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ElSherief M, Sumner S, Krishnasamy V, Jones C, Law R, Kacha-Ochana A, Schieber L, De Choudhury M. Identification of Myths and Misinformation About Treatment for Opioid Use Disorder on Social Media: Infodemiology Study. JMIR Form Res 2024; 8:e44726. [PMID: 38393772 PMCID: PMC10924265 DOI: 10.2196/44726] [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: 12/01/2022] [Revised: 10/01/2023] [Accepted: 11/01/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Health misinformation and myths about treatment for opioid use disorder (OUD) are present on social media and contribute to challenges in preventing drug overdose deaths. However, no systematic, quantitative methodology exists to identify what types of misinformation are being shared and discussed. OBJECTIVE We developed a multistage analytic pipeline to assess social media posts from Twitter (subsequently rebranded as X), YouTube, Reddit, and Drugs-Forum for the presence of health misinformation about treatment for OUD. METHODS Our approach first used document embeddings to identify potential new statements of misinformation from known myths. These statements were grouped into themes using hierarchical agglomerative clustering, and public health experts then reviewed the results for misinformation. RESULTS We collected a total of 19,953,599 posts discussing opioid-related content across the aforementioned platforms. Our multistage analytic pipeline identified 7 main clusters or discussion themes. Among a high-yield data set of posts (n=303) for further public health expert review, these included discussion about potential treatments for OUD (90/303, 29.8%), the nature of addiction (68/303, 22.5%), pharmacologic properties of substances (52/303, 16.9%), injection drug use (36/303, 11.9%), pain and opioids (28/303, 9.3%), physical dependence of medications (22/303, 7.2%), and tramadol use (7/303, 2.3%). A public health expert review of the content within each cluster identified the presence of misinformation and myths beyond those used as seed myths to initialize the algorithm. CONCLUSIONS Identifying and addressing misinformation through appropriate communication strategies could be an increasingly important component of preventing overdose deaths. To further this goal, we developed and tested an approach to aid in the identification of myths and misinformation about OUD from large-scale social media content.
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Affiliation(s)
- Mai ElSherief
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Steven Sumner
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Christopher Jones
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Royal Law
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Lyna Schieber
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Heimer R, Black AC, Lin H, Grau LE, Fiellin DA, Howell BA, Hawk K, D'Onofrio G, Becker WC. Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016-17. Drug Alcohol Depend 2024; 254:111040. [PMID: 38043226 PMCID: PMC10872282 DOI: 10.1016/j.drugalcdep.2023.111040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To determine the relative risk of death following exposure to treatments for OUD compared to no treatment. METHODS In this retrospective cohort study we compiled and merged state agency data on accidental and undetermined opioid overdose deaths in 2017 and exposures to OUD treatment in the prior six months to determine incidence rates following exposure to different treatment modalities. These rates were compared to the estimated incidence among those exposed to no treatment to determine relative risk of death for each treatment exposure. RESULTS Incidence rates for opioid poisoning deaths for those exposed to treatment ranged from 6.06±1.40 per 1000 persons exposed to methadone to 17.36±3.22 per 1000 persons exposed to any non-medication treatment. The estimated incidence rate for those not exposed to treatment was 9.80±0.72 per 1000 persons. With no exposure to treatment as referent, exposure to methadone or buprenorphine reduced the relative risk by 38% or 34%, respectively; the relative risk of non-medication treatments was equal to or worse than no exposure to treatment (RR = 1.27-1.77). PRINCIPAL CONCLUSIONS Exposure to non-MOUD treatments provided no protection against fatal opioid poisoning whereas the relative risk was reduced following exposures to MOUD treatment, even if treatment was not continued. Population level efforts to reduce opioid overdose deaths need to focus on expanding access to agonist-based MOUD treatments and are unlikely to succeed if access to non-MOUD treatments is made more available.
