Drug Administration (FDA) approval to more than 114 000 in 2021, while patients receiving buprenorphine products for OUD increased from approximately 19 000 to more than 1.4 million. The strength of association between waivered providers and patients is significantly different before and after 2017 (P < 0.001). From 2003 to 2016, for each additional provider, there was an average increase of 32.1 [95% confidence interval (CI) = 28.7-35.6] patients, but an increase of only 4.6 (95% CI= 3.5-5.7) patients for each additional provider, beginning in 2017. CONCLUSIONS In the United States, the relationship between the rates of growth in buprenorphine providers and patients became weaker after 2017. While efforts to increase buprenorphine-waivered providers were successful, there was less success in translating that into significant increases in buprenorphine receipt.
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Affiliation(s)
| | - Tse Yang Lim
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- MIT Sloan School of Management, Cambridge, MA, USA
| | - Huiru Dong
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ziyuan Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohammad S Jalali
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- MIT Sloan School of Management, Cambridge, MA, USA
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30
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Byanyima JI, Li X, Vesslee SA, Kranzler HR, Shi Z, Wiers CE. Metabolic profiles associated with opioid use and opioid use disorder: a narrative review of the literature. CURRENT ADDICTION REPORTS 2023; 10:581-593. [PMID: 37982033 PMCID: PMC10656052 DOI: 10.1007/s40429-023-00493-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 11/21/2023]
Abstract
Purpose of Review Opioid use disorder (OUD) is a chronic, relapsing condition that is epidemic in the USA. OUD is associated with serious adverse consequences, including higher incarceration rates, impaired medical and mental health, and overdose-related fatalities. Several medications with demonstrated clinical efficacy in reducing opioid use are approved to treat OUD. However, there is evidence that medications for OUD cause metabolic impairments, which raises concerns over the long-term metabolic health of individuals recovering from OUD. Here, we summarize the scientific literature on the metabolic effects of the use of opioids, including medications for treating OUD. Recent Findings Our findings showed lower body weight and adiposity, and better lipid profiles in individuals with OUD. In individuals with diabetes mellitus, opioid use was associated with lower blood glucose levels. In contrast, among individuals without underlying metabolic conditions, opioids promoted insulin resistance. Treatment of OUD patients with the agonists methadone or buprenorphine caused weight gain, increased liking and intake of sugar, and impaired lipid profile and glucose metabolism, whereas treatment with the antagonist naltrexone demonstrated evidence for reduced sweet preferences. Summary Our findings highlighted a gap in knowledge regarding the safety of medications for OUD. Further research is needed to determine how best to reduce the risk of metabolic disorder in the treatment of OUD with opioid agonists versus antagonists.
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Affiliation(s)
- Juliana I Byanyima
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. Suite 500, Philadelphia, PA 191904, USA
| | - Xinyi Li
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. Suite 500, Philadelphia, PA 191904, USA
| | - Sianneh A Vesslee
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. Suite 500, Philadelphia, PA 191904, USA
| | - Henry R Kranzler
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. Suite 500, Philadelphia, PA 191904, USA
| | - Zhenhao Shi
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. Suite 500, Philadelphia, PA 191904, USA
| | - Corinde E Wiers
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. Suite 500, Philadelphia, PA 191904, USA
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Fleißner S, Stöver H, Schäffer D. [Take-home naloxone: a building block of drug emergency prophylaxis in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1035-1041. [PMID: 37233811 PMCID: PMC10465660 DOI: 10.1007/s00103-023-03705-4] [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: 10/26/2022] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
Naloxone is an opioid antagonist that reverses the (respiratory-paralyzing) effects of opioids in the body within minutes. Naloxone can therefore reduce opioid overdose deaths. Take-home naloxone (THN) is an intervention recommended by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the World Health Organization (WHO). It involves training opioid users and their relatives or friends in the use of naloxone and providing them with the drug in case of emergency.So far, THN has been implemented in Germany mainly by individual addiction support facilities. In order to fully exploit the potential of THN, it is necessary to establish the measure nationwide. In particular, THN can be included in the services offered in (low-threshold) addiction support facilities, in psychiatric facilities, in the context of opioid substitution treatment, and in the correctional system.This discussion article reviews the development of THN in Germany since 1998, highlights the difficulties and obstacles to its widespread implementation, and outlines how THN can succeed as an effective public health intervention in Germany. This is particularly relevant in view of the increasing number of drug-related deaths over the past 10 years.
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Affiliation(s)
- Simon Fleißner
- Institut für Suchtforschung Frankfurt (ISFF), University of Applied Sciences Frankfurt, Nibelungenplatz 1, 60318, Frankfurt am Main, Deutschland.
| | - Heino Stöver
- Institut für Suchtforschung Frankfurt (ISFF), University of Applied Sciences Frankfurt, Nibelungenplatz 1, 60318, Frankfurt am Main, Deutschland
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Marashi A, Warren D, Call G, Dras M. Trends in Opioid Medication Adherence During the COVID-19 Pandemic: Retrospective Cohort Study. JMIR Public Health Surveill 2023; 9:e42495. [PMID: 37656492 PMCID: PMC10504620 DOI: 10.2196/42495] [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] [Received: 09/06/2022] [Revised: 05/09/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The recent pandemic had the potential to worsen the opioid crisis through multiple effects on patients' lives, such as the disruption of care. In particular, good levels of adherence with respect to medication for opioid use disorder (MOUD), recognized as being important for positive outcomes, may be disrupted. OBJECTIVE This study aimed to investigate whether patients on MOUD experienced a drop in medication adherence during the recent COVID-19 pandemic. METHODS This retrospective cohort study used Medicaid claims data from 6 US states from 2018 until the start of 2021. We compared medication adherence for people on MOUD before and after the beginning of the COVID-19 pandemic in March 2020. Our main measure was the proportion of days covered (PDC), a score that measures patients' adherence to their MOUD. We carried out a breakpoint analysis on PDC, followed by a patient-level beta regression analysis with PDC as the dependent variable while controlling for a set of covariates. RESULTS A total of 79,991 PDC scores were calculated for 37,604 patients (age: mean 37.6, SD 9.8 years; sex: n=17,825, 47.4% female) between 2018 and 2021. The coefficient for the effect of COVID-19 on PDC score was -0.076 and was statistically significant (odds ratio 0.925, 95% CI 0.90-0.94). CONCLUSIONS The COVID-19 pandemic was negatively associated with patients' adherence to their medication, which had declined since the beginning of the pandemic.
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Affiliation(s)
- Amir Marashi
- School of Computing, Macquarie University, Macquarie Park, Australia
| | - David Warren
- School of Computing, Macquarie University, Macquarie Park, Australia
| | - Gary Call
- Gainwell Technologies, Tysons, VA, United States
| | - Mark Dras
- School of Computing, Macquarie University, Macquarie Park, Australia
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Havard A, Jones N, Bharat C, Gisev N, Pearson S, Shakeshaft A, Farrell M, Degenhardt L. Mortality during and after specialist alcohol and other drug treatment: Variation in rates according to principal drug of concern and treatment modality. Drug Alcohol Rev 2023; 42:1461-1471. [PMID: 37186492 PMCID: PMC10946946 DOI: 10.1111/dar.13669] [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: 10/25/2022] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION For people accessing treatment for problems with drugs other than opioids, little is known about the relationship between treatment and mortality risk, nor how mortality risk varies across treatment modalities. We addressed these evidence gaps by determining mortality rates during and after treatment for people accessing a range of treatment modalities for several drugs of concern. METHODS We conducted a cohort study using linked data on publicly funded specialist alcohol or other drug treatment service use and mortality for people receiving treatment in New South Wales between January 2012 and December 2018. We calculated and compared during-treatment and post-treatment crude mortality rates and age- and sex-standardised mortality rates, separately for each principal drug of concern and modality. RESULTS Over the study period, 45,026 people accessed treatment for problems with alcohol, 26,407 for amphetamine-type stimulants, 23,047 for cannabinoids and 21,556 for opioids. People treated for alcohol or opioid problems had higher crude mortality rates (1.48, 1.91, 1.09 per 100 person years, respectively) than those with problems with amphetamine-type stimulants or cannabinoids (0.46, 0.30 per 100 person years, respectively). Mortality rates differed according to treatment status and modality only among people with alcohol or opioid problems. DISCUSSION AND CONCLUSIONS The observed variation in mortality rates indicates there is scope to reduce mortality among people accessing treatment with alcohol or opioid problems. Future research on mortality among people accessing drug and alcohol treatment should account for the variation in mortality by drug of concern and treatment modality.
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Affiliation(s)
- Alys Havard
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- Centre for Big Data Research in Health, UNSW SydneySydneyAustralia
| | - Nicola Jones
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | | | | | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
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Whipple CR, Kaynak Ö, Kruis NE, Saylor E, Bonnevie E, Kensinger WS. Opioid Use Disorder Stigma and Support for Harm Reduction in Rural Counties. Subst Use Misuse 2023; 58:1818-1828. [PMID: 37622487 DOI: 10.1080/10826084.2023.2250434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Background: The opioid crisis is a public health emergency in the United States, particularly in rural Pennsylvania. Stigma in rural communities is a treatment barrier and impacts harm reduction programming availability.Objectives: The current study utilized an observational, cross-sectional design to examine latent subgroups of stigma and differences in support for harm reduction strategies (i.e., safe injection facilities, syringe services programs, fentanyl test strips, Naloxone distribution). Participants included rural Pennsylvanians (n = 252), taken from a statewide survey of opioid use disorder (OUD) stigma. Participants reported OUD public stigma (i.e., attitudes/perceptions about OUD, willingness to engage with individuals with OUD) and support for harm reduction strategies.Results: Latent class analysis identified 4 stigma classes: 1) high stigma (HS), 2) high judgment/low stigmatizing behavior (HJ/LB), 3) high stigmatizing behavior/low stigmatizing attitude (HB/LA), and 4) low stigma (LS). ANCOVAs identified subgroup differences in harm reduction support. The HS group indicated less support for safe injection sites, syringe services programs, and fentanyl test strips, compared to the HB/LA and LS groups. The HS group indicated less support for Naloxone distribution compared to the HJ/LB, HB/LA, and LS groups. Lastly, the HJ/LB group indicated less support for each program compared to the LS group.Conclusions/Importance: Findings highlight that OUD stigma profiles differ across rural Pennsylvania and are associated with varying support for harm reduction strategies. Individuals with less stigma report more support for harm reduction strategies. Interventions to implement harm reduction strategies should consider varying levels of stigma and use a targeted approach to inform implementation and messaging strategies.
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Affiliation(s)
- Christopher R Whipple
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Övgü Kaynak
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Nathan E Kruis
- Department of Criminal Justice, Penn State Altoona, Altoona, Pennsylvania, USA
| | - Erica Saylor
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | | | - Weston S Kensinger
- School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
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Mannaioni G, Lugoboni F. Precautions in the management of opioid agonist therapy: from target population characteristics to new formulations and post-marketing monitoring - a focus on the Italian system. Drugs Context 2023; 12:2023-2-6. [PMID: 37664791 PMCID: PMC10470859 DOI: 10.7573/dic.2023-2-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/29/2023] [Indexed: 09/05/2023] Open
Abstract
Opioid use disorder (OUD) is a serious medical condition with vast social, health and economic impact. Individuals with OUD are prescribed opioid agonist therapies, such as methadone, levomethadone, buprenorphine or naloxone/buprenorphine, to reduce the risks associated with illegal substance abuse, eventually leading to opioid use abstinence. The OUD population has peculiar frailties, mainly related to the psychiatric sphere, which may jeopardize their therapeutic course. Amongst the possible phenomena that may contribute to treatment failure, opioid agonist therapy misuse and diversion are of utmost importance, leading to serious repercussions for patients as well as for national health systems. To minimize the consequences related to these practices, it is necessary to implement cross-cutting precautions, from the formulation of abuse-deterrent drugs to the implementation of a national monitoring system that oversees the health situation and signals when action is needed. Based on these premises, this article focuses on data and insights concerning the Italian territory.