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Affiliation(s)
- Robert Heimer
- Yale School of Public Health, New Haven, CT, United States.
| | - Anne C Black
- Yale School of Medicine, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT, United States
| | - Hsiuju Lin
- University of Connecticut School of Social Work, Hartford, CT, United States
| | | | - David A Fiellin
- Yale School of Public Health, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | | | - Kathryn Hawk
- Yale School of Public Health, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | - Gail D'Onofrio
- Yale School of Public Health, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | - William C Becker
- Yale School of Medicine, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT, United States
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3
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Hanson M, Zougris K, Garcia-Santiago O. Contextualizing drug use and pharmacological harm in the United States: a socio-historical overview. J Ethn Subst Abuse 2023:1-29. [PMID: 37363938 DOI: 10.1080/15332640.2023.2224743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
The purpose of this conceptual paper is to navigate through the socio-historical modulations in American tolerance for different psychoactive substances, and propose a theoretical synthesis formed by two vanguard philosophical doctrines, objectivism, and constructivism. Our approach is grounded on the analysis of social historical context and objective harms that have influenced drug use tolerance in the United States based on key historical events such as: heavy drinking at the dawn of nineteenth century, the establishment and repeal of prohibition, late nineteenth century opiate and cocaine tolerance followed by early twentieth century prohibition, post-prohibition drug concerns such as marijuana prohibition in the 1930s, heroin concerns and medical depressant use in the 1950s, poly-drug use in the 1960s, crack cocaine use in the 1980s, and finally modulations in tolerance for peyote use. Evidence supports the notion of drug harms reduction for the privileged, and criminalization of drug use by marginalized groups. Over long spans of history, however, more objectively harmful drugs are rejected, while drugs that can be used regularly without serous dysfunction are tolerated and normalized. We argue that a framework of social status and pharmacological harm can account for the vacillating policy responses that have emerged to different drugs at different times. Our approach informs the role of socio-cultural conflict in drug policy development and infuse the need for empirical research on the effect of socioeconomic positioning on attitudes of medicalization and legalization of marijuana and opioid policy in contemporary America.
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Affiliation(s)
- Mark Hanson
- Division of Social Sciences/Sociology, University of Hawaii West O'ahu, Kapolei, Hawaii, USA
| | - Konstantinos Zougris
- Division of Social Sciences/Sociology, University of Hawaii West O'ahu, Kapolei, Hawaii, USA
| | - Orlando Garcia-Santiago
- Division of Social Sciences/Sociology, University of Hawaii West O'ahu, Kapolei, Hawaii, USA
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Kelly TD, Hawk KF, Samuels EA, Strayer RJ, Hoppe JA. Improving Uptake of Emergency Department-initiated Buprenorphine: Barriers and Solutions. West J Emerg Med 2022; 23:461-467. [PMID: 35980414 PMCID: PMC9391022 DOI: 10.5811/westjem.2022.2.52978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Emergency departments (ED) are increasingly providing buprenorphine to persons with opioid use disorder. Buprenorphine programs in the ED have strong support from public health leaders and emergency medicine specialty societies and have proven to be clinically effective, cost effective, and feasible. Even so, few ED buprenorphine programs currently exist. Given this imbalance between evidence-based practice and current practice, proven behavior change approaches can be used to guide local efforts to expand ED buprenorphine capacity. In this paper, we use the theory of planned behavior to identify and address the 1) clinician factors, 2) institutional factors, and 3) external factors surrounding ED buprenorphine implementation. By doing so, we seek to provide actionable and pragmatic recommendations to increase ED buprenorphine availability across different practice settings.
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Affiliation(s)
- Timothy D. Kelly
- Indiana University Emergency Medicine Residency, Indianapolis, Indiana
| | - Kathryn F. Hawk
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Reuben J. Strayer
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Jason A. Hoppe
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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Slocum S, Ozga JE, Joyce R, Walley AY, Pollini RA. If we build it, will they come? Perspectives on pharmacy-based naloxone among family and friends of people who use opioids: a mixed methods study. BMC Public Health 2022; 22:735. [PMID: 35418048 PMCID: PMC9006069 DOI: 10.1186/s12889-022-13078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose "bystanders" (friends or family of people who use opioids) that may be amenable to intervention. METHODS Eligible bystanders were Massachusetts residents ≥ 18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22) were conducted April-July 2018, to inform the development of a subsequent quantitative survey (N = 260), conducted February-July 2020. RESULTS Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one's drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone. CONCLUSIONS Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma, and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jenny E Ozga
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Rebecca Joyce
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Alexander Y Walley
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA.,Grayken Center for Addiction, Clinical Addiction Research Education Unit, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA. .,Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA.
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Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review. BMC Musculoskelet Disord 2022; 23:238. [PMID: 35277150 PMCID: PMC8917706 DOI: 10.1186/s12891-022-05044-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Long-term opioid use, which may have significant individual and societal impacts, has been documented in up to 20% of patients after trauma or orthopaedic surgery. The objectives of this scoping review were to systematically map the research on strategies aiming to prevent chronic opioid use in these populations and to identify knowledge gaps in this area.
Methods
This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched seven databases and websites of relevant organizations. Selected studies and guidelines were published between January 2008 and September 2021. Preventive strategies were categorized as: system-based, pharmacological, educational, multimodal, and others. We summarized findings using measures of central tendency and frequency along with p-values. We also reported the level of evidence and the strength of recommendations presented in clinical guidelines.
Results
A total of 391 studies met the inclusion criteria after initial screening from which 66 studies and 20 guidelines were selected. Studies mainly focused on orthopaedic surgery (62,1%), trauma (30.3%) and spine surgery (7.6%). Among system-based strategies, hospital-based individualized opioid tapering protocols, and regulation initiatives limiting the prescription of opioids were associated with statistically significant decreases in morphine equivalent doses (MEDs) at 1 to 3 months following trauma and orthopaedic surgery. Among pharmacological strategies, only the use of non-steroidal anti-inflammatory drugs and beta blockers led to a significant reduction in MEDs up to 12 months after orthopaedic surgery. Most studies on educational strategies, multimodal strategies and psychological strategies were associated with significant reductions in MEDs beyond 1 month. The majority of recommendations from clinical practice guidelines were of low level of evidence.
Conclusions
This scoping review advances knowledge on existing strategies to prevent long-term opioid use in trauma and orthopaedic surgery patients. We observed that system-based, educational, multimodal and psychological strategies are the most promising. Future research should focus on determining which strategies should be implemented particularly in trauma patients at high risk for long-term use, testing those that can promote a judicious prescription of opioids while preventing an illicit use, and evaluating their effects on relevant patient-reported and social outcomes.
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Jackson DS, Nguemeni Tiako MJ, Jordan A. Disparities in Addiction Treatment: Learning from the Past to Forge an Equitable Future. Med Clin North Am 2022; 106:29-41. [PMID: 34823733 DOI: 10.1016/j.mcna.2021.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Half-Century long problem of addiction treatment disparities. We cannot imagine addressing disparities in addiction treatment without first acknowledging and deconstructing the etiology of this inequity. This article examines the history of addiction treatment disparities beginning with early twentieth-century drug policies. We begin by discussing structural racism, its contribution to treatment disparities, using opioid use disorder as a case study to highlight the importance of a structural competency framework in obtaining care. We conclude by discussing diversity in the workforce as an additional tool to minimizing disparities. Addiction treatment should be aimed at addressing care delivery in the context of the social, economic, and political determinants of health, which require appreciation of their historical origins to move toward equitable treatment.