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Affiliation(s)
- Guido Mannaioni
- Sezione di Farmacologia e Tossicologia dell’Università degli Studi di Firenze, Florence,
Italy
- Struttura Organizzativa Dipartimentale di Tossicologia Medica e Centro Antiveleni, Azienda Ospedaliera Universitaria Careggi, Florence,
Italy
| | - Fabio Lugoboni
- Unità di Medicina delle Dipendenze, Dipartimento di Medicina Interna, Azienda Ospedaliera Universitaria Integrata di Verona, Policlinico “G.B. Rossi”, Verona,
Italy
- International Society of Substance Use Professionals, Italian Chapter
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Risby J, Schlesinger E, Geminn W, Cernasev A. Methadone Treatment Gap in Tennessee and How Medication Units Could Bridge the Gap: A Review. PHARMACY 2023; 11:131. [PMID: 37736904 PMCID: PMC10514867 DOI: 10.3390/pharmacy11050131] [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: 06/29/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023] Open
Abstract
The opioid epidemic has been an ongoing public health concern in the United States (US) for the last few decades. The number of overdose deaths involving opioids, hereafter referred to as overdose deaths, has increased yearly since the mid-1990s. One treatment modality for opioid use disorder (OUD) is medication-assisted treatment (MAT). As of 2022, only three pharmacotherapy options have been approved by the Food and Drug Administration (FDA) for treating OUD: buprenorphine, methadone, and naltrexone. Unlike buprenorphine and naltrexone, methadone dispensing and administrating are restricted to opioid treatment programs (OTPs). To date, Tennessee has no medication units, and administration and dispensing of methadone is limited to licensed OTPs. This review details the research process used to develop a policy draft for medication units in Tennessee. This review is comprised of three parts: (1) a rapid review aimed at identifying obstacles and facilitators to OTP access in the US, (2) a descriptive analysis of Tennessee's geographic availability of OTPs, pharmacies, and federally qualified health centers (FQHCs), and (3) policy mapping of 21 US states' OTP regulations. In the rapid review, a total of 486 articles were imported into EndNote from PubMed and Embase. After removing 152 duplicates, 357 articles were screened based on their title and abstract. Thus, 34 articles underwent a full-text review to identify articles that addressed the accessibility of methadone treatment for OUD. A total of 18 articles were identified and analyzed. A descriptive analysis of Tennessee's availability of OTP showed that the state has 22 OTPs. All 22 OTPs were matched to a county and a region based on their address resulting in 15 counties (16%) and all three regions having at least one OTP. A total of 260 FQHCs and 2294 pharmacies are in Tennessee. Each facility was matched to a county based on its address resulting in 70 counties (74%) having at least one FQHC and 94 counties (99%) having at least one pharmacy. As of 31 December 2022, 17 states mentioned medication units in their state-level OTP regulations. Utilizing the regulations for the eleven states with medication units and federal guidelines, a policy draft was created for Tennessee's medication units.
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Affiliation(s)
- Joanna Risby
- Tennessee Department of Mental Health and Substance Abuse Services, Andrew Jackson Building, 6th Floor, 500 Deaderick Street, Nashville, TN 37243, USA; (E.S.); (W.G.)
| | - Erica Schlesinger
- Tennessee Department of Mental Health and Substance Abuse Services, Andrew Jackson Building, 6th Floor, 500 Deaderick Street, Nashville, TN 37243, USA; (E.S.); (W.G.)
| | - Wesley Geminn
- Tennessee Department of Mental Health and Substance Abuse Services, Andrew Jackson Building, 6th Floor, 500 Deaderick Street, Nashville, TN 37243, USA; (E.S.); (W.G.)
| | - Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 301 S. Perimeter Park Drive, Suite 220, Nashville, TN 37211, USA;
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Cascalheira CJ, Nelson J, Flinn RE, Zhao Y, Helminen EC, Scheer JR, Stone AL. High-risk polysubstance use among LGBTQ+ people who use drugs in the United States: An application of syndemic theory. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104103. [PMID: 37413908 PMCID: PMC10528101 DOI: 10.1016/j.drugpo.2023.104103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/16/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Compared to heterosexual and cisgender people, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people are more likely to develop problems with high-risk polysubstance use. According to syndemic theory, this disparity in high-risk polysubstance use is produced by the LGBTQ+ community's increased vulnerability to experiencing psychosocial (e.g., discrimination, unwanted sex) and structural (e.g., food insecurity, homelessness) conditions, greater likelihood of coping with concurrent health problems (e.g., human immunodeficiency virus [HIV]), and decreased opportunities to develop protective factors (e.g., social support, resilience). METHODS Data from 306 LGBTQ+ participants living in the United States (U.S.) with a lifetime history of alcohol and drug use were analyzed; 21.2% reported lifetime problems with 10 different drugs. Bootstrapped hierarchical multiple regression was used to test demographic correlates and syndemic predictors of high-risk polysubstance use. One-way ANOVA and post-hoc comparison tests were used to test subgroup differences by gender. RESULTS Results indicated that income, food insecurity, sexual orientation-based discrimination, and social support were associated with high-risk polysubstance use, explaining 43.9% of the variance of high-risk polysubstance use. Age, race, unwanted sex, gender identity-based discrimination, and resilience were not significant. Group comparison tests revealed that, compared to nonbinary people and cisgender sexual minority men and women, transgender individuals experienced significantly higher levels of high-risk polysubstance use and sexual orientation-based discrimination but significantly lower levels of homelessness and social support. CONCLUSION This study provided further evidence for conceptualizing polysubstance use as an adverse outcome of syndemic conditions. Harm reduction strategies, anti-discrimination laws, and gender-affirming residential treatment options should be considered in U.S. drug policy. Clinical implications include targeting syndemic conditions to reduce high-risk polysubstance use among LGBTQ+ people who use drugs.