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Affiliation(s)
- Danielle S Jackson
- Department of Psychiatry, Rutgers- Robert Wood Johnson Medical School, 671 Hoes Lane West, 2nd Floor, Piscataway, NJ 08854, USA.
| | - Max Jordan Nguemeni Tiako
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA. https://twitter.com/MaxJordan_N
| | - Ayana Jordan
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY. https://twitter.com/DrAyanaJordan
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8
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ElSherief M, Sumner SA, Jones CM, Law RK, Kacha-Ochana A, Shieber L, Cordier L, Holton K, De Choudhury M. Characterizing and Identifying the Prevalence of Web-Based Misinformation Relating to Medication for Opioid Use Disorder: Machine Learning Approach. J Med Internet Res 2021; 23:e30753. [PMID: 34941555 PMCID: PMC8734931 DOI: 10.2196/30753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Expanding access to and use of medication for opioid use disorder (MOUD) is a key component of overdose prevention. An important barrier to the uptake of MOUD is exposure to inaccurate and potentially harmful health misinformation on social media or web-based forums where individuals commonly seek information. There is a significant need to devise computational techniques to describe the prevalence of web-based health misinformation related to MOUD to facilitate mitigation efforts. Objective By adopting a multidisciplinary, mixed methods strategy, this paper aims to present machine learning and natural language analysis approaches to identify the characteristics and prevalence of web-based misinformation related to MOUD to inform future prevention, treatment, and response efforts. Methods The team harnessed public social media posts and comments in the English language from Twitter (6,365,245 posts), YouTube (99,386 posts), Reddit (13,483,419 posts), and Drugs-Forum (5549 posts). Leveraging public health expert annotations on a sample of 2400 of these social media posts that were found to be semantically most similar to a variety of prevailing opioid use disorder–related myths based on representational learning, the team developed a supervised machine learning classifier. This classifier identified whether a post’s language promoted one of the leading myths challenging addiction treatment: that the use of agonist therapy for MOUD is simply replacing one drug with another. Platform-level prevalence was calculated thereafter by machine labeling all unannotated posts with the classifier and noting the proportion of myth-indicative posts over all posts. Results Our results demonstrate promise in identifying social media postings that center on treatment myths about opioid use disorder with an accuracy of 91% and an area under the curve of 0.9, including how these discussions vary across platforms in terms of prevalence and linguistic characteristics, with the lowest prevalence on web-based health communities such as Reddit and Drugs-Forum and the highest on Twitter. Specifically, the prevalence of the stated MOUD myth ranged from 0.4% on web-based health communities to 0.9% on Twitter. Conclusions This work provides one of the first large-scale assessments of a key MOUD-related myth across multiple social media platforms and highlights the feasibility and importance of ongoing assessment of health misinformation related to addiction treatment.
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Affiliation(s)
- Mai ElSherief
- University of California, San Diego, San Diego, CA, United States
| | - Steven A Sumner
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Royal K Law
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Akadia Kacha-Ochana
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Kelly Holton
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Munmun De Choudhury
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
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Kopruszinski CM, Swiokla J, Lee YS, Navratilova E, VanderVeen L, Yang M, Liu Y, Miyazaki T, Schmidt WK, Zalevsky J, Porreca F. Preclinical Assessment of the Analgesic Pharmacology of NKTR-181 in Rodents. Cell Mol Neurobiol 2021; 41:949-960. [PMID: 32107752 DOI: 10.1007/s10571-020-00816-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/16/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pharmacological evaluation of the mu-opioid receptor (MOR) agonist properties of NKTR-181 in rodent models. METHODS Graded noxious stimulus intensities were used in rats to establish the antinociceptive potency and efficacy of NKTR-181 relative to morphine, fentanyl, and oxycodone. Characteristics of MOR agonist actions, as measured by antinociceptive tolerance and cross-tolerance, as well as opioid-induced hyperalgesia (OIH) and naloxone-precipitated withdrawal in NKTR-181- and morphine-dependent in mice, were compared. RESULTS NKTR-181 showed dose- and time-related antinociception with similar maximal effects to morphine in the rat and mouse hot-water tail-flick test. No sex or species differences were observed in NKTR-181 or morphine antinociception. Rats treated with NKTR-181 and morphine exhibited decreases in both potency and maximal efficacy as nociceptive stimulus intensity was increased from a water temperature of 50 °C to 54 °C. Evaluation of antinociception at a high stimulus intensity revealed that oxycodone and fentanyl exhibited greater efficacy than either NKTR-181 or morphine. The relative potency difference between NKTR-181 and morphine across all tail-flick studies was determined to be 7.6-fold (90% confidence interval, 2.6, 21.5). The peak antinociceptive effect of NKTR-181 was delayed compared to that of the other opioids and cumulative drug effects were not observed. Repeated treatment with escalating, approximately equi-analgesic doses of NKTR-181 or morphine, produced antinociceptive tolerance and cross-tolerance. Under these pharmacological conditions, OIH and naloxone-precipitated physical dependence were similar for NKTR-181 and morphine. CONCLUSIONS NKTR-181 had a slower onset, but similar efficacy, to morphine in the models studied supporting reduced abuse potential while maintaining analgesic effect in comparison with current opioids.