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Affiliation(s)
- Cory J Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA.
| | - Jessie Nelson
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Ryan E Flinn
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yuxuan Zhao
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Emily C Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jillian R Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Amy L Stone
- Department of Sociology and Anthropology, Trinity University, San Antonio, TX, USA
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Winiker AK, Heidari O, Pollock S, Sodder S, Tobin K. Barriers to Assessing and Treating Trauma in Primary Care and Opportunities for Improvement: Perspectives from Prescribers of Medications for Opioid Use Disorder. Subst Use Misuse 2023; 58:1651-1659. [PMID: 37495397 PMCID: PMC10758239 DOI: 10.1080/10826084.2023.2238301] [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] [Indexed: 07/28/2023]
Abstract
Background: Medication for Opioid Use Disorder (MOUD) is a best practice for treating individuals with opioid use disorder (OUD), and primary care-based MOUD management can reduce treatment barriers among OUD patients. Individuals with OUD experience disproportionately high rates of trauma and violence, highlighting the importance of addressing trauma, mental health, and substance use concurrently. However, clear guidelines for trauma-informed treatment in a primary care setting remain poorly established. Methods: A qualitative approach was engaged to explore primary care providers' perceptions of barriers and facilitators to assessing and treating trauma among MOUD patients. Twenty in-depth interviews were conducted in 2021 with Baltimore-based MOUD prescribers, including primary care physicians and nurse practitioners. Interview questions assessed experiences with identifying and treating trauma among MOUD patients, including challenges and opportunities. Results: Providers reported extensive histories of trauma experienced by MOUD patients. Barriers to addressing trauma include a lack of standardized protocols/procedures for identifying trauma, insufficient training/time to assess and treat trauma, and the limited availability of external mental health providers and specialty services. Opportunities included building strong, mutually respectful patient-provider relationships, providing individualized, person-centered care, and establishing connections to coordinated multidisciplinary treatment networks. Conclusions: MOUD treatment within primary care is an important way to increase OUD treatment access, but clearer standards are needed for the treatment of trauma within this patient population. These findings demonstrate opportunities to improve standards and systems such that primary care providers are better equipped to assess and treat the complex histories of trauma experienced by individuals with OUD.
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Affiliation(s)
- Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Omeid Heidari
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Sarah Pollock
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Shereen Sodder
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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Lybarger K, Dobbins NJ, Long R, Singh A, Wedgeworth P, Uzuner Ö, Yetisgen M. Leveraging natural language processing to augment structured social determinants of health data in the electronic health record. J Am Med Inform Assoc 2023; 30:1389-1397. [PMID: 37130345 PMCID: PMC10354760 DOI: 10.1093/jamia/ocad073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Social determinants of health (SDOH) impact health outcomes and are documented in the electronic health record (EHR) through structured data and unstructured clinical notes. However, clinical notes often contain more comprehensive SDOH information, detailing aspects such as status, severity, and temporality. This work has two primary objectives: (1) develop a natural language processing information extraction model to capture detailed SDOH information and (2) evaluate the information gain achieved by applying the SDOH extractor to clinical narratives and combining the extracted representations with existing structured data. MATERIALS AND METHODS We developed a novel SDOH extractor using a deep learning entity and relation extraction architecture to characterize SDOH across various dimensions. In an EHR case study, we applied the SDOH extractor to a large clinical data set with 225 089 patients and 430 406 notes with social history sections and compared the extracted SDOH information with existing structured data. RESULTS The SDOH extractor achieved 0.86 F1 on a withheld test set. In the EHR case study, we found extracted SDOH information complements existing structured data with 32% of homeless patients, 19% of current tobacco users, and 10% of drug users only having these health risk factors documented in the clinical narrative. CONCLUSIONS Utilizing EHR data to identify SDOH health risk factors and social needs may improve patient care and outcomes. Semantic representations of text-encoded SDOH information can augment existing structured data, and this more comprehensive SDOH representation can assist health systems in identifying and addressing these social needs.
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Affiliation(s)
- Kevin Lybarger
- Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA
| | - Nicholas J Dobbins
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, Washington, USA
- Department of Research IT, UW Medicine, University of Washington, Seattle, Washington, USA
| | - Ritche Long
- Department of Research IT, UW Medicine, University of Washington, Seattle, Washington, USA
| | - Angad Singh
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Patrick Wedgeworth
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Özlem Uzuner
- Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, Washington, USA
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Heerema MR, Ventura AS, Blakemore SC, Montoya ID, Gobel DE, Kiang MV, LaBelle CT, Bazzi AR. Evaluation of the New England Office Based Addiction Treatment ECHO: A Tool for Strengthening the Addiction Workforce. Subst Abus 2023; 44:164-176. [PMID: 37287240 PMCID: PMC10688578 DOI: 10.1177/08897077231179601] [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: 06/09/2023]
Abstract
INTRODUCTION Reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. We sought to characterize the program's impact on the knowledge and attitudes of NE OBAT ECHO participants. METHODS We conducted an 18-month prospective evaluation of the NE OBAT ECHO. Participants registered for 1 of 2 successive ECHO clinics. Each 5-month clinic included ten 1.5-hour sessions involving brief didactic lectures and de-identified patient case presentations. Participants completed surveys at Month-0, -6, -12, and -18 to assess attitudes about working with patients who use drugs and evidence based practices (EBPs), stigma toward people who use drugs, and addiction treatment knowledge. We compared outcomes using 2 approaches: (i) between-groups, which involved comparing the first intervention group to the delayed intervention (comparison) group, and (ii) within-groups, which involved comparing outcomes at different time points for all participants. In the within-group approach, each participant acted as their own control. RESULTS Seventy-six health professionals participated in the NE OBAT ECHO, representing various roles in addiction care teams. Approximately half (47% [36/76]) practiced primary care, internal, or family medicine. The first intervention group reported improved job satisfaction and openness toward EBPs compared to the delayed intervention group. Within-group analyses revealed that ECHO participation was associated with increased positive perceptions of role adequacy, support, legitimacy, and satisfaction 6 months following program completion. No changes were identified in willingness to adopt EBPs or treatment knowledge. Stigma toward people who use drugs was persistent in both groups across time points. CONCLUSIONS NE OBAT ECHO may have improved participants' confidence and satisfaction providing addiction care. ECHO is likely an effective educational tool for expanding the capacity of the addiction workforce.
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Affiliation(s)
- Matthew R. Heerema
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Alicia S. Ventura
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Samantha C. Blakemore
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Ivan D. Montoya
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Danna E. Gobel
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Colleen T. LaBelle
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
- Boston University School of Medicine, Boston, MA, United States of America
| | - Angela R. Bazzi
- Boston University School of Public Health, Boston, MA, United States of America
- Herbert Wertheim School of Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States of America
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Stringfellow EJ, Lim TY, DiGennaro C, Zhang Z, Paramasivam P, Bearnot B, Humphreys K, Jalali MS. Long-Term Effects of Increasing Buprenorphine Treatment Seeking, Duration, and Capacity on Opioid Overdose Fatalities: A Model-based Analysis. J Addict Med 2023; 17:439-446. [PMID: 37579104 PMCID: PMC10460819 DOI: 10.1097/adm.0000000000001153] [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: 02/18/2023]
Abstract
OBJECTIVES Because buprenorphine treatment of opioid use disorder reduces opioid overdose deaths (OODs), expanding access to care is an important policy and clinical care goal. Policymakers must choose within capacity limitations whether to expand the number of people with opioid use disorder who are treated or extend duration for existing patients. This inherent tradeoff could be made less acute with expanded buprenorphine treatment capacity. METHODS To inform such decisions, we used a validated simulation model to project the effects of increasing buprenorphine treatment-seeking, average episode duration, and capacity (patients per provider) on OODs in the United States from 2023 to 2033, varying the start time to assess the effects of implementation delays. RESULTS Results show that increasing treatment duration alone could cost lives in the short term by reducing capacity for new admissions yet save more lives in the long term than accomplished by only increasing treatment seeking. Increasing provider capacity had negligible effects. The most effective 2-policy combination was increasing capacity and duration simultaneously, which would reduce OODs up to 18.6% over a decade. By 2033, the greatest reduction in OODs (≥20%) was achieved when capacity was doubled and average duration reached 2 years, but only if the policy changes started in 2023. Delaying even a year diminishes the benefits. Treatment-seeking increases were equally beneficial whether they began in 2023 or 2025 but of only marginal benefit beyond what capacity and duration achieved. CONCLUSIONS If policymakers only target 2 policies to reduce OODs, they should be to increase capacity and duration, enacted quickly and aggressively.
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Affiliation(s)
| | - Tse Yang Lim
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine DiGennaro
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA
| | - Ziyuan Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Benjamin Bearnot
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA
| | - Mohammad S. Jalali
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA
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Bejarano Romero R, Arredondo Sánchez-Lira J, Slim Pasaran S, Chávez Rivera A, Angulo Corral L, Salimian A, Romero Vadilllo JJ, Goodman-Meza D. Implementing a decentralized opioid overdose prevention strategy in Mexico, a pending public policy issue. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100535. [PMID: 37351156 PMCID: PMC10282171 DOI: 10.1016/j.lana.2023.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/13/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
The public health crisis due to opioid overdose is worsening in Mexico's northern region due to the introduction of illicitly manufactured fentanyl into the local drug supply. Though there is an increase in overdose deaths, there is no accurate report of overdoses by Mexican government agencies and no comprehensive opioid overdose prevention strategy. There is currently only an anti-drug marketing strategy which is likely insufficient to mitigate the growing epidemic. In order to address the growing opioid overdose crisis in the country, it is necessary to create and implement a decentralized prevention strategy, that includes naloxone distribution, expanded treatment services in regions most in need, and create active dialogue with community organisations already implementing harm reduction actions. Decisive action must be taken by the Mexican government to ensure the health and wellbeing of the Mexican citizens, especially those at high risk for opioid overdose.