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Affiliation(s)
| | - Juliana Swiokla
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Yeon Sun Lee
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Edita Navratilova
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Miao Yang
- Nektar Therapeutics, San Francisco, CA, USA
| | - Yi Liu
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | | | - Frank Porreca
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA.
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Oberleitner LMS, Madden LM, Muthulingam D, Marcus R, Oberleitner DE, Beitel M, Gaeta M, Tamberelli JF, Barry DT. A qualitative investigation of addiction counselors' perceptions and experiences implementing an open-access model for treating opioid use disorder. J Subst Abuse Treat 2020; 121:108191. [PMID: 33357602 DOI: 10.1016/j.jsat.2020.108191] [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: 03/26/2020] [Revised: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine addiction counselors' perceptions and experiences of implementing an open-access model for methadone maintenance treatment (MMT), in which the program rapidly enrolled prospective patients, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. Between 2006, when the treatment program initially implemented this model, and 2020, the census of clients receiving methadone maintenance at the study site grew from 1431 to 4500. METHODS Participants were 31 addiction counselors employed at a treatment organization that implemented an open-access model to scale up MMT. We examined counselors' perceptions and experiences of working in programs that employed this model, using individual semi-structured interviews, which an interdisciplinary team audiotaped, transcribed, and systematically coded using grounded theory. The team reviewed themes and reconciled disagreements (rater agreement was 98%). We describe themes that more than 10% of participants reported. RESULTS Counselors described perceived advantages of the open-access model for clients (e.g., "individualized to client needs"), clinicians (e.g., "fewer demands"), and the community (e.g., "crime reduced"). Counselors also described perceived disadvantages of the open-access model for clinicians (e.g., "uneven workload") and clients (e.g., "need for more intensive services for some clients"), as well as program-level concerns (e.g., "perceived lack of structure"). CONCLUSIONS Counselors who work in opioid treatment programs that use an open-access framework described multiple benefits to themselves, their clients, and the public; they also outlined disadvantages for themselves and clients, which research should further explore and address to facilitate MMT scale up.
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Affiliation(s)
- Lindsay M S Oberleitner
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Lynn M Madden
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA
| | - Dharushana Muthulingam
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA; Washington University, Division of Infectious Disease, St. Louis, MO 63112, USA
| | - Ruthanne Marcus
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA
| | - David E Oberleitner
- The APT Foundation, Inc., New Haven, CT 06519, USA; University of Bridgeport, Department of Psychology, Bridgeport, CT 06604, USA
| | - Mark Beitel
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Child Study Center, New Haven, CT 06510, USA
| | - Marina Gaeta
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Joseph F Tamberelli
- Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Declan T Barry
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Child Study Center, New Haven, CT 06510, USA.