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Affiliation(s)
- Raúl Bejarano Romero
- SDSU-UCSD Joint Doctoral Program in Interdisciplinary Research on Substance Use, 5500 Campanile Drive, San Diego, CA 92123-4119, USA
| | - Jaime Arredondo Sánchez-Lira
- School of Public Health and Social Policy, University of Victoria, British Columbia, HSD University of Victoria, Victoria, BC, Canada
| | - Said Slim Pasaran
- Integración Social Verter A.C., C. José Azueta 230, Primera, Mexicali, BC 21100, Mexico
| | | | - Lourdes Angulo Corral
- Integración Social Verter A.C., C. José Azueta 230, Primera, Mexicali, BC 21100, Mexico
| | - Anabel Salimian
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Jorge J. Romero Vadilllo
- Universidad Autónoma Metropolitana – Campus Xochimilco, Calz. del Hueso 1100, Coapa, Villa Quietud, Coyoacán, Ciudad de México, CDMX 04960, Mexico
| | - David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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Fu W, Adzhiashvili V, Majlesi N. Demographics and Clinical Characteristics of Patients With Opioid Use Disorder and Offered Medication-Assisted Treatment in the Emergency Department. Cureus 2023; 15:e41464. [PMID: 37546079 PMCID: PMC10404131 DOI: 10.7759/cureus.41464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background and objective The opioid use disorder (OUD) epidemic is a persistent public health crisis in the United States. Medication-assisted treatment (MAT) with opioid agonists, including buprenorphine, is an effective treatment and is commonly initiated in the emergency department (ED). This study describes the demographics and clinical characteristics of OUD patients presenting to the ED and evaluated for MAT. Methodology A retrospective, single-center descriptive study of 129 adult patients presenting to the ED between July 2018 and July 2020 with OUD and evaluated for MAT. Results A total of 129 patients were assessed for MAT. About half (53%) received MAT; the remaining received only a referral (35%) or declined any intervention (12%). The median age was 36 years interquartile range (IQR, 28-46 years) and predominantly male (73%), single (65%), white (73%), unemployed (57%) with public insurance (55%), and without a primary care physician (58%). Majority of the patients presented with opioid withdrawal (62%) or intoxication (15%), while 23% presented with other complaints. About half of the patients (51%) were discharged with a naloxone kit. The majority of the patients were induced with buprenorphine with 4 mg or less (54%) and only 6% of patients received repeat dosing. Conclusions Male, white patients who are unmarried and unemployed, lack primary care follow-up, and rely on public insurance are more likely to be candidates for MAT. Providers should always maintain a high suspicion of opioid misuse and optimize treatment for those in withdrawal. Understanding these characteristics in conjunction with recent health policy changes will hopefully guide and encourage ED-initiated interventions in combating the opioid crisis.
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Affiliation(s)
- Wayne Fu
- Emergency Medicine, Mercy Hospital, Buffalo, USA
- Emergency Medicine, Staten Island University Hospital, Staten Island, USA
| | | | - Nima Majlesi
- Medical Toxicology, Staten Island University Hospital, Staten Island, USA
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Gao Y(A, Krans EE, Chen Q, Rothenberger SD, Zivin K, Jarlenski MP. Sex-related differences in the prevalence of substance use disorders, treatment, and overdose among parents with young children. Addict Behav Rep 2023; 17:100492. [PMID: 37214425 PMCID: PMC10195847 DOI: 10.1016/j.abrep.2023.100492] [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: 12/05/2022] [Revised: 03/31/2023] [Accepted: 04/22/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Risk factors and treatment rates for substance use disorders (SUDs) differ by sex. Females often have greater childcare and household responsibilities than males, which may inhibit SUD treatment. We examined how SUD, medication for opioid use disorder (MOUD) receipt, and overdose rates differ by sex among parents with young children (<5 years). Methods Using deidentified national administrative healthcare data from Optum's Clinformatics® Data Mart Database version 8.1 (2007-2021), we identified parents aged 26-64 continuously enrolled in commercial insurance for ≥ 30 days and linked to ≥ 1 dependent child < 5 years from January 1, 2016-February 29, 2020. We used generalized estimating equations to estimate the average predicted prevalence of SUD diagnosis, MOUD receipt after opioid use disorder (OUD) diagnosis, and overdose by parent sex in any month, adjusting for age, race/ethnicity, state of residence, enrollment month, and mental health conditions. Results From 2016 to 2020, there were 2,241,795 parents with a dependent child < 5 years, including 1,155,252 (51.5%) females and 1,086,543 (48.5%) males. Male parents had a higher average predicted prevalence of an SUD diagnosis (11.1% [11, 11.16]) than female parents (5.5% [5.48, 5.58]). Among parents with OUD, the average predicted prevalence of receiving MOUD was 27.4% [26.1, 28.63] among male and 19.7% [18.34, 21.04] among female parents, with no difference in overdose rates by sex. Conclusion Female parents are less likely to be diagnosed with an SUD or receive MOUD than male parents. Removing policies that criminalize parental SUD and addressing childcare-related barriers may improve SUD identification and treatment.
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Affiliation(s)
- Yitong (Alice) Gao
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qingwen Chen
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Scott D. Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Marian P. Jarlenski
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, United States
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Slocum S, Paquette CE, Walley AY, Pollini RA. Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104074. [PMID: 37244144 DOI: 10.1016/j.drugpo.2023.104074] [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: 02/09/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.S.A. METHODS Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids but had a close relationship with someone who did. We used a sequential mixed methods approach in which semi-structured interviews (N=22) were followed by a quantitative survey (N=260). Thematic analysis was used to analyze qualitative data and survey data were analyzed using descriptive statistics. RESULTS While some family members were influenced by SUD professionals to petition for civil commitment, influence from social networks based on personal experience was more common. Motivations for civil commitment included initiating recovery and believing that commitment would reduce overdose risk. Some reported that it afforded them respite from caring for, and worrying about, their loved one. A minority discussed increases in overdose risk following a period of forced abstinence. Participants expressed concerns about the variable quality of care during commitment, largely based on the use of corrections facilities for civil commitment in Massachusetts. A minority endorsed the use of these facilities for civil commitment. CONCLUSIONS Despite participants' uncertainty and the harms stemming from civil commitment, including increased risk of overdose after forced abstinence and the use of corrections facilities, family members resorted to this mechanism to reduce immediate overdose risk. Our findings indicate that peer support groups are an appropriate forum to disseminate information about evidenced-based treatment and that family members and others close to those with SUD often lack adequate support for, and respite from, the stress of caring for them.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States; Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States.
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Barnett ML, Meara E, Lewinson T, Hardy B, Chyn D, Onsando M, Huskamp HA, Mehrotra A, Morden NE. Racial Inequality in Receipt of Medications for Opioid Use Disorder. N Engl J Med 2023; 388:1779-1789. [PMID: 37163624 PMCID: PMC10243223 DOI: 10.1056/nejmsa2212412] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Since 2010, Black persons in the United States have had a greater increase in opioid overdose-related mortality than other groups, but national-level evidence characterizing racial and ethnic disparities in the use of medications for opioid use disorder (OUD) is limited. METHODS We used Medicare claims data from the 2016-2019 period for a random 40% sample of fee-for-service beneficiaries who were Black, Hispanic, or White; were eligible for Medicare owing to disability; and had an index event related to OUD (nonfatal overdose treated in an emergency department or inpatient setting, hospitalization with injection drug use-related infection, or inpatient or residential rehabilitation or detoxification care). We measured the receipt of medications to treat OUD (buprenorphine, naltrexone, and naloxone), the receipt of high-risk medications (opioid analgesics and benzodiazepines), and health care utilization, all in the 180 days after the index event. We estimated differences in outcomes according to race and ethnic group with adjustment for beneficiary age, sex, index event, count of chronic coexisting conditions, and state of residence. RESULTS We identified 25,904 OUD-related index events among 23,370 beneficiaries, with 3937 events (15.2%) occurring among Black patients, 2105 (8.1%) among Hispanic patients, and 19,862 (76.7%) among White patients. In the 180 days after the index event, patients received buprenorphine after 12.7% of events among Black patients, after 18.7% of those among Hispanic patients, and after 23.3% of those among White patients; patients received naloxone after 14.4%, 20.7%, and 22.9%, respectively; and patients received benzodiazepines after 23.4%, 29.6%, and 37.1%, respectively. Racial differences in the receipt of medications to treat OUD did not change appreciably from 2016 to 2019 (buprenorphine receipt: after 9.1% of index events among Black patients vs. 21.6% of those among White patients in 2016, and after 14.1% vs. 25.5% in 2019). In all study groups, patients had multiple ambulatory visits in the 180 days after the index event (mean number of visits, 6.6 after events among Black patients, 6.7 after events among Hispanic patients, and 7.6 after events among White patients). CONCLUSIONS Racial and ethnic differences in the receipt of medications to treat OUD after an index event related to this disorder among patients with disability were substantial and did not change over time. The high incidence of ambulatory visits in all groups showed that disparities persisted despite frequent health care contact. (Funded by the National Institute on Drug Abuse and the National Institute on Aging.).
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Affiliation(s)
- Michael L Barnett
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Ellen Meara
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Terri Lewinson
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Brianna Hardy
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Deanna Chyn
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Moraa Onsando
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Haiden A Huskamp
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Ateev Mehrotra
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
| | - Nancy E Morden
- From the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (M.L.B., E.M.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (M.L.B.), the Department of Health Care Policy, Harvard Medical School (H.A.H., A.M.), and the Division of General Medicine, Beth Israel Deaconess Medical Center (A.M.), Boston, and the National Bureau of Economic Research, Cambridge (E.M.) - all in Massachusetts; the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (T.L., B.H., D.C., M.O., N.E.M.); and UnitedHealthcare, Minnetonka, MN (N.E.M.)
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Phoenix BJ, Tierney M, Chapman SA, Spetz J. Influences on advance practice nursing education to prescribe medications for opioid use disorder. Nurs Outlook 2023; 71:101963. [PMID: 37003088 PMCID: PMC11060844 DOI: 10.1016/j.outlook.2023.101963] [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: 09/15/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Opioid misuse is a major public health concern in the United States. Opioid agonist medications are evidence-based treatments for opioid use disorders (OUD) that can be prescribed by advance practice registered nurses (APRNs) with prescriptive authority and appropriate training. PURPOSE Article examines factors influencing preparation to provide medications for opioid use disorder (MOUD) in APRN education. METHODS Data from semi-structured interviews addressing the role of education in preparing APRNs to provide MOUD were grouped into key themes using thematic analysis. Data were collected in a mixed methods study in four states with high opioid overdose deaths whose main findings were previously published. FINDINGS Two overarching themes emerged: "addressing attitudes" and "curriculum change." Sub-themes include affective barriers to providing OUD treatment; motivation to respond to the OUD crisis; and attitude change through experience with MOUD. DISCUSSION AND CONCLUSION APRNs can play a key role in reducing the harms caused by OUD. Attention to attitudinal issues, such as stigma, toward people using opioids is important in educating APRNs about providing MOUD.
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Affiliation(s)
- Bethany J Phoenix
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA, USA.
| | - Matthew Tierney
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA, USA.
| | - Susan A Chapman
- Department of Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco, CA, USA.