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11
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PARK JUNYEONG, ROUHANI SABA, BELETSKY LEO, VINCENT LOUISE, SALONER BRENDAN, SHERMAN SUSANG. Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework. Milbank Q 2020; 98:700-746. [PMID: 32808709 PMCID: PMC7482387 DOI: 10.1111/1468-0009.12470] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug-related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. CONTEXT Drug overdose is the leading cause of injury-related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. METHODS In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The "continuum of overdose risk" framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. FINDINGS De-escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. CONCLUSIONS Without recognizing the full drug-use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.
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Affiliation(s)
| | | | - LEO BELETSKY
- School of Law and Bouvé College of Health SciencesNortheastern University
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Chen Z, Wang R, Zhang M, Wang Y, Ren Y. Acupuncture combined with medication for opioid use disorder in adults: a protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e034554. [PMID: 32565455 PMCID: PMC7310998 DOI: 10.1136/bmjopen-2019-034554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/27/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Opioid use disorder (OUD) is a worldwide health problem. Clinical trials indicated that acupuncture combined with medication is effective in OUD, however, there are different conclusions presented by previous trials. This study is designed to evaluate the efficacy and safety of acupuncture combined with medication in OUD. METHODS AND ANALYSIS PubMed, CENTRAL, Embase, Web of Science, CINAHL, PsycINFO, ProQuest Dissertation and Theses, AMED, OpenGrey, Clinicaltrials.gov and who.int/trialsearch will be searched in September 2019 without a language restriction. Randomised controlled trials (RCTs) and quasi-RCTs which included participants with OUD receiving acupuncture therapy combined with medication versus control group will be included in this study. Two reviewers will independently screen studies, extract data, assess risk of bias by the Cochrane risk of bias assessment tool and assess quality of evidence by Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Any disagreements will be arbitrated by the third reviewer. Data synthesis and analysis will be conducted by using RevMan V.5.3. Subgroup analyses, sensitivity analysis, meta-regression and reporting bias assessment will be conducted if necessary and appropriate. ETHICS AND DISSEMINATION On account of the nature of this systematic review and meta-analysis, ethical approval is not required. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019123436.
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Affiliation(s)
- Zhihan Chen
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rui Wang
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Min Zhang
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yitong Wang
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yulan Ren
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Hatheway JA, Bansal M, Nichols-Ricker CI. Systemic Opioid Reduction and Discontinuation Following Implantation of Intrathecal Drug-Delivery Systems for Chronic Pain: A Retrospective Cohort Analysis. Neuromodulation 2019; 23:961-969. [PMID: 31603605 PMCID: PMC7687163 DOI: 10.1111/ner.13053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/02/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
Abstract
Objective The study evaluated systemic opioid utilization before and after initiation of intrathecal drug therapy in patients with chronic, noncancer pain, as well as the effect of opioid elimination on payer costs. Methods This was a retrospective cohort analysis of administrative claims data (2011‐2016), evaluating patients using systemic opioids for chronic, noncancer pain, newly implanted with an intrathecal drug‐delivery system. Patients were excluded for spasticity, cancer, and device explant. The primary outcome was reduction or discontinuation of systemic morphine milligram equivalents during a 395‐day follow‐up period. The secondary outcome was total commercial insurer payments. Results Of 9223 total patients, 631 met selection criteria. From baseline to 395‐day follow‐up, average daily morphine milligram equivalents decreased in 81.5% of patients, and 43.3% discontinued systemic opioid therapy entirely. Among patients who continued systemic opioids, average daily morphine milligram equivalents decreased in 74.9% of patients. Logistic regression found that morphine milligram equivalents of <50 mg/day prior to initiation of intrathecal drug delivery was associated with two times the odds of discontinuation vs. ≥90 mg/day (odds ratio = 2.08, 95% confidence interval 1.42‐3.02, p = 0.001). Mean annual payer costs were reduced 29% for patients who discontinued vs. continued systemic opioids (−$11,115 per patient). Conclusions A meaningful proportion of patients discontinue or decrease systemic opioid use following initiation of intrathecal drug delivery. Standard of care should include opioid dose tapering prior to intrathecal drug delivery to maximize the probability of systemic opioid discontinuation.
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