| | - Joanne Spetz
- University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
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Mansoor M, Foreman-Mackey A, Ivsins A, Bardwell G. Community partner perspectives on the implementation of a novel safer supply program in Canada: a qualitative study of the MySafe Project. Harm Reduct J 2023; 20:61. [PMID: 37118799 PMCID: PMC10144900 DOI: 10.1186/s12954-023-00789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The adulteration of the illicit drug supply with fentanyl and its analogues is driving the ongoing overdose crisis in North America. While various harm reduction interventions address overdose-related risks, there is growing interest in safer supply programs, including the MySafe Project which utilizes a biometric dispensing machine that provides pharmaceutical opioid alternatives to the toxic drug supply. However, the experiences and perspectives of professional community partners on program implementation remain unexplored. This study aims to examine professional community partner perspectives on the feasibility, as well as barriers and facilitators to the implementation of the MySafe program. METHODS Semi-structured qualitative interviews were conducted with 17 professional community partners involved in program implementation across four pilot locations in Canada. Thematic analysis of interviews focused on perspectives on safer supply, barriers and facilitators faced during program implementation, and recommendations to inform future scale-up of low-barrier safer supply models across Canada. RESULTS Participants identified a variety of barriers, including the dependence on clinician buy-in, coupled with regulatory and logistical constraints. In addition, some participants perceived hydromorphone to be an inadequate substitute to the increasingly toxic street opioid supply. Lastly, technical difficulties were described as barriers to service uptake and delivery. Conversely, having political and community buy-in, availability of wrap-around services, and collaborative communication from the MySafe team served as facilitators to program implementation. Though community partners preferred establishing MySafe machines into existing community organizations, they also discussed benefits of housing-based MySafe programs. The potential role of this program in mid-sized to rural cities was also emphasized. CONCLUSIONS To address the overdose crisis, there is an urgent need to implement and evaluate novel solutions that address supply drivers of crisis. Community partner-informed research plays an integral role in ensuring program acceptability and proper implementation. Our findings identify current gaps and facilitators underlying the efficacy of one such model, together with future directions for improvement. Participant recommendations included a diversification of medications offered and types of locations for MySafe programs, a streamlined national approach to prescribing guidelines coupled with more robust training for healthcare professionals, and an emphasis on service delivery within an integrated services model. Our findings underscore a potential gap between the goals of healthcare providers in ensuring comprehensive care and the necessity for low-barrier models such as MySafe that can function both within and outside of integrated service models.
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Affiliation(s)
- Manal Mansoor
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Annie Foreman-Mackey
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L 3G1, Canada.
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Adzrago D, Evans GS, Dias EM, Kwentua V, White GE, Wilkerson JM. Association of receiving opioid medication-assisted treatment with sexual identity and mental health/substance use disorder symptoms in a nationally representative sample of adults. RESEARCH SQUARE 2023:rs.3.rs-2837899. [PMID: 37162987 PMCID: PMC10168441 DOI: 10.21203/rs.3.rs-2837899/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Although the literature suggests that medication-assisted treatment (MAT) is an effective treatment for opioid use disorder, limited studies have assessed the prevalence or the association between MAT use and sexual identity, mental health, or substance use disorder among a nationally representative sample. We assessed the prevalence and association of opioid MAT use between sexual identity, depressive disorder symptoms, alcohol use dependence, and marijuana use dependence in the United States. Methods We used the 2019 National Survey on Drug Use and Health public-use data on adults aged 18-64 years (N = 38,841) to conduct a weighted multivariable logistic regression analysis. Results A total of 4.80% and 2.32% of the population identified as bisexual and lesbian/gay, respectively. About 0.31% (612,750 people) of the population reported receiving opioid MAT, 3.73% had alcohol use dependence, 1.42% had marijuana use dependence, and 9.13% had major depressive episode (MDE) symptoms. Of those who had received opioid MAT, 0.57% were bisexuals and 1.07% were lesbians/gays, 0.65% were people with alcohol use dependence, 2.32% with marijuana use dependence, and 1.59% with MDE symptoms. Lesbian/gay individuals were more likely to receive opioid MAT (AOR = 3.43, 95% CI = 1.42, 8.25) compared to heterosexual individuals. The odds were higher for people with marijuana use dependence (AOR = 3.44, 95% CI = 1.47, 8.06) and MDE symptoms (AOR = 5.22, 95% CI = 3.46, 7.89) than their counterparts. Conclusions In this study, sexual minorities, people with MDE symptoms, and those dependent on marijuana use were more likely to receive opioid MAT, suggesting the need to investigate further opioid use disorder symptoms and their risk factors among these populations.
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Affiliation(s)
- David Adzrago
- The University of Texas Health Science Center at Houston (UTHealth)
| | | | - Emanuelle M Dias
- The University of Texas Health Science Center at Houston (UTHealth)
| | - Victoria Kwentua
- The University of Texas Health Science Center at Houston (UTHealth)
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Stringfellow EJ, Lim TY, DiGennaro C, Hasgul Z, Jalali MS. Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis. PNAS NEXUS 2023; 2:pgad064. [PMID: 37020497 PMCID: PMC10069612 DOI: 10.1093/pnasnexus/pgad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In 2020, the ongoing US opioid overdose crisis collided with the emerging COVID-19 pandemic. Opioid overdose deaths (OODs) rose an unprecedented 38%, due to a combination of COVID-19 disrupting services essential to people who use drugs, continued increases in fentanyls in the illicit drug supply, and other factors. How much did these factors contribute to increased OODs? We used a validated simulation model of the opioid overdose crisis, SOURCE, to estimate excess OODs in 2020 and the distribution of that excess attributable to various factors. Factors affecting OODs that could have been disrupted by COVID-19, and for which data were available, included opioid prescribing, naloxone distribution, and receipt of medications for opioid use disorder. We also accounted for fentanyls' presence in the heroin supply. We estimated a total of 18,276 potential excess OODs, including 1,792 lives saved due to increases in buprenorphine receipt and naloxone distribution and decreases in opioid prescribing. Critically, growth in fentanyls drove 43% (7,879) of the excess OODs. A further 8% is attributable to first-ever declines in methadone maintenance treatment and extended-released injectable naltrexone treatment, most likely due to COVID-19-related disruptions. In all, 49% of potential excess OODs remain unexplained, at least some of which are likely due to additional COVID-19-related disruptions. While the confluence of various COVID-19-related factors could have been responsible for more than half of excess OODs, fentanyls continued to play a singular role in excess OODs, highlighting the urgency of mitigating their effects on overdoses.
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Affiliation(s)
- Erin J Stringfellow
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
| | - Tse Yang Lim
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
| | - Catherine DiGennaro
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
| | - Zeynep Hasgul
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
| | - Mohammad S Jalali
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
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